Divest from & ban fossil fuels (flat carbon-fee dividend)

 Throughout the 1980s, there were organized student protests at American universities against Apartheid in white-ruled South Africa. 

The common goal of such protests was to get the university to remove corporations involved in South Africa’s economy from the university’s financial investments.

The campus anti-apartheid protests were often large and turbulent. 

There have been no such widespread and intense protests in the current age of global warming to get universities to divest from fossil fuels. 

There have been protests for divestment, and some schools like Harvard have divested from investing in fossil fuels.

Nevertheless, fossil fuels divestment has not captured the attention of the nation the way Apartheid protest did in the 1980s — and the way civil rights did in 2020.

How to explain this relative acquiescence on campus?

There might be numerous reasons, but one reason might be that it is easier to sympathize with people when they are far away.

Historians have noted the similarities of Hollywood stars adopting children in developing countries with Roman aristocrats establishing orphanages in Africa and the Middle East.

Romans at the time slyly observed that the poor of Rome never received that kind of generosity from those who aided foreign orphans.

People can be concerned for those who are far away in either space and time yet remain indifferent toward or afraid of those same kinds of people when they are up close.

For example, homelessness in one’s own town reminds us of our own guilt and culpability, as well as the complexity of the issue and the lack of simple solutions.

But this can be taken even further.

It seems like people are often more concerned for the disadvantaged in distant lands than they are for themselves.

One can become passionately idealistic about injustice abroad with the ease of gasoline being ignited.

In contrast, sustained awareness of the vulnerability of one’s own way of life — and one’s own existence — to a global issue is too horrible to think about.

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There is a remarkable absence of protests against universities’ investments in the fossil fuel industry compared to protest in the past over other things that are largely forgotten (such as student protests for divestment from apartheid-era South Africa). 

There are also fewer protests than one would expect against banks that invest in fossil fuels. 

JP Morgan Chase is a classic case.

• Chase is the leading bank in terms of financing the fossil fuels industry.
• In 2020, it announced that it would cease to invest in coal companies.
• In 2021, it provided Russia’s Gazprom with $1.1 billion in fossil fuel financing. 
• In October of 2021, it announced that it would reach net-zero emissions from its lending and investment portfolios by 2050.

It would seem that JP Morgan Chase launched a 30-year plan in 2020 to gradually move away from fossil fuels and this plan commenced with ending financing for coal.

Skimming through the internet, however, it does not seem that JP Morgan Chase has released their exact timeline for divesting from fossil fuels.

Perhaps JP Morgan Chase is now focused on gradually divesting from the oil industry and will later divest from natural gas investments.

Again, there seems to be relatively little public pressure on universities and banks to divest from fossil fuels.

At the very least, one might expect there would at least be some minimal pressure to get the banks to divulge the timeline of their divestment from fossil fuels.

But even that does not seem to exist.

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JP Morgan Chase has a 30-year timeline to divest from fossil fuels that was launched in 2020.

JP Morgan Chase no longer finances the coal industry.

However, this might not be such an accomplishment because natural gas had begun to underprice coal in 2012.

Can JP Morgan Chase’s plan for divestment from fossil fuels be accelerated and the time frame shortened?

How quickly could America get off fossil fuels?

It has been argued that the US already has everything it needs to decarbonize by 2035.

.https://www.vox.com/energy-and-environment/21349200/climate-change-fossil-fuels-rewiring-america-electrify

Despite the titanic effort it would take to decarbonize, the US doesn’t need any new technologies and it doesn’t require any grand national sacrifice. All it needs, in this view, is a serious commitment to building the necessary machines and creating a regulatory and policy environment that supports their rapid deployment.

In a nutshell, he has shown that it’s possible to eliminate 70 percent to 80 percent of US carbon emissions by 2035 through rapid deployment of existing electrification technologies, with little-to-no carbon capture and sequestration. Doing so would slash US energy demand by around half, save consumers money, and keep the country on a 1.5° pathway without requiring particular behavior changes. Everyone could still have their same cars and houses — they would just need to be electric.

Specifically, it is possible to reduce US emissions 70 percent to 80 percent by 2035 (and to zero by 2050) through rapid electrification, relying on five already well-developed technologies: wind and solar power plants, rooftop solar, electric vehicles, heat pumps, and batteries.

Second, to decarbonize in time, substitution of clean-energy technologies for their fossil-fuel counterparts must ramp up to 100 percent as fast as possible, after a brief period of industrial mobilization. Every time a gas or diesel car is replaced, it must be replaced with an EV; every time an oil or gas furnace is replaced, it must be replaced with a heat pump; every time a coal or gas power plant goes offline, it must be replaced with renewable energy.

This perspective helps to inform a couple of provisional goals:

• American universities must divest from fossil fuels immediately — as a moral imperative based on the unique societal mission of universities.
• All American banks must divest completely from fossil fuels by 2035 based on what seems to be possible even by relying on current technology.

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American universities and banks must divest from fossil fuels.

Could fossil fuels be banned?

According to the internet, there are currently moves to ban: 

• advertising and sponsorships by fossil fuels companies;
• fossil fuel use in new buildings;
• new fossil fuel leasing and permitting on public land.

Politically, the first two initiatives might be possible.

But ceasing to develop oil and gas on public lands might backfire politically.

That’s a lot of jobs that would be sacrificed.

Would it be possible to ban imports of fossil fuels?

And in which time frame?

A legislative proposal in California would ban oil from problematic countries.

https://www.10news.com/news/in-depth/in-depth-bill-would-ban-most-foreign-oil-in-california

SAN DIEGO (KGTV) – A new bill in the California Legislature would effectively ban almost all of the foreign oil imported into California.

Senate Bill 1319 would prohibit oil imports “if the source of the oil is a foreign nation with demonstrated human rights abuses… or a foreign nation with environmental standards that are lower than those in California.”

State Sen. Shannon Grove, a Republican from Bakersfield, is the sponsor. She says the bill would help the environment by favoring oil produced in California, which has stricter environmental rules for drilling and oil production.

“What you can do is produce oil under the strictest and most environmental quality regulatory processes to make it safe,” she says.

According to the California Energy Commission, the state imported 56.2% of its oil from foreign countries in 2021. Alaska provided 14.9% of California’s oil. In-state oil accounted for 28.9%. Grove says the state should decrease its dependence on foreign oil to help the environment and the economy.

This might suggest a timeframe for banning foreign fossil fuels from the USA:

• Immediately ban foreign fossil fuels that originate from problematic countries (Russia, Brazil, Saudi Arabia).
• Ban all foreign fossil fuels by 2035.

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A carbon tax is a tax levied on the carbon emissions required to produce goods and services.

https://en.wikipedia.org/wiki/Carbon_tax

Carbon taxes are intended to make visible the “hidden” social costs of carbon emissions, which are otherwise felt only in indirect ways like more severe weather events. In this way, they are designed to reduce carbon dioxide (CO2) emissions by increasing prices of the fossil fuels that emit them when burned. This both decreases demand for goods and services that produce high emissions and incentivizes making them less carbon-intensive.^[1] In its simplest form, a carbon tax covers only CO₂ emissions; however, it could also cover other greenhouse gases, such as methane or nitrous oxide, by taxing such emissions based on their CO₂-equivalent global warming potential.^[2] When a hydrocarbon fuel such as coal, petroleum, or natural gas is burned, most or all of its carbon is converted to CO
2. 

In a way, a carbon tax is not really a tax but rather a fee that compensates for the “negative externalities” that are imposed on the public by private economic activity.

In fact, pollution is the classic example of a negative externality.

Greenhouse gas emissions cause climate change, which damages the environment and human health. This negative externality can be reduced by taxing carbon content at any point in the product cycle.

It’s been argued that suppressing demand by imposing carbon fees is really the only way to alter behavior to limit carbon emissions.

This is because attempts to lower fuel consumption by increasing efficiency only backfire because increased efficiency lowers prices and thus stimulates consumption.

For example, when highly efficient machinery that burned less coal was installed in British factories, coal consumption did not fall as expected.

https://en.wikipedia.org/wiki/Jevons_paradox

In economics, the Jevons paradox (/ˈdʒɛvənz/; sometimes Jevons effect) occurs when technological progress or government policy increases the efficiency with which a resource is used (reducing the amount necessary for any one use), but the falling cost of use increases its demand, negating reductions in resource use.During the Industrial Revolution, it was believed that highly efficient machines that would use less fuel and so less coal would be consumed.

This is because demand for those goods increased because the price of those goods had fallen thanks to less coal being consumed in their production.

The issue has been re-examined by modern economists studying consumption rebound effects from improved energy efficiency. In addition to reducing the amount needed for a given use, improved efficiency also lowers the relative cost of using a resource, which increases the quantity demanded. This counteracts (to some extent) the reduction in use from improved efficiency. Additionally, improved efficiency increases real incomes and accelerates economic growth, further increasing the demand for resources. The Jevons’ effect occurs when the effect from increased demand predominates, and the improved efficiency results in a faster rate of resource utilization.

Considerable debate exists about the size of the rebound in energy efficiency and the relevance of the Jevons’ effect to energy conservation. Some dismiss the effect, while others worry that it may be self-defeating to pursue sustainability by increasing energy efficiency.^[3] Some environmental economists have proposed that efficiency gains be coupled with conservation policies that keep the cost of use the same (or higher) to avoid the Jevons’ effect.^[6] Conservation policies that increase cost of use (such as cap and trade or green taxes) can be used to control the rebound effect.

In a very American example, the government imposes fuel standards upon the automotive industry, and this has led to breakthroughs in automobile fuel efficiency.

However, contrary to the intentions of the US government, as American vehicles have become much more fuel efficient, they have become much larger because they are cheaper to operate.

• For example, the average fuel efficiency of a VW Beetle in 1972 was about 22 miles per gallon. 
• Fifty years later, the 3.3 liter V-6 Ford F-150 gets 24 mpg on the highway.

Likewise, when people do buy a compact car, they end up burning just as much fuel as they used to because now they drive around more.

Only a rise in the price of fuel can get the public to adopt a lifestyle in which they are cutting back on fuel consumption — the way they did after the oil shocks in 1973 and 1978 (and 2008).

However, raised fuel prices can lead to civil strife.

France is a case in point.

The French government made a push for carbon fees in 2009.

https://en.wikipedia.org/wiki/Carbon_tax#France

In 2009, France detailed a carbon tax with a levy on oil, gas, and coal consumption by households and businesses that was supposed to come into effect on 1 January 2010. The tax would affect households and businesses, which would have raised the cost of a litre of unleaded fuel by about four euro cents (25 US cents per gallon). The total estimated income from the carbon tax would have been between €3–4.5 billion annually, with 55 percent from households and 45 percent from businesses. The tax would not have applied to electricity, which in France comes mostly from nuclear power.

However, from the beginning there was pushback from one segment of the French population.

On 30 December 2009, the bill was blocked by the French Constitutional Council, which said it included too many exceptions. Among those exceptions, certain industries were excluded that would have made the taxes unequal and inefficient. They included exemptions for agriculture, fishing, trucking, and farming. French President Nicolas Sarkozy, although he vowed to “lead the fight to save the human race from global warming”, was forced to back down after mass social protests led to strikes. He wanted support from the rest of the European Union before proceeding.

Carbon fees were finally implemented in France in 2014.

In 2014, a carbon tax was implemented. Prime Minister Jean-Marc Ayrault announced the new Climate Energy Contribution (CEC) on 21 September 2013. The tax would apply at a rate of €7/tonne CO2 in 2014, €14.50 in 2015 and rising to €22 in 2016.^[114] As of 2018, the carbon tax was at €44.60/tonne.^[115] and was due to increase every year to reach €65.40/tonne in 2020 and €86.20/tonne in 2022.

The planned gradual increase in carbon fees led to violent and prolonged rebellion by a segment of the French population.

After weeks of protests by the “Gilets Jaunes” (yellow vests) against the rise of gas prices, French President Emmanuel Macron announced on 4 December 2018, the tax would not be increased in 2019 as planned.

Journalists and French authorities closely examined the dynamics of the “yellow vest” protests.

The protesters were found to be working-class people who lived in small houses outside the city and commuted to work in their cars.

This is exactly the lifestyle that they want, and they do not want to live in the city in an apartment near their work, nor do they want to commute on mass transit.

Entertainment is dear to them, and once a week they like to eat out or go to the movies or attend a sporting event.

As carbon fees rise slightly, they can still get by, but they cannot afford their modest entertainment and so existence becomes unbearable to them.

They then become agitated and violent and threaten the stability of the French republic.

Carbon fees are therefore absolutely necessary yet politically unacceptable.

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There is one conceptual advantage to insisting that so-called “carbon taxes” are really fees.

It offers a way to make carbon taxes (fees) politically palatable.  

A tax has the primary purpose of raising revenue. By contrast, a fee recoups the cost of providing a service from a beneficiary.

• In other words, taxes exist to fund government goods and services, like the military.
• In contrast, fees for negative externalities like pollution reimburse those who are negatively impacted and deter those who are imposing the externalities.

The biggest problem with carbon “taxes” is that they are “regressive” because they have a disproportionate impact on less affluent people. 

This is because fuel expenditures (for transportation and home energy) make up a larger percentage of the household budgets of people who are socioeconomically disadvantaged.

The proposal:

Carbon fees would be returned to the American people in the form of a dividend that would be the same amount for all Americans.

For example, if carbon fees brought in $2,000 a year to the government for every American, then the dividend would be worth a flat $2,000.

https://en.wikipedia.org/wiki/Carbon_fee_and_dividend

A carbon fee and dividend or climate income is a system to reduce greenhouse gas emissions and address climate change. The system imposes a carbon tax on the sale of fossil fuels, and then distributes the revenue of this tax over the entire population (equally, on a per-person basis) as a monthly income or regular payment.Designed to maintain or improve economic vitality while speeding the transition to a sustainable energy economy, carbon fee and dividend has been proposed as an alternative to emission reduction mechanisms such as complex regulatory approaches, cap and trade or a straightforward carbon tax. While there is general agreement among scientists and economists on the need for a carbon tax, economists are generally neutral on specific uses for the revenue, though there tends to be more support than opposition for returning the revenue as a dividend to taxpayers.

This refund would not consist of a once-a-year payout after taxes had been filed.

Rather, Americans would receive a monthly deposit in their bank account.

After all, the French “yellow jackets” show how sensitive much of the public can be to being deprived of even a small amount of “beer money” due to carbon taxes.

People need to be reimbursed on a more frequent basis.

The “fair tax” scheme provides a model.

https://en.wikipedia.org/wiki/FairTax#Monthly_tax_rebate

Monthly tax rebate

The rebate is meant to eliminate the taxation of household necessities and make the plan progressive. Households would register once a year with their sales tax administering authority, providing the names and social security numbers of each household member. The Social Security Administration would disburse the monthly rebate payments in the form of a paper check via U.S. Mail, an electronic funds transfer to a bank account, or a “smartcard” that can be used like a debit card.

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One problem with universal flat carbon-fee dividends is that millions of Americans do not have access to a bank account.

These adults who do not have their own bank accounts are referred to as the unbanked.

The unbanked are described by the Federal Deposit Insurance Corporation (FDIC) as those adults without an account at a bank or other financial institution and are considered to be outside the mainstream for one reason or another. 

https://en.wikipedia.org/wiki/Unbanked

One report found the nationwide rates to be 7.7% unbanked and 17.9% underbanked, with the most unbanked state Mississippi, at 16.4%. 

The Federal Reserve estimated there are 55 million unbanked or underbanked adult Americans in 2018, which account for 22 percent of U.S. households.

Places where over 20% of residents have no bank accounts include Miami, Florida; Detroit, Michigan; Laredo, Texas; Newark, New Jersey; Hialeah, Florida; Hidalgo County, Texas; The Bronx; and Cameron County, Texas. 

Many counties with fewer than 100,000 residents had even higher rates, including Starr County, Texas, at 32.7%. Some census tracts in Savannah, Georgia; Cleveland, Ohio; Nashville, Tennessee; and Atlanta, Georgia had over 40% unbanked residents.

Some reasons a person might not have a bank account include:

• Lack of access via a nearby bank branch or mobile phone
• Minimum balance fees
• Distrust of the banking system, typically due to lack of transparency regarding fees and deposit timing
• No access to government-issued ID, which is required to open a bank account

Being unbanked is sometimes by choice.

It is an expensive choice.

https://www.investopedia.com/terms/u/unbanked.asp

Why Is Being Unbanked a Problem?

Being unbanked can be undesirable for several reasons. Alternative financial services, such as cash-checking services and payday loans, are much more costly. What’s more, without a bank account, people don’t generate the data they need to establish creditworthiness. As a result, when it comes time to cover an emergency car repair or medical bill, a payday loan may be their only option. These extra costs significantly hurt families who are already struggling to make ends meet.

So why do people not open a bank account?

Understanding the Unbanked

Unbanked people generally pay for things in cash or else purchase money orders or prepaid debit cards. Unbanked people also typically do not have insurance, pensions, or any other type of professional money-related services. They may take advantage of alternative financial services, such as check-cashing and payday lending, if such services are available to them.

Why People Become Unbanked

The main reason for being unbanked, according to the FDIC study, is cost—those who are unbanked can’t meet banks’ minimum requirement balances. Another way of looking at it: Traditional banks don’t provide access to the financial services and products unbanked populations need. For instance, someone living paycheck-to-paycheck with very low or volatile income, may not be able to wait for a paycheck to clear at a bank. So they turn to a check-cashing service, which will provide cash immediately, albeit for a fee.

In neighborhoods that are “bank deserts,” such alternative financial services are also likely more common and open longer hours—in other words, more accessible and convenient than arranging for transportation to and from bank branches during limited banking hours. These high transaction costs (e.g. time/cost to visit bank branches, inconvenient hours), lack of clarity about fees, and alternative products that provided a more compelling value proposition have all been identified as reasons people are unbanked.

Lack of trust in banking institutions can also come into play. Distrust was the second main reason cited in the FDIC study for being unbanked—not surprising given the history of lending discrimination experienced by Blacks and Latinx in the U.S. and the lingering inequities. For instance, predominantly Black and Latinx neighborhoods have been targeted for predatory lending, including subprime mortgages. Recent immigrants who experienced banking crises in their countries of origin may also lack trust in banks.

The “underbanked” are an example of people who have bank accounts but choose to use more expensive methods to transfer money.

Again, they make up almost one-fifth of the American population.

Unbanked vs. underbanked

Underbanked is a related term. It refers to families who have checking or savings accounts but often rely on alternative financial services such as money orders, check-cashing services, and payday loans, as opposed to traditional loans and credit cards, to manage their finances.

In terms of universal flat carbon-fee dividends, the underbanked already do have access to bank accounts where their dividends could be forwarded.

Ingrained pandemic misperceptions

 In February of 2020:

• The Diamond Princess cruise ship anchored in Yokohama was a site of Covid superspreading.
• South Korea experienced Covid superspreading in a church, which soon infected a city and province. 

Thanks to these superspreader events, Japan and South Korea figured out very early on that the virus must have been airborne and not bound in droplets that contaminate surfaces.

In August of 2020, New Zealand Prime Minister Jacinda Ardern constructed her own homemade face covering out of fabric. The assumption behind this act was the droplet transmission theory, because a face covering will inhibit the transmission of big droplets but not tiny viral particles that linger in the air. New Zealand is today lauded for its rigorous Covid response, but it was very different from that of other western Pacific nations like Taiwan. Economically advanced countries with strong agricultural sectors like Australia and New Zealand are familiar with disease outbreaks among livestock and the need for quarantine. Thus, these countries relied on strict border closures nationally and regionally to halt Covid. But looking at their policies one gets the sense they did not seem to recognize the airborne nature of the virus.

https://www.reuters.com/article/us-health-coronavirus-newzealand/new-zealands-ardern-takes-mask-making-into-her-own-hands-ahead-of-virus-measure-idUSKBN25O0X2

It was not until November 2021 that the World Health Organization changed its website to officially recognize that Covid was being transmitted through the air and not through surface contamination via droplets. In other words, only a year after the vaccines had become available did the world’s foremost health authority admit the obvious.

But many people today are still acting as if Covid is spread via droplets. For instance, 

• Studies have shown that quality high-filtration masks like the N95 that are snugly worn are extremely effective at protecting from Covid, yet
• Other studies show that mask mandates do not work because people wear loose cloth masks or surgical masks, and/or wear them wrong (for example, below the nose).

The public then assumes that masks just don’t work.

Yet wearing a mediocre mask and wearing it sloppily does make sense if one assumes as the West did — and perhaps still does — that the virus spreads via droplet transmission. That is, if it is droplet transmission, then loosely covering the mouth will probably do the job to protect others from one’s own droplets. 

And so the droplet transmission dogma persists, no longer among Western scientists but semi-consciously among the population. Perhaps it was never adequately explained to Westerners that they can stop washing their hands because the problem is in the air and not on surfaces. That is, they sort of understand that the virus is airborne — but not enough to change their behavior. This might influence how they react to the next major pandemic in 10 to 20 years from now in the current globalized and highly populated “age of pandemics”. In fact, it might affect how they do or do not react to a dangerous new Covid variant a year from now.

https://www.nature.com/articles/d41586-022-00925-7

Why the WHO took two years to say COVID is airborne

Early in the pandemic, the World Health Organization stated that SARS-CoV-2 was not transmitted through the air. That mistake and the prolonged process of correcting it sowed confusion and raises questions about what will happen in the next pandemic.

As 2021 drew to a close, the highly contagious Omicron variant of the pandemic virus was racing around the globe, forcing governments to take drastic actions once again. The Netherlands ordered most businesses to close on 19 December, Ireland set curfews and many countries imposed travel bans in the hope of taming the tsunami of COVID-19 cases filling hospitals. Amid the wave of desperate news around the year-end holidays, one group of researchers hailed a development that had seemed as though it might never arrive. On 23 December, the World Health Organization (WHO) uttered the one word it had previously seemed incapable of applying to the virus SARS-CoV-2: ‘airborne’.

“We’re really talking here about two failures, not one,” says Sandman. “Being reluctant to change your mind, and being reluctant to tell people you changed your mind.” Like other public-health and scientific organizations, the WHO “are afraid of losing credibility by acknowledging that they got something wrong”, he says.

Again, one of the questions raised is how the world will react to the next pandemic judging by the incompetence and dishonesty of public health authorities during the Covid pandemic.

A related question is the issue of “moral hazard”, which is lack of incentive to guard against risk where one is protected from its consequences.

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If Americans have been behaving as though Covid spreads through droplet contamination of surfaces rather through airborne transmission, a similar misconception seems to be rampant in the perception of Covid vaccines. 

That is, at some semi-conscious level, many Americans seem to assume that vaccination is actually “variolation” involving exposure to the virus via the vaccine.

Once upon time inoculation meant exposure to an intact virus.

This is known as “variolation” and it was risky indeed.

.https://www.immune.org.nz/vaccines/vaccine-development/brief-history-vaccination

The practice of immunisation dates back hundreds of years. Buddhist monks drank snake venom to confer immunity to snake bite and variolation (smearing of a skin tear with cowpox to confer immunity to smallpox) was practiced in 17th century China. Edward Jenner is considered the founder of vaccinology in the West in 1796, after he inoculated a 13 year-old-boy with vaccinia virus (cowpox), and demonstrated immunity to smallpox. In 1798, the first smallpox vaccine was developed. Over the 18th and 19th centuries, systematic implementation of mass smallpox immunisation culminated in its global eradication in 1979.

Over time, vaccines became safer, though in some cases the virus was still intact albeit attenuated.

Louis Pasteur’s experiments spearheaded the development of live attenuated cholera vaccine and inactivated anthrax vaccine in humans (1897 and 1904, respectively). Plague vaccine was also invented in the late 19th Century. Between 1890 and 1950, bacterial vaccine development proliferated, including the Bacillis-Calmette-Guerin (BCG) vaccination, which is still in use today. 

In 1923, Alexander Glenny perfected a method to inactivate tetanus toxin with formaldehyde. The same method was used to develop a vaccine against diphtheria in 1926. Pertussis vaccine development took considerably longer, with a whole cell vaccine first licensed for use in the US in 1948.

Viral tissue culture methods developed from 1950-1985, and led to the advent of the Salk (inactivated) polio vaccine and the Sabin (live attenuated oral) polio vaccine. Mass polio immunisation has now eradicated the disease from many regions around the world

This website was last updated in January 2020, and so there is no mention of the mRNA vaccines which were developed over a 20 year period and applied to the Covid virus. 

The mRNA vaccines are a whole different deal from the old vaccines in that no virus or bacteria is being introduced into the body.

All vaccines are a way to introduce the body to its new enemies — much like the “America’s Most Wanted” posters at the post office.

The old vaccines can be compared to the captured aliens in the movie “Independence Day”.

• Will Smith’s character brought in a live one they could talk to.
• The military had a few dead aliens in Area 51 they were studying.

In contrast, the new mRNA vaccines are like a 3D printer that produces a lifelike dummy of a space alien.

That is, your body once vaccinated by the mRNA vaccines creates a chunk of harmless flesh that looks like a part of the Covid virus.

It’s a whole new level of safety. 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html

To trigger an immune response, many vaccines put a weakened or inactivated germ into our bodies. Not mRNA vaccines. Instead, mRNA vaccines use mRNA created in a laboratory to teach our cells how to make a protein—or even just a piece of a protein—that triggers an immune response inside our bodies. This immune response, which produces antibodies, is what helps protect us from getting sick from that germ in the future.

One issue that contributes to vaccine resistance might be the roots of vaccination in variolation.

The point being made here is that vaccine resistance is not purely irrational but has very rational roots that go back to the very real risks posed by variolation.

https://www.washingtonpost.com/history/2020/12/12/abigail-adams-smallpox-coronavirus-vaccine/

The future first lady feared inoculation, but she feared smallpox more.

It was 1776, and Abigail Adams had decided that she and her four children would seek protection from a deadly epidemic. Her husband, John Adams, was in Philadelphia, where the Declaration of Independence had just been announced.

A smallpox inoculation involved a controversial treatment: infecting the recipient with a mild case of the deadly disease.

“God grant that we may all go comfortably through the Distemper,” Abigail wrote her husband.

Some people still fear vaccines because at some semi-conscious level they think they are being exposed to live pathogens when they are being vaccinated.

The experience of being vaccinated often confirms that false intuition because of its side effects.

The vaccination alerts the body’s defenses to an invasion and this triggers an immune response — which can be a pretty rough ride because your body is now mobilizing for war.

However, the subjective experience of being vaccinated can trigger a misperception.

It feels as if one has been infected by the vaccine — and that the side effects of the vaccine mean that the pathogen is growing within you.

In fact, it could be argued that we all sort of feel that we have been infected after a vaccination when we are in the throes of its side effects — but later we remind ourselves otherwise.

The point here is that there is a need to move away from the dichotomy of rational scientists versus the irrational public.

Everybody is semi-rational.

After all, the prevalence of the droplet transmission dogma among scientists in the West during the first two years of the Covid pandemic illustrates how science is a human endeavor.

(HBO “John Adams”, small pox variolation in 1776)

.https://youtu.be/TWxDLG9_eOU

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There seems to be a distinct difference between the outlook of physicians and scientists.

This distinction might make physicians — in particular, emergent care physicians — better judges of how to deal with a pandemic.

In a nutshell, physicians deal with ambiguity, whereas scientists seek to overcome it.

The ambiguity over how to prescribe Paxlovid illustrates how physicians have to negotiate with uncertainty.Paxlovid (nirmatrelvir/PF-07321332 and ritonavir) is an oral antiviral drug that should be initiated as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset. Paxlovid is available for patients by prescription only. Prescriptions can be obtained from your healthcare provider or through the Test to Treat program.

Paxlovid is intended for high-risk groups.

https://aspr.hhs.gov/COVID-19/Therapeutics/Products/Paxlovid/Pages/default.aspx

Paxlovid is authorized for the treatment of mild to moderate COVID-19 in adult and pediatric patients age 12 years and older weighing at least 40 kg, with a positive SARS-CoV-2 test, who are at high risk for progressing to severe COVID-19, including hospitalization or death.

https://www.michigan.gov/coronavirus/resources/therapeutics-information-page/general-information/antiviral/content/paxlovid-information-for-the-public

How do I know if I am a candidate for PAXLOVID?

Your healthcare provider will determine if you are a candidate for PAXLOVID. If you are immunocompromised or not up to date on your COVID-19 vaccine you should consider this therapy. Those with the following conditions are at increased risk of COVID-19 severe symptoms:

• Older age (for example ≥65 years of age)
• Obesity or being overweight (e.g., BMI >25 kg/m2), or BMI ≥85th percentile pediatrics
• Pregnancy
• Chronic kidney disease
• Diabetes
• Immunosuppressive disease or immunosuppressive treatment
• Cardiovascular disease (including congenital heart disease) or hypertension
• Chronic lung diseases (e.g., COPD, moderate to severe asthma, etc.)
• Sickle cell disease
• Neurodevelopmental disorders (e.g., cerebral palsy) or other complexity conditions
• Medical-related technological dependence (e.g., tracheostomy, gastrostomy)
• Other conditions identified by the CDC for the person at risk for disease severity

Is there anything I need to tell my healthcare provider before PAXLOVID is prescribed?

Please let your health care provider know if any of the following apply:

• Allergies.
• Liver or kidney disease.
• If you are pregnant or plan to become pregnant.
• Are breastfeeding.
• Have any serious illness or medical history.
• If you are taking oral contraceptives.
• Provide your provider with a list of all your current medications.

Like all antivirals, Paxlovid works best early in the course of an illness—in this case, within the first five days of symptom onset.

https://www.yalemedicine.org/news/13-things-to-know-paxlovid-covid-19

You take three Paxlovid pills twice daily for five days for a full course that adds up to 30 pills. It helps that the pills are packaged in a “dose card,” basically a medication blister pack that allows you to punch out the pills as needed. 

When it applied for FDA authorization, Pfizer presented data from a clinical trial conducted between mid-July and early December in 2021. The data showed that participants (all of whom were unvaccinated) who were given Paxlovid were 89% less likely to develop severe illness and death compared to trial participants who received a placebo.

Physicians are dealing with the uncertainty of prescribing Paxlovid.

https://www.statnews.com/2022/07/07/paxlovid-prescribing-covid19-rebounds-data/

Physicians generally agree that certain high-risk patients — including people who are unvaccinated or those over 65 with multiple comorbidities — should always be prescribed the drug. But the broader eligibility makes it difficult for some physicians to decide who should or should not receive Paxlovid. A child is not likely to need it, but what about a healthy 50-year-old man? A 65-year-old woman? The experts STAT spoke with didn’t agree.

Some physicians are more conservative when recommending Paxlovid, though they still encourage older patients with one or more comorbidities to accept it. 

For them, it’s the borderline cases — like patients who are older, but otherwise in good health — that are tricky. The disease can manifest in many different ways in different patients, and Paxlovid, like any drug, does come with potential side effects.

Differences have also emerged in the timing of prescribing. Myron Cohen, an infectious diseases specialist and prominent HIV researcher at the University of North Carolina at Chapel Hill, advocates starting on Paxlovid immediately. “The conversation’s a pretty short conversation,” said Cohen. “The data that’s available suggests that if you want to have the maximum benefit of this drug and you want to try to reduce long Covid, that the sooner you take it after you test positive, the smarter you probably are.”

Smith, the UCSD professor, said he’s seen physicians prescribe the drug after a patient is exposed but before they test positive, “even though the study is fairly clear it didn’t have a benefit as prophylaxis.”

Conversely, Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco, speculated that giving Paxlovid early may not give the immune system enough time to ramp up and prepare itself for when the drug tapers off, which he worries may increase the risk of a rebound. (There is no research yet to demonstrate this is the case.) “For someone that I think of as being a borderline candidate, I would say the majority outcome is — if it’s on day one or two — is let’s wait three. … We have till day five to take this,” said Wachter. “Let’s wait until day four and see how you’re doing and if you’re feeling well, don’t take it. If you’re still feeling really bad, then it’s reasonable to take it.” Of Wachter’s patients who followed his advice, some did end up taking the drug. But for “the majority of people,” symptoms were minimal by day three and Paxlovid was not necessary.

Wachter said he’d follow the same advice he gives patients. “I’m 64, I’ve had two boosters — two vaccines and two boosters,” said Wachter. “I think if I got Covid today, I would still take Paxlovid. And would I wait a day or two? I wouldn’t rush to get it on day one. I might wait for day two or three.”

But other physicians disagree about waiting. The first and largest study of Paxlovid treated patients within three days of their experiencing symptoms, so the five days in the emergency authorization already offers leeway, they say, that isn’t as well-supported by the scientific evidence. “Our knowledge is greater about early use than late use. So that kind of ‘let’s see how you do’ doesn’t really make sense to me except in people in whom you don’t think they need Paxlovid,” explained Cohen, the UNC-Chapel Hill physician. Cohen said he and colleagues in his practice prescribe as soon as possible to patients who they believe need Paxlovid.

There is also debate over how long a patient should be prescribed Paxlovid.

In perhaps the highest-profile case of a Covid-19 rebound, Anthony Fauci, the Biden administration’s chief medical adviser, recently experienced rebound after a first course of Paxlovid and received a second regimen of the drug as a result. It’s an unusual move, and one that had experts conflicted. None of the physicians STAT spoke with have prescribed Paxlovid for a patient experiencing rebound, primarily because rebound cases often resolve on their own and rarely progress to a hospitalization or death. But it was unclear to them whether the emergency use authorization allowed a second course, with some physicians stating this was up to each individual state’s medical board and others arguing both sides.

“Some pharmacists have been pretty assiduous,” said Cohen. “When I tried on occasion to give a second course of Paxlovid over a short window of time, they basically argued with me and refused it, which is an unusual thing with a pharmacist.” Li, the Brigham and Women’s Hospital physician, pointed out that the wording of the authorization was unclear as to whether a rebound qualified as a new “day zero” of symptom onset.

There seems to be an emerging general sense that the more Covid risk factors a patient has, the sooner they should begin Paxlovid treatment and that the treatment should last longer.

That sort of “general sense” of what to do seems more like how a physician thinks than how a scientist would think.

For a scientist, there is simply the science and the policy that scientific truth demands, and people must follow it because there is no wiggle room when it comes to physical reality. 

Scientists might consequently have a certain rigidity when it comes to public health policy.

Pharmacists are also rigid — for example, when it comes to prescribing Paxlovid — not because of their scientific background but because they strictly follow the directions of the CDC.

For a physician there is all sorts of ambiguity on how the science should be applied.

The results they see don’t always conform to the conclusions of laboratory testing.

There is also the issue of human nature.

If you tell an American teenager not to smoke or drink or take drugs or have sex they will immediately buy some weed and head to the nearest liquor store.

Accepting human nature is built into public health policy, but physicians are probably more likely than scientists to adopt Plan B when doing the right thing just doesn’t fly.

One example might be sending kids to school during the Covid pandemic.

Ideally, students should have been isolated from one another — especially during the early stages of the pandemic when so little was known.

Unfortunately, 70% of Americans were incapable of working from home.

Not going to work would mean losing their homes and winding up in a homeless shelter where they would have contracted Covid.

Moreover, private schools remained open during the pandemic, so even affluent parents who could work from home were often sending their kids to school anyway.

In June 2020, 

the American Academy of Pediatrics made headlines by recommending that elementary through high school students return to school this fall — in a move that surprised government officials and parents alike.

https://www.pbs.org/newshour/health/analysis-why-some-schools-stayed-open-during-the-1918-flu-pandemic

Perhaps one of the symptoms of rigidity in Covid school policy was the lack of innovation, especially in terms of improving ventilation in schools.

During the 1918 “Spanish flu” influenza pandemic some schools remained open but moved classes outdoors and innovated.

https://www.nytimes.com/2020/07/17/nyregion/coronavirus-nyc-schools-reopening-outdoors.html

The point is that pandemic policy is not primarily based on scientific research — but on action informed by science.

Once upon a time, public health agencies like the CDC were designed to mobilize and coordinate public action during pandemics.

For example, when the Epidemic Intelligence Service within the CDC was created in 1951, it was modeled after the CIA. 

https://en.wikipedia.org/wiki/Epidemic_Intelligence_Service

Creation of the Epidemic Intelligence Service was proposed by Dr. Alexander Langmuir, chief of epidemiologic services, communicable disease center at the U.S. Public Health Service on March 30, 1951.^[4] Dr. Langmuir said that it was of utmost importance to planning of appropriate defense measures against biological warfare germs, development of new detection devices, and train laboratory workers for rapid recognition of biological warfare germs.^[4] It arose from biological warfare concerns relating to the Korean War.

There is the possibility that public health authorities nowadays neither understand nor approve of this earlier model of pandemic mobilization.

Today, the cultures of these public health institutions reflect the stately deliberative approach of professors in academia who eternally mull over issues central (or not) to their field.

https://www.nytimes.com/2022/07/30/opinion/monkeypox-public-health-failure.html?smid=tw-share

The C.D.C. should lead America’s response to viral exigencies. But the agency isn’t a crisis organization. It lacks the infrastructure to mobilize a rapid response and is too hidebound and process driven to move quickly. Its cultural instinct is to take a deliberative approach, debating each decision. With Covid, the virus ‌‌gained ground quickly. With ‌‌monkeypox, which spreads more slowly, typically through very close contact, the shortcomings of C.D.C.’s cultural approach haven’t been as acute yet. But the shortfalls are the same.

Take the scant information available about the domestic outbreak and how it has spread. The C.D.C. has publicly complained that it can’t compel sufficient reporting from states and that it lacks insight into the scope and nature of reported monkeypox cases. That’s true. But the C.D.C. still possesses information from states that do share case reports, which the agency could have used to provide a better clinical mosaic on how the virus was spreading and presenting to physicians.

The political system has tried to work around this paralysis by creating within itself new institutions — but this might just lead to more paralysis when there is a crisis.

That leaves it up to the Biden administration. But its late stab at reform also falls short. It has effectively created an agency out of an office inside ‌the Department of Health and Human Services that is charged with coordinating the federal response to bioterrorism, among other things. The reordering puts the new Administration for Strategic Preparedness and Response on equal footing with the C.D.C. It’s a classic Washington response to a problem: create an agency around it. The move will only add to the muddle.The pandemic mission must remain with the C.D.C., which has the requisite tools and expertise to respond to these crises. I know from my time at the F.D.A. that it’s the agencies that have the operational know-how and capabilities. The C.D.C. has the boots on the ground that provide the frontline needs for attacking these kinds of outbreaks, with its sophisticated tools for detection and surveillance. What it lacks is the authority‌ and a national security mind-set.

It’s time to reform the CDC to be the action-oriented institution that it originally was.

The Biden administration needs to get the C.D.C. back to its disease control roots, by transferring some of its disease prevention work to other agencies. The F.D.A. can handle smoking cessation, leveraging its regulatory toolbox. The National Institutes of Health can tackle cancer and heart disease. Focus the C.D.C. more on its core mission of outbreak response. And imbue the agency with the national security mind-set that it had at its origins. If the C.D.C.’s mission were more tightly focused on the elements required for handling contagion, Congress might be more willing to invest it with the robust authority to do that targeted mission well. Congress would need to reprogram budget lines to get it done, but someone needs to start that conversation.

Time is running out. Diseases like Zika, Covid‌ and ‌‌monkeypox are a dire warning that dangerous pathogens are on the march. The next one could be worse — a deadly strain of flu or something more sinister like Marburg virus. We’ve now had ample notice that the nation continues to be unprepared and that our vulnerabilities are enormous.

The American response to the Covid pandemic brings to mind a couple of movies:

• The American public’s response resembled Netflix’s “Don’t Look Up”.
• The response of public health authorities was like HBO’s “Chernobyl”.

And now it just might happen all over again — for multiple emerging pathogenic threats.

Here’s one pet theory as to the cause:

• Elite American universities are out of touch with reality.

https://www.nytimes.com/2022/08/02/opinion/elite-universities-campus.html

• Elite universities are now the model for other elite institutions because people are compelled to adjust their preexisting values, attitudes, beliefs, ideas, and concepts to their institutional environment — most especially the institutions that they were socialized into.

https://en.wikipedia.org/wiki/How_Institutions_Think

https://www.routledge.com/How-Institutions-Think-Routledge-Revivals/Douglas/p/book/9780415684781

First published in 1986 Mary Douglas’ theory of institutions uses the sociological theories of Emile Durkheim and Ludwig Fleck to determine not only how institutions think, but also the extent to which thinking itself is dependent upon institutions. Different kinds of institutions allow individuals to think different kinds of thoughts and to respond to different emotions. It is just as difficult to explain how individuals come to share the categories of their thought as to explain how they ever manage to sink their private interests for a common good.

Douglas forewarns us that institutions do not think independently, nor do they have purposes, nor do they build themselves. As we construct our institutions, we are squeezing each other’s ideas into a common shape in order to prove their legitimacy by sheer numbers. She admonishes us not to take comfort in the thought that primitives may think through institutions, but moderns decide on important issues individually. Our legitimated institutions make major decisions, and these decisions always involve ethical principles.

Ramping up hospital volunteers

 Can a hospital be run mostly with volunteers during a prolonged emergency?

The hypothetical scenario here would be a natural disaster comparable to the recent volcanic eruption in Tonga or Hurricane Maria in Puerto Rico.

• An island in the middle of the ocean far from outside help.
• Population of almost one million people.
• Many medical facilities are clinics located in open areas or near the ocean.
• Fewer than two dozen ambulances (some of which might become incapacitated).
• If the island is hit by a category 3 hurricane with wind speeds between 111 and 129 miles per hour, then 5,000 people would be killed and 20,000 injured.
• The island might be increasingly likely to face a category 5 hurricane with wind speeds over 157 milers per hour, or even over 175 miles per hour.
• The system of public shelters is problematic at best, and (to be honest) perhaps even functionally non-existent.

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The central challenge in this scenario for healthcare would be hospitals becoming overwhelmed with patients, with service disintegrating for all patients.

Moreover, some staff might not able to get to the hospital.

Would it be possible to buttress the nursing staff with an army of volunteers who had very strictly delimited duties?

For example, there would be one category of volunteer that would focus purely on needle-related tasks, such as injections, setting up an IV, and so forth.

Another category of volunteer would work solely on cleaning patients, bathing them, changing the bedpans and the sheets.

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If volunteers could perform half of these tasks during a crisis, it would relieve staff.

There would be administrative challenges, like training large numbers of people during normal times, who would volunteer in hospitals periodically to refresh their skills.

There would be long periods of boredom when a volunteer would not have any tasks to perform, perhaps necessitating the need to branch out into other tasks.

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The line of thinking here is not so much inspired by natural disasters in Puerto Rico or Tonga, as much as by the supply chain disruptions in the USA.

The challenge is to think beyond the quest for ever greater efficiencies that characterize normal times and to find ways to prepare to ramp up for an inevitable yet catastrophic event.

For years, hospital administrators have been cutting back on nurses in order to squeeze out the greatest efficiency from hospital staff.

What is happening in hospitals now is the product of dismissing and ignoring the inevitability of predictable catastrophic “white swan” events.

Even when everyone knows that disaster is going to happen someday, there is complacency and resistance toward preparation and innovation in favor of efficiency during normal times.

https://www.nytimes.com/2022/01/19/opinion/nurses-staffing-hospitals-covid-19.html

We’re entering our third year of Covid, and America’s nurses — who we celebrated as heroes during the early days of lockdown — are now leaving the bedside. The pandemic arrived with many people having great hope for reform on many fronts, including the nursing industry, but much of that optimism seems to have faded.

In the Opinion Video above, nurses set the record straight about the root cause of the nursing crisis: chronic understaffing by profit-driven hospitals that predates the pandemic. “I could no longer work in critical care under the conditions I was being forced to work under with poor staffing,” explains one nurse, “and that’s when I left.” They also tear down the common misconception that there’s a shortage of nurses. In fact, there are more qualified nurses today in America than ever before.

To keep patients safe and protect our health care workers, lawmakers could regulate nurse-patient ratios, which California put in place in 2004, with positive results. Similar legislation was proposed and defeated in Massachusetts several years ago (with help from a $25 million “no” campaign funded by the hospital lobby), but it is currently on the table in Illinois and Pennsylvania. These laws could save patient lives and create a more just work environment for a vulnerable generation of nurses, the ones we pledged to honor and protect at the start of the pandemic.

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The notion that corporate greed lies behind a shortage of nurses might be too moralistic.

Never attribute to avarice that which can be explained by habit.

In the private sector, it only makes sense to limit the hiring of staff in order to keep costs down.

But this logic of the private sector during normal times does not apply to considerations of national security which take into account future crises.

In the military and in public health, a certain bloat might be necessary to allow a rapid ramping up in the face of a sudden crisis.

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Back in 2006, a virologist traveled the world, warning people that pandemics are 100-year events, and the world was due for a major pandemic in 2018.

His big project then was creating a global network of research outposts in the developing world to identify and study viruses when they crossed over from animal to human populations.

In the aftermath of the Covid pandemic, his new project is creating pandemic insurance that major corporations and governments can buy.

https://www.wired.com/story/nathan-wolfe-global-economic-fallout-pandemic-insurance/

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Pandemic insurance might especially make sense if pandemics will now become ten-year events rather than 100-year events.

We now live in a globalized world with vast numbers of humans and their farm animals intruding into wilderness areas.

In 2021, a global blue-ribbon panel co-chaired by Larry Summers says more pandemics will follow and the international community must mobilize now.

https://www.hks.harvard.edu/faculty-research/policy-topics/health/stopping-next-pandemic

The panel’s report rests on chilling foundations. First, that the COVID-19 pandemic represents “the biggest setback to lives and livelihoods globally since the Second World War,” plunging hundreds of millions of people back into poverty, killing an estimated 4 million people, and incurring cumulative losses that have been projected at $22 trillion. And second, that we have entered an “age of pandemics,” and events like the current pandemic may reoccur with frightening regularity in the years to come.

However, the panel did not mention pandemic insurance.

The panel, made up mainly of economic and financial experts, was established in January by the G-20 to address how to best organize the international community’s finances to prepare for future pandemics.

Its detailed report identifies four major areas of prevention, preparedness, and response that need to be addressed: a global surveillance and research network to prevent and detect future threats; more resilient national health systems; the supply of medical countermeasures and tools, to radically shorten the response time to a pandemic and deliver equitable global access; and global governance that ensures coordination and adequate funding.

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Which governments are most likely to buy pandemic insurance?

Ross Douthat recently observed that the pandemic response in America has been local.

Educated, urban areas have adopted conservative measures and rural and sunbelt areas have let the pandemic rip.

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Douthat suggests as the Omicron variant wanes and the American population is largely immune to severe illness, this sets up the possibility of conflict among liberals on policy.

For example, the reasons currently given for masking in schools would largely not apply by the end of February.

Arguments for continued masking of children might even alienate most Democrats, tearing the party apart.

https://www.nytimes.com/2022/01/29/opinion/mask-school-covid-rules.html

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The point here is that these affluent, educated, urban areas that are Covid-paranoid might be more open to purchasing pandemic insurance — which would prepare them for a future pandemic that might strike around 2030.

That pandemic might involve a pathogen that is even more virulent and transmissible than any variant of Covid.

Also, the inconvenient measures that affluent urbanites are now imposing on their own service workforce (like wearing N95s) just might save time and lives in the face of a new pandemic.

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But these urban areas might also want to purchase insurance for natural disasters, which may become more common.

A public rainy-day fund for natural disasters might not work because it would be appropriated by politicians during an economic crisis.

Politicians eventually forget that rainstorms are inevitable.

And when it rains, it pours.

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Here’s an argument that masking in schools should end when the omicron surge comes to an end.

The omicron surge should be ebb around the middle of February.

https://www.nytimes.com/2022/01/28/opinion/masks-covid-children.html

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Actually, the real argument might be, “Should there be any masking at all right now?

First, the surge has already far along its decline.

Second, almost all of the people dying from Covid now are unvaccinated.

In some hospital ICUs, not one of the patients has received even a single does of vaccine.

One quarter of Americans have not gotten even a single dose of vaccine (a figure that might be understated because in order to get a third or fourth dose, some people are lying and saying that it is their first dose).

Not getting vaccinated is extremely risky compared to getting a booster.

People who have received three doses of vaccine are 78 times less likely to die from Covid than the unvaccinated.

https://www.nytimes.com/2022/01/31/briefing/boosters-cdc-covid-effectiveness.html

On average, about 2,500 Americans are dying every day from Covid.

Theoretically, if every American had received a third dose, that number would be lower than three dozen deaths per day.

That’s about one-third of the number of Americans who die on average every day from the seasonal flu.

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The end of universal mask mandates does not mean the end of mask wearing on a voluntary basis.

The availability of high-quality, high-filtration face masks is a game changer.

Having access to a high-quality mask means that one does not have to rely on strangers to also wear masks in order to help protect oneself from Covid.

As Harvard’s Joseph G. Allen has written, “For anyone who fears moving away from universal masking, the great news is that they can continue to wear an N95 mask — along with being vaccinated and boosted — and live a low-risk life regardless of what others around them are doing.” There was a time when N95s were hard to get, but now the Biden administration has started providing them free. And younger kids who can’t wear adult-size N95s can wear KN95s and KF94s.

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There are a few people who might desire to wear a face masks all the time in public.

For instance, some people, like cancer patients and people with severe asthma who are immunocompromised or have underlying health concerns, should wear masks.

Also, epidemiologists have always warned that hospitals are vectors of dangerous and weird bacteria, viruses, and fungi.

They have typically warned people to “AVOID HOSPITALS!”

So, regardless of a pandemic, it might make sense for anybody who visits a hospital to wear a mask.

That might be particularly true for the elderly.

In fact, it might make sense for most visits to the doctor to be at a location that is at some distance from a hospital.

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Also, seasonal masking might become a custom in urban America.

After all, the Japanese wear masks during flu season — a habit that might go back centuries, or to the 1918 flu pandemic, or to the 2002 SARS pandemic.

Japan is a populous, crowded society, so masking has long made sense for the Japanese.

It seems like a no-brainer for urban areas in the 21st century.

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The single biggest takeaway from the debate on masking in schools might be on the need to upgrade the infrastructure of schools, in particular, their ventilation.

Also, it’s not fair that some schools have spectacular infrastructure while others are mediocre or even dilapidated.

It’s not a matter of equality of condition.

It’s a matter of equality of opportunity.

The educational system is unique because it is a primary source of opportunity in the most formative years of the individual.

Also, in the event of natural disasters or wars, schools become the default shelter for the population — whether they are designed for that task or not.

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Essential workers (& omicron)

 The Omicron variant spreads even more rapidly than do earlier variants of Covid, which were themselves highly transmissible.

However, after about a month, the number of people in a particular place who are infected with the omicron variant peaks and then rapidly declines.

In the USA, omicron began to sweep through the population in mid-December.

This probably means that in mid-January, throughout the USA, the number of daily infections will begin to fall.

However, because the number of hospitalizations from Covid lags behind case rates by two weeks, this might mean that hospitalizations will peak in early February.

This could mean that much of the healthcare infrastructure in the USA will literally begin to collapse around the beginning of February.

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A greater question is whether this disintegration of many basic services will also be true of other crucial sectors of society — especially those reliant on essential workers.

One popular argument is that because the omicron variant is not as harshly virulent as the earlier forms of Covid were — especially thanks to vaccines — then its spread should be encouraged.

The problem with this argument is that if a large chunk of the American population is somewhat ill all at the same time, society will temporarily cease to function.

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One of the perceptions surrounding the response to omicron variant is that its virulence is being downplayed by healthcare authorities as a favor to business interests.

In particular, the CDC has recommended that the isolation period for those with mild Covid be reduced to five days, followed by five days of mask wearing.

https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html

Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation for the public. People with COVID-19 should isolate for 5 days and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that by 5 days of wearing a mask when around others to minimize the risk of infecting people they encounter. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.

However, if there is a pragmatic motive that is influencing this policy change, it is not the sacrifice of lives for the sake of business profit.

The pragmatic motive is the fear of serious societal disruption.

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The omicron variant poses a scenario out of the most subtle of plots in science fiction.

Imagine a plague that does not necessarily kill many people, but makes everybody somewhat ill during a one month period, during which time they cannot work for a week.

Civilization would begin to stumble and then crumble during this brief period, although without completely collapsing.

That scenario of limited societal disintegration was not true even during lockdowns in 2020, when essential services remained intact despite a significant death toll.

However, with omicron, at any given time during its initial surge, a large fraction of essential workers are out of the picture, if only briefly.

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During 2020, there was a call to “flatten the curve” in order to protect the healthcare system from becoming overwhelmed with patients on ventilators in the ICUs.

In the first month of 2022, hospitals are once again being overrun — not necessarily in their ICUs, but in their emergency rooms, with Covid patients.

In the USA, in particular, the lack of testing infrastructure means that people who want to be tested for Covid are going to the hospitals to do so (and sometimes getting infected).

But more than relieving pressure on hospitals, in January, 2022, the goal is to get back to work for the sake of society.

That is, hospitals might indeed begin to fail and collapse as staff become ill and patients overwhelm the system.

But the greater concern would be that essential services might begin to disintegrate during the month of January.

https://www.ft.com/content/d07f4559-f4f5-4063-94e7-c322bdcf62ce

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There have been complaints that the CDC is not adequately articulating the science behind its five-day isolation recommendation.

However, even when the science is relatively sound, the nature of public health messaging is to simplify a complex reality — often to the point that the simple message becomes problematic. 

https://www.nytimes.com/2022/01/05/us/politics/cdc-rochelle-walensky-covid-isolation-testing.html

“I don’t think that the C.D.C. guidelines were significantly wrong,” Dr. Tom Frieden, the agency’s director under former President Barack Obama, said of the latest recommendations on isolation for those with Covid. But he added, “I think the way they were released was very problematic.”

Dr. Frieden said there were three rules to putting out public health guidance: it must be technically correct, simple and workable in the real world.

Although real world conditions shape the message, they are not mentioned in the message for the sake of simplicity.

Dr. Walensky certainly had real-world implications to consider: Would it make sense to recommend that people take Covid tests, when they are so hard to find? And with so many people getting infected with Omicron, encouraging them all to stay home for longer than five days could cripple the economy.

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Thus, the issue might be that the CDC is not communicating how its views on omicron take into account the specter of real societal unraveling, if only for a month.

This “omicron scenario” is not being communicated by authorities probably because it is complicated and overwhelming — and also because it lies beyond the scope of the natural sciences.

That is, the Biden administration and the CDC promised to just stick with science.

Thus, insofar as the societal ramifications of omicron lie outside of epidemiology, it is not put at the forefront of public discussion.

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In sum, the goal during the time of omicron is to get back to work as soon as possible after getting sick in order to protect the socioeconomic order from disintegration.

This time, extraordinary measures are not being called for in order to inhibit the spread of the virus.

Notably, there is currently no public call to “flatten the curve” to save civilization.

Importantly, the context of this silence is a society that often resists basic measures — such as masks, vaccines, and tests — that would slow the spread of omicron (and the seasonal flu, as well).

Because basic precautions are only haphazardly observed in American society, the quality and quantity of masks and tests are limited — which makes flattening the curve so much harder.

This is not simply an administrative bungling or a failure of messaging.

Rather, it is a bottom-up, grassroots complacency that distorts pandemic policy.

We cannot take basic precautions in order to flatten the curve to save essential workers because we just don’t feel like it.

Because we won’t flatten the curve, when we inevitably all get sick at the same time, we need to get back to work as soon as possible to prevent societal disintegration.

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All of this revolves around the central role played by essential workers.

Again, in the dark days of 2020, prior to the vaccines, essential workers kept society functioning even during periods of lockdown, when everyone else was sheltering.

During this period, essential workers suffered disproportionately high death rates, but they kept going to work.

With omicron, the death rate might be much lower — but so many people are missing work because so many people are infected.

(For example, New York City Mayor Eric Adams stated that 20% of the city’s police force is currently infected with Covid.)

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Omicron should therefore be understood and framed as a threat to essential workers and the work they do.

Yet, this issue is not visible in the media.

In fact, essential workers themselves seem comparatively invisible to the media when one considers all the issues related to essential workers that go unaddressed.

For example, essential workers are dissuaded from quitting because they would not be eligible for unemployment benefits.

https://www.vox.com/2020/5/5/21245713/unemployment-insurance-recalled-workers-voluntary-quit-state-reopening

The general rule of unemployment has always been that you can’t collect benefits if you quit your job. But what about during a pandemic, when going to work means putting your life at risk?

Apparently, the rule still applies.

As nonessential workers across the country are being recalled to their jobs, they’re experiencing a similar scenario: Sure, you can quit or decline to go back, but that means no more unemployment insurance.

Because there was a scarcity of job openings during the pandemic, essential workers could not quit their jobs and find other jobs — effectively turning them into forced labor.

https://www.washingtonpost.com/outlook/2020/05/21/essential-workers-pay-wages-safety-unemployment/

For nurses, grocery clerks and transportation workers, quitting is not an option right now. The irony is that while these workers are — in the word of the moment — “essential” to consumers and employers, they have zero leverage in the workplace. That’s because the coronavirus pandemic has destroyed almost all the alternative jobs. There’s nowhere to go.

The situation is so stark that we can ask whether extreme economic circumstances have turned the workers we call heroes into something closer to forced labor. If so, that realization ought to shape our public policies: A just society owes much more than minimal pay and a few plexiglass shields to the citizens — and noncitizens — it compels into service.

Moreover, in the USA, hazard pay for essential workers is irregular and uncertain.

https://www.pbs.org/newshour/economy/whos-a-hero-some-states-cities-still-debating-hazard-pay

When the U.S. government allowed so-called hero pay for frontline workers as a possible use of pandemic relief money, it suggested occupations that could be eligible from farm workers and childcare staff to janitors and truck drivers.

State and local governments have struggled to determine who among the many workers who braved the raging coronavirus pandemic before vaccines became available should qualify: Only government workers, or private employees, too? Should it go to a small pool of essential workers like nurses or be spread around to others, including grocery store workers?

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Compelling essential workers to work during a pandemic might be necessary, but it should be compensated with benefits, such as hazard pay.

Another benefit would be state provisions for basic health insurance.

For conservatives, public health care would create “moral hazard” because it would be granted in some cases to those who do not work — and thus presumably do not deserve it.

https://www.newyorker.com/magazine/2017/10/02/is-health-care-a-right

However, most Americans might agree that some limited form of publicly funded healthcare is justly deserved for those who work in essential services.

Public health care for essential workers would not violate moral hazard.

In fact, it would be similar to the benefits granted to members of the military.

Minimal health care provisions for all people might also be needed for pandemic preparedness in order to get people to see a doctor and take tests that would be free.

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Indeed, this highlights the role of public health in terms of national security.

The relationship between public health and national security also means that essential workers would subject to vaccine mandates.

As they used to say back during the world wars, “You’re in the army now”.

https://en.wikipedia.org/wiki/You%27re_in_the_Army_Now_(song)