Top news, reports and insights for today:
- It’s time to separate from social distancing
The term social distancing has been etched into our collective consciousness as deeply as the SARS-CoV-2 virus has entered our collective bloodstream. It has served its purpose as a rallying cry to national action (albeit later than optimal). However, the term has negative overtones that now warrant reexamination and the search for alternatives. We have learned that viruses compete for hosts in the dog-eat-dog battle of natural selection. We have also learned that the same forces that drive the spread of pathogens also drive the spread of words, ideas, and crazy theories; in short memes. Thinking about the deeper meaning of the term social distancing, I re-read an opinion piece from the New York Times on March 14 by Eric Klinenberg, a sociologist from New York University. Klinenberg is well-known for his ‘social autopsy’ of the Chicago heat wave of 1995; he documented that death depended in part on whether vulnerable citizens had strong social connections. He reminds us that in times of crisis, social solidarity saves lives. Evidence is growing that widening the physical distance between us is a life-saving necessity to flatten the curve and slow the pace of the epidemic. Social distance is another thing entirely. The term social distancing can serve as a justification for self-interest, everyone for themselves. This leads to hoarding at the store, pulling back from civic obligation, and an impulse to circle the wagons, precisely at a time when we should be expanding our sense of collective inter-dependence. Can we achieve greater physical separation and closer social connectedness? It’s time to consider replacing social distancing as a meme. I wish I had a better term.
- U.S. COVID-19 deaths rise unevenly, hot spots emerge in states that refused to take action
The news cycle is dominated by projections of peaking cases and deaths. How much of this is wishful thinking is hard to say, but the data is telling us a complicated story. The figure below shows change in COVID-19 deaths by state and region. It shows increases in deaths over the past three days as a percentage of all deaths in that state since March 1. As we welcome what appears to be peaking deaths in states like Washington, California and New York (although today, that state reported a new record high 731 deaths), hot spots appear on the horizon in other states. States above the 100% line have seen deaths double in the last three days. These include Alaska (+100%), Iowa (+127%), Missouri (+105%), South Dakota (+100%), Wisconsin (+108%), West Virginia (+100%), and Maryland (+107%). Importantly, two of these hot spot states have refused to issue stay-at-home orders (Iowa and South Dakota). Missouri waited until April 6, Alaska and Maryland waited till the end of March (3/28 and 3/30 respectively). Utah still refuse to order its citizens to stay home and has seen an 86% rise in deaths over the last three days. Predicting the next hot spots is complicated by regional variation in the undercounting of COVID-19 deaths. Deaths occurring among patients with pending tests aren’t counted, and deaths in prisons and nursing homes are largely missing.
What this means? The focus has justifiably been on the hardest hit states. Cases and deaths may be reaching a plateau in those states, but deaths lag behind cases. Today’s deaths were infected 2 weeks ago. This virus is a super-predator; when available victims get harder to find in one area, it will move to the next. Alaska, Utah, Iowa, Missouri, South Dakota, Missouri, West Virginia and Maryland are in the cross-hairs of the disease. The governors of some these states will have to answer for their refusal to act or for delay in taking action.
- Spain passes Italy with the highest crude death rate; Europe continues to be the epicenter of the pandemic
The graph below shows just how widely scattered the crude fatality ratios are in this pandemic. The bars (calculations are mine) are COVID-19 deaths per 1 million persons as of Sunday in 61 countries with at least 1,000 total cases. Spain has surpassed Italy at 282 deaths per million. Eight countries have death rates of more than 50 per million. These figures reveal just how devastating the epidemic has been in Europe, with 9 of the top 10 countries. The distribution of death rates is so heavily skewed that the mean (22) is more than 10 times larger than the median (2.0). No body knows yet why these rates vary so widely. At very least, we can say that big differences in how countries are counting deaths is one factor.
The bottom line: Europe continues to be the bulls-eye of this pandemic. It remains to be seen if the death toll is so high there simply because the current wave of the outbreak arrived on European soil first. If true, other parts of the world will be catching up to Europe in the coming weeks and months.
- SARS-CoV-2 exploits existing social inequities: African Americans are being impacted disproportionately
An article from the non-profit newsroom ProPublica on April 3 by Akilah Johnson and Talia Buford presents compelling evidence that the coronavirus is not an “equalizer”. In Milwaukee, where blacks live 14 fewer years compared to whites before the epidemic, half of its cases and 81% of deaths have been African Americans, even though the county is only 26% black. Michigan’s population is only 14% black, but African Americans make up 35% of cases and 40% of deaths. Few states are keeping track of the epidemic’s toll by race/ethnicity (and the CDC is not), but two that are (Illinois and North Carolina), show that African Americans are being disproportionately infected and suffering more severe disease and death. The reasons are many. Just as the SARS-CoV-2 virus exploits weaknesses and biases in the body’s own immune system, it also exploits existing social divisions and inequities. Generations of mistrust in public health authorities fueled early rumors in the black community that African Americans were somehow immune. When stay-at-home orders were issued in hard-hit cities, a painful legacy of government restrictions against minorities led to pushback. The coronavirus is a predator, seeking vulnerable targets. Because African Americans suffer disproportionately from heart disease, diabetes, high blood pressure and obesity, they are now paying a higher price. All of this is compounded by lower access to testing and treatment.
- What this means? If the U.S. and other nations are committed to flattening the curve and preventing suffering and death, coordinated and centralized action is required to direct resources to address the needs of vulnerable groups, not just individuals. The virus that causes COVID-19 is an effective predator, seeking to exploit the weaknesses and vulnerabilities in our society. That should make communities of color the center-piece of our countermeasures, not an afterthought.