All posts filed under: COVID-19

Poultry Farming, COVID-19, and the Next Pandemic

I Upton Sinclair published The Jungle in 1906 to expose the horrific conditions in American factories at the turn of the century. While he intended to highlight the misery and abuse of the workers, his graphic descriptions of disgusting and unsanitary conditions at slaughterhouses were what most outraged the public. President Theodore Roosevelt was among the indignant readers, and he used the outcry over The Jungle to push for passage of the 1906 Food and Drugs Act and the Federal Meat Inspection Act. “I aimed for the public’s heart,” Sinclair later wrote, “and by accident hit it in the stomach.” Jonathan Safran Foer’s Eating Animals (published in 2009)—and the chapter “Influence/Speechlessness,” in particular, about the US poultry industry and the risks it poses to our health—ambitiously aims for the reader’s heart and stomach at the same time. Foer gives us a glimpse into the hellish life of the more than nine billion factory farmed chickens “produced”—all 56.8 billion pounds of them, as the National Chicken Council (NCC) proudly announces—by the industry every year. “It’s hard …

Risk, Uncertainty, and COVID-19 Strategies

Former World Bank President Jim Yong Kim recently argued that “[n]o one in the field of infectious disease or public health can say they are surprised about a pandemic.” And yet, the COVID-19 outbreak did take most policymakers very much by surprise. From their perspective, the situation was still one characterized by the kind of radical uncertainty highlighted by economists such as Frank Knight and George Shackle: Policymakers were simply unable to assess the possible consequences of action and inaction, and this made informed cost-benefit analyses of alternative (probabilistically assessed) outcomes impossible. One thing was, however, clear: The consequences of a runaway pandemic could be disastrous. In such a situation, the precautionary principle tends to apply. As a prominent member of the Danish parliament told us in mid-March: “This is a natural disaster in slow motion. We basically know nothing. The only rational thing to do is to shut down entirely.” That was six weeks ago. At the time of writing, we are already in a very different situation. Now that many more data points …

An ICU Doctor Reports From the Frontline

I had been out of clinical medicine for a couple of years but felt a calling to return to the intensive care unit (ICU) to help my local area in London cope with the additional burden presented by this pandemic. Like everyone, I had read that the National Health Service (NHS) needed a dramatic increase in capacity to save lives—beds, ventilators, and staff. I was a little scared. Would there be enough Personal Protective Equipment (PPE)? Would my new colleagues accept me? Would I survive, or become another face on the news of a frontline staff member who had succumbed to the virus? I felt a little deflated when I contacted four local London hospitals to offer my help, my time, possibly my good health, only to have my emails either not replied to or batted around various HR departments. Hospital administrators struggled to process a volunteer who was an ex-intensive care doctor with 11 years’ experience. Classic NHS, I thought. The national institution that all we Brits know: at times loved, at times hated, …

Human Challenge Trials—A Coronavirus Taboo

The idea is as simple as it is apparently repulsive: allow human challenge trials (HCTs) under which “low risk” and healthy young adult volunteers in double-blind studies would be given trial vaccines (or a placebo) and then intentionally exposed to the novel coronavirus. This would accelerate the assessment of the trial vaccine’s safety and efficacy and more generally expand our understanding of this virus in a controlled setting. According to the World Health Organization (WHO), more than 70 vaccines are currently under development, five of which are already moving to clinical trials. Notwithstanding these Herculean efforts, the earliest we can realistically expect a readily available vaccine is in 12 to 18 months. This is in large part due to constraints imposed by traditional vaccine validation methods, which rely on large test groups and chance exposure to the virus by participants to assess the vaccine’s safety and efficacy. HCTs, using a relatively small low-risk group of volunteer participants, could potentially accelerate the release of a safe and effective vaccine by many months. While conducting coronavirus HCTs …

Italy and the EU: The Hard and Stony Road Ahead

“Too many,” said European Commission President Ursula von der Leyen on April 16th, “were not there on time when Italy needed a helping hand at the very beginning. And yes, for that it is right that Europe as a whole offers a heartfelt apology.” And heartfelt the apology probably was. For weeks, von der Leyen and her colleagues had been receiving frantic pleas for assistance from the Italian government, and little had been forthcoming. By mid-April, Italy was at last beginning to pull out of the dire circumstances that had placed it at the top of the world’s league of COVID-related death: At its grisly peak at the end of March, nearly 1,000 Italians a day were perishing from the virus, a terrible figure that will, as in other countries, almost certainly turn out to be an underestimate. It was still in great need of help—from the EU, above all—but it was no longer the worst place in the world. It was time for the EU to display some public contrition. But, for several reasons, …

COVID-19 Is Not the End of ‘The End of History’

I. If there were an annual award for the world’s most misunderstood essay, Francis Fukuyama would have won it every year for the past three decades. “The End of History?” was published in the National Interest in the summer of 1989, and it argued that the world was witnessing the “total exhaustion of viable systematic alternatives to Western liberalism.” This observation led Fukuyama to a conclusion that has catalyzed more debate than any other single argument since the collapse of the Soviet Union: “What we may be witnessing is not just the end of the Cold War, or the passing of a particular period of postwar history, but the end of history as such: that is, the end point of mankind’s ideological evolution and the universalization of Western liberal democracy as the final form of human government.” Fukuyama must have known how controversial this claim was, but he never could have anticipated the impact his essay would have or how grossly it would be misrepresented. What’s remarkable about “The End of History?” is how fundamentally …

COVID-19 Superspreader Events in 28 Countries: Critical Patterns and Lessons

In 1899, a German bacteriologist named Carl Flügge proved that microbes can be transmitted ballistically through large droplets that emit at high velocity from the mouth and nose. His method for proving the existence of these “Flügge droplets” (as they came to be known) was to painstakingly count the microbe colonies growing on culture plates hit with the expelled secretions of infected lab subjects. It couldn’t have been pleasant work. But his discoveries saved countless lives. And more than 12 decades later, these large respiratory droplets have been identified as a transmission mode for COVID-19. Flügge’s graduate students continued his work into the 20th century, experimenting with different subjects expelling mucosalivary droplets in different ways. Eventually they determined, as a 1964 report in the Proceedings of the Royal Society of Medicine put it, that the quantity of expelled Flügge droplets varies markedly based on the manner of respiration: “Very few, if any… droplets are produced during quiet breathing, but [instead, they] are expelled during activities such as talking, coughing, blowing and sneezing.” A single heavy …

COVID-19’s Gender Gap

When Hilary Clinton said in 1998 that “women have always been the primary victims of war,” it sent a chill down the spine of many. It is a questionable piece of emotional accounting to calculate that, even though men die in greater numbers than women—often after being drafted unwillingly into combat—the impact on women is greater because they lose male relatives, become refugees, and are left with the responsibility of raising children alone. But if you think Clinton’s accounting was reasonable, then you will have no problem with the narrative around the gender death gap in the COVID-19 coronavirus pandemic. You might have noticed that in the media (for example, the BBC, the Guardian), and even in the world of health (for example, the World Health Organisation and the Lancet), a commonly recurring narrative has developed around the pandemic: More men are dying, but the real victims are women. Moreover, this narrative usually implies that men’s deaths are largely due to men’s poor decisions about health behaviour. Are men’s deaths their own fault? The Lancet …

Long-Distance Love during Lockdown

I was going to start this essay by writing that, even at the best of times, long-distance relationships are difficult. But that’s not true at all. At the best of times, a long-distance relationship is wonderful, even ideal. After all, my boyfriend and I are both grown-ups. We have our own incomes, our own homes, and our own children. We have our lives figured out, and I am quite content to manage my affairs on my own, and to have my own space to breathe in. Spending time with him is always something to look forward to, and it is always exciting. He travels a fair amount for work, and that is usually when we see each other. What could be better for a hard-working single parent than romantic getaways to exciting cities, luxury hotels, and fine restaurants? Harried mom by day, Bond girl by night. That is how our relationship makes me feel. I’m happy with the distance, most of the time—even longing for someone who is far away has its own romance. Yet …

Viral Politics

Long after the pandemic has receded, its long-term impact on our society and political life will continue. Just as plagues past have reshaped the trajectory of cities and civilizations, sometimes with fearsome morbidity, COVID-19 is already having a profoundly disruptive impact on our political future. Rather than uniting humanity against a common foe, the pandemic seems to be widening the internal political chasm between nations and within them. The “battle,” “war,” or “crusade” against the novel coronavirus has not to date reprised the London Blitz, Pearl Harbor, or the World Trade Center attack in 2001, during which people closed ranks, even if they thought little of their country’s leaders. Democrats like party strategist James Carville and Speaker Nancy Pelosi insist that Trump has “blood on his hands” and one of Pelosi’s more excitable colleagues has suggested that Trump be tried in The Hague for his handling of the pandemic. On the Right, meanwhile, the pandemic has engendered, in the US and elsewhere, a predictably anti-China and nativist tone, which have sometimes drifted into overt racism, …