Empathy in the Time of Coronavirus — Rate Dynamics and the Maintenance of Health Care Workers (VI)

Braden at Loon Lake — a happier time

One of the things that I’ve discussed in the context of the COVID-19 epidemic is that it is primarily a disease of our immunosuppressed. That tells you a lot about how we need to view the disease in terms of how it actually works, and how we need to frame our discussion going forward. I’ve been Tweeting about this all week — that viral DOSE matters. Why? Two populations are getting hit pretty hard. One, of course, is the immunosuppressed. But the second is our health care providers. And believe it or not, the physics of what is happening to both groups is remarkably similar.

What matters in the context of viruses like COVID-19 is the viral replication rate, as well as the immune response rate — how fast viruses manage to make themselves (modeled, once again, by the ever-popular exponential curve) and how fast the immune system scales up the various antibodies and white blood cells that form the main line of defense. The fact that multi-celled organisms exist is a sign that we’re better at this in the long run than single-celled organisms, like bacteria, or those super-small strands of encapsulated DNA that make up viruses.

But that’s cold comfort to someone suffering from COVID-19, in a major way.

So let’s break this up into the three cases, and take the broader view of what’s happening.

Case 1 – viral replication rate >> immune response rate

In this case, the body doesn’t stand a chance. You get infected, you’re the perfect petri dish, the virus overwhelms your immune system, and you die. Viruses like Ebola, with potential death rates of 90%, operate under these principles.

Why aren’t there more of these? Well, viruses that do this kill off their host. And unless they can survive living in a buzzard’s gastrointestinal tract, you rot on the ground and that virus is not successful. Humans encounter these types of viruses, they flare up, and then an outbreak ends relatively quickly, because the transmitter is, well, dead.

Case 2 — viral replication rate << immune response rate

In this case the virus doesn’t stand a chance. The poor, hapless virus floats into your system, tries to grab on, and then the immune system reacts/overreacts and pulverizes the virus. Dosage — how much of the virus you get into your system — matters. If you don’t get any kind of dose, you won’t see any kind of symptoms at all, as your mean immune response will likely take care of this in no time at all. This is the kind of thing we see with a common cold, typically a rhinovirus. A few symptoms, followed by a cessation in a day or two. And if the cold isn’t particularly virulent, or you don’t get a big dose, you likely will never know that the virus entered your body.

This kind of virus isn’t a whole lot more successful than the first, as it gets wiped out relatively quickly. It has to have someplace to go hang out until conditions (temps./humidity) are ripe for it to come out again.

Case 3 — viral replication rate ~= immune response rate

This is where things get interesting, and COVID-19 seems to fall into this category. Are there signs (without an intensive study) that this points to? Absolutely. A 5-14 day incubation period, before symptoms are shown, are a sign that the virus is slow to warm up to virile levels. The fact the disease itself runs some equivalent 14 day period is more evidence that there is a triggering that occurs. The fact (as we know it) that the virus kills 1% of its patients (terrible, but not so terrible) or the fact that you can even beat back the virus if you’ve got pneumonia is more evidence.

What this means also is that immunosuppressed people have more of a sliding window of rate with respect to their immune systems, that diminish the immune systems’ rate constant (the exponential factor) and make the infection worse if your immune system is indeed impaired. Not good.

What it also shows it that viral dose matters — how big a hunk of the virus you get into your system from exposure in the first place. That’s why masks matter. And experts are starting to chime in — see this opinion piece in the New York Times by Rabinowitz and Bartman from Princeton, who coincidentally happen to be in chemistry and genomics — not infectious diseases. I’m sure they’re using similar logic. A larger dose means that the virus, in this sliding window world, gets a bigger head start, and so can get to the point in more cases where it can overwhelm health care providers’ immune systems. So if they had some smaller weak point, even if they were younger, they could get knocked out of the fight. Or even die.

Understanding this mental model, though, is still in our favor. Instead of being afraid of sub-microscopic invaders, we can now start using more macroscopic notions, and cross-disciplinary ideas. Radiation and how people handle dosing says “shield the user” and it doesn’t always mean wearing lead-lined clothes. Placing appropriate barriers between people also helps, especially because we know that the virus is droplet-spread. Different jigs in high traffic situations will make a statistical difference. Here’s a great piece on a simple acrylic box that doctors in Taiwan are using during intubation. You can imagine how messy that is, if someone has pneumonia in both lungs.

The other thing that can really help is understanding the need to cycle various health care providers out of front-line exposure roles. There is a whole new playbook that we can use. And we should use it — especially in convincing health care professionals who have not yet been hit at epidemic levels. We need to understand that these populations are people under stress, and likely to be reaching for familiar solutions — “More PPE” which really means “more of what I’m familiar with.” But if those gowns aren’t available, or are even rationed, we need to introduce a deeper understanding, with hopefully some collaborative problem-solving. And as dissemination of novel techniques starts bearing fruit, more will clamor for these different approaches. And we need to be ready to help.

How We Know Masks Work – An Informatics Explainer

Temple of the Sun, Teotihuacan, MX

Note — in this piece, when I use the term “mask” — I’m advocating for homemade masks. I absolutely believe that we should save surgical masks for our health care providers. I’ll make the point below that homemade masks are really good enough for any social distancing situations that Americans will encounter. And as our tech gets better, my bet is that our cloth masks will be almost as good as the disposable varieties. I’m on Rev. 4 of my own mask design, and it’s way better than Rev. 1. I am a design prof., after all.

One of the things I’ve been advocating recently, with the idea of getting back to a New Normal after the COVID-19 pandemic has passed, is the idea that all of us are going to have to wear masks in public — at least until we have some vaccine that works and is widespread. To me, this seems obvious. At the same time, I thought it might help to demonstrate how people “make sense” of things, so you can straighten out your own thoughts.

One of the ways that this debate has NOT been framed is understanding this from a scaling (in time/space) perspective. All our information is based on scales, that we more or less incorporate into our judgments. So let’s start at the bottom.

Back when the HIV/AIDS epidemic was a big deal, there was a large contingent on the Religious Right that was saying, among other things that AIDS was a divine punishment, and that the virus was so small, it could easily fit in the little spaces (interstices) in the rubber in a condom. So… because it fit their moral agenda, they went screaming around saying “condoms won’t protect you!” much in the way we now hear “masks won’t protect you!” Of course, condoms are waterproof, and the vehicle where the virus effectively floated, barring failure, couldn’t get through the impermeable barrier. The argument put forth by the “virus is too small” crowd was a canard.

So let’s slow down and understand this — the fundamental scale argument of virus transmission.

#1 principle of all virus transmission. Viruses live in stuff, and usually that stuff is wet. It may not all be water, but it will contain a good hunk of water. And water comes in lots of different forms. The smallest are called aerosols. Aerosols are typically sized at or under 1 micron (micro-meter). That’s really small, and when something is aerosolized (and viruses can be contained in aerosols) that’s super-fine. Viruses — the coronavirus is sized at something like 125 nano-meters. That means that the coronavirus, being somewhere between 10-100 times smaller can definitely fit in an aerosol particle.

But the fact that you can fit a bunch of viruses inside an aerosol particle doesn’t mean much. Because that particle that’s carrying the virus basically evaporates pretty quickly. And you can run this experiment yourself. Go pull out a can of aerosol-something out of your cupboard and spray it. The finer particles do fly — but they dissipate quickly. So no water. And no medium for viral transmission. Yeah, they can “Kinda” get spread around. But run the experiment with a can of air freshener. And another point –since they are aerosolized, they have less virus in them. That turns out to matter.

Super-small particles can indeed be breathed through something like a cloth facemask — that’s the reason behind the whole N95/N100 rating, which is really about how many particles under about .3 micron they’re guaranteed to remove (if the mask is fitted correctly.) You can see now why the rating exists — if aerosol particles are down there around 1 micron, you ideally would like to have a mask that blocks at about the third the diameter (.3 micron) to be perfectly safe.

But the particle has to also be floating around, or sprayed in your general direction. It’s prone to evaporation. And most of what people cough up ISN’T an aerosol.

It’s droplets. Droplets are more easily formed out of, well, snot, because of a lot of different reasons. Water has a certain “viscosity” (stickiness as a function of density) and snot is, well stickier. What this means is you’re likely to have bigger particles. And now another important factor comes into play.

That factor is called surface tension. Surface tension is the internal fluid static force that makes a drop round. Or kinda round when sticking to a surface. The minute a droplet comes flying across the atmosphere, headed toward your mouth, and hits the surface of your mask, it’s going to have a hard time. It’s not going to have a hard time going through the interstices of the fabric just because of droplet size — that’s part of it. The other part of it is that surface tension comes into play and starts slowing stuff down with the fabric itself. Just like when a droplet lands on a surface and turns into a little semi-bubble, the same physics happen with the snot-droplet that hits the cotton of a mask.

So let’s walk through this. A droplet of snot flies through the atmosphere, headed toward your mask. Viruses are in that droplet, and those little suckers are counting on using that droplet like their own little landing capsule. But it hits the cloth, and the droplet spreads out, and it may be kinda gross, but at least the droplet is not headed down into your respiratory tract, where the virus would like to get to.

What if your homemade mask is kind of open at the top? Well, it is absolutely true, once again, using a simplistic analysis, that the virus, and maybe even the snot droplet is smaller than that little gap in the top of the mask. Your mask will NOT be as effective as a fitted respirator. But the droplet has to hit in exactly the right place on your face to bounce down and get into your mouth. You’ve improved your odds with a facemask. A lot.

From This Paper — good stuff!

Since the volume of a droplet increases a WHOLE LOT as it gets bigger, (by a cubic power law, since a droplet is essentially a sphere) a droplet can contain a whole lot more viruses than an aerosolized particle. Regardless, if a droplet hits your mask, it may be gross. But it won’t go far. And yes — droplets are persistent, especially when compared to aerosols. But they’re not going to get thrown as far, as fast.

Now we come to what some may find a controversial part of my analysis. It may seem obvious, but how much of the virus gets in you, by my guess, is going to matter. Dose matters. If you get a lot of virus in you — if the dose is large, you’re far more likely to get sick than if you just get a little. This reasoning comes out of my observations of health care providers, who are getting far sicker than many people with exposure. Health care providers seem to be succumbing to the virus at some 2x – 4x the rate of the general population. No one really knows the answer to this question yet, but the short version is that DOSE MATTERS.

This isn’t true with all viruses, but it is with this one, and one that gives us an operative principle that we should follow. LIMIT THE DOSE.

Is there a situation where dose doesn’t matter? Some stuff is so bad-ass, that even if you get a little in you, you’re done. It’s easier seen with toxic substances. Plutonium is a great example. There is no amount of plutonium you can get in your lungs and not get cancer. Polonium seems to be close, and is used in spy vs. spy poison games.

But that’s not COVID-19. COVID-19 seems to be handled just fine by the vast majority of immune systems. Even if the death rate for the actually infected is only 1% (which is millions of victims — I’m not minimizing here!) the reality is that most folks’ immune systems can handle the virus just fine. Or rather, can handle a more standard DOSE of the virus just fine. How that all works is that your immune system can spin up faster than the virus can replicate.

Once again, masks help minimize the dose that someone might get walking around, practicing the 6′ distance recommended for social distancing.

The immediate physics are in the favor of masks. That’s the bottom line.


But humans are fallible creatures. They make mistakes. They pull their masks down. They fiddle. That’s what things with fingers do. How can we understand that?

For that, we have to draw a bigger circle — one that now contains the statistics of an entire population, and then decide if there’s something different between one population and another.

That’s this picture, which is making the rounds.

The data is from Johns Hopkins, the circles are from @jperla

The data plotted on this graph come from an official tabulation of data from Johns Hopkins, by a staff member of the Financial Times, John Burn-Murdoch. He’s their visualization person.

And who is @jperla? From his Twitter page, he’s a former founder and CTO, and an expert in launching and landing UAVs, and a software dude. He drew the circles.

The process that Joseph followed to draw his circles is somewhat unknowable — in my circle, we call this “sensemaking.” He has friends that are epidemiologists, he obviously knows something about the mitigation processes in the different countries. He took all that knowledge, along with past experience and drew those circles.

And unlocked a torrent of action. Some of that action was profound — the President of the Philippines saw that graph and decreed that the whole country should mask up. Other scientists saw that graph, and immediately started arguing for the various exceptions saying that we don’t know FOR SURE that masks were the cause of the success of the reduction in cases.

OK.

Since this is an explainer, I’m going to hold back on explaining why the various parties think the way they do. There’s much to learn from this particular example on that, how they lock into their various v-Memes and knowledge structures. But I digress.

Why do I believe the figure, and how did I come to the conclusion that we should start wearing masks about the same time as this picture? I honestly didn’t have access to this picture (it came out 10/15) before it went viral.

Here’s why — it is a classic example of a piece of evidence that’s SCAFFOLDED by information on a number of scales. Here we go:

  1. It “makes sense” for the smallest physics. That’s the lowest scale in play — in the context of interpersonal distance and the basic physics of how membranes/cloth/masks work. It reduces viral dose at that level.
  2. It makes sense for the physics of human interaction. At 6′, even a cloth mask is going to have a lot easier time cutting down on the mucus someone is spraying from their nose and mouth.
  3. It makes sense from what I know about societies that have successfully contained COVID-19. I first dialed into the cloth mask argument from my experience with my wife’s original Taiwanese culture, along with what is happening in Japan.
  4. It makes sense from what we don’t know. It is prudent. Though there are potential downsides from wearing a mask (let’s say you never wash it — it could become a virus sponge over time!) these can, in a public health arena be compensated for with education. We know that dosing matters, but honestly have no idea what specific dosing causes, with variation in immune systems, one to become afflicted. But it follows the Hippocratic Oath — do no harm.

One last thing. Any scientist, if they so desire, can tear apart empirical science like the Masks for All plot. Why? Because empirical, data driven science works best on closed systems, where one can run one system with the hypothesis to be tested, while another system can be run with what we call the “Null Hypothesis”. This is always NOT the case with open systems, like entire societies. And there are literally a bazillion examples where one can argue correlation (what we are doing with the mask plot — looking at two similar trends without experimentally confirming the link) vs. causation.

But scaffolding in causation can be present at smaller scales, and is a good start toward understanding larger, wicked problems — like the COVID-19 outbreak. And the primary thing I look for when deciding to believe any larger epidemiological study. Explain the mechanism, and the scaffolding physics.

And then finally, does it satisfy, in the case of public health, the Hippocratic Oath? I think the answer to that is also “yes”, with appropriate education. So I’m all in. I’m wearing my mask.

Finally — if I’ve made a mistake here — leave a comment, and I’ll fix it. I would love it if my multi-phase flow colleagues would give a more eloquent description of coughing than I do. Multi-phase flow is the engineering term for considering the droplets in air and how they move. My intuition tells me there’s some trade-off between body forces and aerodynamic drag linked to particle size that would actually create an inflection point on particle distance traveled dependent on that nominal size. I’m comfortable with the rest of it (surface tension as a dominant force in diffusion.)

Empathy in the Time of the Coronavirus (V) — Watching the Authority-based Knowledge Structure at Work

Longji Porters, Guangxi Province, China

One of the fascinating (sometimes pathologically) things about the COVID-19 epidemic is that because it demands information exchange among superficially diverse (but v-memetically similar) population groups, one gets to see the information dynamics of various societies (which are actually far more homogeneous) in play. There’s also some element of hypervigilance in all of this, as everyone in a given society, at this point, is aware that there is a virus out there, and it might affect them. What THAT does is eliminate sloppy adherence to cultural sidebars that may come from value sets/v-Memes. You show your true value set hand because crisis creates focus.

So it is in the small community I occupy as well. From a material perspective (Pullman is a college town) we really aren’t suffering much during this pandemic. There are still sales on steak in the Safeway, and aside from the toilet paper craziness (and paper towel craziness — I still can’t buy a napkin!) you’d never know we were even in a crisis. Sure, the streets are a little more deserted. The students, by and large, are not here. But that happens every summer, and for someone that’s lived in this community for 32 years, it’s amazing to live in a city with infrastructure for 35K people, and only have 10K people show up. No dystopian nightmares for me.

The local folks that live here year-round are not stupid. But they are mostly conservative. All college towns like to think of themselves as “liberal” — and it’s not like political alignment means a ton in the land of value sets/v-Memes. But our town has, depending on how you count them, at least three Christian mega-churches. Moscow, ID, next door, once again dependent on how you count them, has at least three, as well as a medium-size Full Bible Christian college, founded by a champion of the revival of the Confederacy and slavery.

Even the liberals are mostly lower v-Meme actors. Professors and various technical staff, enshrined in the two state universities, are pretty Legalistic v-Meme in their processing. The natural tendency of my Spiral Dynamics community would be to call them Communitarians, and some, even from a knowledge structure position, are. But it’s probably more fair to call them Legalistic Hippies. There’s a tight dress code, and set of political views most ascribe to. We might be a pretty politically correct community. But we’re still low empathy.

So it’s been super-interesting to watch people in the community’s response just to my moving about. When I go out, I wear a mask all the time now. I do this because, as I’ve written before, I believe in exercising the Precautionary Principle, which is, in short, analyze the situation and maintain a positive outlook, but act as if catastrophe is at your door.

In the face of actual data, it’s the prudent thing to do. COVID-19 testing has been nothing short of embarrassing in our community. And I live under the flight path of Alaska Airline’s five continuing flights from Seattle, which is a declared hotspot. Seattle was definitely one of the entry points for the virus, and students, even though it’s a five hour drive away, have always had a subset that went home and returned on the weekend. My belief, as I taught my classes and watched students slowly drop out, as well as stare at me dumbfounded as I taught them social distancing, is that this community was likely a saturated community, at least at the university level at the beginning of the pandemic.

It may be true that there will be a second wave of infections — just like the Spring Break crowd in Florida, our students evacuated en masse at both the start and end of Spring break, taking whatever they picked up here, with their exuberant conviviality, back to the Puget Sound. That probably has put a huge damper on the number of severe cases, and as such, lowered the level of awareness in this community. But old people in the Safeway, even though they have access to special shopping hours, go through their daily routines, as well as the cashiers, like nothing is amiss. It’s just life as usual.

Until I show up with my mask. Wearing a mask, in their minds, doesn’t label me as prudent. It labels me as infected. No other normal white folks are wearing masks — at all. So people look away. I had a mother with a teenage daughter point at me in the grocery yesterday, and sidle and move quickly past the mushrooms, as I held my 6′ social distancing. I stopped by our local building supply store, and the clerks, always affable, are more than happy to let me bag my own products. After an initial set of rumblings toward our Asian students, who largely started wearing masks at the beginning of all this — WSU-Pullman has a large Chinese student population, both graduate and undergraduate (around 1300 IIRC) — their garb is now considered culturally appropriate. But not so much for a big White Guy.

What it does is illustrate the Authority-driven mindset of the community. From a knowledge structure perspective, there’s a one-one knowledge fragment mapping that happens when they see me wearing a mask. It goes like this: he’s wearing a mask; so therefore, he must be sick. The Precautionary Principle is a higher level of complexity, inherently an inverse transformation, with time-dependent consequentiality, and as such, requires a higher active, automatic v-Meme. “I’m wearing a mask because I don’t want to get sick,” or even higher “I’m wearing a mask so others, especially old people don’t get sick” is just meaningless.

Even when explained, people can’t get over it — because of the fear factor of a Big White Guy wearing a mask in the first place. Trust me — no one comes up and pays me a compliment for my foresight, or modeling what is actually prosocial behavior. Because foresight, in my position in the community, is not particularly appreciated. William Gibson, who famously said “The future is already here — it’s just unevenly distributed,” would not be welcomed in Pullman. At least in the context of me and my mask.

This type of one-one thinking isn’t constrained just to the working folks. One can look at testing strategies for COVID-19 in this community, and the authority-driven nature of the protocols pop out. Though, once again, we likely have a high probability of exposure to asymptomatic cases (young people are not showing symptoms, especially severe ones, nearly as often as immunosuppressed and older populations), so tests are reserved for people showing dramatic symptoms. Though, as the storm advances, we’re seeing a rapid evolution in our health care community, this is also authority-driven behavior. We have had no vaccine, nor medication, for treating the disease.

So inherently, we treat the symptoms. Knowing whether or not someone has COVID-19 really only benefits the authority system – or deeper into the reality of it all, is arbitrary. I ABSOLUTELY DO NOT accuse our health care providers of any malfeasance. I think they’re in a very tight spot. But what it does show is how they think. It’s that one-one mapping thing. If symptoms are already severe, there’s a very limited benefit to consequential planning for the larger community from testing someone. On the other hand, their options are severely proscribed. And there’s nothing like the wolf at your door to rapidly evolve your connected thinking. Here’s hoping that it does.

Unfortunately, the authority-driven mindset reduces our ability to get ahead of the pandemic. The notion that we might mirror communities or nations around the globe never crosses our mind. Japan, with halting steps, and imperfect culture itself, is getting back to normal with people wearing masks, though without the wide-scale testing many epidemiologists think is really necessary. Taiwan and Singapore, with their en pointe quarantine strategies, are, through a combination of individual tracking and visitor quarantine staying ahead of the pandemic. In Taiwan, you have to wait two weeks self-quarantined in a hotel room before you’re allowed to circulate. And if you go outside with your GPS-mandatory cell phone in your pocket, the alarms go off and the Taiwanese police will chase you down.

What’s interesting is that COVID-19 is actually giving a lesson to the world in Complex Thinking 101. We know the source of our illness — it’s a microscopic virus, whose entire identity has been sourced and DNA mapped. It’s one little crack in a world that took advantage of a vast transmission system — our air transport network — to spread maximally to every corner of the globe, in a little over a month. The fact that there are both big and small ripples from that initial hijacking should cause us to shift our mindsets. We can do that by drawing larger system boundaries around all our various loci of contact — hospitals for sure, but grocery stores, gas stations, and the like — and ask how one might affect the other. And how that might affect something else. We have to practice the thinking we need.

But first, we have to realize the thinking we actually have — which, sadly, is poorly consequential, fragmented, and mostly egocentric. Like Donald Rumsfeld so infamously said, “You go to war with the Army you have — not the Army you might wish you have.” And the condition of that Army is shown not just by the heroes and heroines on the medical front lines. It’s also shown by the couple in their 60s eating fish tank cleaner, because they saw it contained chloroquine in it, which Donald Trump had endorsed as a new cure in a press conference. An extreme example of authority-driven mindset for sure — and the husband in the pair paid the ultimate price. But also a signal to consider, especially when this crisis passes. If COVID-19 is an opportunity for Complex Systems 101, fixing Anthropogenic Global Warming is an advanced degree. And we’re going to need that kind of thinking going forward. Because Authority-driven knowledge structures are not even up to snuff for the novel coronavirus. And there are a whole lot more courses, even besides AGM, for which the universe has scheduled us up.

Quickie Post — Why Trump Doesn't Invoke the Defense Production Act as of Sunday AM

One of my favorite signs – Yangshuo, CN — no cobras, dynamite, or sulfuric acid on the bus!

As I’ve covered in my past posts on COVID-19, the main thing governing cumulative mortality at the current time is lack of ventilator (and to a lesser extent, bed) capacity IF you get admitted to the hospital. We don’t have a vaccine, we have no (as of today) effective treatments, though news reports are now coming in of anti-viral medications that might work. So ventilator capacity, and not having hospitals overwhelmed, is how we have to manage this pandemic.

America does have a tool to rapidly gear up production of equipment in the case of a national emergency — it’s called the Defense Production Act. It was passed during the Korean War, and gives the President a broad array of powers to require manufacturers to pivot to supplying critical materiel in the interest of national security. It does what you’d think it does — makes it so people can’t hoard critical materials, and allows the government to direct companies to make stuff.

Yet as of this date and time, while Trump has talked about this, he hasn’t invoked it. This is mystifying a lot of people on social media (Twitter and Facebook) — why wouldn’t he do that?

As a narcissistic psychopath/collapsed egocentric, Trump lives in his own fuzzy bubble, where his belief system defines reality. To the extent that reality interferes in his belief system, what I call validity grounding, which is the thing that inevitably gets all Authoritarians, Trump operates inside his own mind — because his pathologies don’t allow distinct boundaries between his own mind and the outside world. It’s all about him, after all. Others only exist in a magical framework.

Trump, instead, has asked various companies to pivot and step up with supplies – and insists that they are. As of this date and time, I have heard that various companies are going to start making ventilator parts, and some people have started 3D printing parts. In Italy, Ferrari and Fiat have said they will start making parts. But making ventilators, or even gowns is not simple on such a short timescale. And a lack of directed efforts wastes time.

But nothing matters to Trump, until some critical mass of an ever-shrinking pool of influencers manage to ground him. And if he did implement the act proactively, it would be a damning condemnation to his inner ethos. He simply can’t — it’s a law, after all, and Trump has been insisting that laws are the problem. It’s only when his own survival is threaten that he will borrow from that higher v-Meme/value set to accomplish his ends.

The problem with all of this is that Trump’s mind exists largely in a time-invariant world. Nothing changes in the external world until his mind changes. And that is always a jump, followed by an erasure of history of the other mindset.

But this challenge is inherently dependent on varying timescales. Notions like Flattening the Curve require the population to, at least a little, comprehend temporal variation. Yes, there is a part of the population that requires do/do not mandates — but others can start the process of comprehension of the mechanism for these edicts.

The upshot? Trump will change his mind — when his own survival is threatened. Days will be lost in the process, and it will affect the outcomes in hospitals if the pandemic doesn’t slow down. But don’t hold your breath. Wait for an event.

Quickie Post — The DeepOS of the COVID-19 Epidemic – An Immunosuppressed Global Population

The Creek – Dubai – loading the dhow for the transit across the Persian Gulf to Iran

One of the most interesting things about thinking through the COVID-19 epidemic is understanding the statistics, and what is the deep meaning they are attempting to tell us. Information comes, of course, in the form of data — testing (which doesn’t tell us much for most countries,) fatalities, which sadly tell us more. Hospital overwhelm, of course, tells us something profound about our medical facilities capacity for this epidemic, but is largely inconclusive as well.

Still statistics don’t sit alone. The world works in a coherent fashion, regardless if it’s in our favor or not. There is a larger coherence present in understanding how eating a bat in Wuhan may generate chaos across the globe, when coupled with a highly efficient air transport system and a 5 day incubation period.

So it is VERY interesting to realize that some of the estimates of asymptomatic COVID-19 are around 18%. These people can be then responsible for close to 50% of infections. There’s also no good numbers on mild infections. This piece says 66%. When you add those two super-rough guesses together, you get around 85% of folks whose immune systems are more than up to the task of handling this bug.

What this says, though, is that 15% of the population’s immune systems are NOT up to handling the bug. And the laundry list of folks with the problems are diabetics, the elderly and whatnot.

Why does this matter? A disease like Ebola ranges from 25%-90% mortality. That means there is far less ability for our immune system to handle the disease. You get it, you die, though there is much to mine in the overall wellbeing of the African countries where Ebola has appeared. Contrast that with the 1% COVID-19 estimated fatality rate.

What this tells me is that this is a killer disease of the immunosuppressed. And a good hunk of that is driven by a combo of diet and aging. That ought to be something that we study in the future. Are we compromising our long-term health with our crummy diet? I surely think so. There will always be overlap in distributions, but when we have an obesity/overweight ratio hovering around 66%, we need to start asking ourselves what the concentrated effects of sugar and refined carbs is doing to wrecking our health. And preparing us for the next pandemic.

PS (3/21/2020) This article popped up on Buzzfeed re: Iceland. Iceland is (not surprisingly) testing 50% asymptomatic cases, and they have a whole island to run a fascinating experiment on. Which means more evidence that people who are immunocompromised, from air pollution, or diet, or illness, are really the ones we need to worry about. This will be a crazy Big Data study for the coming years.

PPS (3/23/2020) This article popped up about advocacy from the American Diabetes Association advocating special consideration from the federal government for diabetes sufferers.

What’s great about this is that a group like this can serve as a future demographic sensor when figuring out in the medium term what groups were truly affected by the virus. Diabetes is well-known as a metabolic and immunosuppressive source. I’ll be watching.

Empathy in the Time of Coronavirus (IV) — Understanding the Grim Statistics, and Root Cause of Hospital Failure

Baja, South of Loreto – always thinking…

I’ve written about understanding the Asymptomatic cases here, but since we can’t have any real data on actual infection rates considering the generalized population for a while, I think it is important to understand how to make decisions with the data that we have in the short term. Insofar as what can be done, I’m all about “flattening the curve” and such. Whether one understands it completely or not, trust me — it’s the right thing to do. Let’s understand why, with the information we know.

  1. COVID-19 is a new disease. There are no treatments for it. The body must live or die in producing its own immunity.
  2. There currently is no vaccine for COVID-19. Any prior immunity is poorly understood, and information is starting to just emerge on long-term immunity. Evidence coming in shows typical virus immunity does indeed occur. This matters in the long run, and can affect the decisions we make now, but not by much.
  3. The way people die from COVID-19 is respiratory failure. It is a SARS virus (Severe Acute Respiratory Syndrome).
  4. The main reason for respiratory failure (not completely preventable) is poor treatment, and hospital’s overrun in ventilator capacity.
  5. The pandemic will continue until treatments and a vaccine come into play, or until herd immunity takes hold. The time to do that depends on the degree of localization we can successfully practice. Localization ranges in scale from things like lockdowns, to individual detection. This lengthens the timescale of the pandemic, lessening the short-term impact, and giving the society time to find a vaccine or effective treatments.

So what we can now understand is that in the short-term, the main reason for deaths is, and will continue to be, a lack of pandemic preparedness signified mostly by a lack of ventilators. It may be that the actual death rate from the disease is < 1% in the long run, which is still 10X the flu. But the real problem IN THE PRESENT is that our hospital system, instead of preparing for the potentials of outbreak viruses, has optimized medical care around two factors. These are:

  1. Winning the Medical Arms Race with other facilities — more treatments, often offered competitively, that are high-status and make the hospital look better relative to its peers (buying another PET scanner instead of coordinating use with another hospital close by.)
  2. Minimizing extraneous costs (like managing Just-In-Time supply dynamics) for a better bottom line, in part because of pressure from insurers. This McKinsey-esque crunch across our entire economy is driven by the need to return ever-higher returns to shareholders in the short term, and among other things, has killed innovation.

I’m not really into the blame game, as much as I am into understanding the structural memetic dynamics of the current situation. What we are seeing, however, is an expression of the lack of empathetic development of many of our core systems. And the deeper problem with that is the ancillary collapse of consequential thinking because of that lack of development. Authority/Status-driven systems suck at thinking in terms of long-term consequences — we’re seeing the effects of that right now — because status is whatever the equivalent Louis Vuitton handbag equivalent is in the medical profession. And it is intrinsically coupled to following the crowd, or whoever the highest-status institution/person is in the crowd. It is IRRATIONAL — based on limited data, and insulated from grounding consequences in the surrounding environment.

What happens when you take an Authoritarian/Legalistic social structure, and you starve it is exactly what we’re seeing in our hospital system right now. You have shortages of key items necessary for care above any legally mandated baseline. You have no reserve capacity for anything resembling an epidemic. You have no training for people to anticipate these kinds of things. It’s unsexy to have a container full of masks that you may never use. But, as we can see, that’s exactly the kind of thinking that would prevent a higher death rate from the current crisis.

And smaller countries, like Taiwan, are showing that having that “crisis insurance” mentality, saves lives and money. Taiwan knew something was up the minute a cluster of pneumonia cases showed up in Wuhan. They kicked into high gear immediately and sent a team there. 99% of Taiwanese covered by health insurance shows an empathetic foundation for a society — I covered the success of Taiwan in this piece. It shows how empathetic, geeky, non-narcissistic leadership actually had the correct consequential thinking that managed the initial outbreak, and will now contain the small resurgence that is coming as the Taiwanese elite (also high-status, low empathy) fled the island, and then started returning home.

And because their relational network was large — many Taiwanese work in China, and have no illusions about their narcissistic Authoritarian neighbor — they knew they’d be connected. That’s the deep power of empathetic development. The Wuhan outbreak was NOT a Black Swan for them. It was an event that happened. Read this piece to understand the dynamics.

What does all this mean? It is time to understand and modify the DeepOS of our hospital system. And the only way to do this is to understand that the current Authoritarian/Legalistic hierarchy that drives administrations, as well as physicians’ personal development has to change. If we don’t change, we shouldn’t expect any different long-term outcomes. We have to create a new medical system focused on wellness, and getting people OFF of drugs — that part is easily said. Understanding that it will require a re-thinking of social structure to create the thinkers we need will be the challenging part. Why? Because to understand the demands of complexity requires complexity in thinking to start. It’s a killer chicken-and-egg problem.

We can start at the bottom. When was the last time you knew that doctors and nurses engaged in an empathy circle? Or doctors and patients? What about understanding how nutrition affects health, and the development of support groups for people of all stripes? What about more forgiveness of student loans for nurses, and doctors, so they don’t have the pressure to move so many people through the system? There are other avenues and decisions to be made. They must be made, though, in maximizing the empathy development of the people involved — because those rewired brains, along with a radically different social network, will be the things that actually figure out the right thing to do.

I’ll wrap it up here. Here is a key point. We SHOULD have national health insurance. It is a necessary first step. But national health insurance/single payer did not stop this epidemic in countries that had it, and some of those countries (like Great Britain) are literally hurtling into the abyss through a series of Pollyanna thinking, and the same lack of consequential thinking present in our own system. The social structure may be somewhat different, but obviously is NOT different enough.

By doing this — realizing our problems, working on top-level solutions, like stockpiling medical supplies and developing individual identification, along with focusing on activities that develop empathy in the health care system, we will create the people to anticipate uncertainty. By evolving the people, we will create the pretext for the emergent future that will stop these pandemics. You have to trust in the social physics. We can’t know what we don’t know. But we can create the people, out there on the front lines, to be our early warning system.

And yeah — it’s all about empathy.

Postscript — there is a whole post to be written about very specific target areas in people’s bodies around the idea of loosely coupled/tightly coupled physical systems inside our bodies, and how management of pandemics needs to be centered around the tightly coupled systems. Respiratory systems are prone to causing mortality through failure because they are, intrinsically, tightly coupled inside our bodies. Gastrointestinal failure is less tightly coupled. If this intrinsically makes sense to you, then enjoy the brain candy!

Empathy in the Time of Coronavirus – Interlude (III)

Happier times, Longji, Guangxi Province, China

There’s a story associated with the above picture that is insightful and funny, and interestingly relevant in these times.

I was in China, spending time in the Pearl River Delta, where I was visiting various factories in Shenzhen and Dongguan, in an attempt to understand manufacturing changes in China. I decided I also wanted to visit rural China, so I could better understand the demographic changes happening across the country, to understand why people would move to the Pearl River Delta. I had a talk to give in Guilin, which is famous for the upright karst formations and the Lijiang River.

Countryside outside Guilin
Lijiang River — note construction cranes on the edge of this scene

So my guide and I went to Guilin, and planned a side trip to Longji (The Dragon’s Back), in the mountains, famous for its terraced rice paddies. Longji is also in the heart of the Zhuang ethnic minority, people who do not identify as Han Chinese, the dominant ethnic group in China.

Stairs — always stairs

We stayed in a broken down hotel with little water, and the infamous hard Chinese beds. After we checked into the guesthouse, it was time for a stroll up and down the mountainside. Anyone who’s been to China will tell you that mountainous regions are famous for steps, and Longji was no different.

Longji rice terraces

At various places, there were overlooks. And on those overlooks were young women dressed in native costumes. For a fee (something like $2 US) they would pose with you. There were three on this particular overlook, and two were being pushy. The young woman in this picture, though was holding her peace off to the side.

So I selected her. We had a very fun 10 minute situation where we posed in the standard poses. I bowed and gave her a quick peck on the cheek. She smiled.

I then continued around the rest of the loop, using my bad Mandarin to raise hell with the old women who occupied a different town square up the mountain. “Why are you not wearing a wedding ring?” they asked. “Because I’m not married,” I replied. “But you should be married,” they said. I replied “But I have no money!” They started laughing. “Well that’s why maybe you shouldn’t be married!”

Some humor is truly transcultural.

After the remaining walk, I trundled down to the small bar in the village, ordered up a Tsingtao, and sat down. There was Wifi, and I turned on my computer.

After about five minutes, a beautiful young woman came walking directly toward me, in modern dress (she had a Tommy Hilfiger sweater on,) literally making a beeline. It startled me a bit, as she stuck her hand out. Of course, she was the young woman earlier up on the hill, in the costume.

With the aid of Google Translate, we spent a delightful hour of conversation. She explained to me her life. “1/3 of the season, I am getting a B.A. in Accounting in Guilin where I go to school. 1/3 of the time, I am in the costume, making money for my family and to help pay for school. And 1/3 of the time, I am helping my father behind the Shui-Nyu (the water buffalo) planting rice.”

Lots of shui-nyus everywhere

What she had offered was a view into a transitional society — one moving from Tribal value sets, that were obviously still very strong, to a future where Performance/Goal-based thinking and Legalistic/Algorithmic rule processing would dominate.

Understanding this is vital in communicating with people about the virus. Different Value Sets will be receptive to different messaging, with different complexity. I am writing for the top of the complexity stack in my posts. But if you want to communicate down the stack, you have to realize people can only understand what they are developed to understand.

An example. If I were coaching her on what to tell her grandmother, this is what I’d say. “Nǎinai/Ama, I love you. And now, to honor you, I will take care of you as you stay in this corner of the house and do not go out. One day, you will play with my grandchildren.”

It’s not that hard.

A prosperous historic village outside Guilin – Not Longji

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Closer to the Western milieu, for all those that are authorities, I would recommend remember the Little Prince — especially, when the Little Prince visited the planet where the King had set up shop.

From the book, online here (Chapter 10) —

For what the king fundamentally insisted upon was that his authority should be respected. He tolerated no disobedience. He was an absolute monarch. But, because he was a very good man, he made his orders reasonable.

“If I ordered a general,” he would say, by way of example, “if I ordered a general to change himself into a sea bird, and if the general did not obey me, that would not be the fault of the general. It would be my fault.”

“May I sit down?” came now a timid inquiry from the little prince.

“I order you to do so,” the king answered him, and majestically gathered in a fold of his ermine mantle.page28image3814125184

But the little prince was wondering… The planet was tiny. Over what could this king really rule?

“Sire,” he said to him, “I beg that you will excuse my asking you a question−−” “I order you to ask me a question,” the king hastened to assure him.
“Sire−− over what do you rule?”
“Over everything,” said the king, with magnificent simplicity.

“Over everything?”

The king made a gesture, which took in his planet, the other planets, and all the stars.

“Over all that?” asked the little prince.

“Over all that,” the king answered.

For his rule was not only absolute: it was also universal.

“And the stars obey you?”

“Certainly they do,” the king said. “They obey instantly. I do not permit insubordination.”

Such power was a thing for the little prince to marvel at. If he had been master of such complete authority, he would have been able to watch the sunset, not forty−four times in one day, but seventy−two, or even a hundred, or even two hundred times, with out ever having to move his chair. And because he felt a bit sad as he remembered his little planet which he had forsaken, he plucked up his courage to ask the king a favor:

“I should like to see a sunset… do me that kindness… Order the sun to set…”

“If I ordered a general to fly from one flower to another like a butterfly, or to write a tragic drama, or to change himself into a sea bird, and if the general did not carry

out the order that he had received, which one of us would be in the wrong?” the king demanded. “The general, or myself?”

“You,” said the little prince firmly.

“Exactly. One much require from each one the duty which each one can perform,” the king went on. “Accepted authority rests first of all on reason. If you ordered your people to go and throw themselves into the sea, they would rise up in revolution. I have the right to require obedience because my orders are reasonable.”


Here is hoping that our authorities remember that their subjects are under stress, and ask what is reasonable. Empathy is the cornerstone.