Commentary

Commentary, COVID-19

Nine observations from carbon dioxide monitoring

Introduction

In the first year of the COVID-19 pandemic I learned that we can estimate our level of risk by checking the concentration of carbon dioxide in the air, because when infected people breathe out virus aerosols, they also breathe out CO2.  I recently wrote about some limitations on this technique, and tips for getting reliable information.

A carbon dioxide monitor reads 3208 parts per million, at 31 degrees Celsius and 48% relative humidity. It is being held in a hand between bare knees in a commuter train car.

I’ve been checking carbon dioxide levels for over three years now, and I’ve started to see patterns.  I don’t have to keep checking the same places, because they have the same levels under similar conditions.  Today I charged my carbon dioxide monitor for the first time in weeks, because I’m flying on a plane for the first time in almost two years.

I’d like to share some of the things I’ve learned, so that you can benefit even if you haven’t been monitoring carbon dioxide on your own.

Outdoor air helps reduce the chance of passing on respiratory diseases

A carbon dioxide monitor reads 486 parts per million, at 80 degrees Fahrenheit and 69% relative humidity.
In a cafe with the door open and without

We’ve known this for over a century, but my readings have confirmed it.  I’ve been to at least two cafes on warm fall days when the front door is open, and gotten nice low carbon dioxide readings.  I came back a few weeks later when it was colder and the door was closed, and I wouldn’t have taken my mask off in there during an outbreak! The pictures above show the readings from one cafe with the front door open and closed.

It doesn’t have to be a door or a window that’s open.  A good ventilation system can exchange infectious air for cleaner outdoor air, or pass air through a filter that removes aerosols.  The facilities manager at my employer is very proud of the ventilation system he’s set up, and the measurements I’ve taken show generally low concentrations of carbon dioxide across campus.  I can feel the ventilation in certain hallways, like a stiff breeze.

After these observations, if I see that there’s a window or a door open in a cafe, or if I can feel a breeze in a hallway, I have a good guess that it’s relatively safe.  I might try to confirm it periodically, but I wouldn’t have to check it every time.

Speaking louder and breathing harder increases the likelihood of transmission

A carbon dioxide monitor in the dark reads 2839 parts per million.

In 2020 we heard about the unfortunate performers in the Skagit Valley Chorale who contracted COVID-19 from an infected choir member at a rehearsal, two of whom died.  Analysis, supported by other studies, showed that forceful singing and heavy breathing increase the chance of both transmitting and catching COVID and other infectious respiratory diseases.

This can be seen in the carbon dioxide levels I measured during more than one large professional meeting, where the CO2 levels increased dramatically after the audience cheered, despite the good ventilation. Also, when COVID transmission levels were low, I participated in a musical performance with lots of singing and measured one of the highest levels I’ve gotten.

This means that if COVID transmission levels are high and I know people are going to be speaking loudly or singing in an indoor space, I will avoid that space if possible.  If I can’t avoid it, I’ll wear a mask.

The level of crowding makes a difference

If I’m sitting quietly in a room by myself, or maybe with one or two other people, and there’s halfway decent ventilation, I’ll see carbon dioxide concentrations that aren’t too different from what I see outside.  But if that same room is full of people sitting quietly, the readings will be much higher.  Because of this, when COVID transmission levels are high, I’m much more comfortable in indoor spaces with lots of room to spread out. High ceilings help as well.

Supermarkets are not safe during an outbreak

An orange Temtop air quality monitor shows 9.7 parts per million of PM2.5 particulate matter, 10.8ppm of PM10, 4166 particles per liter and 1217ppm CO2, at 22 degrees Celsius and 36% relative humidity, in a supermarket aisle.

All these factors were present in supermarkets I visited. When the supermarkets were relatively empty, I got low readings, but at peak times the carbon dioxide concentrations were very high. I got the highest readings by the checkout counters, even though they were near the doors. It could have been a quirk of my supermarket’s ventilation, but I think it was just so many people standing there and talking to each other.

Some of the worst readings I got were in doctors’ offices

A carbon dioxide monitor sitting on a green pleather bench reads 1345 parts per million at 24 degrees Celsius and 58% relative humidity

I was very frustrated to find that some of my worst readings were in doctors’ offices, especially because I was bringing my elderly mother to doctors, and she wasn’t very careful about wearing her mask. I discussed this with my primary care doctor, who said she shared my concerns, and had tried to improve the ventilation, but her office was in a relatively old house without central air conditioning.

Even when transmission levels are low for respiratory diseases, I still try to wear a mask at all times in doctors’ offices, because many of the people in doctors’ offices are already sick, many of them are immunocompromised, and a lot of them have difficulty keeping their masks on. Discovering that the ventilation is not always good made it even more important.

Trains, buses and elevators are not always safe

A carbon dioxide monitor reads 1930 parts per million, 25 degrees Celsius and 50% relative humidity. In the background is a strip map for the L train of the New York City subway, showing that the train is eastbound between Bedford Avenue and Lorimer Street.

In 2020 there was a lot of speculation that subways and buses were a transmission vector for COVID in New York City.  Various studies showed mixed results, and it clearly wasn’t the only transmission vector, since hundreds of thousands of people got sick and killed without ever taking the subways or buses.  So are they safe?

What I’ve found is that when the subways are uncrowded, they’re safe.  If there’s room for everyone to sit, I see carbon dioxide concentrations close to outdoor levels.  But the ventilation can’t handle crowds.  If there are a lot of people standing, I get readings that are considered unsafe without a mask if transmission levels are high.  If a subway car is crush loaded – not enough room for people to move freely – I get readings that are considered unsafe even with a mask.

Airplane taxiing is the most dangerous time, mid-flight is the least dangerous, boarding is not necessarily safe

In an airplane seat, an INKBIRD carbon dioxide monitor reads 2299 parts per million, 75 degrees Fahrenheit and 51% relative humidity.
In an airplane seat, an INKBIRD carbon dioxide monitor reads 735 parts per million, 84 degrees Fahrenheit and 24% relative humidity.
In an airplane seat, an INKBIRD carbon dioxide monitor reads 1616 parts per million, 85 degrees Fahrenheit and 38% relative humidity.
Taxiing, midflight and landing on an Airbus 320

This is a pattern I heard about before I started monitoring carbon dioxide: when people are sitting quietly on an airplane and the jets are on, the ventilation system can generally handle things.  Similarly, when the plane is connected to airport power, it can keep the air pretty clean.

My readings generally confirm this: I’m writing this section on a fully booked Airbus 320 in mid-flight, and just got a reading of 750 parts per million, which is considered safe.  While taxiing I got a reading of 2299, which is not safe.  But with airport power, the system doesn’t seem to handle people moving around.   At the gate just before takeoff, I got a reading of 1826.

This also varies depending on how full the plane is, and how heavily the passengers are breathing.  But in general, if you don’t want to catch or transmit COVID or any other deadly respiratory infection, you probably want to keep your mask on from the gate until cruising altitude, and from descent until you get off.  Even if COVID transmission levels are low at both ends of the flight, because you don’t know who else is on the plane and where they’re coming from.

On long distance trains, dining cars are safer than coach cars

On the tray table in an Amtrak coach seat, a carbon dioxide monitor reads 2172 parts per million, 78 degrees Fahrenheit and 37% relative humidity
On a table in an Amtrak cafe car, a carbon dioxide monitor reads 1129 parts per million, 78 degrees Fahrenheit and 35% relative humidity

The ventilation on Amtrak is among the worst I’ve seen.  I’ve gotten some of my highest readings ever on a full Amfleet coach.  And that made me apprehensive, because I take trips that are five hours or longer, and I like to eat and drink.

Fortunately, people tend to get on and off Amtrak trains, so it often isn’t crowded the whole trip, and I found that the carbon dioxide concentrations went down as the car emptied out.  And I found that the levels were lower in the cafe car, even if all the seats were full and there were people standing in the aisle. My guess is that the seats are still much more spread out than in coach.

Look for spacious rooms with high ceilings

The JACX&Co food hall in Long Island City, where a carbon dioxide monitor shows 440 parts per million, at 69 degrees Fahrenheit and 57% relative humidity

In the winter of 2022, there were times when it really was so cold it wasn’t comfortable to eat outdoors. I had done enough testing that I suspected there would be places that would be safe to eat indoors. I took some carbon dioxide readings and substantiated that hunch: large spaces with high ceilings have low CO2 when they’re relatively uncrowded and people aren’t breathing heavily. The food hall trend was great for COVID-safe dining; I went to several food halls around the city at off-peak dining times and found safe CO2 levels.

I hope these observations help people to stay safe and keep others safe!

by grvsmth
Commentary, COVID-19

So you want to monitor carbon dioxide levels

On an elevated train platform, a generic CO2 monitor reads 1230 parts per million, at 76 degrees Fahrenheit and 43% relative humidity. An Aranet4 monitor reads 1335ppm CO2 at 79.6 degrees Fahrenheit and 47% relative humidity. Both indicate that the levels represent moderate risk. In the background is a New York City subway train with its doors closing, and a sign reading "Exit 52nd St & Roosevelt Av, 24 hour booth."

One amazing thing about the COVID-19 pandemic, compared with previous epidemics, has been the availability of high-quality open data, keeping medical professionals, epidemiologists and even the general public aware of trends and risks.  Ideally we wouldn’t have needed these, but too many politicians, doctors and public health professionals have chosen to play games with the data instead of making straightforward recommendations.

And yet, one area where there wasn’t enough information was indoor air quality.  We knew fairly early that COVID is transmitted in aerosol particles that can remain in the air for hours.  So we knew that enclosed indoor spaces were some of the most dangerous places to be, and uncrowded outdoor spaces were among the safest places.  We knew that masks helped prevent transmission, but we have to take our masks off to eat and drink.  But we didn’t have good guidance about which indoor spaces were the most risky, and which were the safest.

In 2022 I had friends who dismissed all the risks from COVID and tried to go back to their pre-COVID lives as quickly as they could.  I decided I wanted to continue taking precautions, partly because I don’t like getting sick, and partly because I realized it’s one of the easiest ways to save lives.  Our politicians were telling us just to go to concerts, eat indoors, fly on airplanes and work in offices, but I checked the statistics and saw that people were still dying – hundreds of people a day in some waves, just in New York City.  I wanted more clarity, so I bought a carbon dioxide monitor.

Why carbon dioxide?  Because everyone who exhales COVID (or flu, or RSV) aerosols also exhales carbon dioxide, and good ventilation removes both disease aerosols and CO2. Under many conditions, the concentration of CO2 particles in a space can give us an idea of how much risk there is of catching or passing on a respiratory disease.

Unfortunately, the relationship between the numbers on a carbon dioxide monitor and the disease risk is complicated, so there are some things to know if you want to do your own monitoring.  On the plus side, after over three years of checking the CO2 levels in a variety of places, I’ve learned a lot about how are moves around, to the point where I don’t feel the need to carry the monitor with me all the time.  In a future post I’m going to talk about some of the things I’ve learned through monitoring CO2, and in this post I’m going to discuss four things I learned about CO2 monitoring itself.

There are no absolutes

I would love it if we could just look at a readout and know how likely we are to catch a respiratory disease in any given room, but our bodies are complex and the air is complex.  The likelihood of transmitting COVID, the flu or RSV is affected by many factors including the temperature, humidity, wind, indoor ventilation, how many infected people are in the space, how infected they are, how heavily they are breathing, whether they are trying to project their voices, how robust the other person’s immune system is and whether they’ve been vaccinated against the strain that’s in the air.

The upper deck of a New York City Ferry boat, crowded with tourists on a sunny afternoon in December 2023. In the background the towers of Four New York Plaza can be seen, and the Statue of Liberty is visible in the distance.

There have been studies suggesting that a person can catch COVID from another person who’s simply jogging past them in a park.  When I contracted COVID in the winter of 2023, one of the ways I might have gotten it was on the open, upper deck of a ferry crowded with tourists.

That said, during an outbreak, a general rule is that if the carbon dioxide levels are below 800 parts per million, it’s generally safe to not wear a mask, and if they’re over 1200 parts per million, an N95-type mask may not be enough to protect against these viruses.

Find a CO2 monitor that fits your budget

A monitoring device sits on a table next to an alcohol wipe and a tube marked "STERILE." The device reports HCHO 0.308 mg/m2 and TVOC 2.000 mg/m2, but erroneously CO2 1965ppm at 73 degrees Fahrenheit and 35% relative humidity.

I started off with one of the cheapest carbon dioxide monitors available on Amazon, but I soon discovered that it didn’t directly measure CO2.  It measured the concentration of formaldehydes, and used a mathematical formula to estimate CO2, but that wasn’t always accurate.  In particular, it was affected by other sources of formaldehydes, like gas stoves, alcohol wipes and gasoline-powered cars.  These are not great for your health, but do not transmit these diseases.

I then bought another one on Amazon for around $80.  I was satisfied with it, so when the battery stopped charging, I bought a similar model.  They are listed under different brand names, but the one I have now is called INKBIRDPLUS.

The gold standard for CO2 monitoring is the Aranet4, which currently sells for a little under $200.  Another public health advocate lent me one for a couple of weeks, and I compared the output of the Aranet4 to the other two monitors, and found that the INKBIRDPLUS-type monitor tracked the Aranet4 fairly well.

Plants can affect CO2 levels without affecting respiratory disease levels

I know of two combination florist/cafes, one near my apartment and one near my office.  They’re both very pleasant, but I wouldn’t trust any carbon dioxide readings from there.  Plants consume carbon dioxide, and thus might cause the CO2 levels to be lower than those in a similar room without as many plants, but they don’t take virus aerosols out of the air.

Good air purifiers can reduce disease transmission, but won’t remove CO2

Air purifiers are the converse of plants: they can filter out disease aerosols, but carbon dioxide particles just pass right through them.  So we may get high CO2 readings, which can be bad in themselves, but they aren’t evidence that there’s a high risk of catching or passing on COVID, the flu or RSV.

Those are some things to keep in mind if you want to do your own carbon dioxide monitoring. In an upcoming post I’ll share some things I’ve observed from my CO2 monitoring.

by grvsmth
Commentary, COVID-19

Why I care about the flu too

This is part of an ongoing series exploring how to live with compassion in our world of infectious diseases, which tend to recur in waves.  It started with me trying to figure out how to avoid getting and passing on COVID-19, but I pretty soon realized that it applied to influenza and respiratory syncytial virus (RSV).  In fact, it applies to any disease that can cause major damage or kill, and travels through the population in these wave formations.

When I express concern about COVID-19, I have some friends who say, “Well, isn’t it just like the flu now?”  Some COVID-cautious people respond by saying, “No, it’s nothing like the flu!”  I’m not an epidemiologist, but from everything I’ve heard, a better response is, “Well, it is kind of like the flu, but we should care about the flu too!”

I tend to suffer from recurring sinus infections, but in 2018 they started affecting my lungs as well.  From September 2019 through March of 2020 I had four distinct episodes of nasal congestion, sore throat and coughing.  In January and March of 2020 I had fevers.  In between those episodes I almost felt well.

Of course, even in January 2020 people were talking about this new virus, which came to be called COVID-19.  My infection in January or March might have been COVID, but we didn’t have tests available then.  As I’ve written, I went into the COVID pandemic thinking that it would be necessary and unavoidable for large numbers of people to die, and over those first few months came to understand that mass mortality was neither necessary nor unavoidable, and also that it was massively unjust.

Contrary to what a lot of people have claimed, I found that the sacrifices I was being asked to make as a middle class technology worker – work from home, shop online, socialize without physical closeness,  wear a mask in enclosed space, even avoiding live vocal performance – were relatively minor and felt like the least I could do to avoid endangering people in more vulnerable positions.  I also found that they put a stop to my own respiratory infections.  And when eating outdoors became more available, I found that I enjoyed it even more than I had before.

As I was making these changes to my lifestyle, I kept thinking back to my respiratory infections in the fall and winter of 2019-2020.  I tried to stay home, especially when my symptoms were at their worst, and even give myself a day of added recuperation.  But I got bored and missed social contact, so I kept going out as soon as I felt better, and sometimes when I didn’t feel better.

One time in particular I keep coming back to, when I attended a karaoke meetup in late 2019.  I sang “Total Eclipse of the Heart” with a friend, and I had practiced the Bonnie Tyler part before, so I told my friend I wanted to sing it.  But my lungs were so messed up, I wound up singing some kind of screechy death metal version.  My friend and the rest of the group seemed to enjoy it, but months later, after COVID had arrived, all I could think of was how I might have been spewing whatever virus or bacterium throughout that fairly large karaoke room, infecting the whole group.  If one of them went home and passed it on to an immunocompromised relative, that could have really hurt them, or even killed them.

This is not idle speculation.  While it appears that current strains of influenza aren’t very lethal by themselves, and RSV mostly kills small children, they both can weaken an adult’s immune system to the point where they catch bacterial pneumonia.  As I wrote this past February, my 86-year-old mother was hospitalized with both RSV and a case of pneumonia that appears to have been caused by the RSV.  She was released from the hospital with a diagnosis of congestive heart failure that may well have been caused by the pneumonia.  She died last month after collapsing due to shortness of breath.  We don’t have definitive proof, but the RSV she caught in November 2024 may well have snowballed into the conditions that killed her a year later.

Influenza and RSV are not exactly like COVID-19, but they have similar serious effects that can kill or seriously disable people, and they are especially dangerous to those of us who are vulnerable for other reasons, like age, disability or other health conditions.

Back in 2019 I was vaccinated against the flu, but I didn’t have a lot of guidance telling me not to go out and sing.  Unlike the worst period of the COVID pandemic, in the flu seasons I remember before 2020 we didn’t get detailed updates on the progress of the virus.  At best we got a news report saying something like, “Epidemiologists are predicting that this flu season will be particularly severe,” but no real discussion of asymptomatic transmission, and no monitoring to tell us when to ramp up our protective measures, and when to dial them back.

This is why I started talking about Outbreak Mode, and setting thresholds for going into and exiting from Outbreak Mode, and why I created my Contagion dashboard to compare the reported indicators against those thresholds.  It’s why I decided to to pay attention to the flu and RSV, not just COVID, because the flu and RSV kill people too, and they don’t have to kill as many people as they currently do.

by grvsmth
Commentary

Why eliminating the Department of Education is racist

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On March 20, Donald Trump issued an executive order promising to “dismantle the Department of Education,” something he promised to do in his campaign.  I saw a wide range of reactions from centrists, liberals and leftists, but for some reason none of them came out and said it: this is a deliberately racist action.  Racists understand it, because it’s something they’ve wanted for decades, and Trump is happy to do it.

Many years ago I spent a year in North Carolina and worked in an IT job.  I was taking an independent study on research methods in grad school, so I asked some of my co-workers, twentysomething white guys, if they’d be willing to participate in a sociolinguistic interview.  I asked them all what high school they went to, and none of them responded with any of the local public high schools.

All these white guys said they attended the local Christian Academy.  I thought that was a bit odd, because none of them seemed particularly religious, just a few years out of high school, and filed it away in my mind.  Years later I found the answer: most towns in the South have these “Christian Academies” and they’re also called segregation academies.

When the civil rights fighters of the sixties won several victories against official segregation policies, racists didn’t just fight back using the Ku Klux Klan.  They turned their private, religious schools into instruments of segregation.

I think it’s important here to pause and point out why racists hate integrated schools.  It’s partly because they want to make sure that white kids always have more education than kids who aren’t white.  It’s partly because they want to control the messages that kids are taught.  But it’s also because kids in schools tend to get to know their classmates as peers, and that can lead to equal interracial relationships.  And those can undermine the racial hierarchy.

Of course, there have been interracial relationships for all of human history, and there are structures enforcing segregation and racial hierarchies within schools.  But the fact that children of different races are likely to spend time together in class, in the cafeteria, in libraries, teams and clubs means that they’re more likely to develop friendships and romantic relationships than if they just encounter each other in work and service situations, which are often explicitly structured to reinforce hierarchies.

Here in New York we use municipal and neighborhood boundaries for segregation, especially in suburbs like Levittown and Bronxville, but even, as Nikole Hannah-Jones and others have documented, in places like Brooklyn Heights and the Upper West Side.  It took me years to realize that “good schools” was usually code for schools without too many nonwhite children.  And this is practiced in the South as well.

In New York we also use religious schools for segregation, and that’s obvious for Orthodox Jewish schools, but it’s a bit more subtle for Christian schools, since many of the Catholic orders who run schools view their missions as including nonwhite students.  Catholic schools here often have a similar racial mix to the public schools, but significantly whiter.  They also are not required to take any student, so they can use the threat of expulsion to enforce all kinds of “traditional” hierarchies.

Municipal and neighborhood segregation results in segregated schools funded by public taxes, but under current law, segregation by religious schools requires them to be funded through church tithes and other contributions, or through private tuition.  Meanwhile, parents who are paying tithes and tuition for religious schools are more or less required to fund the education of other kids, many of whom are likely to not be white.

This is why racists care so much about school vouchers, an issue that mystified me for years.  Vouchers put public tax money back in the control of people who run private schools, especially the racists who run the segregation academies.

But what the racists would like even better is to completely dismantle the whole apparatus that was set up in the mid-twentieth century to enforce laws against segregation, to promote integration, and to fund education for all.  They want to return to a system where the highest priority for school taxes was educating white kids, and the nonwhite kids got whatever was left over, if anything.  A system where white kids were kept away from any nonwhite kids who might have a chance to earn their respect and admiration.  And where the local racists were empowered to control the curriculum.

This is why they want to destroy the federal Department of Education.  It’s a goal that Donald Trump, who was educated at a (non-sectarian) private school here in Queens, sympathizes with, and is happy to deliver for them.

by grvsmth
Commentary, COVID-19

What infectious disease hospitalization looks like

Selfie wearing a KN95 mask in a hospital emergency room. On the wall in the background is a small sign reading A-25.

Two weeks ago as I was relaxing before bed, I got a call I dreaded.  The EMTs were in my mother’s apartment; she had fallen and hit her head.  I got dressed, rushed over and joined them in the ambulance, and we set off for the trauma center at Elmhurst Hospital.

A CT scan and some X-rays determined that my mom didn’t have a concussion or broken bones, so the hospital released her the following morning.  They had done some blood and urine tests and discovered that she had a urinary tract infection.  I didn’t know that you could get a UTI from pneumococcal bacteria.  I had noticed her coughing for several weeks, and wondered if there might be a connection. PCR tests for COVID and the flu were negative.

We still didn’t know why she fell, so after her Medicaid-supplied home health aides went off their six-hour shifts, my wife and kid would spend the next eight evenings with her, and I stayed overnight on an air mattress.  Our family doctor listened to Mom’s lungs with a stethoscope and said she didn’t hear anything.  Later that day Mom fell again, caught by her home health aide.

Selfie of me and mom sitting at a table in her apartment. In the background are paintings she's done, including paintings of me and my stepfather.
Mom and me last week, when we thought she could recover at home

Elmhurst Hospital recommended a follow-up visit eight days after they released my mom.  She seemed to be doing better for a few days, but the night before the follow-up her breathing was much worse.  I had a hard time sleeping.  The doctor heard her cough and ordered a chest X-ray.

The following day, last Friday, after the X-ray, I checked the radiology website and saw the images, but the radiologist’s report wasn’t available, only a message saying it was under review.  I kept refreshing the website.  Finally the doctor called me: the X-ray showed my mom had pneumonia, and the doctor recommended I take her to the hospital.

I decided to go to Mount Sinai Queens instead, where they have a bit more room.  They looked at the radiologist’s report and put my mom in an “upgrade” observation room, hooked up to oxygen through a “nasal canula” – the little plastic tube that goes under your nose.  We waited.  I tried to get some sleep.

In the middle of the night, the doctors told me they had done a PCR test: my mom had RSV.  Shortly after that, she started breathing very heavily.  The doctors brought her over to the respiratory area of the emergency room and started preparing some tubes.  I was a bit concerned: “You know she has a DNR?”

The staff stopped work immediately.  “DNR and DNI?”  I wasn’t familiar with the difference, but it turns out that DNR is Do Not Resuscitate, while DNI is Do Not Intubate.  I showed them the scan of my mom’s signed order on my phone.  The doctor spoke with her briefly to clarify that she didn’t want to be resuscitated or intubated – no CPR, no life support.  She had discussed this with me several times: she had seen relatives on life support and didn’t want to “be a vegetable.”

What the staff used next was a BIPAP machine.  It doesn’t have a tube that goes down your throat, but it forces the air down with air pressure, on a rhythm that gives you time to exhale.  My mom was uncomfortable with it in general, but she was able to tell me that one of the straps was pressing against the remaining staple on her head wound, so I relayed that to the nurses and technicians, and they were able to adjust it.

After a couple of hours, the staff judged that my mom was stabilized enough to take it off and bring her upstairs to a ward called the Step-down Unit.  I stayed with her until the daytime shift came on at 9am Saturday, and then went home and slept for most of the day and the night.  

I woke up with a cough and a sore throat on Sunday morning.  I’m pretty sure it’s the same RSV that she had;  I was really frustrated because I knew how important it was to be there for my mom, but I also knew that I would get sicker if I went.  My wife, who was getting over some mild sniffles herself, agreed to go instead.

While my wife was still on the train, I got a call from the hospital.  I don’t want to go into more detail, but there was a situation that they couldn’t handle.  My wife called me, and she couldn’t really handle it either, so I got on the train.  I stayed in that hospital for five hours in my KN95, going out for a short break, trying to rest as much as I could, and when things seemed under control at 9:30pm I went home.  

I woke up on Monday with pain every time I coughed.  Fortunately, my mom has gotten a little bit better starting Tuesday, without me there.  My kid went to visit on Tuesday and my wife visited Wednesday.  Today (Thursday) I finally felt well enough to go visit her. She’s now been moved out of the Step-down unit to a regular hospital ward, but these six days have taken a lot out of her, and I’m afraid it’ll take her a while to recover.

As I was home Tuesday, in between naps, I made a connection: I’ve been doing analysis and reporting of hospitalization statistics for over a year, on Mastodon, on my blog and on a new dashboard I created this winter.  I’m not an expert in any of this, but our leaders haven’t been giving the experts the support they need to make things clear to us, so I’ve been doing what I can, in an effort to avoid situations just like this one.

I’ve been tracking the government statistics on hospitalizations, cases and wastewater traces of RSV, as well as COVID-19 and influenza, trying to prevent myself and my family from winding up in the hospital.  I’ve been wearing KN95 masks in crowded spaces (trains, buses, elevators) and where there are vulnerable people (hospitals, doctors’ offices, pharmacies and grocery stores).  When the case counts for these diseases went up, I stopped singing in-person karaoke.  The city’s restrictions on outdoor dining have made it difficult, but I’ve tried to find uncrowded, well-ventilated restaurants.

My mom got RSV and pneumonia because we live in a society with lots of people interacting, and it’s not enough just for me to take precautions.  This is why I post about these things here on my blog, and on social media.  And I recognize that we have a lot of work to do, especially given the current political climate.

The statistics can be a little dry; I found myself wondering what it means to be hospitalized for one of these respiratory diseases.  I hope that hearing about my mom’s experience – and about my experience struggling to advocate and care for her because I’m fighting the same disease – helps you understand why it’s important to pay attention to warnings about infectious disease outbreaks and help limit the spread of these diseases.

This story also helps highlight some of the limitations of these statistics.  My mother was admitted to the hospital last Friday, and that hospitalization will probably be reported as either RSV or pneumonia, maybe both.  But she visited the emergency room two weeks before, for a fall.  She probably fell because she fainted due to pneumonia, but that visit won’t get reported in the counts of emergency room visits for pneumonia or influenza-like illness.

by grvsmth
Commentary, COVID-19

When to go into Outbreak mode

Recently I described how I monitor the disease indicators published by government agencies, and how I’ve set a threshold of 6 people hospitalized per hundred thousand residents for deciding when to relax out of “outbreak mode” and eat and sing indoors.  So then, when to go back into outbreak mode and start taking precautions again?

I need to stress again here that I am not a doctor or an epidemiologist.  I’m not qualified to make these decisions, and I wish we had guidance from experts.  Unfortunately, the experts are assuming that everyone cares only about themselves and provide no guidance for people who care whether they pass these diseases on or develop long term conditions.  I do care, so I’m figuring this out as best I can.

Hospitalizations and deaths are trailing indicators: after infection it can take weeks for people to become sick enough to go to the hospital, and longer to die.  That means we need to look at leading indicators like case counts and wastewater concentration.  I’ll talk about wastewater in a future post.

Case counts are less reliable than hospitalizations and deaths, because they depend on the number of tests administered.  As we know, the number of tests dropped precipitously when President Biden declared an end to the State of Emergency and stopped reimbursing for tests. Providers tend to administer tests when they think people might be sick, so if they don’t anticipate infections they may not find them.

Case counts could be inaccurately low, so we should always keep an eye on hospitalizations.  There’s a chance that case counts could be inaccurately high, but if that happens, the worst that could result is that we think an outbreak is more severe and take too many precautions.  Of course, it’s better to err on the side of caution.

So if we’re looking at case counts, what is a good threshold for going into outbreak mode?  This turned out to be a lot more complicated than I thought, but let’s start with the basics and assume that all the data is three weeks old.

I looked at the seven outbreaks we’ve had since the the first wave (when we didn’t have good tests) and found the point when the 7-day average of COVID hospitalizations in New York City went above 6 per lakh per day.  Then I looked at the case rates for the day three weeks earlier:

Outbreak First day with hospitalizations > 6.2 Cases 3 weeks earlier
Fall 2020 2020-11-10 55.4
Fall 2021 2021-08-03 30.8
Winter 2021 2021-12-01 70.8
Spring 2022 2022-05-01 172.8
Fall 2023 2023-09-05 85.5
Winter 2023 2023-12-14 55.4
Summer 2024 2024-07-12 57.5

As you can see, there’s a fair range of variation.  But let’s pick a rate that’s in the more common range, say 60 cases per lakh population per day.  How much warning would that give us?

Outbreak First day with hospitalizations > 6.2 First day with cases > 60 Days notice
Fall 2021 2021-08-03 2021-07-18 16
Winter 2021 2021-12-01 2021-11-03 28
Spring 2022 2022-05-01 2022-03-13 49
Fall 2023 2023-09-05 2023-08-02 34
Winter 2023 2023-12-14 2023-11-20 24
Summer 2024 2024-07-12 2024-06-20 22

It looks like anywhere from 2-7 weeks, usually about three weeks, which is basically what we want.  If we see a case rate above 60, that means that the hospitalization rate is likely to go above 6, and may already be above 6.  That’s a sign that it’s time to go into Outbreak Mode.  For me, that means moving karaoke online, avoiding indoor dining and social events, and wearing a mask in all indoor public spaces.

Keep in mind that COVID is only one of many infectious respiratory diseases that can kill or disable.  I chose the rate of 6 hospitalizations per lakh per day because that was what we were prepared to tolerate during the 2018-2019 influenza season.  The hospitalization and death rates we care about are for all these diseases, but flu and RSV are not as well documented as COVID.  Hospitalization rates for flu and RSV are reported nationwide, but the local reports for New York only give absolute numbers for cases and hospitalizations for those diseases.

What I tend do do is to estimate a ratio based on the total case counts for all three diseases, or on the nationwide hospitalization rates.  If RESP-NET is reporting that there are as many flu and RSV hospitalizations as COVID hospitalizations nationwide, I’ll assume that that applies to New York.  If New York’s flu and RSV report shows that there are half as many positive tests for flu and RSV as for COVID, I’ll go into outbreak mode at 40 COVID cases per lakh instead of 60.

Stay tuned for that post about wastewater concentrations!

by grvsmth
Commentary, COVID-19, Queens

How do we know it’s safe?

Hospitalizations per 100,000 people (for week ending on listed date) All ages 03/09 2.06 To prevent unreliable rates, rates are suppressed if the underlying count is between 1 and 4.

I shouldn’t be writing this.  I have no training in medicine or epidemiology.  I’m just some random person.  And if you have something from a better trained source that tells you how to manage your exposure to airborne infectious diseases like COVID, the flu or RSV in order to avoid passing it on to others and perpetuating the pandemic, you should probably go with that.

Unfortunately, our expert doctors and epidemiologists at organizations like the United States Centers for Disease Control and Prevention, and the World Health Organization, haven’t provided any guide for people who want to avoid passing COVID or other airborne diseases on to others.  Their guides focus on telling people how to minimize the risks to themselves.  They assume that everyone is a selfish asshole.

I’ll talk about what I’ve tried, but again, I’m just one person, with three close people in my family.  I have no way of doing an exhaustive study of the transmission of COVID or the flu.  My priorities are different from those of many other people.  So are the strengths and weaknesses of my body, my family’s bodies, and our risk tolerance.  So what works for me – or doesn’t – may well work differently for you.

We’ve also only had four years of COVID.  Our understanding of it is constantly evolving, and the disease itself is constantly evolving, so that what works one year may not work in the next.

With that in mind: a year ago I articulated a provisional strategy for balancing my wants and needs, and those of my family, with our desire to avoid catching COVID (and other infectious diseases), spreading it to others, and perpetuating the disease.

I plan on doing the following for the rest of my life:

  • Wearing an N95-type mask in medical settings, including pharmacies
  • Monitoring outbreak warnings
  • Monitoring hospitalization rates for COVID, the flu and RSV
  • Getting tested regularly during outbreaks

During an outbreak, I plan on:

  • Wearing an N95-type mask in indoor public spaces
  • Eating outdoors
  • Organizing events online/outdoors
  • Avoiding risky activities like singing

When I’m sick, I plan on:

  • Staying home as much as possible
  • Isolating from my family

This much is fairly straightforward, but the key questions are when to switch between regular mode, outbreak mode and sick mode, and back.  First of all: which indicators should we watch, and what will tell us that it’s a good time to change our behavior?

Citywide: deaths Data from the most recent days are incomplete 7-day average 03/05 3

Hospitalizations and deaths per population are the indicators that seem to fit most closely with what we care about with COVID.  The mild cases I’ve experienced are no fun, but they’re not much worse than what I’ve had for colds, flu, strep or other respiratory infections.  Death is the worst outcome, but we want to prevent people from getting infections that are so bad they are admitted to the hospital.  We really need a good measure of Long COVID, but as of writing we don’t have one.

Hospitalizations and deaths are trailing indicators – they tell us what happens after infections – so they are good for conservative estimates about when to relax our precautions.  They can be compared across time and geographic area by counting the number of deaths or hospitalizations for a fixed number of residents of that geographic area.  Dividing by 100,000 gives us nice easy numbers that are usually between 1 and 100.  100,000 is a standard quantity in Indian arithmetic: one lakh.

Last year I found out from the Centers for Disease Control and Prevention that the nationwide peak of hospitalizations during flu seasons before COVID was around 6 per lakh, flu and RSV combined.  That means that before COVID we were tolerating six people in the hospital with flu and RSV every day, and not taking extraordinary measures like lockdowns or working from home.  I decided that that was a good benchmark: when the combined hospitalizations for flu, RSV and COVID are below 6 per lakh, it’s no worse than what we used to tolerate in 2019.

We can tell when we’re below 6 hospitalizations per lakh nationwide, but how easy is it to check that locally?  I’m fortunate that the New York City Department of Health and Mental Hygiene publishes regular reports of citywide COVID cases, hospitalizations and deaths.  The data is compiled by day; in 2021 and 2022 these reports were updated daily, but as of writing in May 2024 they are updated weekly.

Influenza positive laboratory test results reported to NYC DOHMH by season In the 2019-2020 season, positive test results start to rise in late november, peak around 8500 at the end of January, and fall to zero by the end of March. In 2020-2021, they remain consistently low. In 2021-2022, they start to rise in December, peak around 3,000 in late December and fall back to negligible amounts by the end of January. Another wave starts in March and remains around 3,000 through the end of the chart in mid-May. In 2022-2023, positive results start in November, peak around 18,000 in mid-December, drop to around 1,000 by the end of January and remain around that number through May. In 2023-2024, positive results start to rise in late November, peak around 14,000 at the New Year, and slope gradually down to their most recent count around 1,000 on May 11.

Data for influenza and respiratory syncytial virus is much less comprehensive.  Both the CDC and New York City release weekly reports during the infectious seasons for these diseases, but while the CDC measures hospitalizations, New York City does not. That means there is a nationwide way of measuring the cumulative risk of catching or spreading any of the three diseases, but locally we can only measure COVID and guess at flu and RSV.

RSV positive laboratory test results reported to NYC DOHMH by season In the 2019-2020 season, positive test results start to rise in early november, peak around 1500 at the end of January, and fall to zero by the end of March. In 2020-2021, they start to rise in early March, peak around 1,000 in late April, and decline through May. In 2021-2022, they are already around 1,000 when the chart begins in October. They peak around 1,300 in late December and fall to around 200 by the end of January, where they remain through the end of the chart in mid-May. In 2022-2023, positive results start at about 950 at the beginning of the chart in October, peak around 5,000 in mid-November, drop to around 1,300 by the end of December and slowly decline to the teens through May. In 2023-2024, positive results begin the chart around 800, peak around 4,900 in early December, drop to around 1,300 by mid-January and slope gradually down to their most recent count around 200 on May 11.

Eyeballing the data from the most recent winter wave, it looks like COVID cases constituted roughly half of hospitalizations nationwide.  It’s quite possible for flu and RSV hospitalizations to outpace COVID or vice versa, but as a first approximation we can say that if COVID cases drop below three hospitalizations per lakh residents per day, we are no longer in an outbreak and can relax some precautions, like eating and singing indoors.

That is the principle I used to determine when to start organizing in-person meetups for the New York Tech Karaoke Meetup, where I am an organizer, and in general to switch from outbreak mode to normal mode. Switching from normal mode to outbreak mode is a different challenge that deserves a separate blog post. Spoiler alert: I failed to take adequate precautions in December 2023 and was sick with COVID, so I’ll talk about some lessons learned from that experience.

by grvsmth
Commentary, COVID-19

The end of the emergency

When I first heard that President Biden was going to announce the end of the COVID-19 state of emergency, I was not happy.  I was similarly uncomfortable about my employer lifting mask and test mandates.  Hospitalization and death rates were still very high, in the United States and worldwide.  They could have stayed high, and the end of the state of emergency would have been a disaster.  Fortunately, they didn’t, so the emergency does seem to be ending, for now at least, in the United States.

Death rates are now at their lowest since agencies started reporting numbers, in my hometown of New York, across the United States and worldwide.  Hospitalization rates are also at their lowest since the hospitals first started filling up.

There’s even more good news: the US Centers for Disease Control and Prevention hosts a web page called RESP-NET that allows you to compare current rates of hospitalization for SARS-COV2, influenza and Respiratory Syncytial Virus (RSV), from the current “season” (October through May) with rates from previous seasons going back to 2018-2019.

In the week of March 11 of this year, RESP-NET shows that the combined hospitalization rate for all three dropped below the peak combined rate for flu and RSV in 2018-2019.  Hospitalization rates for all three respiratory diseases have continued to drop since then.  If that trend continues, we could wind up the way we ended flu seasons in previous years, with hospitalization rates below 4 people per million per day.

We did get close to those hospitalization rates in June of 2021 and April of 2022, but in each of those cases there was a new wave of COVID right after that.  We have to be vigilant, and we have to be prepared to reinstitute emergency procedures if the hospitalization numbers start rising again.

I’m pleased to say that my family and I are starting to wind down some of our own state of emergency, which we’ve maintained since our government started loosening restrictions.  Until this week we have tried to wear masks in indoor public spaces whenever possible.  With very limited exceptions, we have not eaten in indoor public spaces, and we have avoided vocal and wind instrument performances, and anywhere there are likely to be large numbers of unmasked people.

A trio of jazz performance students (singing, guitar and upright bass) perform at a staff party at the New School, May 4, 2023

From now on we will start dropping some of these precautions.  We have stopped wearing masks in our building hallways, and yesterday I attended a social event at work where there was food and live music.  We plan on attending more events, and traveling more.  I plan on organizing in-person karaoke events.

We are in no rush to get back to normalcy.  My mother is 84 years old and has multiple risk factors,  The rest of us have health issues which make us a bit more vulnerable than the average American.  We’ve read that airplanes are particularly high transmission sites, especially when on the ground.  And we like eating outdoors!

We also want to minimize our involvement in spreading COVID.  There are still billions of unvaccinated and under-vaccinated people.  New York is a global port city, and we regularly encounter people from all over the United States and the world.  On Monday I had breakfast with cousins from Georgia who were leaving on a transatlantic cruise.  My mother has several Medicaid-supplied home health aides, most of whom are from different countries all over the world, and who travel home periodically to visit family.

My family and I live in the epicenter of the first COVID outbreak in Spring 2020, and we saw how it hit our poorer, immigrant, nonwhite neighbors harder than us and our more privileged neighbors.  I also have several friends who are immunocompromised in various ways, and who have seen their lives restricted because others refuse to make spaces and events safe for them.

I thought back to times when I had upper respiratory infections before COVID.  Nobody ever suggested wearing a mask or eating outdoors when I was sick, and if people talked about staying home, it was usually for my own recuperation.  I have memories of sneezing on the subway, coughing in restaurants, and even singing karaoke while battling a sinus infection.

The author wearing a KN95 mask on a Long Island Railroad train. The destination sign reads "Grand Central."

I’ve decided that in the future I want to be more careful about spreading infectious diseases, particularly influenza, colds and of course COVID.  I plan on doing the following for the rest of my life: 

  • Wearing an N95-type mask in medical settings, including pharmacies
  • Monitoring outbreak warnings
  • Monitoring hospitalization rates for COVID, the flu and RSV
  • Getting tested regularly during outbreaks

And when I’m sick or during an outbreak, 

  • Staying home as much as possible
  • Wearing an N95-type mask in indoor public spaces
  • Eating outdoors
  • Organizing events online/outdoors

The bottom line is that COVID is not over.  We have so far failed to eradicate it.  It can come back at any time.  And I do not want to be complicit in spreading it to vulnerable people.  If it becomes necessary, I plan on reinstating the precautions I’ve been taking for the past few years.  It will be inconvenient and annoying, but it’s a small price to pay for saving so many lives.

by grvsmth
Commentary, COVID-19

Now it ain’t so neat to admit defeat

There are three kinds of attitudes towards the spread of a disease like COVID-19. You can be indifferent to the suffering of others, you can be in favor of eradication, or you can give up. Recently I’ve noticed that more and more of the people I know have given up. At first I was puzzled that so many people refused to talk about our failure to eradicate the disease, but over time I’ve come to understand that this is just what most people do.

First, I want to talk about how we’ve failed on COVID. And when I say “we” I mean all of humanity, but specifically the United States, and more specifically New York State and New York City.

Before I get to our failures, I want to give a nod to our successes. Shutting down non-essential in-person businesses in the spring of 2020 allowed us to “flatten the curve” of hospitalizations. Our hospitals were under severe strain, but we did not get to the point where we needed to use the Javits Center or the Navy hospital ship. After that, the restrictions on indoor dining and avoidance of other indoor in-person activities helped us to keep hospitalizations and even deaths relatively low until the vaccine rollout.

Our record after that has been pretty dismal. Over 800,000 people have died of COVID in the United States since the first vaccine was administered on December 13, 2020, more than twice as many as had died before. Thousands of people have been reinfected with COVID again. Thousands suffer from long COVID. We have failed them.

Our worst failure, of course, is the failure to completely eradicate COVID. We live in an era where humans have eradicated smallpox from the world, eliminated polio and guinea worm from most countries, and are aiming to eliminate malaria and other diseases. We have successfully eliminated the first SARS coronavirus, the cause of the 2002–2004 outbreak, and have made progress against MERS. We had the power to eradicate COVID, and we failed.

I hope that one day we will eradicate COVID, and many of the other diseases that cause misery to humans and other animals on this planet, including diseases that we have not yet encountered. But for COVID, the possibility of eradication gets harder with every new variant.

The result is that many political and institutional leaders have told us we’ll be “living with the virus,” in ways that ensure that thousands will be dying with the virus for many years. The “reopening” of institutions to unmasked indoor activities is a cruel joke to immunocompromised people who are unable to participate. More than a billion people around the world are still unvaccinated or undervaccinated, most through no choice of their own.

What baffled me for months was the inability of almost everyone I know to acknowledge this failure.

Of course, people are plenty willing to acknowledge the failures of others. Here in New York, lots of people are willing to heap well-deserved blame on Donald Trump and his enablers. Some are willing to blame Andrew Cuomo, who deserves at least as much blame, and on other Democrats like Bill de Blasio, Joe Biden, Kathy Hochul and Eric Adams. But I have yet to hear someone acknowledge their own failures.

Remember in 2020 how we were all in this together — wearing masks, socially distancing, getting tested, even washing our hands? Of course, a lot of this was a fiction, but many of us felt like we were contributing to the effort to stop the spread of the disease. I know lots of people who for months, if not years, were diligent about eating outdoors, wearing masks, working from home, avoiding indoor entertainment.

I know some people who have continued to this day with careful measures to avoid spreading COVID. As of this writing, my family and I are still avoiding eating in indoor public spaces, foregoing in-person concerts, and wearing N95-type masks when necessary. But many others just stopped at a certain point. And what struck me was how quietly they all did it.

I’ve seen some people on social media — and on mainstream media, and even in person — announce that they were going to their first party “since COVID,” or maybe attending their first concert or conference, or giving their first interview. Some have even gotten visibly emotional about it, and talked about feeling nervous. But nobody talked about why they decided to start attending parties or conferences, or performing in theaters. Nobody acknowledged that this meant they had stopped taking precautions to avoid spreading COVID.

Some people have parroted the bullshit put out by the Centers for Disease Control and Prevention — that COVID is now “endemic,” and we have to start “living with the disease.” But they pivoted awfully quick from “we have to stop COVID” to “we’ll never stop COVID,” without going through the stage of “we have failed to stop COVID.”

What I eventually figured out — and only recently — is that people just don’t like to admit defeat. Some people are okay with acknowledging setbacks — we’re retreating to the hills, but we will be back! But colossal, catastrophic defeat, the kind that means that a million more people will die, that we may see many thousands die every year for the rest of our lives? That’s something people don’t want to think about.

The key to my understanding this was a Mastodon post I made about the recent fad of Large Language Models. I had noticed a similar pattern: that some people who were typically critical of new technologies had started incorporating LLMs into their work. I posted a critical response to an LLM post from someone I considered a friend, and was shocked that he basically told me to shut up with the criticism.

An older woman in black stands at the front of a stage and looks towards the audience. A man about her age looks at her. Behind them, a group of people dressed in gray and yellow watch them. Everyone in the group is wearing bright yellow shoes.
A 2014 production of The Visit at the Theater of St. Gallen, Switzerland. Photo: Tine Edel

I recognized this pattern from other trends I’ve studied as well. It reminds me of a scene from Friedrich Dürrenmatt’s play The Visit (Das Besuch der alten Dame), where the character Alfred finds the entire population of his village turning against him. He realizes this when he sees them wearing new shoes, which are yellow, and in most productions of the play they are bright yellow. I’ve never seen the play performed, but my high school English teacher described Alfred seeing first one neighbor wearing yellow shoes, then another, and then looking across the stage and seeing everyone wearing bright yellow shoes. The image has stuck in my mind for decades.

I’ve also been listening to the History of Byzantium podcast, and the recent episodes focus on the capture and sack of Constantinople by the Fourth Crusade. I thought about the people of the city, seeing several emperors killed in quick succession, the harbor filled with Venetian ships, and Frankish knights parading through the streets.

It was too late to flee. What could they do but swear to serve their new lords? And once you decide to serve the new lords, why take the risk of pissing them off by showing insufficient enthusiasm?

On the television, anchor Kent Brockman speaks to the camera. In the upper left hand corner of the television, a man lies on the ground raising his hand as an insectoid with human legs cracks a whip over him.
Screenshot of the “Deep Space Homer” episode of the Simpsons

In my Mastodon post I compared the new large language model fans to Kent Brockman, the news anchor from the Simpsons who, spooked by a magnified image of an ant crawling across the camera, immediately announces, “I, for one, welcome our new insect overlords.” What I realized recently is that the only thing Brockman does differently from real people is to react a little more quickly.

It’s important for me to acknowledge here that I don’t think that these people gave up fighting the spread of COVID, or the imposition of large language models, because they stopped caring. I think that tomorrow if they thought there was as much chance of eradicating COVID as they thought there was in 2020, they’d mask up again and stop eating in indoor restaurants.

Clearly, they don’t think that wearing a mask again will do much. And they can see that most of our leaders and the institutions they control have come down against eradicating COVID. They’ve gotten their orders from the Centers for Disease Control and Prevention, or from the boss telling them to show up at work in person.

They’ve seen the announcements for in-person conferences and job fairs, with food and drink provided indoors. They don’t want to miss out on those opportunities while less scrupulous competitors take advantage of them.

So why do I care? Why did I expect anything else? Why do I think it’s important to acknowledge failure?

I’ve worked in tech support on and off for most of the past 28 years, either as a direct support technician or as a developer responsible for fixing bugs as they are found. One thing I’ve found to be essential to providing good support is acknowledging and documenting failure. If we don’t understand why we failed, we’re just going to keep making the same mistakes again.

Normal conditions great need America's present need is not heroics, but healing; not nostrums, but normalcy; not revolution, but restoration; not agitation, but adjustment; not surgery, but serenity; not the dramatic, but the dispassionate; not experiment, but equipoise; not submergence in internationality, but sustainment in triumphant nationality.
An excerpt from Warren Harding’s “Readjustment” campaign speech, June 29, 1920

I remember my eighth grade Social Studies teacher telling us how in 1920 the American people were so hungry for “A return to normalcy” that they voted for a cretin like Warren Harding. But he only told us that they craved an end to involvement in World War I; I don’t remember hearing or reading anything about the flu epidemic in that class.

We need to talk about what happened: the people who wanted to sacrifice the vulnerable to preserve their profits organized and won. We need to remember how they did it and figure out how to overcome that. And we need to preserve that knowledge so that the people who are looking out for humanity in the next pandemic can be prepared.

We won’t be able to do that if we continue to live in denial.

by grvsmth
Commentary, COVID-19, Queens

We’re not in this together anymore

Do you remember the first couple of months of COVID pandemic restrictions? Here in New York, all “non-essential businesses” were closed, then some stores and takeout restaurants were allowed to reopen. We washed our hands a lot because we thought it would help. We stood six feet apart. And gradually, those of us who hadn’t learned the value of face masks began to figure it out, or at least to suppose that the majority and the authorities were worth listening to for a while.

Those of us who weren’t “essential workers” worked from home when we could, and every night we cheered and banged on pots for the people who were stocking the grocery shelves, driving the buses, tending to the sick, disposing of the dead. We had support from the government: extended unemployment, eviction moratoria, cash payments, interest-free loans..

We also supported each other. We met up for walks, and later for outdoor dining and to-go cocktails. We organized events on Zoom, Skype, Microsoft Teams and Spatial Chat. We watched each other’s Twitch streams. We maintained Open Streets. We marched in masked, socially distanced Black Lives Matter protests.

When our city government loosened the rules around outdoor dining, restaurateurs and builders got creative, building shelters that protected from rain and wind and provided heat, but still allowed good airflow.

Of course we weren’t all really in it together. From the beginning there have been people willing to minimize the risk of COVID, to spread misinformation about it, and to use its presence as a weapon against people they didn’t like. Restaurants that were secretly open, raids on karaoke clubs, openly defiant bar owners on Staten Island. Servers who wore masks around their chins while taking orders to go. Shacks closed so tight only a meager draft made it inside

Our homicidal president at the time saw that feelings about pandemic responses could be used to divide the country and unite his supporters. Our self-absorbed governor was only interested in saving lives to the extent it supported his political ambitions, and our bumbling mayor was afraid to let saving lives get in the way of any other priorities.

A group of evil people (I can’t think of a better word for them) had the gall to worry that taking care of people might erode the public’s faith in capitalism, so they set out to undermine every protection against COVID, and call, over and over again, for “reopening” and “return to normal,” no matter how little evidence there was that the danger was past. They named their evil plan after a lovely little town in Massachusetts that doesn’t deserve to be attached to it.

COVID has touched all sectors of society, but if you look at the statistics it’s clear that it has had a much greater impact on people who were poor, people who weren’t white, people who couldn’t afford bedrooms of their own to isolate in, people who didn’t have jobs that allowed them to work from home, or savings to keep them going until work picked up.

There was a particular point, I believe some time in April 2020, when the news media in the US reported that the disease was disproportionately affecting poor people, nonwhite people and immigrants. A number of people observed that there was a marked increase in the clamor for “reopening” immediately after these reports. And of course it came from people who were mostly wealthy, white US citizens with large houses and jobs that allowed remote work.

Despite all that, on the streets of New York, and with my friends, I felt a sense of caring. We were all in this together, and we were looking out for each other. Eventually we got a new president who decided to put all his eggs in the vaccination basket, and he and our self-absorbed governor started rolling back the protections that were keeping us safe. The most significant one, I’ve come to realize, was the ban on indoor dining.

Let’s be very clear about this: indoor dining was completely unsafe before vaccines, and is not particularly safe now. It continues to be a vector of COVID transmission among vaccinated people and between them and unvaccinated people. There was no epidemiological justification for lifting the ban on indoor dining. The only possible justification was economic, and that has been undermined by the cost of the subsequent outbreaks that could have been avoided.

What I’ve observed is that here in New York, allowing indoor dining has divided us. Allowing indoor performances, dancing, karaoke and other entertainment has deepened the divide. Even though I knew about the bars and restaurants that defied the indoor dining ban, I was surprised at the number of people who were willing to eat indoors as soon as it was legal.

Shortly after Andrew Cuomo allowed indoor dining in New York, I went to pick up some takeout and saw people eating in the restaurant. All I could think of was the scene in The Matrix where Agent Smith takes Cypher out for a steak dinner.

Agent Smith: Do we have a deal, Mr. Reagan?

Cypher: You know, I know this steak doesn’t exist. I know that when I put it in my mouth, the Matrix is telling my brain that it is juicy and delicious. After nine years, you know what I realize? Ignorance is bliss.

Agent Smith: Then we have a deal?

Cypher: I don’t want to remember nothing. Nothing. You understand? And I want to be rich. You know, someone important, like an actor.

Agent Smith: Whatever you want, Mr. Reagan.

Even more people began eating indoors after vaccines became widely available. Organizations began holding conferences and seminars in person again. Employers began ordering office workers to stop working remotely.

Of course, there are only so many people, and people only have so many active hours available. As people began participating in work and play indoors, there was a noticeable reduction in the amount of restaurants that offered any outdoor options. While many Open Streets and pedestrian plazas have continued to offer outdoor entertainment and activities, and many meetups, conferences and activities have continued online, we don’t see the same energy, creativity and enthusiasm for exploring outdoor and online activities.

For me, this has broken the feeling of unity that I felt in 2020. For me now the world is divided into three groups. The first is the group of people who avoid indoor group activities as much as I do or more. Maybe they share my unwillingness to be a part of the transmission chain or my fear of long COVID, or maybe they just prefer outdoor and online activities.

The second is the people who participate in some indoor group activities but are also interested in outdoor or online activities. They’re available, but not as much as they were before, because sometimes they’re doing stuff indoors. And then there’s a third group who I see on television or social media, who just don’t do much outdoors or on Zoom at all.

So we’re not in this together anymore. There’s a group that’s decided that COVID is over, that anyone who’s not vaccinated deserves what they get, and that anyone who gets seriously ill is just an acceptable sacrifice. And then there’s the rest of us, but we’re getting smaller every day.

Here’s the most ironic thing: the normalcy crowd complains about how difficult it was to take precautions to keep others safe from COVID: wearing masks, eating outdoors, avoiding long-distance travel and indoor meetings, performances and parties. I miss eating indoors in bad weather, long distance travel, and indoor conference, performances, parties, but it never felt horrible or unsustainable.

What feels horrible and unsustainable? Being one of a dwindling handful of people willing to take precautions while I watch my colleagues, friends and relatives flying around the world, singing, dancing and going to shows.

The main reason it’s unsustainable is that these precautions only work if they’re systematic and communal. It doesn’t do vulnerable people that much good if a small percentage of Americans are still wearing masks and avoiding indoor dining while the majority are happy to serve as a conduit for COVID to bounce around the world.

by grvsmth
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