Wait - why is Jason talking about COVID-19? And why are these written like FaceBook posts? There’s a longer explanation here but the short version is that my day job for the past 15+ years has been developing models of human health effects and medical response for chemical injuries and biological illnesses, including pandemics. I’ve been making these posts on FaceBook and I was asked to put them in a more shareable manner. I’m linking to the posts on the explanation page. These are the original, unedited posts. I’ll continue until I run out of things to say.
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Originally posted here on July 2nd..
I haven't posted here since April 21st - that was over two months ago. My last post was about expanding your quarantine group. I started that post by saying that I was getting involved in some COVID-19 modeling. It was inevitable; physiological modeling and disaster planning is what I’ve been doing for almost 16 years now. The modeling I did started with a simple question: if we were to transport approximately 200 infected people on a 12-hour flight, could we protect the crew? The answer was complex, but the basic starting point was, “Everyone needs to have on a mask.” There’s always going to be complications - you can’t plan for a twelve hour flight without accounting for eating or drinking or going to the bathroom. But if you didn’t start with an assumption that everyone is wearing a mask, there was no way to make the plans workable. At the time it seemed so obvious that I was actually embarrassed to talk to people about it - if felt like, to most people, we were spending money doing something that you didn’t need math to figure out.
Welcome to July.
I haven’t posted partly because I have been busy. It’s also been such a weird time; I’m working from home and my work is occasionally related to COVID and the idea of writing apolitical pieces on the math of pandemics and triage just feels so trivial. There have also been mass protests in the streets, long-overdue discussions about race, political jockeying around health and social issues, and a happy ignorance that’s painful to see.There has also been personal loss which feels so trivial compared to some of the losses some of you all are going through, but loss is loss. I would say that I’m lucky that my family has come out of this unscathed, I know so many families who haven’t, but I feel like that’s tempting fate - we are so far from out of this.
Back when this whole thing really started ramping up, I was on the phone with a colleague. We’ve collaborated a lot over the past decade, including on pandemic modeling and medical response. She told me how weird this all is - whenever we do the analyses we do we tend to focus on the big killers. Smallpox, with it’s near 35% fatality rate. Pneumonic plague with its 100% fatality rate if not treated early enough. The idea that something that seems to max out at a 10% CASE fatality rate (and has a significantly lower actual fatality rate) would grind the world to a halt seemed, at the time, a little ridiculous.
But that’s the problem with a mathematical approach to something like this - numbers are cold and faceless. There are societal issues baked into those numbers that are often neglected. The fact that the elderly, communities of color, and essential workers are the ones who are carrying the brunt of the burden, the ones succumbing to severe infections disproportionately, is something that gets overlooked when you model a person as a number.
In one of my posts I talked about the nightmares I used to get when I first started this job. Every one of my colleagues went through that period. We tally up injuries and deaths on a daily basis. My recurring nightmares were always either: a) seeing a nuclear detonation and knowing someone I loved was on the there side of it or b) realizing that what I thought was rain was actually sulfur mustard and pretty soon my skin and lungs would start to burn. Eventually the nightmares stop, you get used to it. You start saying things like, “X event in Y place will lead to fewer immediate deaths than you might imagine...which also means you need to be able to scale up to treat more survivors.” "Fewer deaths” is something like 50,000 or 60,000 people. The number of patients you might expect could be in the hundreds of thousands. But they’re always numbers.
Just numbers - no number different than another number. No names or faces.
This post, as you may have guessed, isn’t about numbers.
I go for runs in the morning. Three days a week, at least. It’s hot outside, and since DC was founded on a swamp, the air gets sticky as soon as the sun starts to come over the horizon. I wear a mask when I run. It was hard at first, I found myself sucking air a lot more than usual, but now I can do my usual 3+ miles with no problem. While I run I see that most of the people in my neighborhood are not wearing masks. They’re jogging or biking or running, getting close to people, and breathing steadily at a rate that results in a higher emission of viral particles.
I will do a little math and science in this paragraph. A lot of people have one thing very wrong - they like to talk about how UV rays kill the virus and that is absolutely true, but in order for UV rays to get to the virus and kill it quickly, the outer water shell that surrounds the droplet needs to dry down significantly. Those initial experiments that people still cling to were done in less than 40% humidity. DC in the summer routinely gets over 80% humidity in the morning. That extra moisture keeps the particles that you’re shedding nice and wet; keeps them alive. When you run in humid weather, you’re leaving a trail of virus behind you for the people you’re passing to pick up. They’ll settle on the ground, sure, but they’ll also find a nose or two as you make your way down the trail.
It’s not just on the trails where people aren’t wearing masks. Folks in my area will put their masks on in grocery stores but not on their way to the store. They’ll sit outside at a restaurant now and never put on a mask once, not even when talking to their server.
Here’s the deal, in simple terms: you all have been told. Now, when you don’t wear a mask while outside of your house, it is an act of violence. Overwhelmingly, it is an act of violence against the elderly, against communities of color, and against essential workers.
If you post memes for healthcare workers but don’t wear a mask outside, you’re a hypocrite.
If you post “Black Lives Matter” but don’t wear a mask outside, you’re a hypocrite.
If you talk about the greatest generation but don’t wear a mask outside, you’re a hypocrite.
You are complicit in the continued sickness and death of the most vulnerable and helpful populations in your community. No amount of virtue signaling, faux-compassion, or reposted memes is going to absolve you of your selfishness. No amount of trolling or blatant ignorance is going to stop this pandemic from eventually coming to your doorstep. The cascading effects of continued hospitalizations and deaths will eventually poison every life in this country to varying degrees.
It is remarkable to me how little people are doing. Whenever we used to model contagious disease we were paranoid about the worried well population. Worried well folks are people who aren’t sick but show up at a hospital anyway. I was once asked, “If smallpox showed up in NY, how many people could we expect in the hospital in one year?” and I answered, “All of NY...probably within the first week.” The thought was always that people would be so worried about getting sick that they would start manifesting symptoms of anxiety and assume they were sick. I would get asked, “What about non-compliance?” and would usually answer, “Sure, it matters, but it’s probably not a huge factor.”
Welcome to July, where non-compliance is the baseline.
It’s all so upsetting, to be honest. It’s upsetting that there is a community that worked on this exact problem for decades and yeah we got some of it wrong but not a lot of it! And it didn’t really matter, because this is just the most selfish population the world has ever seen. It’s upsetting because so many people stayed home, did the right thing - so many jobs were lost, so many people died, so many people will be rehabbing for a year and so many people will never be healthy again - and it was all for nothing. Every little bit of it was all for nothing. It’s only going to get worse.
Anyway, that’s my update. I’ll go back to doing math and planning things now. Get some exercise, wear a mask, etc.
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These are my opinions and thoughts and analyses - I am not representing any government agency or my company. More disclaimers on the main page.