Masked Years

Masked years

Masks are here, effectively forever. Time to rethink little bits of furniture, retail, 

So, this note: first, something on the maths and science of mask effectiveness. A rumination on life in Taiwan and other parts of Asia. But first, a market for masks?

  1. Masks – health imperative and fashion market

As the pandemic swept toward the USA, masks were a hot commodity. We were urged, at first, to NOT wear them. A peculiar argument, which only made short-term sense – to enable medical front line workers to get them. And made terrible, long-term nonsense, since it encouraged strange thinking and worse actions. I’m not going to ruminate on the actions or motives of people who insist on not wearing them.

But now the shortages are past, I note my local Target has them in nice varieties. Neighbors have them in all types: macho boys and somewhat renegade musicians have bandana-style cloths. Tidy accountants have tidy masks. They’re necessities and they’re personal statements. We dare not leave home without one, so we may as well express our personalities. I’ve at home:

  • Now-banned ones; solid-color but a one-way valve that preferentially lets my breath escape. Ooops.
  • A small set of medical-quality N95s. Acquired a while ago, as forest fires ravaged nearby Northern California. I use these for dangerous trips into hostile territory. Like going to the grocery.
  • A pair of quirky ones: one that renders my face into a cartoon version of a teddy bear’s mouth. I wear those out when the neighbors’ kids are playing.
  • Three that a neighbor made! (She made some for my wife and one, I kid you not, has sequins on it.). I wear these while walking the dog or taking out trash.
  • Some nice, easy-to-wear, white-only, enriched paper masks made by a company for its factory workers. I wore them plus a face mask to go to BLM protests, of course.

And so, my little collection of masks starts to resemble my no-longer-used set of ties, whose colors and styles and prints in their way expressed a tiny element of personality: conformance or edginess; color or drab. Except: masks are really useful and mostly require handwashing and gentle air drying, and some need a little place for the PM2.5 activated charcoal filters.

The contractors working here have sturdy ones with the company logo. A neighbor has a set of Biden 2020 masks. Another, a white woman, has Black Lives Matter masks. Etsy reports it has nearly 6,000 Black Lives Matter masks. Yay!! I think I’ll get the raised fist one!

Okay, then. So there are, what, seven and a half billion people on earth. And they all need masks. Now, some are going to go crazy and have lots. Some will say: these for work, these for social, these for that. The world’s billion or so wealthiest individuals will have 10 or 20 each. And replace them every six months or more frequently. That, friends, is 30 billion masks a year, at $5 or $10 apiece. Just like that, a worldwide market of at least $300 billion a year.

Masks are a much bigger retail market than socks (now that folks work from home a lot more, who wears socks?). No wonder big fashion brands are heading toward this: we need to buy them; they need to sell something – and, frankly, we also need the quality control of someone to assert that the masks are reasonably effective. And the design aesthetics of someone better than me or, probably, you. https://www.forbes.com/sites/sboyd/2020/04/24/5-fashion-brands-pivoting-to-create-masks-for-the-public/#5f05b756648f

  1. Why we wear masks: the science of the effectiveness of wearing masks

COVID is an airborne, respiratory pathogen. The principal vector is from via disease-carrying droplets expelled from the respiratory system of the infected person, via the air, into the respiratory system of the unlucky recipient. Droplets expelled by coughing, sneezing, wheezing, singing, shouting, talking, breathing.

Masks should work, then, right?

Here’s Larry Brilliant, epidemiologist of some noted: “If 80% of people wore a mask 80% of the time, COVID would go away.” Is that really true?

Really. Yes. They’re easy and inexpensive, and the life you save may not be your own. So let’s note the science of how good they (and their wearers) have to be.

The science of how good masks need to be is well understood. The droplets start out (leaving the mouth or nose) in sizes from low tens of microns to low hundreds of microns. They shrink – due to evaporation – but then stay airborne, with smaller droplets staying in the air longer. So the first lesson is: since they’re bigger as they’re exhaled, it’s critical that the infected person has something to block droplets. But, as we all know: there’s a long period during which a person is infected and contagious – but doesn’t have symptoms. And decent cloth is really good at blocking droplets. Masks are pretty good at blocking inhaled droplets as well – but they don’t have to be that good there.

These pictures show the principle: more violent or more prolonged respiratory output is worse, and masks well at preventing transmission.

These ideas give mathematicians enough to get cracking on modelling.  It’s hard work but the basic idea is to answer the question: what level of face mask adoption by the public, associated with what level of face mask efficacy, would be required to reduce the effective reproduction number (R) below 1? And the answer is … indeed, Brilliant is right. If nearly everyone wore reasonably effective masks nearly all the time … COVID goes away.

The graphs attached show modelling (Oxford University group, Stutt et al) that examines effectiveness at quashing transmission of COVID given lots of variables: the effectiveness of the mask – the graphs reading from left to right represent increasing effectiveness; the R(0) of COVID – the blue lines are the higher R(0) estimate; whether the masks are only worn after symptoms are determined (top rank) or all the time (bottom rank); and what percentage of people wear masks – each graph, from nobody to everyone. Each of the eight little graphs shows the effective R (written as R/e) in each case. The goal: R needs to get below 1.0.

OK, what to do?

First – compare the two rows. Wearing masks only after symptoms never does enough to spread contagion for R(0) = 4.0. Never.

Then look at the bottom row, the 3rd column – 75% mask effectiveness. Everyone, or nearly everyone, wearing reasonably effective masks, all the time ( = outside your household) kills the spread of COVID.

The message: Don’t wait for someone to have symptoms. Always wear masks. Limit your exposure to unknown places and people. Always wear masks.

  1. Masks and culture in Taiwan (and Japan, Hong Kong)

Crowded cities, packed trains, high humidity, people eating out all the time. Almost no COVID deaths.

Masks everywhere.

Taiwan, particularly, I know because I lived there and have many friends there. When I lived there, it was a decade after the SARS epidemic of 2002 – 2003. But the reflex was there: masks everywhere. If someone thought they had a cold, perhaps felt a little run down or had a sore throat coming on: wear a mask. Employees at stores where they were in constant contact with the public – convenience stores, like 7-11, banks, train stations, toll takers on the highways: always wore masks. 

And, Taiwan has a decades-old tradition of scooters as a means of inexpensive transit, and a nasty, long history of unconstrained dirty industries. Both meant that the air was sometimes filthy with soots and chemical fumes. You know what works well for these?

Scooters in Taipei: https://totobobo.com/blog/2019/02/totobobo-for-riding-a-scooter-in-taiwan/

And so it was, of course, that I developed a sore throat one particularly cold, damp winter. Off to 7-11. Masks for sale included nice masculine ones in sober colors and cute pink ones for young girls and Hello Kitty masks for dating-age young women. Of course, the would-be-tough young men would wear ones with death’s head skulls, but 7-11 doesn’t stock those.

Taiwan was and is where we all will be. Respiratory diseases are well quelled by wearing masks. They’re inexpensive and they can save lives. Done well, they express your personality. We’re going to have to wear them, either by mandate, or because we are humane enough to not want to be vectors of contagion. Cool. Let’s do it!

Disease and Incompetence

It is a truth universally acknowledged, that a nation, in the throes of a dire predicament, must be in want of a competent government.

To be honest, that truth is not universally acknowledged. It is particularly the case that the wanton incompetence of some governments in the face of the COVID pandemic has many wondering about the role of government at all. So, let’s look at what we know so far about how competence, or its lack, has affected outcomes. 

Why think of this in the context of a “new normal”? Because the pandemic is not going away, but what we demand and expect from governments should be shaped by what is essential in the context of existential threats from disease and other challenges. COVID shows what governments can and should do in our immediate futures.

Where you live can kill you

In a nutshell: how well a government led the response to COVID has, so far, an effect on mortality of at least 2,000 fold. Meaning: in one reasonably affluent country, the death rate is 0.3 / million, while in another of comparable size it’s nearly 800. A cluster of countries have kept their death tolls in single digits / million; another cluster has death tolls from 100 to 600. It’s amazing.

The lessons, perhaps simplified: preparedness; rapid response; respect for the numbers and the science; leading the people to join in sharing the mutual sacrifice for the mutual benefit. Do these well, and your country and your economy gets through this. Do these poorly, and a vast death toll and economic devastation are the consequences.

A rapid response

The need for early, fast and firm response is driven by the inexorable maths of exponential growth. Consider: COVID’s early spread in many countries had the number of infected individuals rising at 25% per day. That’s just insane growth. At that rate, in just 31 days the number of infected individuals rises 1,000-fold. (To be precise: 1.25^31 = 1,009.) A country that postpones action for a month faces a 1,000-fold larger challenge. 

Thus, the vast range: Taiwan, like some other countries, had a pandemic preparedness plan and started acting to it even before they had confirmed cases. Unlike some others, it stuck to it. It enforced compliance – but had a populace already used to the arrival of contagions from China. It had medical expertise in the country’s leadership – including an epidemiologist as the number 2 in the whole country.

Comparing COVID mortality to date with wealth and population. 

Data from Our World in Data (COVID mortality as of 19th May, 2020, .csv files), IMF / Wikipedia for GDP/capita (nominal) and population data. The three countries indicated by colors are discussed further in this piece. Circles are proportional to population.

Some notes:

  • The 19 countries whose outcomes (so far) are depicted here are all Western-style economies with democratic governments and a generally free press. They have roughly similar economies.
  • Three countries (USA, UK and Australia) have bombastic, populist leaders. One has done well in fighting COVID; the other two have not. Australia’s death rate is about 1% of those in the USA or the UK – and nobody can describe Australians as normally meek and compliant.
  • The country with the weakest government institutions – Belgium (which didn’t even have a functioning government from 2007 to 2011) currently has the worst COVID outcomes.
  • A particular and stunning peculiarity: NONE of the Asia-Pacific countries have more than 6 deaths per million – but this cannot be attributed to Confucian compliance with central leadership since Australia and New Zealand are in this list. In contrast, NONE of the Atlantic / Mediterranean countries have less than 30 deaths per million.

What do we want from leaders? What do we want from government?

Do we want a self-proclaimed superman as leader? “I alone can fix it” (Donald Trump, Republican convention, 2016). Do we want leaders who aim to unify us and create strength from cohesion? “trust your values — our values — and to hold me responsible for living up to them” (Ronald Reagan, Republican convention, 1980, cited in the same article). Do we want Government to be the first place to solve problems for the people (what Britain’s Tories sneered at as a ‘Nanny State’)?

And then comes a super-national-scale crisis, and the criteria for government come into sharp focus.

As the COVID pandemic slowly resolves, it will eventually be a task for historians and pundits to analyze which government approaches worked, and which did not. It’s definitely early to make definitive conclusions, but it’s not too early to look across the various countries’ (and USA states’) responses and note some that seem to have worked so far, and some that seem utterly disastrous, to date. Let’s assume that “worked” and “disastrous” can be quantified by counting COVID death rates (COVID-caused deaths per million people).

If you scan the data, and reject those with dodgy data (I don’t believe Mexico’s or China’s data or those from lots of countries) you still end up with death rates that vary by factors greater than 2,000. Literally: your chance of dying was better or worse by vast factors depending quite narrowly on WHERE you live. The weirdness of this defies easy explanation.

The large ranges continue within countries and within regions: I live in Northern California which has far lower COVID contagion rates than the Los Angeles and San Diego regions.

It’s hard – impossible for now – to peel out unambiguous causes. But let’s look at a few countries, each under democratic governments, of similar sizes (geographic and population), with a vigorous, caustic free press, each relatively wealthy and reasonably literate, and with comparable and generally adequate access to inexpensive health care: Italy, Taiwan, Britain.

Italy – a country on fire with COVID

Italy’s prior experience with plagues and epidemics is well-known, since its role in the 13th to 18th centuries included much worldwide trade: the word “quarantine” derives from the Venetian dialect expression of 40 days – the time ships were supposed to be isolated before they offloaded crew and cargo.

Italy’s high death toll from COVID, what caused it? Was it …  a/ the high percentage of the population that was elderly? (nearly 95% of the deaths were of people aged 60 or older, and Italy has the 5th-highest median age of any country), b/ dense housing in older buildings with inadequate ventilation or sanitation? c/ vigorous community activities (can you imagine Italy without noisy cafes, markets or churches)? d/ multiple generations living together? e/ a communication style that tolerates proximity – cheek kissing – and noisy speaking? f/ smoking? g/ other diseases, comorbidities? h/ inadequate health care prior to or during COVID? I’ve probably missed a few, but even so: the likelihood of getting clear causality against these is slim. (Note, all the data on Italy are from the Wikipedia entry, HERE.)

A brief calendar of COVID in Italy

  • First cases emerged in late January via travellers from Wuhan (who had arrived on 23rd January)
  • First clusters emerged from mid- to 21st February
  • Lockdown started in specific towns from 22nd February and expanded nationwide around 8th March (nearly three weeks after clusters were identified): one month from cases arriving.
  • Case confirmation peak occurs around March 20th
  • Peak deaths around March 27th.

The chart below depicts the growth and tapering off of COVID in Italy.

Growth of COVID in Italy from the discovery of the first COVID clusters

If there’s one unambiguous lesson from Italy, it’s this: the two-plus week between identifying clusters and initiating widespread lockdown cost dearly in terms of deaths.

Taiwan gets COVID nearly right

Taiwan’s experience with Chinese-origin epidemics is recent and urgent. The SARS epidemic in 2004 found the country ill-prepared and with its representation at the World Health Organization shut off by the People’s Republic of China. This led Taiwan to bolster its epidemic response. By late 2019, it had a robust Center for Disease Control, modelled explicitly on the similarly-named USA institute, with a health command center explicitly set up to deal with epidemics. They’d planned for this for years, and knew they’d be on their own. Further, it had as the nation’s vice president an individual – Chen Chien-Jen – with a master’s degree in public health (and some years in medical practice, still focusing on pandemic response). Taiwan does have free and universal health care, but ⅔ of beds in Taiwan are in privately-operated facilities, with many or most services paid for through the central government.

But, proximity to China and the enormous, fluid flow of people across the Taiwan strait still left it vulnerable. As many as  850,000 of its citizens reside on the mainland; another 400,000 work there and rotate between work on the mainland and home in Taiwan. For work and for tourism, China send many visitors to Taiwan – 2.71 million last year. Add to these factors very dense housing, some old and with poor sanitation, extensive use of public transport, and a tradition of communal eating in the evenings. (see discussion of Taiwan’s predicament and response HERE)

IT wasn’t all bad. People throughout Taiwan would have seen Wuhan not as some strange, distant locale, but as a place where family members originated or worked. They knew of the potential of chimeric contagion from China. Many would have heard family word-of-mouth news, in addition to the TV or newspaper reports. They knew. (The data below are, again, from Wikipedia, link HERE.)

A brief calendar of COVID in Taiwan

  • Starting at the end of December, travellers arriving from Wuhan were subject to health tests upon arrival and contact tracing thereafter. (Note: they started acting BEFORE there were known cases in country!)
  • Taiwan’s first case emerged in late January via a traveller from Wuhan (who had arrived on 21st January)
  • Throughout January over 100 discrete measures were implemented, including a vast increase in production and distribution of masks (and mandatory mask-wearing) and of alcohol for hand sanitizers. The government invoked emergency measures to step up production of protective gear. Mask production reached 10 million per day in mid-March (at which point it started exporting them; some are sold, but many are donated to countries suffering worse from COVID, including the USA). By 20th January, Taiwan had on hand 44 million surgical masks, 1.9 million N95 masks and 1,100 negative-pressure isolation rooms. The existential threat from COVID meant political barriers and industry rivalries were, for the moment, set aside.
  • By 14th March, persons arriving in Taiwan had to go into 14-day quarantine.
  • Various measures including shuttering restaurants and businesses took effect.
  • The peak of new cases occurred around 20th March (even so, just 27 cases were reported on that day). There isn’t really a peak in deaths, because there were so few. As of this writing, only seven COVID deaths have occurred in Taiwan (an island with a population of just under 24 million).

By mid-May, Taiwan’s industry had largely retooled for safe return-to-work. (One large firm, well-known for its role in producing famous computers, took a few days to retool a factory to make protective equipment – for its own workers.) Mandatory face masks, temperature testing, contact tracing, and so on are everywhere. One recent informal estimate I’ve seen is that Taiwan’s economy, which was projected to have 2% growth this year before COVID hit, may still eke out moderate growth for calendar 2020.

UK gets COVID nearly completely wrong

It’s hard to imagine a country getting so much wrong about a pandemic. The UK had a highly educated population, broad access to a well-liked (but financially stressed) health care system, a world-leading set of universities and pharmaceutical companies. Even the World Health Organization relied for much of its epidemiological analysis on a UK group (the MRC Centre for Global Infectious Disease Analysis at Imperial College: this writer’s alma mater, although at a different time, and I know none of the participants). And yet …

It now seems that the first COVID cases in the UK may have occurred as early as late November. More certainly, several members of a choir returned from Wuhan in mid-December with COVID-19 symptoms. But, even as late as 22nd January, when the medical world was fully informed of the outbreak in Wuhan, the outbreak’s severity was only upgraded from “very low” to “low”. It was too late, as there were other cases and clusters, and travel bans were ineffective, as people continued to flow in from other countries in Asia and from Europe. People coming into the UK from known-affected countries throughout Asia and Europe were politely asked to self-isolate – if they already had symptoms. Again, we see a country that acted – gently – against COVID months after it was already spread out of control.

In mid-March, the Imperial College epidemiology group published a report (report 9) – which had already been shared with UK and USA leaders – predicting that significant non-pharmaceutical interventions were needed, else the death toll would reach a half million in the UK (and as many as 2.2 million in the USA).  Despite this the prime minister, throughout much of March, while steadily activating some of the machinery of the health system, was out in public, shaking hands with all he could. Through the middle of March, he took part in the debates and ceremonies at the Houses of Parliament – a grand but crowded and poorly ventilated place, with all members obliged to sit close to each other. The prime minister’s jaunty continuous handshakes caught up with him: he was hospitalized with COVID – including a few scary days in ICU.

On the same day as the Imperial report 9 was published, the British government “suggested” people should avoid pubs and clubs and theaters. Their enforced closing followed a week later. And, a few weeks later yet, it created a series of military field hospitals “Nightingales” (named for the 19th century pioneer of field medicine for the British Army, Florence Nightingale) – that took over exhibition halls and warehouses and aircraft hangars; they shut down airports to dedicate them only to medical flights. The government appealed for the public to volunteer to provide food and essential services to those shut in, or to provide childcare support for medical staffs and so on. They sought 200,000 volunteers and got over a million.

All that was so much, and so well coordinated. But all so late, in the face of unconstrained exponential growth. And such dissonance between the explicit capabilities of government and the ‘no problem’ leadership message expressed by the personal behaviors of Johnson and others.

Disclaimers: I’m British by birth, and have a PhD, in physics, from Imperial College, but have no contact with the Imperial epidemiology team. I’ve lived in Taiwan – and have at least once met both the current premier, Tsai Ing-Wen, and her predecessor, Ma Ing-Jou – but we don’t know each other. I am a US citizen and resident, but elected to not discuss the USA because there are no nations of comparable size and complexity to use as peers. I have no financial interests or conflicts to disclose.

A version of this document with more complete data source information is online at THIS LINK. That document may be updated as new COVID data become available.

COVID, Fossil Fuels, & Health

Few subjects – individually – are more vexed and vital than the Coronavirus pandemic, the fate of the fossil fuel industry (bound up in climate change and the future of the entire planet) and the economics of the vast healthcare industry (or, outside the USA, the health care services sector). And yet, in our pandemic world, they are tied together, and their convoluted ties provide intriguing lessons that can be digested without anger:

  • We need a vibrant economy.
  • We are spending trillions to keep the economy alive as the pandemic’s damage expands.
  • We are already spending vast sums – worldwide these are also trillions of dollars – to prop up the fossil fuel industries.
  • We are spending trillions of dollars on health care – amounts that are expanding due to COVID.

Too many trillions. Too much pain. Too expensive.

One particular thread to pull on is this: the world spends trillions of dollars per year to deal with the health damage caused by fossil fuel use. The health consequences of fossil fuel use are adding to the scope of human suffering, and to the cost of dealing with it – and the mandated shutdowns have resulted in similarly vast potential long-term savings.

We are at a place where rebalancing the economy becomes imperative. Here’s one way to not waste trillions of dollars AND have a healthier populace AND have a more vibrant economy.

The other costs of fossil fuels

Marine Photobank

Our relationship with fossil fuels is one in which we give vast subsidies – hundreds of billions of dollars each year – and it gives us back cheap oil – and a grim toll of death and disease. We get to pick up the tab for the hospitals and funerals as well, another few hundred billion dollars. It’s time to rethink the balance.

Explicitly, this must include adding in the costs of death and diseases to the balance sheets of fossil fuels. It must include thinking of the great monies being spent here and looking to use them to build a cleaner, post-COVID future.

The IMF (and, separately, this author and others) have estimated the total health costs of use of fossil fuels. The IMF estimates that the worldwide, annual health-associated costs of air pollution from fossil fuel use exceed $2.3 Trillion dollars. (My estimates, and some others, are higher – as much as $2.9 Trillion per year.) These costs are external to the fossil fuel industry – they are borne instead by you and me and the rest of the world in pulmonary diseases and syndromes, and in loss of life and diminished vitality.

The data are already in: we can save money and lives

One sad consequence of the COVID pandemic is that it is already so vast, and covers such numbers of people, countries, industries, lands, that – alas – some statistical analyses are already instructive. The health consequences go far beyond sitting at home and losing jobs and reducing the contagion of COVID. Here are two important ideas:

  • The worst instances of COVID infection occur in areas with lowest air quality – with fossil fuel use atop the list of culprits.
  • The close-down of industry in Wuhan to deal with COVID resulted in air quality improvements so vast that the lives saved by improved air quality likely greatly exceed the death toll from COVID.

We’ve found ourselves in an unholy, nay, terrible, cycle in which our addiction to heavily subsidized fossil fuels both worsens our health problems and limits our ability to pay to solve those health problems. The inevitable outcome must be cutting this knot, by driving to a place where we rebalance our economy. So, while this piece is not about how or when we get to a post-COVID economy, it is about what that economy must look like.

Note: the rest of this note deals with the death toll and costs of COVID and other problems without empathic consideration of the human misery it has brought, sickness, job losses, bankruptcies and more. Each death and severe sickness and job loss and company failure is a tale of suffering. I mourn for those, and yearn for a world in which we can solve problems, and that is what this note is about.

COVID and health quality

Urban pollution ,Photo by Holger Link on Unsplash

Wuhan has achieved notoriety as the point of origin of COVID. I’ve been there, a decade or more ago. It already had the worst air I’d ever experienced; I’m sure it’s become worse since. My meetings ended in mid-afternoon and we emerged from the building we’d been in and … you could stare, safely, at the sun – a blood-red disk in a yellow-brown haze.

At a primitive level (I’m not a medical doctor), it makes sense the air pollution or heavy smoking (also prevalent in Wuhan) would make for worse COVID outcomes – they both cause persistent and grave challenges to lung function: the inhabitants of Wuhan already had lungs that daily suffered significant injury. But it’s not just in China. We now have the first statistically-significant analyses of COVID and air pollution in the USA – a Harvard-led analysis of the correlations between air pollution and COVID outcomes, looking at the known air quality in over 3,000 US counties. Key takeaways (the following are direct quotes):

  • The majority of the pre-existing conditions that increase the risk of death for COVID-19 are the same diseases that are affected by long-term exposure to air pollution
  • … an increase of only 1 μg/m3 in PM2.5 is associated with a 15% increase in the COVID-19 death rate, 95% confidence interval
  • A small increase in long-term exposure to PM2.5 leads to a large increase in COVID-19 death rate, with the magnitude of increase 20 times that observed for PM2.5 and all-cause mortality.

Now, correlation is not causation. We all know that the poorest people live in the dirtiest places and have the worst diets and the weakest access to healthcare. EPA researchers have previously linked PM2.5 counts to a variety of health concerns including: premature death in people with heart or lung disease, non-fatal heart attacks, irregular heartbeats, aggravated asthma, decreased lung function, and increased respiratory symptoms such as inflammation, airway irritations, coughing, or difficulty breathing

But, the authors claim, they were able to correct for the background – it’s a large data set and so, in principle, you can do that. From the paper: “We adjust by population size, hospital beds, number of individuals tested, weather, and socioeconomic and behavioral variables including, but not limited to obesity and smoking.” Insofar as these adjustments are accurate, in important conclusion of immediate value: COVID illness and death rates are significantly exacerbated by pre-existing bad air quality.

COVID shutdowns and improved longevity

Back to Wuhan. This is a vast city in central China, home to over 11 million people. According to government statistics, 81,000 people were sickened and over 3,300 died. (Note: the only data from China are “official”, and their accuracy cannot be verified. One noted source, worldometers.info, is maintained by a tiny company based in Shanghai.)

Only through aggressive tactics did the Chinese government succeed in preventing the death toll from soaring to hundreds of thousands. Factories closed, roads were empty. Satellite images from NASA show a fast and truly stunning decrease in air particulates across China. The best current estimate is that the improved air quality saved far more lives than were lost to COVID. Literally – Chinese official statistics initially asserted that COVID claimed over 3,000 lives; improved air quality may have saved as many as 73,000 lives.

From the paper: “2 months of 10µg/m3 reductions in PM2.5 likely has saved the lives of 4,000 kids under 5 and 73,000 adults over 70 in China.”

Much of this is due specifically to lowered fossil fuel use. The specific gas tracked in the NASA images shown here is nitrous oxide – also a major contributor to climate change – and not specifically PM2.5. But nitrous oxide has the same sources, so it allows the deduction of improved longevity due to the shutdown caused by COVID. 

NASA images of pollution. (Beijing and some other cities continued to have bad air during the COVID shut downs, likely because of use of coal-fired power plants for electricity generation.) Images from NASA observatory; their site also has specific images of air quality improvements in the Wuhan area.

What is PM2.5?

PM2.5 is a term used to describe particulates in the atmosphere that are smaller than 2.5 microns. (For a reference, the COVID virus itself is less than 100 nanometers in size – one 30th of the size of the particles at the upper range of  PM2.5; there’s a wide range of sizes of aerosol droplets from someone coughing or sneezing – from less than 1 micron to 100 microns). There’s a good, lay discussion at THIS SITE.

There are lots of particles in the air. Anything smaller than about 10microns (one hundredths of a millimeter) can be easily brought into our lungs. Those between 2.5 micron and 10 microns tend to deposit in the larger passages. These include ash from fires or the ground-up grit from roads; these are in the PM10 category. Much smaller ones can travel further into the many fine channels in the lung. Diesel particulates particularly, and many other fine soots from cars fit into these categories. These are particularly damaging – and their damage to the fine structures of the lung are especially nefarious in the context of COVID.

What is absolutely true:

  • COVID death rates are significantly increased by PM2.5 (as is true for many diseases)
  • The leading cause of PM2.5 particulates is the fossil fuels we burn

Now what?

COVID pandemic illustrates many societal ills. High on that list is that the costs of fossil fuels include extraordinarily high health costs. Countries – like the USA – that don’t have a national health system, see these costs as extraneous to those businesses. That conception was breaking under strain due to fossil fuels’ health consequences before COVID. It’s clearly a bankrupt idea now.

It’s high time to rebalance our economy, and it’s over time to bring the external costs to the table as we do that and as we build a cleaner economy for our future.

Photo by Zbynek Burival on Unsplash

Plagues Return

Iron lungs in gym Courtesy of Rancho Los Amigos National Rehabilitation Center

There was a time when the United States, flush with cash and robust with plentiful food and roads and cars and televisions, became paralyzed with fear of a contagion. Pools and schools were closed. Quarantines were imposed, fear was everywhere, businesses failed, tempers were frayed. Of course, I’m referring to the late 1940s and early 1950s, when Poliomyelitis – Polio – stalked the land, crippling tens of thousands, killing thousands, ruining lives. There have been no cases of Polio in the USA in the past 40 years, but I could as easily have been referring to HIV-AIDS, which arose in the 1980s, and has killed 32 million people since.

The thesis of this site is that the new, post-COVID normal is to be different. That we will have to adapt, that we will have to change some key parts of our behaviors, our social constructs, our industries and economies. And that we benefit by thinking of the strange new world.

Equally likely is that the years before COVID were the unusual ones, the strange ones.  That plague-free times were abnormal, and that plagues, ghastly waves of pandemic diseases have time and time again raged, running unstopped and little hindered through vast populations.

We were never supposed to forget. How did we as society forget? There are plenty of educated adults around for whom COVID was their FOURTH widespread health epidemic – pandemic. Polio, HIV-AIDS, SARS and COVID. Or even their fifth or even sixth, if you add H1N1 flu, or Ebola. Nonetheless, collectively, we forgot.

Ebola Virus, CDC

Plagues, pandemics, pestilences, contagions have been a near-constant in the rise of humanity. As fast as our improving technologies win more battles, new diseases rise against us. Vaccines won the war against Polio, and may yet push adequately back against COVID: vaccines for coronaviruses are really challenging, but there are over 80 programs underway to create one for COVID / SARS-COV2. Strict quarantines pushed back on SARS and Ebola (which now has a decent vaccine). But we as humanity and our societies have not built strong enough systemic safeguards against future challenges.

The 1918 – 1920 ‘flu pandemic infected as much as one third of all humanity alive at the time, and killed tens of millions. Cholera killed over a million Russians in the mid-19th century, and killed tens of thousands in each of many countries for years around then. 

Earlier pandemics were even more fatal. Bubonic plague, black death, killed as much as half of Europe’s population in the decades (in the 14th century) when it ravaged Europe – the word quarantine dates to this time – from the Venetian-dialect word for 40 days (of isolation). Large outbreaks were noted as early as the 6th century, but major outbreaks occurred in the 17th and 19th centuries.

And while genocide did its part in enabling Europeans to take over the Americas (a ghastly truth), imported diseases killed more. As many as 20 million native Americans were killed by infections brought over the Atlantic by Western colonizers and invaders – particularly Smallpox – eradicating as much as 90% of the indigenous population. Parts of the eastern seaboard of what is now the USA were almost completely emptied by new diseases. A later outbreak of smallpox in southern Africa, again brought in by Europeans, erased large parts of the native Khoisan peoples.

Photo by CDC on Unsplash

Some diseases never went away, and still killed in vast numbers. Tuberculosis was responsible for about one half of deaths for adults (ages 15 to 35) in Europe’s major cities in the late 19th century. Other contagious diseases, diphtheria, cholera and more, were always there, killing by the thousands. Influenza and the common cold evolve and persist and kill.

No wonder that the Bible and Shakespeare and many other writings (notably Camus, Defoe, and Garcia Marquez) throughout history, have harped on plagues, pestilences. Invisible diseases with new, strange, and poorly-understood vectors and contagion.

The thesis of Strange New Normal, then, is not only that COVID alone will change society, or that we will change society specifically to deal with COVID. It’s also that we have a moment, now, to build societies that are more resilient against, and better prepared for major disruptions, black swans. Better prepared for the next pandemics. For history tells us: they’re coming, they’ve come before, they’ve never stopped coming.

For one thing COVID has shown is: we were (mostly) unprepared. Our systems were taut, with little room for slack, few inefficiencies. All gone was the padding, the fat that enables resilience. We were, for the most part, uneducated on pandemics. We’d forgotten.


Left: Image of “Doctor Beak”, a plague doctor, Rome, 1656. https://en.wikipedia.org/wiki/Plague_doctor
Right: Selfie of the author of this piece, heading out to buy groceries, California, April 2020.

Make some noise: music after COVID-19

If music be the food of love, play on; Give me excess of it

William Shakespeare, Twelfth Night

How dull a future without energetic, live, frenetic music! And yet, it’s a real problem. COVID-19 spreads by breath and proximity. Singing requires energetic breathing. Live music thrives on heaving crowds.

Hardly Strictly Blue Grass, San Francisco; photo by Photo by Kristen Wrzesniewski, at ConsequencesofSound.net

Music is important to most people – perhaps all but the congenitally hearing-impaired. Music elevates and soothes and creates safe spaces and it energizes. Every society of humanity has music. Every age group and every ethnicity.

We’ve all (I hope) done it: gone to a too-noisy concert and come back with ringing ears, and a sore throat from singing along. As a kid, church choral singing was part of my life (think: boy soprano, angelic solo voice filling a church). No surprise – a single church in South Korea created a large number of that country’s COVID-19 sufferers – perhaps creating the leading source of contagion in the nation.

Apart from the absurdity of singing with a mask on, there are real challenges. Here are two:

You can’t really have much lively, live music where the musicians are distributed. There’s a technical reason for this. Humans like music that – sometimes – has a lively clip. A few beats per second. Musicians learn to time themselves to the rhythm, and to know when someone else is about to lean in and start their own riff. You have to have reflexes that are well below 1/10 second for this to work. 

Technical problem: the speed of light (and the processing speed of network gear). If you allow 1/30th of a second for just transmission, then a one-way trip (you hit the drum, the singer hears it) has to be within 500 miles. And you may think: but the singer’s only six blocks away. Too bad. A telecom network knows nothing of this, and will happily route your traffic through network points tens, hundreds of miles away or more. The network – transmission and routing gear – adds similar delays – in the hundreds of microseconds, if it’s behaving well. It often isn’t. And consumer-grade WiFi gear adds delays.

Photo by Allie Smith on Unsplash

The next time you’re on a zoom conference, try looking at the delay between the lips moving and the sound you’re hearing. Or think of the awkward moments when people start talking over each other, and then imagine doing that while playing music. It doesn’t work. Zoom – and its peers – try hard to keep latency (the technical word for the end-to-end delays) below 150 milliseconds – far above the delays needed for synchronized musicians.

The business models are broken. Ripping MP3s and the business practices of streaming services mean that a lot of music floats around for free – meaning no money at all to the musicians – or delivers only minor royalties. Apple Music may pay 7 tenths of a cent per play; YouTube and Spotify can deliver as little as 7 hundredths of a cent. Only the biggest acts can make enough on volume. Back then (before COVID-19) the message was: move on, musicians, get on the road, make the money on live gigs and paraphernalia. Oops.

The near-term future, the new normal of music?

Live musicians, in the same place, recording or performing for a streamed viewing: stay more than 20 feet apart. No heaving, sweating audience.

Lots of aethereal, slow music, so that people can sing in approximately adequate time. 

And lots of solos or duos. Very small bands, the return of the singer-songwriter.

And small music. A small group, playing in a large park, with people spread out, enjoying an atmosphere beautiful in its own way, but far from frenzied crowds.