“Like lepers”

From yesterday’s Guardian:

Contentious advice will be removed from the government website, a spokesperson confirmed on Tuesday evening. It had advised against all but essential travel to and from eight areas of England where the Covid variant identified in India has been spreading. Instead, people will be advised to “minimise travel”.

This gets to something that I observed last spring when I (like many people) decided to immerse myself in the literature of epidemics — The Last Man, La Peste, Journal of the Plague Year, Pale Horse Pale Rider: In an epidemic, people can’t help but think of contagion as a moral failing, and so, thinking of themselves as blameless, underestimate the possibility that they could unwittingly infect someone else. This makes it socially uncomfortable to insist that others practice necessary hygiene, because it sounds like you’re accusing them of secret turpitude. Strangers should wear masks, but “we’re friends”, or even — much too casually — “you’re in my bubble”.

Thus two Bolton residents, whose hotel reservations on the Isle of Wight had been cancelled purely from abhorrence of their municipal origins, complained to the press: “Bolton people are being treated like lepers”.

On a literal level we have here people who are feared to be at high risk of carrying an explosively contagious infection that produces an acute disease with no very good treatment, that is often rapidly fatal; complaining that they are being unjustly shunned as though they might be carrying a different, mildly contagious infection, that produces a chronic disease that can be completely cured with medication.

But, of course, what they really mean is, we’re being treated like morally culpable potential disease carriers. This is a status that has traditionally been conferred on carriers of leprosy, something we do not question, but that only highlights our moral — hence also virological — purity.

Does a shot of vitamin B protect against Covid?

Thirty years ago there were some who envisioned a new united Germany combining the best of east and west: A vibrant market economy with an expanded commitment to economic justice, a confident democratic federal government balanced by a greater variety of states, and a commitment to individual liberty reinforced by the recent experience of dictatorship. A bridge between the solid democracy in America and the rising democracy in Russia.

Instead, Covid has revealed the modern Federal Republic as the combined worst of both systems: A timid central government in thrall to private business interests, unable to take decisive action to protect public health because of a lack of confidence that their authority would be seen as sufficiently legitimate. A resurgent right wing inspired by American and Russian ethnonationalists to express their individual liberty by rejecting even elementary public health measures. And now, a public vaccination campaign dominated by the financial and status needs of private physicians, and prioritising those people with high levels of what the East Germans called Vitamin B — “B” for “Beziehungen“, connections, the way scarce resources were distributed under socialism.

When the vaccination program started it was concentrated in large vaccination centres (Impfzentren). These were highly efficient, providing rapid throughput and simple logistics, and the official priorities of the Permanent Vaccination Commission (Ständige Impfkomission, or STIKO) — covering people over 60 years old, those with serious medical conditions putting them at elevated risk of Covid complications (including pregnant women and their companions), police, teachers, and government officials — could be securely monitored.

There were two major problems with this system: First, the physicians in private practice, for whom vaccinations were traditionally a great money spinner, felt that they were losing money and influence; Second, there was no unobtrusive path to providing priority immunisation to people who were important, influential, or just rich, threatening to lead to the sort of blatant corruption that just embarrasses everyone. This led the government* to bring the GPs into the vaccination program, paying them upwards of €50 per vaccine. The GPs, unsurprisingly, rushed to vaccinate their friends and favourite patients — particularly those patients with private insurance, who they are generally keen to hold on to, as the private insurance covers all manner of treatments that the public insurance won’t pay for, and the payment levels are generally significantly higher.

How should one respond to this? The Ethics commission is very concerned… that people who haven’t been clever enough to work the system might be jealous of the superior people who have. Here is a comment from a recent podcast interview with commission chair Alena Buyx:

AB: We shouldn’t confuse the people who have gone the extra mile and somehow managed to get it organised, or had a stroke of luck, with those who have cheated.

Spiegel: … It could be that someone who isn’t so resourceful… for various reasons, it could be social background, it could be language, it could be some lack of access to information –and I can understand that they might feel he or she feels like you’re taking something away from them.

AB: These are things that one couldn’t have imagined earlier. We have vaccine envy and also vaccine guilty conscience. But all I can say is: Good People, every vaccination is a good vaccination… Those who have been lucky, or who have profited from this “flexibility” — if they haven’t cheated anyone — they should enjoy their good fortune.

From there to full social Darwinism is just a small step, and that step was taken by one Christoph S. in the comments section of the national newspaper Die Welt:

In my social circle — definitely well off — is just about everyone vaccinated, and always the whole family, including the university-age children. None of them in the vaccination centre, always in the GP practice or through doctors they know personally. In other words, since the GPs have been doing vaccinations the prioritisation has fallen away de facto, at least for the “higher” levels of the population. This is not pretty, but as long as they’re managing to vaccinate up to a million people a day in Germany, I find it acceptable. One shouldn’t make a fuss about the people who try to cut ahead at the vaccination centres; Germany has much bigger problems than someone getting vaccinated a few days early. And, by the way, this is how it’s always been, that those who make the most noise prevail, and presumably that’s why Homo sapiens has managed to survive.***

* Just to be clear, this is not the official justification. This is a purely speculative exercise on my part. It’s hard to think of any other justification, though. It’s not as though the GPs were otherwise unoccupied, with huge amounts of spare capacity for taking on vaccination duty.

Continue reading “Does a shot of vitamin B protect against Covid?”

Panic goods

I was listening to a talk by Ian Diamond of the Office for National Statistics, about the statistical response to Covid. He showed the results of a survey that was organised spontaneously a year ago by ONS, of the price changes of various “panic goods”. There were 22 product categories on the list, including

  • antibacterial surface wipes
  • baby food
  • toilet rolls
  • vitamin C
  • tomato puree
  • nappies
  • paracetamol
  • pet food

The choice makes perfect sense. And I found myself imagining showing this list to myself 2 years ago, and being challenged to guess what the theme of the list is…

Absence of caution: The European vaccine suspension fiasco

Multiple European countries have now suspended use of the Oxford/AstraZeneca vaccine, because of scattered reports of rare clotting disorders following vaccination. In all the talk of “precautionary” approaches the urgency of the situation seems to be suddenly ignored. Every vaccine triggers serious side effects in some small number of individuals, occasionally fatal, and we recognise that in special systems for compensating the victims. It seems worth considering, when looking at the possibility of several-in-a-million complications, how many lives may be lost because of delayed vaccinations.

I start with the case fatality rate (CFR) from this metaanalysis, and multiply them by the current overall weekly case rate, which is 1.78 cases/thousand population in the EU (according to data from the ECDC). This ignores the differences between countries, and differences between age groups in infection rate, and certainly underestimates the infection rate for obvious reasons of selective testing.

Age group0-3435-4445-5455-6465-7475-8485+
CFR (per thousand)0.040.682.37.52585283
Expected fatalities per week per million population0.071.24.11345151504
Number of days delay to match VFR120070206.41.80.60.2

Let’s assume now that all of the blood clotting problems that have occurred in the EEA — 30 in total, according to this report — among the 5 million receiving the AZ vaccine were actually caused by the vaccine, and suppose (incorrectly) that all of those people had died.* That would produce a vaccine fatality rate (VFR) of 6 per million. We can double that to account for possible additional unreported cases, or other kinds of complications that have not yet been recognised. We can then calculate how many days of delay would cause as many extra deaths as the vaccine itself might cause.

The result is fairly clear: even the most extreme concerns raised about the AZ vaccine could not justify even a one-week delay in vaccination, at least among the population 55 years old and over. (I am also ignoring here the compounding effect of onward transmission prevented by vaccination, which makes the delay even more costly.) As is so often the case, “abundance of caution” turns out to be the opposite of cautious.

* I’m using only European data here, to account for the contention that there may be a specific problem with European production of the vaccine. The UK has used much more of the AZ vaccine, with even fewer problems.

The poisoned roots of German anti-vax sentiment

I’ve long thought it odd that Germany, where the politics is generally fairly rational, and science education in particular is generally quite good, has such broad acceptance of homeopathy and a variety of other forms of quackery, and a special word — Schulmedizin — “academic medicine” — to express a dismissive attitude toward what elsewhere would be called just “medicine”, or perhaps “evidence-based medicine”. I was recently looking into the history of this, and found that attacks on Schulmedizin — or “verjudete Schulmedizin” (jewified academic medicine) — were as much a part of the Nazi state science policy as “German mathematics” and “Arian physics”.

Medicine in the Third Reich remained a weird mixture of modern virology and pseudo-scientific “racial hygiene”. The celebrated physician Erwin Liek wrote

Es ist mein Glaube, dass das deutsche Volk berufen ist, nach und nach eine ganz neue, rein deutsche Heilkunst zu entwickeln.
(It is my belief, that the German people has a calling, gradually to develop a pure German art of healing.)

Liek was appealing for a synthesis of Schulmedizin with traditional German treatment. As with Arian physics*, and the Nazi state was careful not to push the healthy German understanding so far as to undermine important technology and industry. But the appeal to average people’s intuitive discomfort with modern science was a powerful propaganda tool that they couldn’t resist using, as in this 1933 cartoon “The vaccination” from Der Stürmer that shows an innocent blond arian mother uncomfortably watching her baby being vaccinated by a fiendish Jewish doctor. The caption reads “This puts me in a strange mood/Poison and Jews never do good.”

1933 Cartoon from Der Stürmer: Blond German mother looking concerned as a beastly Jewish doctor vaccinates her baby. Caption: "This puts me in a strange mood/Poison and Jews are seldom good."
1933 Der Stürmer cartoon “The vaccination”.

Today’s anti-vaxers fulminating against Schulmedizin and the Giftspritze (poison shot) are not necessarily being consciously anti-Semitic, but the vocabulary and the paranoid conspiracy thinking are surely not unconnected.

* Heisenberg was famously proud of having protected “Jewish physics” from being banned at his university, considering himself a hero for continuing to teach relativity theory, even while not objecting to the expulsion of the Jewish physicists, and agreeing not to attach their names to their work. Once when I was browsing in the science section of a Berlin bookstore in the early 1990s a man started chatting with me, telling me that he had worked for decades as a radio engineer in the GDR, and then going on to a long monologue apropos of nothing about how wonderful Heisenberg was, and how he had courageously defended German science during the Third Reich.

Exotic animal farming

I remember when people were muttering about Covid-19 being all the fault of the weird Chinese and their weird obsession with eating weird animals like pangolins.

So now we have a second version of Covid, that may start a completely novel pandemic, and it comes from the weird Europeans and their weird obsession with wearing the fur of weird animals like minks. Apparently, it was well known that Covid was spreading widely among the minks, but the animals were too valuable to give up on, so they tried to get away with just culling the obviously sick ones. And now we can just hope that they can get the new plague out of Denmark under control before it becomes a second pandemic.

But the people who advocate just giving up on eating and wearing animals are still treated as something between dreamy mystics and lunatics…

The opposite of a superficial lie

“The opposite of a fact is a falsehood. But the opposite of a profound truth may very well be another profound truth.”

Niels Bohr

The news media have gotten themselves tangled up, from the beginning of the Trump era, in the epistemological question of whether any statement can objectively be called a lie. Yes, Trump says things that are untrue, that contradict objectively known facts, but are they lies? Does he have the appropriate mens rea to lie, the intention to deceive, or is that just a partisan insult?

The opposite problem has gotten too little attention. Just because Donald Trump says something that corresponds to objective facts, one cannot infer that he is speaking the truth. (We don’t really have a word in English to correspond to the opposite of lie, in this dichotomy.) A good example is the controversy over Trump’s private and public comments on the incipient Coronavirus pandemic in February and March of this year. On February 7, 2020, Trump told Woodward

You just breathe the air and that’s how it’s passed. And so that’s a very tricky one. That’s a very delicate one. It’s also more deadly than even your strenuous flus.

This is quite an accurate statement, and also very different than what he was saying publicly. On February 10 he said, in a campaign speech,

I think the virus is going to be — it’s going to be fine.

And February 26 in an official White House pandemic task force briefing:

The 15 [case count in the U.S.] within a couple of days is going to be down to close to zero. … This is a flu. This is like a flu.

When you see that someone has been saying one thing in public and something completely different in private, it’s natural to interpret the former as lying and the latter as the secret truth — particularly when, as in this case, the private statement is known to be, in fact, true, and the public statement false. And particularly when the speaker later says

I wanted to always play it down. I still like playing it down, because I don’t want to create a panic.

With Trump, though, this interpretation is likely false.

The thing is, while his statement of February 7 was true, he could not have known it was true. No one knew it was true. We can see any number of statements by responsible public-health officials making similar statements at the time. For example, Anthony Fauci on February 19:

Fauci doesn’t want people to worry about coronavirus, the danger of which is “just minuscule.” But he does want them to take precautions against the “influenza outbreak, which is having its second wave.”

“We have more kids dying of flu this year at this time than in the last decade or more,” he said. “At the same time people are worrying about going to a Chinese restaurant. The threat is (we have) a pretty bad influenza season, particularly dangerous for our children.”

And it’s not just Americans under the thumb of Trump. February 6, the day before Trump’s remark to Woodward, the head of the infectious disease clinic at a major Munich hospital, where some of the first German Covid-19 patients were being treated, told the press that “Corona is definitely not more dangerous than influenza,” and criticised the panic that was coming from exaggerated estimates of mortality rates.

Researchers were posting their data and models in real time, but there just wasn’t enough understanding possible then. This is the kind of issue where the secret information that a government has access to is of particularly limited value.

So how are we to interpret Trump’s statements? I think the key is that Trump is not a liar per se, he is a conman and a bullshitter, someone to whom the truth of his statements is completely irrelevant.

In early February he probably did receive a briefing where the possibility that the novel coronavirus was highly lethal and airborne was raised as one possibility, as well as the possibility that it was mild and would disappear on its own. .In talking to elite journalist Bob Woodward he delivered up the most frightening version, not because he believed it was true, but because it seemed most impressive, making him seem like the mighty keeper of dangerous secrets. When talking to the public he said something different, because he had other motives. It’s purely coincidence that what he said in private turned out to be true.

It would be poetic justice of Trump were to be damaged by the bad luck of one time accidentally having told the truth.

Early Trumpist medical treatments

And then I see the disinfectant, where it knocks it out in a minute. One minute! And is there a way we can do something like that, by injection inside or almost a cleaning. Because you see it gets in the lungs and it does a tremendous number on the lungs. So it would be interesting to check that.

When Donald Trump used a Covid-19 press briefing to recommend injecting disinfectants to kill viruses within the human body, people reacted as though this were entirely unprecedented. But it wasn’t, entirely. From Frank Snowden’s Epidemics and Society:

Of all nineteenth-century treatments for epidemic cholera, however, perhaps the most painful was the acid enema, which physicians administered in the 1880s in a burst of excessive optimism after Robert Koch’s discovery of V. cholerae. Optimistic doctors reasoned that since they at last knew what the enemy was and where it was lodged in the body, and since they also understood that bacteria are vulnerable to acid, as Lister had demonstrated, all they needed to destroy the invader and restore patients’ health was to suffuse their bowels with carbolic acid. Even though neither Koch nor Lister ever sanctioned such a procedure, some of their Italian followers nevertheless attempted this treatment during the epidemic of 1884–1885. The acid enema was an experimental intervention that, in their view, followed the logic of Koch’s discoveries and Lister’s practice. The results, however, were maximally discouraging…

Apparently it’s a not uncommon response on someone first learning of the germ theory of disease.

Plagues and statues

I’ve been reading Camus’ La Peste, hoping to obtain some insight into one of the great crises of the present, and finding him commenting on a completely different one. At the height of the epidemic of the novel, the narrator comments on the aspect of the silent, immobilised city, and expresses resentment toward the statues that are permanently in that condition.

La grande cité silencieuse n’était plus alors qu’un assemblage de cubes massifs et inertes, entre lesquels les effigies taciturnes de bienfaiteurs oubliés ou d’anciens grands hommes étouffés à jamais dans le bronze s’essayaient seules, avec leurs faux visages de pierre ou de fer, à évoquer une image dégradée de ce qui avait été l’homme. Ces idoles médiocres trônaient sous un ciel épais, dans les carrefours sans vie, brutes insensibles qui figuraient assez bien le règne immobile où nous étions entrés ou du moins son ordre ultime, celui d’une nécropole où la peste, la pierre et la nuit auraient fait taire enfin toute voix.

The huge, silent city had become nothing more than a collection of solid, inert cubes, where the taciturn effigies of forgotten benefactors or ancient great men were suffocated forever in bronze, evoking a solitary, degraded image of what man had once been. These mediocre idols, enthroned under a thick sky, in the lifeless crossroads, unfeeling beasts that symbolised well the immobilised realm we had entered, or at least its ultimate order, that of a necropolis where plague, stone, and night would have finally silences any voice.

I’ve commented before on how odd it is that, just because some of our ancestors chose to cast their images in heavy bronze or marble and plonk them down at significant sites in our cities, that we should feel obliged to keep them there. But I assumed that the current attacks on statues of racists was unrelated to the pandemic situation, mere coincidence of crises, except perhaps that the lockdown left people with lots of pent-up energy.

But maybe there’s something about coping with an epidemic that inspires iconoclasm?

Adrift on the Covid Sea

Political leaders in many countries — but particularly in the US and UK — are in thrall above all to the myth of progress. Catastrophes may happen, but then they get better. And to superficial characters like Johnson and Trump, the improvements seem automatic. It’s like a law of nature.

So, we find ourselves having temporarily stemmed the flood of Covid infections, with governments laying out fantastic plans for “reopening”. Even though nothing significant has changed. The only thing that could make this work — absent a vaccine — would be an efficient contact tracing system or a highly effective treatment for the disease. None of which we have. But we still have a timeline for opening up pubs and cinemas (though less important facilities like schools are still closed, at least for many year groups).

It’s like we had been adrift for days in a lifeboat on the open ocean, carefully conserving our supplies. And there’s still no rescue in sight, but Captain Johnson announces that since we’re all hungry from limiting our food rations, and the situation has now stabilised, we will now be transitioning toward full rations.