Thursday 22 October, 2020

Glenteenassig Lake, Co Kerry, on a November morning.

Quote of the Day

“What demons are at work here? You don’t know. But at least you know you don’t know. That’s a start. That’s where doctors begin when trying to diagnose patients with bizarre symptoms that may indicate a fatal disease. They distrust theories and try to see what they see. They go slow and keep their wits about them. That is your most precious possession right now: your wits. Try not to lose them.”

Musical alternative to the morning’s radio news

Paddy Keenan | Uileann pipes | Three tunes, including the Cork Hornpipe | 2011


I love Uileann piping but hadn’t known of Keenan until Ross Anderson (also a piper), told me about him.

There’s a nice comment by Liz Moran under the video:

He is not playing that fast in the the first few minutes and you’ll notice he “swings” the tune, he plays slightly behind the beat like a good jazz musician. He takes his time and he does not rush the melody. The last, which I know as the “Cork Hornpipe,” is a pretty simple tune with lots of nice jumps where you can fly the notes, add fills and make it nice and showy. I had the good fortune of meeting his father and listening to his chanter playing, in the family caravan, Ballyfermot, 1975.

If you’re pinning your hopes on a Covid vaccine, here’s a dose of realism

David Salisbury writing in the Guardian.

TL;DR summary: A targeted immunisation programme may offer some protection, but it will not deliver ‘life as normal’.

Even if countries do decide to switch from a personal-protection policy to a transmission-interruption strategy, obstacles remain. Much will depend on the successful vaccination (probably with two doses) of people who have not previously seen themselves to be at elevated risk. The challenge will be persuading the young, for example, to be vaccinated, not for their own benefit, but for the benefit of others.

Adherence to recommendations for any Covid-19 interventions – social distancing, lockdowns, home working, cancelled holidays or vaccinations – depend on trust. If politicians are telling us that the present impositions on our lives are only going to last until we have vaccines, then the reality is that a false hope is being promulgated.

Vaccines are probably the most powerful public health intervention available to us. But unless their benefits are communicated with realism, confidence in all recommendations will be put at risk.

David Salisbury used to be Director of Immunisation at the Department of Health.

It’s going to take quite a while until the penny finally drops: Covid-19 represents a radical break with the past.

How long before UK prisons explode?

Sobering Covid-diary post by David Vincent:

As it dawns on the rest of us that this nightmare has no end-point in sight…

There seems little prospect of any of the Government’s semi-privatised schemes ever working, nor is it likely that a vaccine will get on top of the pandemic until well into the New Year. As Christmas is imperilled, prolonged anxiety and unending isolation are wearing away at the spirits.

Nowhere is this more apparent than in the prisons, which, as I have argued in earlier posts, have been exposed to destructive solitude on a scale not seen anywhere in civilian life. Time has been the currency of the penal system in Britain since it began to move away from physical punishment in the early nineteenth century. The gravity of a crime is measured in the years that must be served.

It was apparent from the beginning that locking prisoners up for twenty-three hours a day to protect them from infection was likely to cause serious harm to inmates who were rarely in good psychological condition at the outset.

David has been reading the just-published Report of the Chief Inspector of Prisons, of Peter Clarke, who is about to retire. In it, Clarke draws attention to the consequences of the lockdown in prisons:

“Given the obvious linkage between excessive time locked in cells and mental health issues, self-harm and drug abuse, it was concerning to find that the amount of time for which prisoners were unlocked for time out of cell was often unacceptably poor. Nineteen per cent of adult male prisoners told us that they were out of their cells for less than two hours on weekdays, including 32% in men’s local prisons. Is it any surprise that self-harm in prisons has been running at historically high levels during the past year?”

Clarke was quoted in the Guardian as saying: “The question is: is it intended to keep people locked up for 23 hours a day ad infinitum? Or until the virus is eliminated? That simply can’t be right.”

It can’t. One obvious thing to do is to release categories of prisoner who pose little danger either to themselves or to the public to ease the pressure on the system. David Vincent says that at the onset of the pandemic, France released 10,000 prisoners precisely for this reason. It’s just common sense, really.

But Johnson & Co don’t do common sense. And even if they did decide to take radical steps like the French, the reflective howls from Britain’s tabloids would return them cringing to their bunker.

It Wasn’t Just Trump Who Got It Wrong

America’s coronavirus response failed because we didn’t understand the complexity of the problem.

Great piece by Zeynep Tufecki (who now has a Substack newsletter, btw).

On January 29, about a week after China’s government shifted from a deny-and-censor strategy to massive action and communication, Chinese scientists published a significant paper in The New England Journal of Medicine. The paper estimated the R0 (the basic reproduction number of an infectious disease) from the first known case of coronavirus in early December through January 4 to be little more than 2. That means that, left somewhat unchecked, each infected person infected two more people. Crucially, the paper pointed out evidence of mild and even asymptomatic cases, unlike SARS, which almost always came with a high fever. It also confirmed the reports that the disease was most dangerous for the elderly or people with underlying conditions. The paper came out just after China made the unprecedented move to shut down all of Wuhan, a metropolis of 10 million people, and also Hubei, a province of 50 million people.

For people stuck in asystemic thinking, all this may well have seemed like a small, faraway threat. If one merely looked at the R0, the virus wasn’t outrageously contagious. The number was similar to seasonal flu, but nothing explosive like measles, which has an R0 of 12 to 18—one ill person can infect another 12 to 18 people. For an asystemic thinker, it probably didn’t look that deadly, either. The mortal threat was disproportionately to the elderly, who already succumb to colds and influenza at much higher rates than younger, healthier people. The case-fatality rate (CFR), or the percent of infected people who die, for younger people seemed fairly low, perhaps comparable to seasonal influenza, which kills about 0.1 percent of its victims, exacting a toll in the tens of thousands in the United States alone. On January 29, the known global death total for COVID-19, the disease caused by the coronavirus, was still under 200, less than a weekend’s worth of traffic accidents in the United States, let alone the flu. And to an asystemic thinker, the threat seemed remote, unfolding as it was in Wuhan, a place that many people outside China may not have heard of.

Thus from the end of January through most of February, a soothing message got widespread traction, not just with Donald Trump and his audience, but among traditional media in the United States, which exhorted us to worry about the flu instead, and warned us against overreaction…

This essay isn’t just the product of 20/20 vision btw. Tufecki has been ahead of this from the beginning. Her argument is an analytical one. Our difficulties with the virus, she says, stem from the fact that we don’t — as individuals or societies — think systemically.

Here’s my paraphrase of her analysis:

  • We’re used to thinking in linear terms, but we live in a complex system — and in such systems everything is nonlinear — tipping points, phase transitions (water boiling or freezing), and cascades and avalanches (when a few small changes end up triggering massive shifts) are all examples of nonlinear dynamics in which the event doesn’t follow simple addition in its impacts. Which is why the coronavirus was never just about its R0 or CFR.
  • In complex systems, efficiency, redundancy, and resiliency pull in different directions: Efficient systems, are cheaper because they eliminate redundancies, which provide resilience but cost more. Over the last 40 years capitalism has been building efficient but fragile systems — just think of medical supply chains, or those that stock our supermarkets.
  • Health systems are prone to nonlinear dynamics because hospitals don’t have resilience; they are resource-limited and necessarily strive for efficiency. They can treat only so many people at once, and they have particular bottlenecks with their most expensive parts, such as ventilators and ICUs. The flu season may be tragic for its victims; but an additional, unexpected viral illness in the same season isn’t merely twice as tragic as the flu, even if it has a similar R0 or CFR: It is potentially catastrophic.
  • Worse, COVID-19 isn’t even just another flu-like illness. By January 29, it was clear that it caused severe primary pneumonia in its victims. That’s like the difference between a disease that drops you in the dangerous part of town late at night and one that does the mugging itself. COVID-19’s characteristics made it clear that some patients would need a lot of intensive, expensive resources: ICU beds, ventilators, negative-pressure rooms, critical-care nurses, etc.
  • Nonlinear dynamics and complex-system failures can also happen because of tight coupling between the components. This means that every part of the system moves together so even small things can cause a crisis. For example, COVID-19 testing requires slender swabs that can reach the nasopharynx. We still have a shortage of swabs because we didn’t ramp up their production when we had time

Our survival as a species will require us to learn to think systemically. Which is worrying because we’ve never been good at that.

Other, possibly interesting, links

  • Donald Trump is getting desperate — and his mental pathology is getting worse every day. Not really news, but this piece in Salon (Link) is written by two mental health professionals.

  • On Tuesday, NASA’s OSIRIS-REx spacecraft touched down on an asteroid called Bennu for about six seconds to collect a mineral sample to bring back to Earth. Watch it land on the asteroid Link

  • Trailer for the documentary about the former White House photographer Pete Souza. Link

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