July 13, 2024 / by 

 

It’s the Inequality, Stupid: Why Test, Trace, Isolate Won’t Stop Covid-19 in America

Asian teens dancing memes on disease safety precautions are amazing

Everything is changing, and in the face of that, America is failing. Over 90,000 souls have paid for our failing. Millions more are living in terror for their livelihoods and their families. But Covid-19 isn’t a technology problem, or a science question, or a supply chain issue, or even a question of doctoring. This challenge is public health, and that is something we’ve been failing at for a damn long time. Not completely, but for most people the American health system is a nightmare, and interacting with it is among Americans’ greatest fears. Without addressing that fact, anything else we do can’t succeed, not in the models of countries like South Korea, Germany, or the overlooked best of all pandemic responses, Vietnam. (Not only did they aggressively treat, trace, and quarantine every case, but they did wonderful and memeworthy public communication from the start)

 

…Versus pasty uncool white people protesting their right to sicken other people before they die themselves.

California Governor Gavin Newsom, who reacted quicker than any other governor to shut down the state of California, saved innumerable lives. Now he is opening many shops for curbside pick up, and relaxing other measures. “This is a very positive sign,” he said, “and it is happening for only one reason: The data says it can happen.”

But with testing capacity still lacking in the state, (fewer than 1 in 20 Californians being tested) the data says no such thing, and it’s even worse in most of the country. We are not ready to open. The history of fighting epidemics from Ebola to AIDS to antibiotic resistant TB is very clear. To stop an epidemic: catch every case with testing, trace every contact, and make sure the ill and their contacts can and do isolate safely, and be treated promptly if they fall ill. That last part is key, and each of these epidemics have borne  out that treatment is important to both preventing transmission, and creating a unified populous for fighting the epidemic. Without all of those elements, the only thing stopping Covid-19 burning through the world is staying home, staying distant from everyone else – the isolated life we’ve been living so far in this pandemic.

Sars-CoV-2 is an infectious respiratory virus with a as-of-yet unknown but presumed small infectious dose. One person missed, one popular guy or woman about town doing essential work can start the whole cycle again within days without ever so much a cough or a headache. One party full of invincible young people or one pre-symptomatic nurse can begin another train of transmission that can eventually sicken or kill thousands.

The decisions that determine the course of an epidemic, all epidemics, are personal decisions. They happen millions of times every day in all kinds of contexts around the world. They happen when a kid stays in, or sneaks out a window. They happen when a community of faith cannot bear to be apart and tries to find ways to cope. They happen when people are balancing the need for health and comfort against the proclamations of some local official who is now a soi-disant disease expert. They happen when a doctor with unexamined bigotry passes over caring for a black patient in favor of a white one, or a rich man over a poor woman. They walk the balancing line between top-down power, community consciousness, and the choices each person makes about who they care about and how they enact that caring. On this score, in this pandemic, America has one terrible failing that rises above all of its others: its unwillingness to provide treatment to the sick.

This nonsense.

There are a lot of bad and desperate ideas in America right now: immunity get-out-of-jail-free cards, Bluetooth contact tracing apps, incoherent partial re-openings, and going wild and pretending it’s all going to go away if we just can get a haircut.

The idea of certifying immunity status would be terrible. If you wanted something like that to work, it would have to convey no immediate benefit to the person being certified immune, and certainly not convey the benefit of being free and able to earn a living for yourself and your family. It is the ultimate moral hazard arising out of an immoral and unjust system.

How would you punish people for defrauding this system? Incarceration and fines would only drive more disease. And people faking immunity is the best case problem a health system would face. The worst is people intentionally getting the disease in order to be allowed back into society, and spreading the virus, even knowingly, because they are desperate. What will you do to the people using this system to get ahead in life? Covid-19 parties are inevitable, because people are people, but what happens when they become a condition for public life? Not only will it drive the poor to risk death while the rich sit away safer in their homes, it means that the level of disease will persist in semi-permanently trapping everyone who doesn’t want Covid-19 and can afford to never go out.

Bluetooth apps do not contract trace. Tracing is an intimate process, a long empathetic conversation with a person who understands your community and seeks to understand and hear you. You have to trust a contact tracer, you have to feel like the people who you name and place in their system will be cared for, protected, and treated, should the worst come to pass.

Bluetooth can’t tell if there’s a wall between you. It can’t tell how windy it was between you and that other person, or if you were stuck in traffic next to them for a half hour. An app can’t tell that you left your phone at home that one time. It cannot tell you of someone who went to the emergency room suddenly, phone lost and forgotten, only to be admitted for a week. It cannot tell you about someone who died alone at home, without ever being tested at all. It can tell you about neighbors you never see or speak to, but it can’t tell you it’s them, so you sit, wondering who it was, wondering if it was real, and what to do now.

Tracing a disease through a community is a human conversation. These are things only humans can do. This is a human job, and a job for those who are trusted by their communities, that speak the language, that know about the things that happen in the neighborhood.

Contact tracers don’t just question people. They mostly are there to listen, and to listen carefully, to safeguard people’s secrets and hopes as well as their shame and their double lives. They need to not just speak the language of those affected by the disease, they need to speak the culture. In the largely Spanish-speaking immigrant neighborhood where I am sheltering-in-place, I take many walks. And in those walks, I have seen hundreds of informational flyers, but almost none in Spanish – more failing.

We know that we need more testing and contact tracing, and we know we need people to quarantine to slow this disease, but before all that, we need to treat the people who are most at risk as human beings. In the long term, everyone’s fate depends on that.

If you want people to stay home and be safe, it has to be financially and logistically possible. People who are doing the right thing have to be supported and cared for. If you want people to seek medical care, it must be available and not cost more than the patient can reasonably pay – which means nothing for the poorest people.

Using police powers to enforce public health is also fool’s game. Any use of police powers must be rare and only for the most unusual situations — no one should be able to look at those situations and say “That could be me there.” The racist enforcement we’re seeing now defeats the goals of public health and endangers everyone, not only spreading the disease to the victims of these arrests, but preventing the populations they come out of from cooperating with public health investigations. Incarceration or fines only threaten to spread disease as wells as deepen poverty and resentment. Diseases, all diseases, feed on poverty and resentment.

Even with some as yet un-obtained insight into immunity status, we won’t know for years how long immunity lasts, or how strong it will be from person to person. We still need to understand how the virus is likely to evolve, and how it affects its victims long term, before we can say much about what the elusive goal of “herd immunity” would really mean.

The simple fact is: a million tests a day, a hundred million, won’t make a difference if the people most likely to get the virus don’t want to be tested because they can’t afford to test positive.

The unspoken problem with engaging with a testing regime is why do it when you can’t get treatment, or afford it if you could get it? Why go to the doctor when that risks destroying your family’s future? We want to test, trace the contacts of every case, and isolate everyone infected, and thus reopen the economy, but without the treatment piece, this idea fails the most basic part of epidemiology: universal participation.

The way we get out is not immunity passports or herd immunity, it’s not test test test, it’s a whole system of health that cares for the whole population. The things that have worked the world over, from Germany to Vietnam, always begin and end with universal access to healthcare. Not just testing, tracing, isolating, but the most important part of public health: treatment. But doing that requires a public health system with the public as the beneficiary, not a small percentage of those who can afford it with ease.

If you want people to work together to get out of this, the people coming forward need to know that themselves and their people will be tested and treated with dignity and mercy. They need to know that going to the hospital with Covid-19 doesn’t mean going bankrupt, giving up on dreams of educating their children, taking care of their parents, or facing deportation. They need to know that they will be treated on the basis of their illness, not their skin color, class, sex, or any other distinction the virus doesn’t respect. Biology doesn’t care about social distinctions. The virus doesn’t either — it is a simple machine that responds to the environment it finds itself in. It’s we who create more susceptible bodies through stress, ill health, co-morbidities untreated in a failed healthcare system. But the virus is not prejudiced, it only seems so in statistics. It will kill rich men in good health, and spare prisoners.

Not everyone is going to be prosocial, but when incentives are right, and peoples’ needs are met, overwhelmingly people do the right thing. There’s always exceptions, and those exceptions become news, but rarely are those the people who tip the balance. People well cared for and informed, educated and competent, will act for the best of their communities and loved ones. This in turn creates the kind of healthy communities that break the chains of transmission. If we concentrate on building healthcare capacity and supporting communities, many of the antisocial people will disappear into them, looked after by their own people. There will always be exceptions, but no one can tell you what to do like Grandma can, especially if Grandma can also see to it you get healthy food, a good education, and most importantly right now, medicine when you’re sick.

America’s health disparities, and the likelihood that Covid-19 could follow other coronavirus immunity patterns could mean that we’re doing this again every couple of years, even as other places in the world begin to recover. Our inability to treat, based on our desire to make medical treatment profitable, will doom us to cycles of disease until most susceptible Americans have died, and others who remain are maimed by the potential long term consequences of this disease.

Even with a vaccine, access in our current system, as well as the poison of antivaxxers, could doom the effort to control the disease. If we chose to do nothing to help or treat the victims of Covid-19, our commitment to denying healthcare to all could potentially keep chains of transmission alive for decades. With universal access to care and aid for isolation, we could break that chain in the next few months. But as we have currently constructed what it means to be American, that would be impossible. The choice this country faces is whether to change as a country, or possibly cease to be out of our commitment to inequality.


My work for Emptywheel is supported by my wonderful patrons on Patreon. You can find out more, and support my work, at Patreon. Photo thanks to Becker1999, and more thanks to Ryan Singel



A Video Guide to Understanding Covid-19 without Freaking Out

It’s a complicated time, and we’re all emotionally worn out.

Here at emptywheel we’ve covered the current pandemic’s scientific side in some depth. (see Jim White’s look at the origin of the virus, Rayne has done several very good updates on the science, politics, and misinformation,
and I’ve gone into the mechanisms of the disease and how it compares to other pandemics )

But we haven’t done as much for the overtaxed, overwhelmed reader who just wants some pretty pictures and gentle talking heads to make Covid-19 make sense. Even those of you who voraciously keep up with Marcy’s intricate political  and media analyses might like to give the emotional roller coaster a break, and still feel like you have some frickin’ idea what is going on.

The Modeling

Nothing is more calming yet informative than 3Blue1Brown’s soothing and surprisingly clear explanation of epidemic models. This 3Blue1Brown explainer uses SIR, a mathematical modeling system for epidemics. While simplified, it can give you a sense for how more complicated models work, and why policies like social distancing and contact tracing are important and effective.

SIR stands for:
S = the number of susceptible individuals
I = the number of infected individuals
R = the number of removed individuals (removed here means no longer infectious, and includes both immune and deceased.)

3Blue1Brown is also one of the most pleasant-to-watch Youtubers of all time. Even when you don’t have any clue about the math he’s describing, it all comes together and you feel smarter by the end. “It’s the mental equivalent of ice-skating,” my daughter says, “You’re a little bit worried about falling over, but it’s nice.”

The smartypants at minutephysics and Aatish Bhatia teamed up to visualize the progress of Covid-19 cases around the world. They use a visualization with a logarithmic map of total cases versus new cases to clearly show both how similar the track of the disease is, and what it looks like for a geographical area to get a handle on the spread. This video explains how it works, and here is the site where you can watch the model play with current data.
But why did this happen?

The why us and why now question is lurking in the back of everyone’s mind, and SciShow comes through on it. SciShow has a long and storied history of well-researched and approachable science education, and their video tackling the zoonotic source of Covid-19 (and other viruses) in bats keeps in the tradition. Bats have evolved different approaches to having a mammalian immune system, which makes them better at handling some of the viruses and worse at handling other pathogens we can overcome easily — this is why their viruses can be so rough on us. We have a lot to learn from them, but we should probably stop disturbing their habitats if we don’t want to keep catching novel viruses from them.

The Medicine

If you’ve heard a lot of terms and you don’t know what they mean, Dr. Hope’s Sick Notes goes through 26 of them with clear and non-technical definitions. Dr. Hope is an NHS doctor who teaches and works in an English emergency department as well as a YouTuber. (His ongoing Covid-19 vlog is great, but more stress inducing than the videos featured here.) He gives easy explanations of complicated concepts with handwritten flashcards, a nice soft focus, and some comforting quiet background music. At the end he hands it over to Dr. Sonia, an anesthesiologist at the same hospital, defining some of the more hardcore technical terms we’ve been hearing in the media, but with equal calming friendliness.

Dr. Sonia appears in our next video as well, as an avid AFOL (Adult Fan of Lego). Dr. Hope and Dr. Sonia discuss how the ICU and ventilation really work, demonstrating with a detailed Lego model built by Dr. Sonia in her day off. It goes over all of the scary terms and procedures and why and how they’re used, but with Lego, so it’s fine. My daughter confirmed this too.

 

 

There’s a lot of questions about immunity, herd immunity, and the potential for re-infection, and a lot of misunderstanding about what any of those terms mean. Dr. Seema Yasmin breaks it down on a spectrum from life-long immunity to HIV (The worst). Where and how Covid-19 might fit into this is yet to be found, but she lays down the situation and puts it in context.

 

And Finally, Something of Less Value

Watching night shows, comedy news, and Youtubers adapt to filming inside their houses has been some hits and a lot of misses, but there’s a few amazing hits. These aren’t so much information about Covid-19 as a few gems life in quarantine has generated. Relax, it’s what everyone’s therapist is suggesting we do.

Stephen Colbert interviewing fellow Daily Show alumnus John Oliver is somehow both unbearable and ten minutes of comedy gold. I wish all late night interviews could be like this, but I also think that would kill me.

 

Kate McKinnon takes to a spare bedroom to reprise her role as Barbara DeDrew, trying to get you to adopt a cat, any cat, all the cats, from Whiskers R We.

 

 

 

Last but not least: what would you say to yourself, if you could travel back to January?


Please feel free to add your own calming and informative, or just funny contributions in the comments, BUT NO STRESS INDUCERS!!!11!!!!!

Um, am I doing this right?


My work for Emptywheel is supported by my wonderful patrons on Patreon. You can find out more, and support my work, at Patreon. Thanks to H.alhajji for the featured image.


We’re In This for the Long Haul

Update: Peterr clarifies the difference between food bank and food pantry, etc., here.

(Hey, I know that complaining about politics is our jam in Emptywheel comments, but can we keep the ones on this post to mutual aid and resources for now?)

The time of Covid-19 is different time, and we have to meet it with different commitments.

This pandemic isn’t just killing people, it’s putting people out of work, and driving the precarious into being the marginal of society. What many people need right now, even more than medical care, is food. At the same time, food banks are losing their donations while serving more people than ever. This need is immediate now, but it’s also going to last much longer than the quarantine itself. The world will be reeling from this for many years.

I try to support and lift up people doing good and vital work every month, but this time is different. I’m committing to support the food bank local to where I am now, for the minimum of two years, and one that I would especially exhort you to consider doing this yourself, in the opening hours of this era of need.

The history of pandemics isn’t just a history of disease and death, it’s a history of the breakdown of logistical systems, of economic hardship, and of tremendous working together and mutual aid. It’s a time of social upheaval, but also times of social innovation. Epidemics wreck nations, and birth public health systems. They teach us fragility, and we fall silent at the end of the lesson.

Everyone is going to have a lot of time to think about their place in the world in the next months, at least, I hope you all do. Many of us will be touched by tragedy, and some of us will be crushed. Some of us will be able to give to institutions like food banks, and some of us, some of the people reading this, are going to need them.

I hope that you and your people emerge unscathed, but I also know not everyone will. The history of plagues is surprisingly full of generosity and honor. And we’re going to need a lot of those qualities in the coming years. In that spirit, I’m committing to a monthly donation to the SF-Marin Food Bank, not in one lump sum, but for years to come.

America is not a kind country, and the need is tremendous here, and it will last years after Covid-19 has largely passed. Please join me in making a two or more year commitment to supporting a local food bank, if you can.

If you can’t, and you find that you need a food bank, don’t hesitate. They are there to help you, and we all need you back on your feet.

Here’s a directory of food banks in America, one for Canada (Thanks, Mary R!), and another one for the UK. If you know of other directories or food banks, please leave them in the comments. If you decide to support a food bank, please also leave that in the comments.


Understanding Covid-19 for Viral Newbies

These days we’re drowning in information about the pandemic, but without much context for understanding the virus causing it. With a never-before-seen virus, the best place to get that context is from looking at the history of previous diseases, and by understanding what they’ve done to our biology and society, as we try to figure out what this one does to our biology and society.

One of the first and most important questions is how Covid-19 infects people, and this disease is pretty damn infectious. Not as bad as diseases like Measles, Mumps, and Rubella, but worse than most flus. (The most infectious diseases tend to become the diseases of childhood because you’re born, and BAM! you get them, they’re so infectious.) Transmission is measured with the R₀ (“R-naught”) we keep seeing in news stories, measuring how many people one infected person will infect in a given time period. But it’s not a number that just exists without context — lowering that number is why so many of us are staying at home, trying to figure out how we’re going to pay the bills right now. But without the social distancing, Covid-19 is more infectious than anything most of us have experienced in our lives.

What makes Covid-19 infectious has a lot to do with how well the particular virus that causes it, SARS-CoV-2, survives in the world, along with how good SARS-CoV-2 is at finding the kind of cell it uses as a host and then invading it.

To contrast Covid-19 with the most recent nasty pandemic, AIDS, it is much more likely to spread and much less likely to kill those it spreads to. HIV, the virus that causes AIDS, is a delicate virus, despite causing a nasty disease. HIV dies if you blow on it.

The only fomite (the word for inanimate objects that can pass infections) that transmits HIV in the normal course of life is a needle full of HIV-infected blood, and that’s not easy to accidentally infect yourself with on your way to a restaurant. Other than direct blood transmission, it has to be transmitted person to person through intimate contact.

HIV is also good, but not great, at finding and infecting its target cells, and it happens to use the same kind of cells that Yersinia pestis, better known as the plague, and one of the worst pandemics ever, likes to invade. (This fact becomes very important in the story of contemporary civilization, hold on to your hats.)

So the limits to HIV spreading come from how hard it is for the virus to survive when it’s not in an ideal environment, and how hard it is to invade certain immune cells, its host of choice. This is why it is much easier to catch it from needle/blood transfer than anything else, and why some sex is more likely to transmit it than other sex is. For all the gay plague talk, the absolute safest sexually active group in the AIDS epidemic was lesbians. (I guess God loves lesbians the most?)

HIV is not passed via the respiratory system. The entrance to the respiratory system is the leaky liquidy parts of your face: eyes, nose, and mouth. This is an extremely important point. If HIV was transmitted that way, if it was a little hardier and could live in droplets you expel from your face, everything, and I do mean everything, would be terrible.

This isn’t because a respiratory infection couldn’t do what HIV does – there is a respiratory version of the plague that’s completely horrific. Pneumonic plague is in that category of diseases so bad that they burn themselves out by being so horrible and deadly that they run out of hosts, if not for the fact that it has other ways to spread, namely fleas. (Y. pestis is the worst.)

So while HIV is terrible and has cost the world immeasurably, it’s not the plague. Also, because of the plague, HIV is considerably worse at infecting immune cells in populations that were genetically impacted by the plague. HIV uses a receptor on immune cells called CCR5. The “receptor” here is a little protein lock that opens up a cell. A bit like a tiny door with lock and doorknob. Seven hundred years before HIV came around, Y. pestis, despite being a bacterium rather than a virus, was using the same CCR5 to get inside immune cells. It killed somewhere around half of Europe and came back and kept killing for hundreds of years until the human genome declared FUCK THIS and mutated CCR5 out of service in a portion of the population, a portion that then had the chance to have more kids.

 

This is why despite having similar chances to spread, HIV is less prevalent in European populations that went through that plague-induced genetic narrowing than in sub-Saharan Africa, which was probably never seriously afflicted by Y. pestis in the way Europe, western Asia, and North Africa were. This made them far more vulnerable to HIV, with the tragic results we see now.

To bring it back to our current bug: SARS-CoV-2’s infectiousness is closer to pneumonic plague than HIV in infectiousness, but also different because there’s no insect vector.

This little bugger can hang on in the environment. SARS-CoV-2 can survive for days on common surfaces like steel or plastic. It survives for four hours on copper. Copper is basically the Purell of metals. That’s not good.

SARS-CoV-2 is very good at accessing and infecting its target cells, which are generally surface tissue (epithelial) cells with ACE2 protein receptors, analogous to the CCR5 that Y. pestis and HIV use. Anything with that ACE2 receptor will work for SAR-CoV-2, but lung cells are the tissues they most likely encounter when someone breathes in the virus. It’s harder for it to get to those same receptors in your intestines from your nose. But it’s entirely possible that for the people who do experience intestinal symptoms like diarrhea, SARS-CoV-2 got to those ACE2 receptors as well.

You can think of the ACE2 receptor as a little locked door on the surface of the cell. In order for the useful things that the cell makes to get out, or for the cell to get a useful thing it needs to get in, other cells will come by with the key that fits into the receptor and unlock it.

A coronavirus is a small ball of fat and protein covered in lock picks, which in this case are little “spike” proteins that fit into the ACE2 receptor and open the door for the virus’s RNA to come in.

That’s it, that’s how it works. It’s amazing how much, when you get biology down to the micro level, bodies work like legos and tinker toys, but wet.

The thing about this virus, which makes it more infectious than the flu or even classic SARS or MERS, is that the spike protein on the surface of SARS-CoV-2 picks the lock of the ACE2 receptor very well. As soon as it hits it, it locks in. That means fewer viruses are needed to infect a person.

That, along with how well it survives and travels in droplets, is what stopped the world.

The good news is for most people Covid-19 doesn’t do much. In many cases, it does even less than the flu or a normal cold. It’s good news for people who get Covid-19, but not great news for a planet trying to find and isolate asymptomatic cases. You win some, you lose some.

There are two kinds of immune systems at play in responding to anything that threatens the body: the innate immune system, and the adaptive immune system.

The innate is your first level of defense, looking for and eliminating baddies like SARS-CoV-2. But the innate system isn’t where you get immunity. Immunity comes from a process where the innate system reacts to a novel bug it has never seen, and learns about it. Then a certain kind of innate immune cell, called a dendritic cell, presents the shape of a coronavirus, or whatever other nasty pathogen the body is fighting, to the T and B cells of the adaptive immune system, which then go all Terminator and hunt down and kill whatever is shaped like the thing they got from the innate system.

That process is what we call acquiring immunity, and it’s why no one can, by definition, be immune to a novel virus, including this one. Immune is not the same as showing no symptoms, even though many people, including journalists, keep using those terms interchangeably. That is a dangerous mistake, so let me repeat this: the only people on our beloved blue-green world who are immune to Covid-19 are those who have had it and recovered from it, and we’re not even sure how immune they are. So why do some people seem immune?

Covid-19 seems to have some way of calming down some innate immune responses (mechanisms which seem work strangely in children, that’s still unclear). It doesn’t usually win against the learned immune response in most people who get infected, who clear out the virus and become immune. Of course, this isn’t how it goes for everyone… but thankfully for most of us, it’s mild to asymptomatic.

The problem is with the virus calming the innate immune response is that the innate immune system is what gives you symptoms. Viruses don’t give you fevers and headaches, coughs, aches, and the desire to stay in bed, your immune response does that.

Without those symptoms infected people spread this very hardy virus all over until the immune system catches up with making them feel sick. We don’t know how long asymptomatic carriers shed virus this way. It could be a day, it could be two weeks.

In the end, it’s likely most of us are either going to get Covid-19 or get a vaccine. With this much global spread, the disease is headed to be the next coronoavirus to be endemic in humanity (the common cold is caused by other coronaviruses between 15-20% of the time).

Endemic means this is a disease the floats around the population, with pretty much one infected person infecting one more person (R=1). Many endemic diseases in history are nasty, like Smallpox, which in its prime regularly killed a third of children in Europe.

Endemic diseases can also flare into epidemics, when they encounter a large group of people without immunity, and then calm down again once they’ve done their damage. Diseases going from epidemic to endemic don’t just change our lifestyles and our societies, they change us at the genetic level, and we change them back.

We see that with the HIV and plague connection, and with European explorers accidentally (mostly) wiping out the vast majority of the new world, for whom the Smallpox virus was, like Covid-19, novel, and consequently far more deadly.

I hope we get the vaccine, and the news is good there, so far. SARS-CoV-2 doesn’t seem to be a fast mutator, unlike HIV, which has dodged all of our attempts to vaccinate for it.

Covid-19 might be treatable with some kind of antiviral medications, which would be nice, but that needs to go through trials first before any more unscrupulous doctors and incompetent politicians make up things about malaria meds, and people start eating fish tank cleaner en masse.

But in general, this is a bit like plague-level nightmare transmission, but with novel influenza lethality. Not great, but it could be much worse. At its most terrible, Y. pestis could kill up to 80% of its victims. (Y. pestis is the worst.)

How long we stay immune is another question, and we are far from answering it.

There’s two factors at play – one is that some immunity (like Smallpox) is for life, but for some other diseases, the adaptive immune system forgets about them after enough time passes. The second factor is how much the virus changes as it mutates going through hosts. The more people it infects, the more chances there are for the virus’s genes to drift as it reproduces. That makes more chances for it to become different enough that the body has to learn about it again, which unfortunately gets done by getting re-infected. It’s early days, but so far SARS-CoV-2 doesn’t seem to be prone to drifting.

SARS-CoV-2’s apparent genetic stability is some of the best news we’ve had for beating this disease in the long term, but it’s still early days. When bugs become endemic, they tend to lose some of their virulence as well. Killing your hosts isn’t very adaptive for a parasite, and dying isn’t very adaptive for us. But that is generations away.

For now, keep washing your hands and staying home for everything but essential work, store runs, exercise, and medical care. This is going to be very hard for everyone, but humanity will get through it together.


My work for Emptywheel is supported by my wonderful patrons on Patreon. You can find out more, and support my work, at Patreon.


Une FAQ Utile

(My friend Meor and @rafi0t have traslated my Covid-19 FAQ into French for the francophones out there- QN; Ed: for those who missed the English version the first time, it is here.)

1. Vais-je mourir?

Oui, malheureusement, tout le monde meurt.

2. Non, je veux dire est ce que je vais mourir du Covid 19?

Ah, ça! Probablement pas. La plupart des personnes touchées et malades présentent des symptômes assez mineurs. Par mineur, comprends que ta vie ne sera pas en danger direct, mais ça ne sera pas non plus une expérience très agréable. Selon les estimations actuelles, 80% des cas sont mineurs, 20% nécessitent une intervention médicale et quelque part entre 0,7% et 5% peuvent causer le décès ou s’en rapprocher suffisamment pour avoir une lumière brillante pointée dans leur direction.

3. Tu parles d’une expérience de mort imminente pour 5% des gens?

Non, je parle de l’éclairage d’hôpital, il est tellement lumineux et désagréable! Ça me donne mal à la tête à chaque fois. Ne peuvent-ils pas utiliser des ampoules aux teintes plus chaudes?

4. Je pose les questions ici.

Soit. Désolée, continue.

5. Est ce que beaucoup de personnes devront être hospitalisées?

Il semblerait. La plupart des personnes de plus de 70 ans et des personnes souffrant de problèmes de santé auront besoin de ce qu’on appelle des «soins de soutien». Ils sont dits “de soutien” car nous n’avons pas de remède ou de traitement direct contre ce virus. Ce que nous pouvons faire c’est maintenir la personne en vie pendant qu’elle se bat pour créer suffisamment d’anticorps, tuant ainsi les virus en balade en son intérieur. Concrètement, cela peut signifier un supplément d’oxygène, une surveillance par le personnel de santé, voire carrément un respirateur pour le patient.

6. Que faisons-nous à propos du trop grand nombre de personnes devant se rendre à l’hôpital en même temps?

C’est précisément le scénario cauchemardesque que nous essayons d’éviter, en mettant en oeuvre ce que les épidémiologistes appellent le ralentissement, pour réduire le taux de personnes qui se rendent à l’hôpital. Pour ralentir la propagation du virus, tu peux te laver les mains, nettoyer les surfaces autour de toi (plus de détails bientôt) et éviter de te rapprocher des autres personnes à l’extérieur. Mais les maires, les députés, les administrations scolaires et les autres autorités en charge de ces espaces où de nombreux gens sont proches peuvent faire beaucoup plus : en annulant les événements, en encourageant le travail à domicile, en fermant les écoles et les universités et en limitant le nombre de personnes autorisées à se rassembler ainsi que leur proximité.
Chaque endroit où le public se réunit devient un lieu où le virus passe d’une personne à l’autre. C’est essentiel car, si nous pouvons ralentir la propagation, la file d’attente pour les si confortables lits des soins intensifs sera équilibrée dans le temps et tout le monde ne se précipitera pas sur des respirateurs comme c’était Black Friday version santé.

Voici un excellent graphique expliquant ce que nous essayons de faire avec toutes ces distanciations sociales et le lavage des mains, en particulier le lavage des mains. Ai-je mentionné l’importance de se laver les mains?

La courbe en pointe correspond à des infections sans aucun contrôle, la courbe lisse et plus lente est ce que nous essayons d’accomplir en retardant la propagation.

7. Pourquoi n’avons-nous pas de remède? Je dois souffler dans les bronches de qui à ce propos?

Écoute, nous vivons dans une telle époque des merveilles, de duplicité politique et d’inepties qu’on pourrait se dire, dès que’un mauvais événement arrive, “Il ne peut que s’agir de négligence ou de malveillance”. Le fait est que la nature peut toujours nous botter le cul à tout moment. Ce n’est la faute de personne, c’est le genre de chose à laquelle les êtres humains ont dû faire face bien avant que nous soyons… humains.

8. Il doit bien y avoir quelqu’un sur qui crier quoi quelque chose?

Ne t’inquiète pas : Il y en a! Les autorités comme les personnes les plus banales peuvent faire beaucoup pour ralentir la propagation de cette maladie et rendre le traitement plus efficace.
Sur le plan personnel, tu peux crier après tes enfants / colocataires / parents / etc. de se laver les mains pendant 20-30 secondes plusieurs fois par jour, avant et après être sorti, avant de préparer la nourriture, d’utiliser les toilettes, de toucher de la nourriture, de se toucher le visage, d’éternuer, de tousser, de cracher ou de jurer…

9. Attends, jurer?

Oh, ça ne peut pas faire de mal.

10. Ah. ok. Continue.

Tu peux aussi nettoyer régulièrement les surfaces touchées fréquemment – pense poignées de porte, de tiroirs, comptoirs, interrupteurs, claviers, boutons, robinets … la boite de pétri ambulante qu’est ton téléphone portable, regarde simplement les espaces qui t’inquiètent, publics ou privés et pense aux endroits que les gens touchent, où ils toussent, éternuent ou qu’ils lèchent.

11. LÈCHENT? Tu sais quoi, je ne veux pas savoir. Avec quoi dois-je tout nettoyer? Alcool, eau de javel, feu?

Toutes ces choses fonctionneront, mais honnêtement, le savon ou les nettoyants de surface de base sont très bien. Les lingettes désinfectantes sont idéales pour un nettoyage rapide et pour les téléphones portables, mais tu peux aussi utiliser un nettoyant ménager habituel, vaporisé en bonne quantité puis bien essuyé avec de l’essuie tout, y compris ton téléphone portable dégoûtant. Le savon (détergent) est nickel aussi. En fait, c’est souvent mieux que l’alcool ou le peroxyde d’hydrogène. Il faut se souvenir d’une chose, ce coronavirus, SARS-CoV-2, a un seul brin d’ARN et quatre protéines spécialisées toutes soutenues par une bi-couche lipidique qui maintient le paquet ensemble. Le fait d’avoir une enveloppe virale lipidique le rend sensible aux détergents…

12. Tu peux arrêter de nerder?

Pardon. Si tu mets du savon sur le virus et que tu frottes un peu, il éclate, puis il disparaît.

13. Wow!

N’est-ce pas? Tu peux bien sûr y mettre le feu, y verser de l’alcool ou autre produit de ton choix, mais il suffit de quelque chose qui dissout la graisse et de quelques petits va-et-vient. Et là, tu peux imaginer ces minuscules petites boules hérissées éclater et déverser leurs minuscules petites tripes partout. C’est une chouette image. Ça donne envie de tout frotter.

Le gel hydroalcoolique fonctionne de la même façon, bien qu’il soit moins efficace que du savon ordinaire. Il y a toutes sortes de produits de nettoyage, mais ce bon vieux savon fait parfaitement l’affaire. Tu ne veux pas non plus utiliser des produits qui dessèchent et provoquent des gerçures dans la peau – toute tâche sanguinolente est un point d’entrée. Cela pourrait également signifier que tu devrais te procurer de quoi garder tes mains douces, souples et exemptes de trous superflus.

En bref, et très sérieusement, lave-toi les mains avec du savon et de l’eau et ne te touche pas le visage. C’est à peu près la meilleure chose que chacun puisse faire!

Voici une vidéo de Baby Shark avec des danseurs montrant la bonne technique de lavage des mains, et en voici une autre. Internet regorge de ce type de choses…

14. D’accord, mais revenons à la partie où je vais crier sur des gens à ce sujet.

Bien sûr. Le virus se transmet d’une personne à l’autre par les microgouttelettes que nous toussons, éternuons ou même expirons. Cela inclut potentiellement nos larmes, nos crachats, notre sang et nos affaires dans la salle de bain. Ça fait beaucoup de moyens de transmission interpersonnels, et cela signifie que nous devons nous tenir éloignés les uns des autres pour ralentir la propagation de ce virus.
Tu peux alpaguer les responsables locaux et autres organisateurs d’événements pour faire annuler ou reporter les rassemblements impliquant des contacts assez étroits entre personnes, y compris ceux qui concernent des enfants. Les écoles, les conférences, les services religieux et d’autres annulations d’événements publics sont déjà en cours et elles devraient se multiplier. Tu peux alerter avec véhémence les autorités locales à ce sujet!

15. Qu’en est-il des tests?

Oh, tu peux crier à plein poumons à ce sujet!
Les tests, en particulier aux États Unis, ont été ridicules. Le dépistage généralisé est l’un des meilleurs moyens de cartographier et donc de contenir toute épidémie, notamment lorsque de nombreuses personnes (en particulier les enfants) semblent présenter des symptômes bénins, il est encore plus important d’avoir des tests largement disponibles.
Idéalement, les tests devraient être accessibles à tous au sein d’une zone infectée. La Corée du Sud a effectué des tests, la Chine a rendu une grande partie de ses tests obligatoires.
Dans la plupart des cas, si tu as le virus, il te suffit de le savoir pour que tu sois confiné chez toi jusqu’à ce qu’il passe. Mais si tu ignore être porteur du virus, tu peux le répandre, ce qui est exactement ce que font de nombreuses personnes qui se sont vues refuser le test aux États-Unis, en Australie, au Japon et bien d’autres pays. Tester uniquement les personnes les plus malades confirme leur propre situation, mais ne renseigne pas sur la façon dont le virus pourrait se propager en ce moment. Les personnes très malades ne se promènent plus vraiment en toussant. À certains égards, il est moins important de savoir si les très malades ont le virus que de connaître les malades qui marchent encore, peuvent en être atteints… et le transmettre!
Quelle que soit la cause du retard des tests aux États-Unis, l’excuse n’est pas assez bonne.

16. Covid 19 est-il la faute de Trump / Mitch McConnell / Nancy Pelosi / Jay Inslee / Gavin Newsom / Rush Limbaugh / Etc.?

Honnêtement, au moment où nous sommes, peu importe le ou les fautifs. “La maison est en feu et nous devons l’éteindre.” comme dit l’adage. Nous pourrons découvrir qui blâmer quand ce sera réglé. L’urgence est de commencer à tester le plus largement et le plus rapidement possible et de transmettre ces informations aux différentes communautés pour les aider à prendre des décisions basées sur de bonnes données, et de façon compréhensibles.
De plus, pour être prudent, ne lèche pas les pangolins que tu rencontres.

17. Comment puis-je faire en sorte que mon oncle / ma mère / mon enfant / moi-même arrête de FLIPPER COMPLÈTEMENT à ce sujet?

Si tu lis ceci, tu n’es probablement pas un professionnel de la santé travaillant en première ligne de la réponse ou un administrateur qui planifie la logistique dans ta région. Tu n’as donc tout bonnement pas besoin de connaître les dernières nouvelles et spéculations sur Covid 19. Ce qui vaut vraisemblablement pour ton enfant, ton conjoint, ton cousin ou ton chat. Informé c’est bien, mais noyé dans l’information et paralysé émotionnellement c’est mal.
Choisis un moment de la journée pour recevoir tes nouvelles sur Covid 19, puis … arrête.
Si c’est vraiment nécessaire pour toi, vas-y et vérifie deux fois par jour.
Si des gens en parlent autour de toi, parle de la bonne procédure pour se laver les mains et du nettoyage des surfaces jusqu’à ce qu’ils n’en puissent plus. Personne ne veut parler autant de nettoyage des mains comme des surfaces, sauf moi, peut-être.

Si tu as affaire à un être cher qui pique une crise, mets en place une activité : un jeu de société, un film, quelque chose qui procure une pause. Débranche accidentellement ton accès Internet pendant un certain temps. Si tu as le sentiment que tu dois faire quelque chose, nettoie la maison, cela ne peut pas faire de mal. Imprime des affiches sur le lavage des mains et place-les dans les salles de bain que tu visites. Varie tes activités et surtout parle d’autres sujets. Le monde tourne toujours, il y a des livres à lire et des films à regarder et des choses à faire : avoir peur de Covid 19 n’est pas ton travail à plein temps.

18. Est-ce l’Apocalypse Zombie?

Non, ce n’est qu’un énième virus chiant qui cause une mauvaise infection pulmonaire. Il y en a beaucoup, mais parce que celui-ci est nouveau, pour nos organismes comme nos chercheurs, nous n’avons aucune immunité. Ça va être difficile et triste pendant un moment.

19. Tu vois ce que je veux dire. Ce virus… Est-ce l’état profond ou une arme biologique échappée d’un laboratoire maléfique du gouvernement? Est-ce que le virus SARS-CoV-2 sera joué par Dwayne «The Rock» Johnson un jour, quand la vérité sera révélée?

Oh Seigneur, OK, tu gardais cette question pour la fin. Permets-moi de te dire à quel point ce genre de chose est aussi ennuyeux qu’inévitable.
Ce nouveau virus appartient à une famille de virus appelés coronavirus. Ils ont été découverts dans les années 1960. La plupart d’entre eux provoquent des symptômes du rhume courants. Ce sont des virus à ARN génétiquement similaires, mais tu peux presque les considérer comme de simples machines pour injecter de l’ARN dans certaines cellules qui en font ensuite involontairement des copies. Mais rien de tout cela n’est très précis, et les erreurs pénètrent constamment dans la prochaine génération de virus à ARN, c’est ainsi que nous nous retrouvons avec de nouveaux virus. C’est à peu près aussi malveillant que des Roombas qui se reproduisent: un peu malveillant certes, mais aussi un peu stupide. Les nouveaux virus émergents provoquant des épidémies sont inévitables, ils se produisent non seulement depuis plus longtemps que l’humanité, mais avant même que nous soyons des animaux.
Et non seulement la création d’une arme biologique virale qui tue principalement les personnes âgées et les personnes immunodéprimées est impossible avec la technologie actuelle, elle n’est pas non plus particulièrement utile.

Ce n’est pas le seul nouvel agent infectieux que nous verrons, ce n’est même pas le seul que nous ayons vu ces dernières années – SRAS, MERS, SIDA, H1N1, Ebola, SARM, ce sont tous de nouveaux (plus ou moins) agents infectieux contre lesquels nous nous battons. Alors que nous perturbons les habitats et envahissons les grottes des chauves-souris, les virus et les bactéries qui ne sont pas déjà allés dans notre corps finiront par tenter le coup. La plupart d’entre eux échoueront et nous ne saurons jamais rien de leurs tentatives, dans notre corps, à la recherche de quelque chose sur quoi s’accrocher. Mais de temps en temps, l’un de ces minuscules salauds cochera les bons numéros du Loto. C’est la raison même de l’existence des domaines scientifiques et cliniques de l’épidémiologie. Nous avons tendance à l’oublier, en pleine époque de techno-merveilles, mais la nature est toujours le boss de fin.

20. C’est déprimant et un peu décevant.

Je sais. Peut-être pouvons-nous demander à Dwayne Johnson de jouer le Dr Tedros Adhanom, chef de l’Organisation mondiale de la santé (OMS) qui démonterait les gens refusant de se soumettre à des tests et exigeant que le public soit autorisé à rentrer chez lui et à pratiquer la distanciation sociale.

21. Okay, c’est une idée terrible pour un film. Et soit, ce n’est pas un complot secret du gouvernement. Si je ne suis même pas un zombie, comment savoir si j’ai Covid 19?

Les symptômes à surveiller sont la fièvre, l’essoufflement (difficulté à respirer) et la toux.

22a. Whoa attends exactement ce que je-slash-la personne qui lit ceci à côté de moi a! QU’EST-CE QUE JE FAIS MAINTENANT?!

Tout d’abord, calme toi. Ceux-ci peuvent être des symptômes courants de la grippe, et heureusement, la grippe (avec son taux de mortalité beaucoup plus faible) est encore plus courante. Mais si tu te trouves dans une zone de transmission ou si tu as récemment voyagé dans une zone où une épidémie s’est déclarée, cela vaut la peine de se faire dépister si des tests sont disponibles. Si tu es malade, ne vas pas à l’hôpital ni chez le médecin, tu mettrais d’autres personnes en danger. Appelle ton médecin ou la ligne d’urgence dédiée et dis-leur pourquoi tu penses que tu pourrais avoir Covid 19.
Si tu es très malade et que tu devras te rendre à l’hôpital, appelle une ambulance et préviens les que tu soupçonnes une infection par le Covid 19. Ainsi, ils pourront se présenter avec le bon équipement pour assurer ta sécurité et celle des autres.

22b. J’ai un nez qui coule et un mal de gorge et je me sens généralement un peu merdique.

On se calme. J’ai ça aussi, c’est un rhume. C’est pourquoi cette FAQ est si tardive.

23. Est-ce que tout cela disparaîtra quand il fera plus chaud?

Eh bien… c’est difficile à dire. Version courte, la réponse est non, mais c’est peut-être possible? Cela dépend en grande partie de la façon dont le virus du SRAS-CoV-2 survit sur les surfaces, et il ne survit pas aussi longtemps sur des surfaces chaudes, ou n’aime pas être frappé par les rayons UV du soleil. Cela pourrait, en théorie, réduire l’infectiosité globale de la maladie, mais nous n’en savons rien pour l’instant.

24. J’ai une très bonne assurance maladie, ça veut dire que je suis cool, non?

Oh, désolé, mais pas cette fois. Le principal problème est de savoir si nous pouvons ralentir le virus suffisamment pour nous assurer que les lits d’hôpitaux et les services qui y travaillent ne sont pas pleins et débordés lorsque tu en auras besoin.
Quelle que soit la qualité de ton assurance maladie, si les hôpitaux n’arrivent pas à traiter suffisamment rapidement les personnes malades et que l’épidémie est en expansion, tu vas devoir attendre… et les conséquences peuvent être douloureuses. Ai-je trop parlé de se laver les mains?

25. Pourquoi les enfants sont-ils immunisés? Pourquoi ne souffrent-ils pas comme nous tous?

Compliqué, mais allons-y. Les enfants ne sont pas immunisés : ils attrapent le virus dans le même délai et l’ont probablement aussi longtemps que nous les adultes. Ils ne semblent tout simplement pas avoir beaucoup de symptômes. Si tu mets un coton-tige dans leur nez, tu pourras détecter le virus, mais ils ne présentent pas de signe de maladie. Quant à savoir pourquoi… Ils pourraient avoir très peu d’activité virale et ainsi répandre le virus comme de minuscules et adorables Mary Typhoïde partout sur leurs grands-parents. Il y a beaucoup de choses que nous ignorons encore totalement sur ce virus ou ce qu’il fait dans le monde. C’est nouveau, c’est difficile à gérer. De nombreux articles sortent, de nombreux scientifiques se ruent sur toutes les données dont nous disposons. La recherche sur Covid 19 est peut-être l’une des seules choses à voyager plus vite que le virus en question, mais il reste encore beaucoup à comprendre.

26. Quelle distance sociale dois-je pratiquer?

Cela dépend en partie de toi. Si tu es plus âgé, immunodéprimé ou à risque élevé, tu devrais probablement te préparer à rester à la maison pendant quelques semaines si le virus arrive en ville.
S’il est déjà en ville, évite les foules et les transports en commun bondés. Travaille à domicile si c’est possible et prépare toi à la fermeture des écoles.
Si tu es malade d’une autre maladie et que tu dois sortir, c’est le moment de porter un masque, un masque chirurgical est très bien.
Lave-toi les mains et ne te touche pas le visage.
Si tu es touché par le Covid 19, vraiment, ne sors pas. Essaye de te faire livrer tout ce dont tu as besoin jusqu’à ce que tu te rétablisses.

27. Une fois que j’irai mieux et que j’aurai vaincu le virus, je serai un super-héros invulnérable au coronavirus, non?

Eh bien, euh, il y a plus d’une souche du virus, et nous ne savons pas si avoir survécu à l’un d’eux confère une immunité générale. Jusqu’à ce que nous le sachions, tu devrais faire encore attention.

28. SÉRIEUSEMENT?!

Oui, nous en saurons probablement plus bientôt, mais comme je le répèté, c’est nouveau, nous sommes tous en processus de compréhension.
Pardon.

29. Il semblerait que je vive avec quelqu’un qui a le virus et que je doive m’en occuper, ou cette personne est dans une catégorie à risque et je m’inquiète de le leur transmettre.

Cela dépasse le cadre d’une FAQ sarcastique, mais je vais essayer.
Si tu vis avec une personne vulnérable, tu dois t’astreindre immédiatement à l’éloignement social, l’auto-isolement et suivre les mesures de sécurité.
Si tu prends soin de quelqu’un, c’est exactement la situation dans laquelle tu as besoin d’équipement de protection individuelle comme des masques N95, des gants, etc. Attention : tu dois ajuster les masques correctement. Les tutoriels Youtube sont tes amis.

30. Dois-je aller à l’école? Travailler? Puis-je quand même sortir manger? Ou obtenir la livraison? Je ne sais pas comment faire bouillir de l’eau…

Cela dépend en grande partie de ce qui se passe et de là où tu te trouves. Il devrait y avoir des annonces locales sur les écoles, le travail et les rassemblements qui aident à guider tes décisions, mais tu devras peut-être être plus prudent en fonction de ta propre situation de santé.

En ce qui concerne la préparation de plats, un repas cuisiné va tuer le virus, mais il serait bien que les personnes travaillant dans les cuisines commerciales portent des masques et se lavent beaucoup les mains. Si tu sors, ne vas pas pas dans un endroit bondé. Tu veux entre 1.5m et 2m entre chaque personnes, avec une bonne ventilation. Si tu reçois te fais livrer, assure toi que tes aliments sont chauds et traite les sacs et contenants comme s’ils étaient contaminés – lave-toi les mains, jette l’emballage, lave toi les mains à nouveau.

31. Que fais tu à ce sujet, toi, hein, Quinn?

(Version originale: Oh, mets mon argent là où est ma bouche, hein? (C’est une idée terrible, l’argent est presque toujours contaminé, alors j’utilise autant que possible ma carte de crédit)

Oh, faites ce que je dis pas ce que je fais? Mais je parle beaucoup, tu as vu…” Alors, je suis actuellement à San Francisco, où il n’y a pas (encore) de crise médicale mais nous avons une transmission communautaire. L’école de ma fille est toujours ouverte, ce qui me déplaît, mais pour l’instant elle s’y rend. Quand j’avais des symptômes de rhume, je portais un masque. Je vérifie régulièrement ma température, tout comme mes colocataires. Je me lave beaucoup les mains. J’essuie les surfaces très sensibles avec du détergent plusieurs fois par jour.

Ma fille et moi prenons des multi-vitamines. Certaines personnes pensent que le zinc peut aider, ou la vitamine D, ou C, ou quoi que ce soit, et honnêtement, personne ne le sait – c’est un nouveau virus! Ce dont je suis sûr, c’est que les carences aggravent la maladie et qu’un apport en multi-vitamine ne peut pas faire de mal. (Sauf que les hommes biologiques ne devraient pas prendre de vitamines pour femmes en raison du fer qu’ils contiennent.) Je sors encore et je fais quelques activités, mais je ne fais pas la queue ni ne m’approche des gens. Je suis allé à Safeway, j’ai vu des lignes et je suis sortie aussi sec. Je marche généralement pour me déplacer, mais je prendrais plutôt un tram presque vide. Je fais toujours des courses et je vois des gens promener des chiens. C’est bon, tant que nous restons bien éloignés les uns des autres. Quand je reviens… devine : je me lave les mains.

32. Où puis-je trouver des informations fiables et moins sarcastiques que cette FAQ?

L’Organisation mondiale de la santé dispose d’un site d’information sur ce nouveau coronavirus

L’Université Johns Hopkins gère également un excellent site informatif

… Ainsi qu’un tableau de bord indispensable pour suivre la progression du virus.

Worldometer (Worldometer appartient à une société appelée Dadax) est un très bon agrégateur avec une belle section sur les coronavirus.

En francais, Le gouvernement a une très bonne FAQ (moins marrante, mais plus complète.

Et le site de la santé publique a aussi beaucoup d’informations.

Recherche également des informations locales du lieu où tu te trouves. En espérant que les dirigeants des administrations locales sont ceux qui les connaissent le mieux.

Ai-je mentionné que tu devrais te laver les mains?


Shelter in Place

In the final hours before the six-county Shelter in Place order came into effect in Northern California, signs went up, people gathered for last drinks, and the homeless tried to find warm places to sleep. Here are some scenes from San Francisco’s Mission District and the Castro, just before the order came into force.

Cliff's Hardware

Cliff’s Variety is a hardware and home goods store which has a cornerstone of the Castro area of San Francisco, even since before it was know as a haven to the gay community. Hardware stores will remain open, but many are limiting their hours and the number of people who can be in the store at any one time.

A San Francisco city worker disinfects a public bathroom late at night in the Castro area. Homelessness is prevalent in the area, and many homeless people rely on these public bathrooms for health and safety.

 

Orphan Andy’s, a diner in the Castro, shuts its doors following the Shelter in Place order.

The Purple Star cannabis dispensary serving customers lining up out the door as people prepare to hunker down in San Francisco’s Mission District.

A Mission District PrEP clinic is closed by the Covid-19 Shelter in Place order, putting people in the community more at risk for HIV transmission. PrEP stands for Pre-Exposure Prophylaxis, and is often given to people at high risk of exposure to HIV, like injection drug users, mixed status couples, and sex workers. PrEP therapies are highly effective at stopping the transmission of the virus, but only if taken daily.

 

 

 

 

Markets are changing their hours and controlling access, trying to clean and stock shops while keeping their employees and customers safe.

 

 

 

 

 


A homeless man in a wheelchair makes his way along a dead-end street next to the 16th and Mission BART station in San Francisco. Having nowhere to go, the homeless are exempt from the Shelter in Place order. Governor Newsom of California has begun securing hotel rooms to bring the homeless inside, but it’s  a fraction of what’s needed to help with the enormous homeless population of the Bay Area.

Two bins in front of a salon in the Castro area of San Francisco protect a homeless sleeper. Salons won’t be among the essential services that can remain open under the Shelter in Place order, and their workers rarely have any form of paid time off.

Harvey’s restaurant and bar, name for Castro human rights legend Harvey Milk, serves a few last patrons before closing for all but delivery service.

Bars in the Mission District that were still open as the Shelter in Place order was about to take effect were often filled, with possibly unwise patrons trying to get in last drinks.

Schools in San Francisco, like Mission High School are closed until April, though it seems possible they won’t reopen for this school year as the pandemic progresses.

 

 

 


A helpful FAQ on Covid 19

1. Am I going to die?

Yes, unfortunately everyone dies.

2. No, I mean am I going to die of Covid 19?

Oh right, that! Probably not. Most people who get it have fairly minor symptoms. Though by minor, I mean not life threatening, not necessarily pleasant to experience. Current estimates are that 80% of cases are minor, 20% require some kind of medical intervention, and somewhere between .7% and 5% may die or get close enough to see that bright light coming for them.

3. You mean a near-death experience for as much as 5% of people?

No, I mean hospital lighting, it’s so bright, and so unpleasant! It gives me a headache every time. Why can’t they use warmer bulbs?

4. I’m asking the questions here.

Right, sorry, go on.

5. Will a lot of people need to be hospitalized? 

It looks that way. Mostly people around 70 or older, and people with existing health conditions, are going to need what’s called “supportive care.” Supportive care means we don’t have a cure or direct treatment, but we can often keep the body going while it fights the good fight to created enough antibodies to kill the viruses floating around inside the Covid 19 patient. That can mean extra oxygen, monitoring by healthcare staff, or more, all the way to a machine that breathes for the patient.

6. What do we do about too many people needing to go to the hospital at once? 

This is the nightmare we’re trying not to have, and we need to practice what epidemiologists call delay, to slow the rate of people heading for the hospital. You can wash your hands, clean the surfaces around you (more on that soon) and avoid getting close to other people outside. But mayors, governors, school administrations, and other authorities in charge of spaces where a lot of people are close together can do a lot more by canceling events, encouraging work from home, closing schools and universities, and limiting how many people can congregate and how close they can be. Anywhere the public comes together will become a place where the virus travels from person to person. This is important, because if we can slow it down, then the line for those plush Intensive Care Unit beds will be balanced out, and everyone won’t be rushing for ventilators like it’s Black Friday at Medical Walmart.

Here’s a great visual of what we’re trying to do with all this social distancing and hand washing especially hand washing did I mention hand washing?

7. Why don’t we have a cure? Who do I yell at about this?

Look, we live in such and age of wonders and such an age of political duplicity and ineptitude that it can seem like anything bad that happens is negligence or malice. But the fact is, Nature can still kick our collective ass anytime it wants to. This isn’t anyone’s fault, this is the kind of thing humans have been dealing with since before we were humans.

8. There must be something I can yell about and someone to yell it at?

Don’t worry! There is. There’s a lot both authorities and regular people can do to manage the spread of this disease and make the treatment more effective. On the personal level, you can yell at your children/roommates/parents/etc. to wash their hands for 20-30 seconds several times a day, before and after going out, before preparing food, using the toilet, touching food, touching their face, sneezing, coughing, spitting, or cursing…

9. Wait, cursing?

Well, it can’t hurt.

10. sigh Go on. 

You can also clean commonly touched surfaces a lot — think doorknobs, handles, counters, light switches, keyboards, knobs, buttons, faucets… your germ-nursery of a cellphone, just walk around the spaces you’re concerned about, public or private, and think about where people touch, cough, sneeze or lick.

11. LICK? You know what, I don’t want to know. What do I have to clean everything with? Alcohol, bleach, fire?

All of those things will work, but honestly soap or basic surface cleaners are fine. Disinfecting wipes are good for quick cleaning and for cellphones but you can also just spray a little surface cleaner on a paper towel and wipe things down well with a good amount of cleaner, including your disgusting cell phone. Soap (detergent) is great. In fact, it’s often better than alcohol or hydrogen peroxide. Here’s the thing, this coronavirus, SARS-CoV-2, has a single strand of RNA and four specialized proteins all supported by a lipid bilayer holding the package together. Having a lipid viral envelope makes it susceptible to detergents…

12. Could you stop with the nerd talk?

Sorry. If you put soap on the virus and rub a bit, it pops, and then it dies.

13. Wow!

I know, right? You can set it on fire and pour alcohol on it or whatever, but anything that cuts grease and little back and forth, and you can just imagine those tiny little spiky balls popping and spilling their tiny little guts everywhere. It’s great. Just makes you want to scrub everything.

Hand sanitizer works similarly, but not actually as well as regular old soap. There’s a lot of cleaning products out there, but you’re really much better off with soap. You also don’t want to use things that will dry out and cause cracking in your skin — any bloody spot is an entry point. That might also mean you should get some lotion and keep your hands soft, supple, and free of extra holes.

But seriously, wash your hands with soap and water, and don’t touch your face. That’s pretty much the best thing we can all do.

Here’s a Baby Shark video with dancers showing proper hand washing technique, and here is another. The internet is truly full of things .

14. Ok, but let’s get back to the part when I get to yell at people about this. 

Sure. The virus travels between people on the tiny droplets that we cough, sneeze, or even just exhale. It’s also potentially in our tears, spit, blood, and our bathroom business. That’s a lot of ways for it to get from one person to the next, and that means we need to get away from each other to slow the spread of the disease. You can yell at local officials and event organizers to cancel or postpone gatherings where people might be in close contact, and those people might include children. Schools, conferences, church services and other public event cancellations are already happening, and they need to happen a lot more. You can yell at your local authorities about that.

15. What about testing?

Oh, yell your head off about this. Testing, especially in America, has been abysmal. Widespread testing is one of the best ways to map out and contain any epidemic, and given that many people (especially children) seem to have mild symptoms, it’s even more important to have widely available testing. Ideally testing should be available to everyone in an infected area. South Korea has drive through testing, China made a lot of their testing mandatory. In most cases, if you have the virus you just need to know to go home and stay there until you get through it. But if you don’t know it, you can run around spreading it, which is exactly what many people who were turned down for getting tested in the USA, Australia, Japan, and more, ended up doing. Testing only the sickest people tells you about them, but not about how the virus might be spreading at the moment. Very sick people aren’t walking around anymore coughing on everything. In some ways knowing if the very sick have the virus is less important than knowing about the still walking sick who may have it.

Whatever is causing the delay in US testing, the excuse isn’t good enough.

16. Is Covid 19 the fault of Trump/Mitch McConnell/Nancy Pelosi/Jay Inslee/Gavin Newsom/Rush Limbaugh/Etc.? 

Honestly, it doesn’t much matter whose fault it is right now. The house is on fire, and we need to put it out. We can figure out who to blame later. The important thing is that we start testing as widely and quickly as possible, and getting that information into the communities to help them make decisions based on good data. Also just to be on the safe side don’t lick any pangolins you come across.

17. How do I get my uncle/mother/child/self to stop COMPLETELY FREAKING OUT about all of this?

If you’re reading this you’re probably not a medical professional working the front lines of the response or an administrator planning logistics for your area. You just don’t need to know the latest news and speculation about Covid 19, and neither does your child, spouse, cousin, or cat. Informed is good, but drowned in information and emotionally paralyzed is bad. Pick a time of day to get your Covid 19 news, and then just… stop. If you really must, go ahead and check two times a day. If people bring it up, talk about hand washing and cleaning surfaces until they drop it. Nobody wants to talk about hand washing and cleaning that much, except possibly me.

If you’re dealing with a loved one that’s just losing it, plan an activity. A board game, a movie, something that gives everyone’s brain a break from it all. Accidentally unplug your internet for a while. If you just feel like you need to do something about it, clean house, it can’t hurt. Print up hand washing posters and put them up in bathrooms you visit. Do, and talk about, other things. The world is still turning, there are books to read and movies to watch and work to do and being scared of Covid 19 is not your full time job.

18. Is this the Zombie Apocalypse?

No, this is just another boring bug that causes a bad lung infection. There are a lot of them, but because this one is new (hence novel) we don’t have any immunity to it. It’s just going to be difficult and sad for a while.

19. You know what I mean. Is this… that virus? Is it the deep state, or an escaped bioweapon from an evil government lab? Is the SARS-CoV-2 virus going to be played by Dwayne “The Rock” Johnson one day, when the Truth is Revealed? 

Oh Lord, OK, this one. Let me tell you how boring, and inevitable, this kind of thing is. This novel virus is from a family of viruses called Coronaviruses. They were discovered in the 1960s, most of them cause common cold symptoms. They’re genetically similar RNA viruses, but you can almost just think of them as simple machines for injecting RNA into certain cells who then unwittingly make copies of them. But none of this is very precise, and errors get into the next generation of RNA viruses all the time, which is how you end up with new viruses. It’s about as sinister as self replicating Roombas, which is kind of sinister but also kind of stupid. Novel emerging viruses that cause epidemics are inevitable, and they’ve been happening not just since before we were humans, but before we were even animals. Not only is creating a viral bioweapon that happens to mostly kill older people and people with immune conditions not terribly possible with current technology, it’s also not particularly desirable.

This is not the only novel infectious agent we’ll see, it’s not even the only one we’ve seen in recent years — SARS, MERS, AIDS, H1N1, Ebola, MRSA, they’re all new(-ish) infectious agents we’ve been fighting in the last few decades. As we disturb habitats and invade bat caves viruses and bacteria that aren’t used to our bodies will end up trying us out. Most of them will die and we’ll never know they were there in us, looking for something to latch onto. But every once in a while, one of these tiny bastards hits the Lotto numbers. That’s part of what we have the scientific and clinical field of Epidemiology for. We forget this in our age of technowonders, but Nature is still the OG asskicker, and always will be.

20. That’s depressing, and kind of a letdown. 

I know. Maybe we can get Dwayne Johnson to play Dr. Tedros Adhanom, head of the World Health Organization (WHO) and he can beat up people who are withholding testing and demand that the public be allowed to go home and practice social distancing.

21. OK that’s a terrible idea for a movie, but fine, it’s not a secret government plot. If I’m not even a zombie, how do I know if I have Covid 19?

The symptoms to keep an eye out for are a fever, shortness of breath (difficulty breathing), and a cough.

22a. Whoa wait that exactly what I-slash-the person reading this next to me have! WHAT DO I DO NOW?!

First off, calm down. Those can be common flu symptoms, and thankfully the flu (with its much lower fatality rate) is still more common. But if you’re in an area with community transmission or have recently traveled to an area with an epidemic outbreak, it’s worthwhile to get testing if testing is available. If you’re sick, don’t go to the hospital or the doctor’s office. Call your doctor or the hospital, and tell them why you think you might have Covid 19. If you’re very sick, and you need to go to the hospital, call for an ambulance, and tell them you believe you may have Covid 19. That way they can show up with the right equipment to keep you and everyone else safe.

22b. I have a runny nose and a sore throat and generally feel a bit crap.

Chill. I have that too, it’s a cold. It’s why this FAQ is so late.

23. Will this just all go away when it warms up?

Well… It’s complicated. The short answer is no, but maybe it kind of could? A lot of this has to do with how well the SARS-CoV-2 virus survives on surfaces, and it doesn’t survive as long on warm surfaces, or enjoy being hit by UV rays from the sun. That could, in theory, lower the overall infectiousness of the disease, but we just don’t know yet.

24. I have really great health insurance, that means I’m cool, right?

Oh, sorry, not this time. The problem is whether or not we can slow the virus down enough to make sure the hospital beds aren’t full when you need them. No matter how good your health insurance is, if hospitals are racing to catch up with how many sick people there are and the epidemic is in a crisis, you’re going to be stuck waiting. Have I mentioned washing your hands a lot?

25. Why are children immune? Why don’t they suffer like the rest of us? 

Harsh, but ok. Children aren’t immune, they get the virus in the same timeframe and probably have it as long as we grown-ups do. They just don’t seem to have a lot of symptoms. If you put a swab in their nose you can detect the virus, but they don’t seem to get very sick. As for why, we don’t know. They could have very little viral activity, or they could be shedding it like tiny adorable Typhoid Marys all over their grandparents. There’s a lot we just don’t know about this virus or what it’s doing the the world. It’s novel, and that’s hard to deal with. Many papers are coming out about it, many scientists are pouring over all the data we have. Research on Covid 19 may be one of the only things traveling faster than than the virus, but there’s still so much to figure out.

26. How much social distancing should I be practicing?

Some of that depends on you. If you’re older, immunocompromised, or otherwise high risk, you should probably at least be prepared to stay home for a few weeks if the virus comes to town. If it’s in town already, avoid crowds and busy transit. Work from home if you can, and prepare for school closures. If you’re sick with something else and you must go out, that’s the time to wear a mask, but a surgical mask is fine. Wash your hands and don’t touch your face. If you’re sick with Covid 19, really, don’t go out. Try to get anything you need delivered until you’re well again.

27. Once I’m well, and I’ve beat the virus, I’m an invulnerable coronavirus superhero, right?

Well, uh, there’s more than one strain, and we don’t know if having one confers general immunity. Until we know you should probably still be careful.

28. SERIOUSLY?! 

Yeah, we’ll probably know more soon, but this is novel, and we’re all still figuring it out.

Sorry.

29. It looks like I’m living with someone who has the virus and I have to take care of them, or they are high risk and I’m worried about giving it to them. 

That’s beyond the scope of a sarcastic FAQ, but I’ll try. If you’re living with a vulnerable person, you need to go their speed when it comes to social distancing, self-isolation, and safety precautions. If you’re taking care of someone, this is the situation in which you need PPE (Personal Protective Equipment) like N95 masks, gloves, etc.. And you need to fit the masks correctly. Youtube tutorials are your friends.

30. Should I go to school? To work? Can I still go out to eat? Or get delivery? Man, I don’t know how to boil water. 

A lot of this depends on what’s going on where you are. There should be local announcements about schools, work, and gatherings that help guide your decisions, but you may also need to be more careful based on your own health situation.

As for getting prepared food, a cooked meal is going to kill the virus, though it would be nice for people working in commercial kitchens to wear masks and wash their hands a lot. If you’re going out, don’t go somewhere crowded. You want 4-6 ft between between people, with good ventilation. If you’re getting delivery, make sure your food is hot and treat sacks and containers as possible contaminated — wash your hands, throw packaging out, wash your hands again.

31. What are you doing about it, yourself? Huh, Quinn?

Oh, put my money where my mouth is, eh? (That’s a terrible idea, money is almost always contaminated, so I’m using my credit card as much as possible) I’m currently in San Francisco, where there isn’t a medical crisis (yet) but we do have community transmission. My daughter’s school is still open, which I’m unhappy about but for now she’s going. When I had cold symptoms I wore a mask out. I’m checking my temperature periodically and so are my roommates. I wash my hands a lot. I’m wiping down high-touch surfaces with detergent a few times a day.

My daughter and I are taking multivitamins. Some people think Zinc can help, or Vitamin D, or C, or whatever, and honestly no one knows — novel virus! What I am sure of is that deficiencies make illness worse, and a multivitamin can’t do any harm. (Except biological males should not take women’s vitamins due to the iron they contain.) I’m still going out and doing a few things, but I don’t stand in lines or get close to people. I went to Safeway, saw lines, and noped right out of there. I’m usually walking to get around, but will get on a mostly empty tram. I’m still going for runs, and see people walking dogs. That’s fine, as long as we stay well away from each other.  When I get back, I wash my hands.

32. Where do I find good and reliable information that’s less sarcastic than this FAQ?

Did I mention you should wash your hands?


My work for Emptywheel is supported by my wonderful patrons on Patreon. You can find out more, and support my work, at Patreon.


What Happens After You’re Cancelled

This is a highly personal account of what happens after a social media crowd destroys a life. It includes talk of mental illness, severe pain, trauma, and suicide. Stop now if that’s not for you. Also, it’s long. 


I was folding laundry with my partner one day when I looked up at him and said, “Do you think they’d be happy if I did kill myself?”

He looked at me, and took a long breath, and said, “No.”

“You’re right,” I said, “I know it. Nothing makes them happy.”

Taylor Lorenz, a staff writer at the New York Times told The Stranger: “In internet culture, being canceled is only good for your career. It usually results in going viral, which is default good in today’s broken world.”

I suppose it seems this way because you only see the people who survived it, who stayed in the public mind or their jobs. The rest of us, we cease, unpersoned and exiled. We are not in the observational data set, we are never spoken of when people talk about this mode of human life. To this day, as many articles as the New York Times has published about the phenomenon, never once has anyone mentioned my name.

The second time it happened, the bad time everyone remembers, I got a call in a movie theater. That was where I was when the internet wrecked my career, watching Black Panther, and my body still goes cold when I remember it. Katie Kingsbury called me, just before Killmonger died, just before he said “Bury me in the ocean with my ancestors who jumped from the ships, because they knew death was better than bondage” – I missed that part. As I was walking out, she asked me if I’d tweeted something, and I was confused by it. I said, “That doesn’t sound like me.” It turned out it wasn’t my tweet, it was a nine-year-old retweet of John Perry Barlow, an angry clap back at racists shortly after the first Obama election, and it contained the N word.

In the next hours, people would dig up tweets and display them out of context to paint me as an unrepentant racist and homophobe. I never had a chance, before I got home from the theater I was fired from my new job. The Times never asked me to explain the tweets. By the time the King of Wakanda was landing in Oakland, my life as I had know it was gone.

The only tweet anyone at the Times asked me about (after that initial call) was one where I was angry tweeting criticism of the Times’ coverage of the Michael Brown shooting. It was a tweet saying that I’d make a lot more money as a racist at the New York Time than I was making then, right after they’d published their “Michael Brown was no angel” article. I didn’t stop with the tweet. I wrote a satirical piece making fun of how the Times and other outlets covered Brown’s death and other police shootings, about how no one could be good enough to make the conventional media question the police, called Man Killed by Local Police in the Province of Judea.

I’ve spent a lot of my career weaving in elements of satirical bait-and-switch into my commentary and articles, and plenty of the bait without the switch was on display that day. I realized I couldn’t counter it, not all of it, and really not even a bit of it. No one was listening.

Online crowd stomping someone is like a sealioning of mythic proportions, where the crowd tempts you to think if you could just explain it would be OK, but it’s not true, it’s a lie that fucks with your head, a crowd screaming why are you hitting yourself while also telling you to kill yourself.

It’s not that the crowd used my weaknesses against me, it’s that they used my strengths. My pacifism, my work with weird and marginalized communities, my love of flawed people, my humor, my long thoughts and hopes about complicated moral topics, these were all used to reduce me to nazi sympathizer, a homophobe, a white supremacist.

So many of the things people brought up and threw at me weren’t my mistakes at all, but things I’m proud of, like trying to argue an anon out of making rape jokes at a feminist on Twitter.

And then my colleagues in American journalism did me dirty. They ran with the crowd, releasing fast articles without any more context than Twitter and Facebook, without talking to me or trying to understand what was happening. Not all, but most. Enough that I knew I wouldn’t get work again, that anyone who googled me would not speak to me again. And yes, they’ll complain I didn’t get back to them. But I was nine hours ahead of the west coast and overwhelmed. I had just been fired, I was preparing for spinal surgery, and I needed to sleep.Or at least, I needed to try to sleep.

The New York Times apologized for hiring me, but it would be years before anyone would apologize to me. It would be even more time before I found my anger. But it helped when I did.

You don’t know me, you assholes. You don’t even think that matters. All that matters is the last thing you saw, and feeling like you’re better than other people. You’re like the amnesiac goldfish of self-righteous hatred.  

But then, I also know why they did it, I spent years studying and trying to understand exactly the forces that wrecked me that day. I had written about them, had spoken to the situations in which they arise, had suggested ways of making the internet better. Education, mostly, and creating the cultures you want to see on the net through active moderation, among other things. Maybe someday I’ll be able to write about it again.

That February 2018,  I was in a level of pain hard to fit into words. I was struggling to type, I’d all but lost the use of my left hand and my right was starting to fail too. I had written about the pain the five months before,  but it hadn’t improved since then. That’s what the spinal surgery I was preparing for was supposed to fix. This was the final cut on top many years of agony, physical and emotional. I explained everything as best I could in those days following my firing. I wrote about my philosophy, I wrote about what the Times and the crowd had done to me, the how and the why. Often I wrote by dictating notes into my phone, because typing was so painful and difficult. I hoped someone in journalism would retract their claims about me, but no one did. Regular people did, they still do. Sometimes out of nowhere someone on Twitter will say, I was in the mob, and I’m sorry. Not every article was a hit piece, but mostly they were, and none, not a single one that I could find, ever criticized my writing as racist or homophobic. Just me, on social media, in snippets no one wanted to understand.

Publications I was talking to replied that obviously they couldn’t work with me now. People who knew me apologized quietly, but with a few exceptions, they just felt like if they stood up for me they’d be destroyed by the mob too.

Friends, horrified by what happened to me, retreated from the internet. I found myself comforting them. I’d say the internet was not all bad, it was mostly wonderful, and that I would be OK. The first was true, the second, I still don’t know.

When the chips were down I found out I was mostly alone. It wasn’t the first time I felt that. It wasn’t the first time a crowd came for me, nearly drove me to the point of self-harm.

I’d felt it five years earlier, when the media and public went looking for a bad guy to blame for Aaron’s suicide. There were bad guys, MIT and the prosecution, US Attorneys  Stephen Heymann and Carmin Ortiz, but they were safe behind the walls of institutional power. The crowd came for me for the same  reason Heymann did: because I was powerless and easy to exploit and they wanted blood.

I was at my girlfriend’s flat in London the morning Aaron died. I woke up and opened my laptop to see mails and messages from everyone saying to call them, and that it was about Aaron. I said something like “No, no, what did you do, you didn’t do it no no no” and, of all things, pulled up Wikipedia. There, on the page, was Aaron’s end date. As I recall it, I just rocked and cried and said “no no no you didn’t do it” until I had to explain it to my girlfriend. She fed me and looked after me while I booked my way back to New York and then Chicago for the funeral. I went to a conference and did a presentation on Anonymous. Everyone told me I didn’t have to, including the organizers, but I wanted the distraction. I wanted to go through the motions of a normal life I already knew was never going to be normal again.

I met a filmmaker friend of mine at the conference. He hadn’t known Aaron, but now he was surrounded by people who had, and he wanted to understand more. He did a few interviews with me and other people, and said he thought this might be a short film. I looked him in the eye and said, “this is a feature length film.” He was thoughtful and silent. Later, with the camera rolling, he asked me why so many people cared so much about Aaron, and I said, “He was the internet’s own boy, and the old world killed him.”

That film, Internet’s Own Boy, would be shortlisted for the Oscars.

What I didn’t tell Brian that day was the complicated role I played in Aaron’s prosecution, or the complicated roles we played in each other’s lives. That would come out later, in the movie, and in articles, including my own. I would bring most of it out, but already under attacks from people who wanted someone to suffer for what had happened to Aaron. I’d been on and off in a romantic relationship with Aaron for years, and we had both struggled with depression in that time, even before he was arrested while riding my bike in Cambridge.

We’d gone through his arrest and investigation together. I was so angry at him, though you must understand, not for downloading journal articles. I was angry he hadn’t told me what he was doing. When I was being questioned by the Secret Service they couldn’t believe that I didn’t know, because we were so close. I wanted to pound on the table and explain that if I’d known they would never have. There wouldn’t be a laptop in Evidence, purchased with my credit card, there’d be a smoking crater where the JSTOR server used to be and not a shred of evidence that lead anywhere. Aaron wasn’t that kind of hacker. I, on the other hand, had done plenty of things no one ever caught me for.

My lawyers, who were terrible and sold me down the river, had advised me not to say that to the prosecution. They were probably right about that at least.

Aaron was so angry at me for meeting with them on my lawyers’ advice. He was right, but I didn’t know that. He was angry at me for betraying him, but not the way everyone thinks. I was the only one he told when he was suicidal, which was often during the investigation. One day I blurted it out to his lawyer on a speakerphone call. “Aaron is suicidal,” I told him, but he didn’t respond and Aaron hung up and yelled me that his lawyer wouldn’t care and it didn’t matter. I wouldn’t know that his lawyer had tried to act on that information until after Aaron died.

My life with Aaron started at the same time that my spinal problems started, and started with the loss of control of my hands and daily migraines. Just as my marriage collapsed, my body also started to collpase. In 2008 when the first MRI came back, the specialists explained that I could maybe control symptoms with physical therapy, Botox injections, and cortisone injected into my spinal neck, but that very little could be done for me, and when I had surgery, I’d lose mobility. That I would suffer a decline and my body would fail and that it would be terribly painful. “Maybe,” I was told. “Someone will invent a prosthetic.”

Ten years later, thousands of miles away in a country with more mercy for the ill, I was fired from my job, and waiting for that prosthetic to be inserted into three sections of my cervical spine, all while the crowd was trying to move into my mind.

Recovery was not easy. I had to cross Paris on the metro and take a train home, and it was a shockingly painful experience, even for someone as familiar with pain as I was. For the next weeks, I would patiently get up and reach up on the walls to feel them and push myself along. I’d shuffle my way along the edges of my room, trying to balance, trying to move. I didn’t have adequate pain medication, complained, and then I had too much. I became physically dependent on Fentanyl, and then wrote about the withdrawal.

I handed my Twitter account over to a group of friends for my recovery period, and they tweeted the details of my post-operative condition. “Every time I lose a follower, an angel gets its wings,” I joked with them. I was already retreating from the world, as I had when strangers had spent their time telling me I’d killed my beloved.

The weeks passed. I talked to a few publications, but no one  wanted to be seen with me. I felt like an unperson. My throat would tighten until it felt like I would choke, just sitting there. I was fighting to get my body back, and fighting the memories of being a pariah for all of my childhood. It had all welled up and poured over my psyche after the Times, along with the inadequacy I felt at not being able to save Aaron. I was barely keeping my grip on reality. I still had support on Patreon, which was both shocking and intimidating. I felt like I couldn’t produce, I felt broken down completely, and unsure how to rebuild myself, physically, mentally, or emotionally.

And then, a ray of hope. Out of the blue, a publication I dearly love offered me a column. It sounded like it would be coming home, and I said yes. They told me whom I would talk to next in the process to brought on board, and then there were no more mails. They ghosted me. I wrote and wrote asking for the next steps, and they simply never wrote back. I never learned why.

Some little thing in me snapped after that. It was too much. I fought back thoughts of suicide on a daily basis. I talked them through with friends and my partner, and defanged them, but always temporarily.

I was fighting my worst depression in years, and I was using everything I knew to fight it. I was exercising and doing mental work and trying to manage my sleep, but my PTSD was also out of control. I was dreaming every night of fights with Aaron, Occupy camp evictions, seeing my dead father’s body, being visited by all the people who had died, and sometimes just straight up monsters chasing and killing my people, both alive and dead. It had progressed to hallucinations that lasted up to a few minutes after I’d wake up. I’d bat at the air, fighting demons my mind dreamt of, until I realized what was happening, and stopped. I apologized when I woke up my partner.

When I’d dealt with every self-harming thought as well as I could cognitively, they retreated into urges, a feeling like my body would just act on its own, however I might fight it. I became scared to walk across bridges. I tried to not be alone too much. I hated feeling like a burden, I hated feeling like I couldn’t do or be anything helpful or productive for the world, but I had hung on, until the day came when I couldn’t.

I didn’t trust myself anymore. I walked over to the bus stop, and caught the last bus of the night that would take me to the Emergency Room. When they asked me why I had come, I said I was afraid I was going to hurt myself.

They asked me to sit down and before long had a staff psychiatrist talk to me. He spoke some English, but not well. He asked what had happened, and why I was feeling so bad, and I started to tell him about Twitter and the New York Times. I stopped, realizing that he didn’t understand much about this crazy story and I was going to get the wrong diagnosis if I wasn’t careful. I called my partner, and put him on the phone to explain in French.

I watched the psychiatrist. He was an older man with a trace of corrected cleft palate. This comforted me in ways hard to explain. He’d known pain, and flaws, and problems with society. He couldn’t really understand me or my world, but I knew he could understand the pain of being different, of people being thoughtless. He nodded with the phone to his ear and ask questions, and eventually handed my phone back to me. He suggested I take a bed in the hospital for the night.

My trust was not misplaced. Over the next few days we never had much of a real conversation, but he listened and tried to help.

I was admitted to the psych ward that night. It was not a great experience for me, but it was safe. And more than anything I felt like I’d pulled the emergency cord on my life. I’d stopped the whole train, just to say, I need help, I need something to change. I’m not going to survive this without help. I spent two days there, stabilizing and trying to figure out a long terms plan for care. It didn’t work out. Luxembourg, which had so wonderfully cared for me when it came to my spine, has next to nothing in terms of mental health care options. The only care they would pay for outside of the country was inpatient. A former NHS psychologist who had recently moved to Luxembourg was found to talked to me a few hours while I was in the ward, but there was no option to see her later.

Still, the few hours did help.

I went home two days later, in the strange and liminal mood that comes after you’ve done something that changes everything. Everything was a different color. I wasn’t better, but I had nothing on my to do list but survive.

I went back to America, where I knew I could see providers, but for a lot of money. I passed the hat — and old school gofundme — to pay for a couple months of therapy and a visit with a creative, young, and damn expensive psychiatrist. I walked into his office with a twenty-year history of drugs which either had unlivable side effects or hadn’t worked on my depression and PTSD. He took it, read through it, and said “You’ve taken all the drugs.”

I talked about the night terrors, which I never had before. He prescribed me a hypertension drug, which somehow someone realized controls PTSD related night terrors in overly high doses. I had to ramp up over six weeks, but I did. The night terrors aren’t completely gone, but they’re much reduced, and the hallucinations have almost disappeared. It was the second time a drug had actually helped me mentally, the first being taking Trazodone to help me with lifelong insomnia.

But controlling the wider PTSD and depression symptoms wasn’t working. I sought out more group therapy as well as one-on-one, and started a short term treatment with ketamine in hopes that it would control my depression. I tried everything I could at the beginning of 2019.

It didn’t work. It wasn’t a total failure, my sleeping was better, but I was still struggling to live. I felt like I gave it all I could.

When I came back home everything was quiet, around me, and in my head. I felt allowed to do anything I wanted to get better, what was left? Who could say anything to me? I figured if I wanted to run off to a forest and drop acid to get better, so be it, I was going to do whatever I wanted. I had tried everything. I read the studies, saw so many clinicians, read books, tried apps, even taught myself a fair bit of neurology. I was allowed whatever I wanted at this point. I was allowed to call myself treatment resistant.

I didn’t run off to the forest and drop acid, that was mostly theoretical, I don’t even know how to buy acid. But I felt better thinking I could if I wanted to.

I started a new drug prescribed to me by a pschiatrist, new enough that it had to be brought in from France and wasn’t cover by my national insurance. Maybe it helped, I don’t know. It gave me migraines again, which we tried to control through more Botox and other drugs including heavy duty NSAIDs and triptans.

I let the days go by, mostly. I cooked and helped people where I could, I wrote when I was able. I felt time slipping away with panic again, just as I had when my hands stopped worked and every day was full of physical pain. There were ups and downs, but for a while, it seemed to be getting better. My doctor thought it was the new drug, I was not so sure. Trying to understand this stuff makes the three body problem look like child’s play. Controlling one variable is a fun game researchers play, while clinicians laugh at their theories. In the real world, you still have to throw things at the wall, and hope.

I started declining again. I stopped writing, and hated myself for it. I began reaching for anything — exercising, meditation, but everything just got worse. I went back on sleep medication, and upped my antidepressant, figuring I’ll just live with the migraines. I went looking for more ideas, more research, more anecdotes. The familiar gift of desperation was back, accompanied by the fireworks that heralded 2020.

I am out here on the peculiar edge of human experience: the hate of the crowd, in a peculiar era where the crowd can kill you and you still find yourself untouched, alive, and ill-equipped for this life.

Looking for ideas in one thing after another, I found research about holocaust survivors who, having told their story, started doing better. Their physical and mental health improved after they stopped holding in the stories of what happened and how awful it was. I looked at my blown deadlines, and my loving partner, my hesitant career, and all these secrets I was keeping about how much it hurt to get hated and driven out of my career, and I thought, well, what the hell do I have to lose? So here I am, saying what it’s like to try to rebuild a life after a cancelling, and so far, largely failing.

I’ve been harassed on the internet most of my life, but it has tried to kill me twice, a kind of civic death absent stockades or end dates. It nearly succeeded both times. Some days I’m still shocked by the absurdity of still being alive.

The first piece I was going to write for the Times was about how human proclivities and network math work together to sort us into strange crowds, and how hard they can be to escape from. It’s still here, on this hard drive, almost finished for years. I look at it occasionally, but I can’t find the strength in my fingers and mind to tie up its loose ends. I am one of those loose ends now. Every day is hard.


Thanks to my Patrons on Patreon, who amazingly keep trying with me,

even though I struggle and complain so much.


New Years Day: Things I Have Learned in The Last Ten Years

For this first day of the 2020s I would like to share with you some of the frustrating, hopeful, and baffling things I’ve learned over the last decade about humans and the planet we share. Most of what anyone learns in any decade isn’t particularly useful for others, and this is as true for me as anyone, whether it’s the fate of benthic foraminifera in the Paleocene–Eocene Thermal Maximum (bad) or advancements in the treatment of HIV, spinal conditions, and Ebola (quite good!)  This is an update on what I learned in the first 10 years of the 21st century, and I hope to keep the trend going as long as I can manage.

May you come by this knowledge easier than I did.

  • The human capacity to heal and grow and move on is amazing, and comes with no dependable limits beyond death.
  • Luxembourg is a country between Germany, France, and Belgium.
  • You can’t do good for the world if you can’t do good for the people in front of you, and you can’t do good for the people in front of you if you can’t do good for yourself.
  • Most of the things people call self-care are in fact self-indulgence. Self-care comes with an annoying amount of self-discipline, high fiber foods, and socially inconvenient bedtimes.
  • Awareness raising only helps to a point, and that point is reached almost at once in the modern media environment. After that it’s often a fight against your own side to make people understand that fear isn’t a motivator or a teacher, and that anger isn’t advocacy. The things that feel righteous and build the feeling of righteous unity in activism are often destructive not only the the cause, but the people in it.
  • Harnessing your emotions, organizing your calendar, and getting the right data are the high fiber diets and early bedtimes of activism.
  • Being part of a mob can be euphoric, but is often damaging. Most dangerously, it is often both at once.
  • Computers are a deep part of the human story, like books and music before them, and like any part of the human story they repeatedly scream their flaws into the endless void of things humans just don’t want to deal with.
  • Almost all bugs and security flaws are solved problems, but our systems aren’t set up to care about creating safe or good software, or a safe or good internet.
  • The men from the government are as incompetent and clueless as anyone else, what really makes them dangerous is how often they don’t know it, and it’s no one’s job to tell them.
  • Both of these are choices we’ve made as a society and we could unmake them.
  • The problems we face in managing our planet, from climate change to pollution to food supply to biodiversity are like software — largely solved at a technical level. We know what to do, we even know how to do it.
  • Humanity rarely has technical problems for long, be they computer or civil engineering or resource management. What we generally  have, (and have in spades when it comes to climate change) is governance and coordination problems.
  • Despite there being only 7.6 billion people on the planet, there’s an infinite supply of asshats on the internet.
  • Leaderless collectives are easy for governments and other traditional sources of power to quash and co-opt. But as soon as they do, the leaderless collective problems get much stranger and more widespread. I hope to learn what this means in the next ten years.
  • Anything you say, do, or are, can and will be used against you and against your loved ones in order to weaken and destroy you. These people are not playing, and they are scared of everything.
  • We like larger-than-life and badly written superhero movies because we all have super powers now, which we treat with the maturity of a 13 year old that just got bitten by a radioactive mobile phone.
  • The constant media cycle has made us far too tolerant of mixed metaphors.
  • Do one thing at a time.
  • No matter how strong you are the world will find a way to break you, this goes for nation-states as well as people.
  • Representative democracy is in the process of failing. I don’t know if it’s new media forms, or just 7.6 billion people, but it’s time to invent new political forms that balance between the imposition of common values and comprehension of people’s hopes and desires. Figuring out how to coordinate and act on that information at scale is the point of a polity, and representative voting systems aren’t doing that anymore.
  • Redemption is going to be the most important story in the 21st century, so we ought to get started on that.
  • You have to watch the line, not the obstacles. What’s true in extreme sports is also true in politics and planetary coordination for the 21st century. If you look at the obstacles, you hit them. If you look beyond the obstacles to where you’re going, you have a chance of getting there.
  • In this past decade we’ve lost any idea we might have had about where we’re going, and we’re just aggressively driving into one obstacle after another. We should change that.
  • People often think when disasters happen they’ll all start eating each other. But in truth, mostly, they start feeding each other. When the chips are down, this is who we really are.
  • You should feel pretty good about that.
  • Reasoning with children works beautifully, whatever their age, but as with anything, it takes a lot of practice. Reasoning with adults works almost as well.
  • We give up on reasoning too fast. Imagine if we gave up on rollerblading or playing the piano as fast as we give up on reasoning with people.

Be good to each other, and see you again in another ten years.


Picture CC By Paulius Malinovskis


My work for Emptywheel is supported by my wonderful patrons on Patreon. You can find out more, and support my work, at Patreon.


It’s Une Wonderful Strike

Last year, eight million people got on SNCF trains in France and went to visit their loved ones for Christmas. This year, a week before Christmas, almost no trains are running at all. France is paralyzed in a general strike against sweeping and nebulous changes to the social support system that would ripple down through generations. Despite the threat of damaging Christmas, the strike is supported by 54% of the French public, according to polling yesterday.

France is having a moment.

At the time of this writing, a crowd of protestors is spread, thickly and thinly, across a protest route that stretches from La Republique through the Bastille to la Nation. Firefighters are being teargassed and beaten by police. A university president is trying to move the CRS police force out of the way.

This is the latest protest in the ongoing strike against Macron’s pension reforms, a strike that’s paralyzed the transport system, made firefighters into protest heroes, and recently welcomed some Paris waste workers to the ongoing general strike, which, depending on how much waste workers strike, could make for a fragrant holiday.

Today protestors stood before the police and chanted that they wanted the same retirement plan as the police — a reference to the Macron promising the police a better pension than anyone else, to keep them in the street enforcing his order.

Strikes are not wholly discrete or singular things in France, and this one is no different. Healthcare workers have been on strike for months in France – but it’s illegal for them to actually strike in the not-working sense, so they’ve worn armbands to indicate their strike status and went on helping patients. It’s a move the government has safely ignored and will probably continue to. It’s also not legal for firefighters to strike, or to wear their gear in protests, to which the firefighters have responded with roughly the attitude “You and whose army?” Schools are striking a few days a week, as are some libraries and museums. Radio France, the public broadcaster, is on partial strike and some days have more or less material coming out. SNCF and RATP, national and Parisian transit respectively, are on strike with two metro lines and a few buses occasionally working in Paris, and few trains running nationally at all. Even the CRS police force had a thousand person blue flu recently, leaving the military Gendarmarie to monitor the protests.

The strike is currently unlimited, and the unions are prepared to go through January, unless the government gives in and cancels its pension reform plans. The pensions are complicated — there are different plans for miners and sailors, public utility workers an hospital employees, and even Catholic priests in Alsace-Lorraine, who are still paid by the government for reasons having to do with post WWI treaties. (French politics and law can be weird. French legal exceptions have legal exceptions.)

But as arcane is it is, these protests are not just about pensions. They are full of Gilets Jaunes, the weekly protests that have plagued the government for more than a year, which began as a protest of a fuel tax but are largely about inequality and the curtailed opportunities for the poor and rural. They have the usual Black Bloc and Parisian anarchists. The protests are as much about the Macron government doing anything as they are about the Macron government reforming pensions specifically. Macron is deeply unpopular, trailing the general strike threatening to ruin Christmas by by 20 point at a 34% approval rating. But with him, neoliberalism is also unpopular, and that’s what Macron represents.

The government has said nothing since their minister of pension reform resigned under a corruption scandal. The next meeting with the unions and  the Prime Minister about the pension reform is scheduled for tomorrow with  an announcement to follow. France will be getting ready for Christmas, wrapping gifts, buying food and wine, and waiting in the streets.


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Originally Posted @ https://www.emptywheel.net/author/quinn/page/2/