I can’t keep up. Yesterday, the day before, today, the cases, the deaths mount. The New York Times notes that the United States reported at least 1,470 deaths from the coronavirus on Wednesday, Aug. 13, 2020, the highest single-day total yet in August.
Merriam Webster defines denial as the refusal to admit the truth or reality of something; and/or a defense mechanism in which confrontation with a personal problem or with reality is avoided by denying the existence of the problem or reality.
Clearly, fully acknowledging and confronting the risk from COVID-19 is a Grade-A drag. Asymptomatic people living amongst us, unidentifiable, spreading a disease that can send us to the ICU is a real-life version of “Invasion of the Body Snatchers.” Those with COVID, yet not experiencing symptoms, look like us and act like us. They are, in fact, us. Capital Us.
Even the horrendous death figures we’ve gotten used to, — 167,300 as of Aug. 14, 2020 — are probably an underestimation by 60,000 according to the New York Times: “Across the United States, at least 200,000 more people have died than usual since March, according to a New York Times analysis of estimates from the Centers for Disease Control and Prevention. This is about 60,000 higher than the number of deaths that have been directly linked to the coronavirus. As the pandemic has moved south and west from its epicenter in New York City, so have the unusual patterns in deaths from all causes. That suggests that the official death counts may be substantially underestimating the overall effects of the virus, as people die from the virus as well as by other causes linked to the pandemic.”
All of the COVID pandemic inconvenience. Social distancing. Masks. Living with and suffering from mind-boggling incompetence, inefficiency, corruption from the federal government. And then on top of it, watching a growing movement to sabotage science, to embrace fiction over fact, large numbers convinced that a real estate huckster who lost hundreds of millions of his daddy’s money knows more about viruses than those who’ve spent decades successfully fighting them. So, more times than not denial is a minor impediment to living a fuller life. But in this case, denial has brought death to America. More death than any other industrial nation. So much unnecessary death.
As the COVID-19 virus continues unabated in many parts of the nation, for many here, it’s easy to imagine we are a version of the National Basketball Association, that the South Berkshires is a self-contained bubble, far removed from where the pandemic is actually happening. It’s why great numbers of people don a mask simply for the few minutes they have to, if they’re going to get their cappuccino or freshly picked corn from Taft Farms, Guido’s, Big Y and the Chopper. But just as quickly as possible, the mask is off.
Still, as of Aug. 10, 2020, COVID lives in Massachusetts. Here’s the graph showing new cases, as well as seven-day averages, from March to August in the state:
And the graph of total cases and cases in the last seven days in some of the counties, with Berkshire County highlighted:
So far, we’ve been relatively blessed — that is, those of us lucky enough not to be infected. My buddy Mark hasn’t been so lucky. He shared his story in The Berkshire Edge: “For five weeks Mark experienced some of the more common symptoms associated with COVID -19: fatigue, low-grade fever, night sweats, body chills, lack of appetite, chronic insomnia, body aches, a strange feeling like there was movement within the center of his body, diarrhea and nausea. Mark’s lack of sleep increased the already debilitating fatigue. He would go to bed each night at 11 only to fall asleep at 5 a.m., and if lucky, get one to two hours of sleep. He also had some neurological issues — poor concentration and an inability to focus — which made it difficult to watch TV or read a book, two activities he typically enjoys doing. Mark found that his symptoms came in waves, with different ones each day.
“Mark quarantined himself in the basement of his house for five weeks. During that time, he said, ‘I felt trapped. I often wondered how I got here and when was I’m going to leave.’ Even though Mark had several symptoms, he never sustained organ damage or lost the ability to smell and taste. However, subsequent to his recovery, he has had lingering symptoms, which he has found concerning and bothersome. For instance, the fatigue is constantly present, which has affected his lifestyle. He has shortness of breath, especially when he goes up a flight of stairs, something he never had prior to COVID-19. In addition, he can be emotional with angry outbursts as well as have crying jags.” Just the other day Mark wrote: “Still suffering from this virus 4 months on. Fatigue, chest pressure/pain, brain fog, mood swings, shortness of breath, depression and anxiety. Getting thru day to day. It’s real folks, protect yourselves.”
Yes, it makes sense why, after months of social distancing, many seem determined to dine in public with masks hanging uselessly below their chins, betting that our low rates will allow them to enjoy that pizza, those enchiladas, the burgers and sushi without consequence. That they won’t be another Mark.
I understand. In the days before COVID I was known to sit before a slot machine, doing my very best to bond with Loretta, she who, if she was so disposed, could send so many coins cascading my way, serenading me with ding-ding-ding. Yes, somewhere in the recesses of my brain I knew Loretta was a prisoner of a computerized random number generator, absent any free will. But a man can dream.
Here, for the moment, the COVID mathematics work. Only 11 new cases in Berkshire County in a week. I failed analytic geometry and calculus. But my friend Jon, a talented programmer, knows mathematics and statistics and helped put those 11 cases in the context of a recent blip in a population of 126,000. Still, numbers aside, I see my friend Mark.
Of course, as nationwide the numbers surge in states once thought to be safe spaces, one of the great benefits of denial in the ongoing COVID debate is that one is only required to offer an opinion. Some of the most popular opinions you might encounter on social media: the virus isn’t real; it’s part of some odd conspiracy to wrest more power for [add your own nemesis here] Fauci, Soros, Bill Gates. Then, there’s: COVID will go away; it is going away; kids are immune; masks don’t work. And worse than that: masks prevent herd immunity.
Science, on the other hand, requires you to ask questions, offer theories, do research, test those theories with experiments, analyze what you’ve learned from those experiments, refine and revise your hypotheses and then retest. It’s a collaborative process with other people checking the theory, criticizing methods and conclusions, ultimately making the work better and more reliable — far less convenient than proclaiming something to be true without proving it to the satisfaction of others.
If you’re interested, here’s some recent research. Let’s start with some of the risks posed with close contact with asymptomatic or symptomatic folks with COVID-19.
Even the newly configured Trump-friendly Centers for Disease Control and Prevention notes:
The San Francisco Chronicle noted: “Talking can release thousands of fluid droplets per second that can remain suspended in the air for 8 to 14 minutes … Masks are effective in blocking or at least limiting your exposure to these contagious viral droplets and aerosol particles.” (Emphasis added.)
A March 17, 2020, letter in the New England Journal of Medicine described “10 experimental conditions involving two viruses (SARS-CoV-2 and SARS-CoV-1) in five environmental conditions (aerosols, plastic, stainless steel, copper, and cardboard) … SARS-CoV-2 remained viable in aerosols throughout the duration of our experiment (3 hours) …” (Emphasis added.)
According to a June 2, 2020, article in the Proceeding of the National Academy of Sciences of the United States of America: “Speech droplets generated by asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly considered to be a likely mode of disease transmission. Highly sensitive laser light scattering observations have revealed that loud speech can emit thousands of oral fluid droplets per second …” (Emphasis added.)
Perhaps knowing how far COVID droplets can travel when your maskless friend or that maskless stranger who’s sitting, standing, nearby, symptomatic or nonsymptomatic, talks or coughs or yells or sneezes might make some pause before crowding around places like Bash Bish Falls:
Of course, there is no one better at creating and promoting an alternate reality, repeatedly encouraging rally-goers, revelers, COVID-denying and impatient folks and school boards who have tired of this annoying pandemic than Donald J. Trump. From suggesting injecting bleach to imbibing lights, to pushing contra-indicated drugs like hydroxychloroquine, then, both on Twitter and in person, offering a dizzying variety of denials, especially underestimating the extent of the virus and its virulence. Desperate to pretend it isn’t what it is, he repeatedly ridicules those who actually report what is happening in our hospitals, and contradicting those who take real steps to protect us, mocks reporters who are careful to wear masks in the crowded White House pressroom.
And because, even after all this time, we still aren’t doing the kind of accurate and extensive testing we need to safely open our schools, he consistently makes the bizarrely inaccurate claim that increased testing is linked to increasing COVID cases and hospitalizations:
And to spare you the need to look up other examples of how our president and his staff tried to convince you that the Wizard of Oz actually knew what he was doing, Tweeter Steve Wind (@sdwind125) added many of their statements to the image of surging cases from February to July:
Meanwhile, as parents and teachers and school personnel and school boards are agonizing over decisions about opening schools, it turns out that we’re missing some critical and relevant information about children and how vulnerable they are to COVID and how likely they are to spread the disease to adults. Sadly, we really haven’t done a very thorough job of testing children. As the American Academy of Pediatrics points out: “Children 0-17 years make up a very small share of COVID-19 tests reported to CDC but are more likely to test positive for COVID-19 than the general population.” The almost-impossible-to-see red bar at the bottom of the chart represents tests of children up to 4 years of age; the gray bar represents children from 5 to 17. You can see what a small share of total tests have been performed on children in this, our moment of critical need. (Emphasis added.)
“What Scientists Know About How Children Spread COVID-19,” a July 23, 2020, report from smithsonianmag.com highlighted several studies from around the world: “For one study, published in May, researchers analyzed reports from more than 600 people from two cities in China: Wuhan, the epicenter of the outbreak; and Shanghai. In this relatively small sample size, they found children were a little more than a third as likely to be infected as adults. But children had roughly three times as many chances to become infected when schools were open, effectively canceling the difference. (Emphasis added.)
“A recent study from South Korea of 5,706 infected people and their 59,073 contacts found children under 10 transmitted less often to adults while those between the ages of 10 and 19 spread the virus as well as adults do. Households with the older children had the highest rate of spread to other members — 18.6 percent — of any age group while households with younger children had the least spread, just 5.3 percent. The overall average was 11.8 percent.
“There’s evidence as well that children, including those without symptoms, are as likely to be infectious. Researchers in Berlin tested more than 3,700 COVID-19 patients, including 127 individuals under 20 years old. The study found that compared to adults, kids carried the same viral load, a signal of infectiousness.” (Emphasis added.)
“Some reports place children at the center of spreader events. In Israel, the number of new cases has risen from fewer than 50 per day two months ago, before schools reopened, to more than 1,500 per day now. Those numbers followed school outbreaks that infected at least 1,335 students and 691 staff … (Emphasis added.)
“Yang Yang, a biostatistician at the University of Florida’s College of Public Health, is completing a study based on nearly 20,000 households. He says his preliminary results reveal that children do infect adults, especially in the same households. “Our analysis is that children are a little bit more infectious than adults with in-house transmission,” he says, but that may just be because they are tended to by parents or grandparents in homes.” (Emphasis added.)
A large study of coronavirus (COVID-19) infections within the community population in England, excluding those in hospitals, nursing homes or other institutional settings, found that “It is also not possible to say with confidence that there are any differences in infection rates across age groups.”
The New York Times reported on a groundbreaking new study conducted in the United States that found that contrary to previous assumptions, children are far more vulnerable to COVID-19 than we knew, and are, in fact, able to spread the virus: “As schools face the daunting challenge of reopening while the coronavirus continues to spread, at least 97,000 children around the United States tested positive in the last two weeks of July, according to a new report from the American Academy of Pediatrics and the Children’s Hospital Association. It says that at least 338,000 children had tested positive through July 30, meaning more than a quarter tested positive in just those two weeks.” (Emphasis added.)
Here’s a summary of the results of the study:
To summarize, while statistically it is rare that children die from COVID-19, we’ve learned that 8.8 percent of cases involve children, and the eight states that reported testing children found between 3.6 percent to 17.8 percent of children were tested positively. Between 0.6 percent to 8.9 percent of children with COVID ended up in the hospital. (Emphasis added.)
The Washington Post reports: “One paper published in July in the journal JAMA Pediatrics found that children younger than 5 with mild to moderate cases of COVID-19 had much higher levels of virus in their noses than older children and adults — suggesting they could be more infectious. That study, conducted by doctors at the Ann & Robert H. Lurie Children’s Hospital of Chicago, used data from 145 children tested at drive-through sites in that region.”
Luckily, as of July 30, there have been zero deaths of children in Massachusetts. With Massachusetts highlighted, here a chart of child COVID cases:
Later in the day, at his afternoon press conference, the president was asked about this new data: “Q: 97,000 children tested positive for coronavirus in the last two weeks in July according to the American Academy of Pediatrics. Does that give you any pause about schools reopening for in-person learning?
President Trump: “No, because they may have, as you would call it a case and maybe a case, but it’s also a case where there’s a tiny, it’s a tiny fraction of death, tiny fraction, and they get better very quickly. Yeah, they may have it for a short period of time. But as you know, the seriousness of it in terms of what it leads to is extraordinarily small, very, very much less than one percent …
Q: “Do you still believe that children are essentially immune?
President Trump: “Yeah. I think that for the most part, they do very well. I mean, they don’t get very sick. They don’t catch it easily. They don’t get very sick … don’t get very sick. They don’t catch it easily. They don’t get very sick. And according to the people that I’ve spoken to, they don’t transport it or transfer it to other people, or certainly not very easily. So yeah, I think schools have to open. We want to get our economy going. We have incredible numbers despite this. If we could get this going, I think it’s a very important thing for the economy to get the schools going.” (Emphasis added.)
Recently we witnessed a real-life test of the Trumpian impulse to get the schools going no matter what. The New York Times asked: “925 Quarantined for Covid. Is This a Successful School Reopening?” and went on to explain:
“While many of the nation’s largest school systems have opted in recent weeks to start the academic year online, other districts have forged ahead with reopening. In Georgia, Tennessee, Mississippi, Indiana and elsewhere, some schools, mainly in suburban and rural areas, have been open for almost two weeks.
“Their experience reveals the perils of returning to classrooms in places where the coronavirus has hardly been tamed. Students and teachers have immediately tested positive, sending others into two-week quarantines and creating whiplash for schools that were eager to open, only to consider closing again right away.
“All of this has only further divided communities where parents and teachers have passionately disagreed over the safety of reopening.
“Depending on whom you ask, the string of positive tests and isolation orders in Cherokee County either proved the district’s folly for opening schools during the worst American public health crisis in decades, or demonstrated a courageous effort to return to normal.
“‘This is exactly what we expected to happen,’ said Allison Webb, 44, who quit her job as a Spanish and French teacher in the district because of her concerns about reopening schools, and who put her daughter, a senior, in the district’s remote-learning program. ‘It’s not safe’ to return to the classrooms now, Ms. Webb said …
“By Tuesday, the number of quarantined students and staff members in the district had more than tripled, to 925, with 59 positive cases. Etowah High School, where nearly 300 people had been ordered to isolate after at least 14 positive cases, switched to online classes for the rest of the month. And Dr. Hightower pleaded for more routine mask use.”
Decision-making is made all the more difficult with insufficient testing, no viable regime of contact-tracing, haphazard on-and-off social distancing (witness recent decisions in Great Barrington to encourage outdoor dining on Railroad Street and the Triplex parking area where/when diners understandably need to remove their masks to fully enjoy their meal and to converse with friends.) Hopefully, this will all prove to be safe. But, really, it’s only safe if everyone participating is virus-free. And with tourists visiting from all over, who can guarantee that’s the case?
As for what can be done in the midst of chaos, I support the decision of the Biden-Harris team to call for mandatory mask-wearing in public at all times.
In a world where denial holds sway over both the powerful and powerless, every decision becomes more difficult. Parents, children, caregivers all pay a price for keeping kids at home. Every pre-existing disadvantage — racial bias, poverty, lack of access to the internet, learning disabilities — are all magnified. And so the pressure to resume in-person schooling increases. But can we keep children and teachers and other critical school personnel, bus drivers, etc., safe and secure? Can we modify our school spaces to stymie the virus?
You might find it helpful to check out how Dr. Sanjay Gupta, a fixture on CNN, and his family tried their best to figure out what to do about schooling in the time of COVID. He touches on so many critical aspects of our problem: “As a father of three teen and preteen girls, this has been a constant discussion in our household, and it hasn’t been easy. My girls want to go back to school, and they are placing enormous pressure on us parents to make it so. They miss their friends, the social structure and the immersion in humanity that kids need and crave at this age. Virtual learning has played an important role for them, but it is not a substitute for in-person learning, especially for younger kids. As things stand now, my children are scheduled to start school next week …
“For starters, I visited my kids’ school and spent time with the head of the school to best understand the safety precautions they were putting in place. They are very much in line with recommendations from the US Centers for Disease Control and Prevention. There will be a mask mandate, plenty of hand hygiene stations, physical distancing plans, frequent disinfecting of surfaces and even outdoor classes when possible. Students will eat lunch in the classroom, and there won’t be any mass gatherings or assemblies. While physical distancing is the toughest challenge, the school has made creative use of space in libraries, gymnasiums and cafeterias to obtain the necessary square footage to try and address this. It has been a herculean effort over the past few months, but of course, none of this works if the students themselves aren’t diligent about following these practices on buses, in hallways and in classrooms.
“Our school also took the extra step of testing all the students and faculty and staff this past week, and the results were made available within 96 hours. My girls all tested negative, and that gives us some reassurance for those kids who choose to attend school, as those students testing positive will be asked to isolate at home. I fully realize this sort of ‘assurance’ testing is sadly still not nearly available enough in this country, and it is also not a perfect tool. Some tests have been known to give a considerable amount of false negatives, depending on the type of test you take and how early you take it. And, while someone may test negative today, there is no guarantee they won’t test positive for the virus tomorrow …
“It is true that children are far less likely to get sick from Covid-19, as compared to adults, but they are by no means immune. They can become infected and they can spread it quickly …
“Within the Fulton County Schools system, where we live, the guidelines for schools to return to full-time, face-to-face instruction requires the county rate of new cases per 100,000 people to be fewer than 100 for the last 14 days. Fulton County’s current rate? 316.2 …
“Just over the past few weeks, we have been given several clues of what may happen as schools start to reopen. An overnight summer camp in North Georgia had nearly 260 attendees become infected, though the CDC noted some could’ve contracted Covid-19 another way. A high school in Woodstock, Georgia, is temporarily closed after at least 14 positive Covid-19 cases in its first week. Hundreds are under quarantine in the county. Another school in Dallas, Georgia, opened and then closed its doors after six students and three faculty became infected …
“It is a lot to consider, but in the minds of our family, the evidence is clear. After considering all the objective criteria and assessing the situation in our own community, we have made the decision to keep our girls out of school for the time being. This was not an easy decision, but one that we believe best respects the science, decreases the risk of further spread and follows the task force criteria. As a compromise, we will allow our children to have a physically distanced orientation meeting with their new teachers so they can meet them in person before starting to interact with them on a screen. And, after two weeks, we will reassess.” (Emphasis added.)
Clearly far less well-endowed Berkshire County school districts can’t take advantage of some of the “assurances” of his kids’ school, but if you ask me, continually “considering all the objective criteria and assessing the situation” makes so much more sense than denial.
But with all we’re facing, please bear in mind that the Trump administration has worked hard to politicize science, and organizations we are used to relying on have tailored their advice to please the president. For example, on Friday, Aug. 14, 2020, the CDC offered revised guidance: “People who have tested positive for COVID-19 do not need to quarantine or get tested again for up to 3 months as long as they do not develop symptoms again. People who develop symptoms again within 3 months of their first bout of COVID-19 may need to be tested again if there is no other cause identified for their symptoms.” Almost immediately physicians began speaking out that this advice could be inaccurate and dangerous, that not only did it contradict their recent experience in hospitals on the ground but that the CDC didn’t offer rigorous data to support that conclusion.
Sadly, in Trumpovia, not only our Post Office is being destroyed. And still the deaths by denial mount.
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References and resources
“The True Coronavirus Toll in the U.S. Has Already Surpassed 200,000”
Denise Lu, Aug. 13, 2020, New York Times
https://www.nytimes.com/interactive/2020/08/12/us/covid-deaths-us.html?
https://www.mass.gov/info-details/covid-19-response-reporting – covid-19-daily-dashboard-
“‘The body aches could knock you down’: Personal stories of living with and recovering from COVID-19 in the Berkshires”
Rita Dichele, July 30, 2020, The Berkshire Edge
https://theberkshireedge.com/the-body-aches-could-knock-you-down-personal-stories-of-living-with-and-recovering-from-covid-19-in-the-berkshires/?
Centers For Disease Control and Prevention: Coronavirus Disease 2019 (COVID-19)
How to Protect Yourself & Others
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
Video: Covid-19 spread by micro droplets
March 28, 2020
Earlier this week, scientists in Japan released video footage capturing microdroplets they believe contribute to the spread of the coronavirus.
Using special “high sensitivity” laser beams and cameras, they captured microdroplets—that are 1/10,000 of a millimeter in size—that are invisible to the naked eye and can be produced by talking or breathing normally.
https://www.youtube.com/watch?v=LLzMDvzWeV8
https://www.nejm.org/doi/full/10.1056/NEJMc2004973
“The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission”
Valentyn Stadnytskyi, et. al., Proceedings of the National Academy of Sciences, June 2, 2020
Speech droplets generated by asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly considered to be a likely mode of disease transmission. Highly sensitive laser light scattering observations have revealed that loud speech can emit thousands of oral fluid droplets per second. In a closed, stagnant air environment, they disappear from the window of view with time constants in the range of 8 to 14 min, which corresponds to droplet nuclei of ca. 4 μm diameter, or 12- to 21-μm droplets prior to dehydration. These observations confirm that there is a substantial probability that normal speaking causes airborne virus transmission in confined environments.
https://www.pnas.org/content/117/22/11875
“Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19”
Lydia Bourouiba, PhD. March 26, 2020, Journal of American Medical Association
https://jamanetwork.com/journals/jama/fullarticle/2763852
https://www.nytimes.com/2020/08/10/world/coronavirus-covid-19.html?
“What Scientists Know About How Children Spread COVID-19”
As communities struggle with the decision over whether to open up schools, the research so far offers unsatisfying answers
Jim Morrison, July 23, 2020, smithsonianmag.com
https://www.smithsonianmag.com/science-nature/what-scientists-know-about-how-children-spread-covid-19-180975396/
“Coronavirus (COVID-19) infections in the community in England: July 2020
Characteristics of people testing positive for the coronavirus (COVID-19) in England from the COVID-19 Infection Survey.”
Office of National Statistics, UK. July 7, 2020
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19infectionsinthecommunityinengland/july2020 – infection-rates-by-age-sex-and-ethnicity-over-the-study-period
“Children and the virus: As schools reopen, much remains unknown about the risk to kids and the peril they pose to others”
Haisten Willis, Chelsea Janes, Ariana Eunjung Cha
Aug. 10, 2020, Washington Post
https://www.washingtonpost.com/health/children-and-the-virus-as-schools-reopen-much-remains-unknown-about-the-risk-to-kids-and-the-peril-they-pose-to-others/2020/08/09/e40f0862-d81e-11ea-930e-d88518c57dcc_story.html?
Donald Trump Press Conference Transcript Aug. 10: Shooting Near White House, Economy, Coronavirus
https://www.rev.com/blog/transcripts/donald-trump-press-conference-transcript-august-10-shooting-near-white-house-economy-coronavirus
Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1–July 25, 2020
Early Release / Aug. 7, 2020 / 69
https://www.cdc.gov/mmwr/volumes/69/wr/mm6932e3.htm?s
“925 Quarantined for Covid. Is This a Successful School Reopening?”
A suburban Atlanta county opened its schools amid controversy and a growing case count, previewing a difficult national back-to-school season.
Richard Fausset, Aug. 12, 2020, New York Times
https://www.nytimes.com/2020/08/12/us/georgia-school-coronavirus.html?
Dr. Sanjay Gupta: Why I am not sending my kids back to school
Dr. Sanjay Gupta, Aug. 12, 2020, CNN
https://www.cnn.com/2020/08/12/health/covid-kids-school-gupta-essay/index.html
“Coronavirus Live Updates: C.D.C. Guidance Shows Three-Month Window of Safety After Recovery”
If you recover from the virus, you’re protected for up to three months, the C.D.C. says.
https://www.nytimes.com/2020/08/14/world/covid-19-coronavirus.html?
“When to Quarantine”
https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html
