newyorker--2020-04-21--Why Psychiatric Wards Are Uniquely Vulnerable to the Coronavirus

B. spoke to me by Zoom from the car parked outside their house—we couldn ’ t talk when B. was at work , or inside the house , where B.
’ s children were playing .
B. has also used the car to Zoom with colleagues about trying to devise safety protocols for their workplace , because those , too , are conversations B. can ’ t have at work .
B. is the medical director of an inpatient psychiatric unit in a small hospital within a large for-profit network .
The hospital ’ s administration , B. told me @ @ @ @ @ @ @ their own N95 masks or other protective equipment , even though the hospital had little equipment to issue .
Nor were doctors able to test or isolate patients with suspected cases of COVID-19 .
Psychiatrists , B. told me , were still being required to appear for in-person consultations , when remote communication would have been possible and safer .
There was no way and no real effort to enforce physical distancing , B. told me .
Patients could be isolated only once they were symptomatic and had tested positive , but patients @ @ @ @ @ @ @ continued to intermingle on the ward .
I heard similar accounts from several other physicians working in inpatient psychiatric wards in for-profit , nonprofit , and state hospitals , across multiple states .
All of these doctors , who spoke on condition of anonymity , told me variations on the same story : how a lack of testing , P.P.E.
, and seclusion protocols were making a difficult task—maintaining the safety of a highly vulnerable population and their care workers during a pandemic—virtually impossible .
All of them told me about conflicts with @ @ @ @ @ @ @ battling the cruel logic of business models and insurance payments .
The challenges faced by psychiatric-ward physicians across the country are legible in what few casualty statistics we have .
At Western State Hospital in Washington , for example , at least twenty-seven workers and six patients have tested positive for COVID-19 , with one death—but these numbers tell us little , since , according to reports , only two patients at the facility were tested during the first two weeks of April .
The New York Post wrote that , as of @ @ @ @ @ @ @ Jersey ’ s four psychiatric hospitals had two hundred and forty cases of the coronavirus and five fatalities .
Four of the deaths were at a single hospital , Greystone Park Psychiatric Hospital in Morris County , where thirty-three patients—about one in ten people being treated there—and forty-four employees tested positive .
Among New York ’ s twenty-four state mental hospitals , five have patients with COVID-19 in every unit .
The coronavirus , and the public-health measures undertaken to slow its spread , is uniquely hostile to psychiatric care .
An ordinary @ @ @ @ @ @ @ patients are generally in bed , in their rooms , physically distant from one another .
By contrast , the prevention of solitude is built into the architecture of psych units , and enshrined in the laws and regulations that govern them .
Psychiatric units are often designed to facilitate communication and group activities ; now , however , they seem as if they were designed to spread the virus .
Unlike in other hospital units , patients do not spend their days in their rooms : they are expected to attend therapy @ @ @ @ @ @ @ go outside , and take their meals together with other patients .
C. , the medical director of a state psychiatric hospital , said that his facility has revised patients ’ schedules to insure that no more than ten people are in a day room or dining hall at one time .
Between meals , therapy , and supervised group activities , patients have four hours when no activities are planned , and this is when hospital staff try to persuade them to stay in their nearly empty rooms , for reasons that @ @ @ @ @ @ @ .
The rooms have no televisions or telephones ; personal devices such as cell phones , tablets , and computers are not allowed because of , among other things , the concern that patients would harm themselves or take pictures or videos , thereby violating privacy regulations .
Most facilities have MP3 players , but usually not enough for every patient .
New York State is currently trying to arrange a bulk purchase of tablets with disabled cameras for mental-health patients , but the cost is likely to prove prohibitive .
Doctors can @ @ @ @ @ @ @ their rooms .
The law in most states allows confining patients to a room only when they pose an immediate danger to themselves or others , and only for a short time .
Seclusion itself requires frequent reassessments , each accompanied by copious paperwork , and most units have only one or two seclusion rooms , which are often needed for actual psychiatric emergencies , rather than social distancing .
“ You can ’ t use seclusion to isolate someone because of COVID-19 , ” G. , a physician who works for a @ @ @ @ @ @ @ After all , G. argued , in the world outside a psychiatric unit , people are not forcibly locked up to enforce social distancing , so the same rules should apply on the ward .
If dysregulation is getting in the way of being able to persuade the patient to observe social distancing , then it ’ s the doctor ’ s job to find the right medication until he can have a successful conversation .
What about patients whose mental impairment is permanent—such as dementia , which often afflicts people on geriatric @ @ @ @ @ @ @ the coronavirus could be most terrifying ?
The only other option is sedation , G. said .
When S. , the medical director of a psychiatric unit at a nonprofit hospital , discovered that an asymptomatic health-care worker who shuttled between units might have exposed their twenty-nine patients to the coronavirus , S. immediately split the unit into two parts .
It required a bit of creativity : S. ’ s unit is normally divided into two : one for adults and one for elderly patients .
S. used the physical separation to @ @ @ @ @ @ @ didn ’ t have it .
Then S. separated adult patients from gerontology patients within each of the resulting units .
“ That ’ s not usually how we practice in psychiatry , as we have different programming for each age group , ” S. told me .
“ What I did , I did on the spur of the moment .
It may not be the right thing .
There were no guidelines.
” So far , about fifteen people in S. ’ s hospital have tested positive .
S. also fought @ @ @ @ @ @ @ test every new patient who is admitted to the unit .
“ And still we are taking a huge risk , because we know the test has thirty per cent false negatives , ” S. said .
For patients who have tested positive , S. waits for two consecutive negative tests before the person is allowed to move to the non-COVID part of the unit .
The hospital administration is unhappy with this practice , S. told me , because it is more stringent than Centers for Disease Control guidelines .
Testing new @ @ @ @ @ @ @ inpatient psych units are likely to be coming from precarious living situations , or no home at all—no place to self-isolate or even wash their hands .
Unlike most people who come to a regular emergency room , psychiatric patients are mobile , and often highly energized ; they don ’ t necessarily receive close physical examinations on arrival .
They are also likely to have other , compounding medical conditions .
The very illness that brings them to a psychiatric hospital may make it harder for them to follow hygiene , self-distancing @ @ @ @ @ @ @ increases the risk to them and everyone around them .

B. spoke to me by Zoom from the car parked outside their house—we couldn’t talk when B. was at work, or inside the house, where B.’s children were playing. B. has also used the car to Zoom with colleagues about trying to devise safety protocols for their workplace, because those, too, are conversations B. can’t have at work. B. is the medical director of an inpatient psychiatric unit in a small hospital within a large for-profit network. The hospital’s administration, B. told me, was not permitting doctors to wear their own N95 masks or other protective equipment, even though the hospital had little equipment to issue. Nor were doctors able to test or isolate patients with suspected cases of COVID-19. Psychiatrists, B. told me, were still being required to appear for in-person consultations, when remote communication would have been possible and safer. There was no way and no real effort to enforce physical distancing, B. told me. Patients could be isolated only once they were symptomatic and had tested positive, but patients with whom they had been in contact continued to intermingle on the ward.
I heard similar accounts from several other physicians working in inpatient psychiatric wards in for-profit, nonprofit, and state hospitals, across multiple states. All of these doctors, who spoke on condition of anonymity, told me variations on the same story: how a lack of testing, P.P.E., and seclusion protocols were making a difficult task—maintaining the safety of a highly vulnerable population and their care workers during a pandemic—virtually impossible. All of them told me about conflicts with hospital administrators. All of them were battling the cruel logic of business models and insurance payments.
The challenges faced by psychiatric-ward physicians across the country are legible in what few casualty statistics we have. At Western State Hospital in Washington, for example, at least twenty-seven workers and six patients have tested positive for COVID-19, with one death—but these numbers tell us little, since, according to reports, only two patients at the facility were tested during the first two weeks of April. The New York Post wrote that, as of the second week of April, New Jersey’s four psychiatric hospitals had two hundred and forty cases of the coronavirus and five fatalities. Four of the deaths were at a single hospital, Greystone Park Psychiatric Hospital in Morris County, where thirty-three patients—about one in ten people being treated there—and forty-four employees tested positive. Among New York’s twenty-four state mental hospitals, five have patients with COVID-19 in every unit.
The coronavirus, and the public-health measures undertaken to slow its spread, is uniquely hostile to psychiatric care. An ordinary hospital unit is a lonely place: patients are generally in bed, in their rooms, physically distant from one another. By contrast, the prevention of solitude is built into the architecture of psych units, and enshrined in the laws and regulations that govern them. Psychiatric units are often designed to facilitate communication and group activities; now, however, they seem as if they were designed to spread the virus. Unlike in other hospital units, patients do not spend their days in their rooms: they are expected to attend therapy, play games, watch television, go outside, and take their meals together with other patients.
C., the medical director of a state psychiatric hospital, said that his facility has revised patients’ schedules to insure that no more than ten people are in a day room or dining hall at one time. Between meals, therapy, and supervised group activities, patients have four hours when no activities are planned, and this is when hospital staff try to persuade them to stay in their nearly empty rooms, for reasons that are difficult for some patients to process. The rooms have no televisions or telephones; personal devices such as cell phones, tablets, and computers are not allowed because of, among other things, the concern that patients would harm themselves or take pictures or videos, thereby violating privacy regulations. Most facilities have MP3 players, but usually not enough for every patient. New York State is currently trying to arrange a bulk purchase of tablets with disabled cameras for mental-health patients, but the cost is likely to prove prohibitive.
Doctors cannot actually require patients to stay in their rooms. The law in most states allows confining patients to a room only when they pose an immediate danger to themselves or others, and only for a short time. Seclusion itself requires frequent reassessments, each accompanied by copious paperwork, and most units have only one or two seclusion rooms, which are often needed for actual psychiatric emergencies, rather than social distancing. “You can’t use seclusion to isolate someone because of COVID-19,” G., a physician who works for a state regulatory agency, told me. After all, G. argued, in the world outside a psychiatric unit, people are not forcibly locked up to enforce social distancing, so the same rules should apply on the ward. If dysregulation is getting in the way of being able to persuade the patient to observe social distancing, then it’s the doctor’s job to find the right medication until he can have a successful conversation. What about patients whose mental impairment is permanent—such as dementia, which often afflicts people on geriatric psych wards, where the impact of the coronavirus could be most terrifying? The only other option is sedation, G. said.
When S., the medical director of a psychiatric unit at a nonprofit hospital, discovered that an asymptomatic health-care worker who shuttled between units might have exposed their twenty-nine patients to the coronavirus, S. immediately split the unit into two parts. It required a bit of creativity: S.’s unit is normally divided into two: one for adults and one for elderly patients. S. used the physical separation to divide patients with COVID-19 from those who didn’t have it. Then S. separated adult patients from gerontology patients within each of the resulting units. “That’s not usually how we practice in psychiatry, as we have different programming for each age group,” S. told me. “What I did, I did on the spur of the moment. It may not be the right thing. There were no guidelines.”
So far, about fifteen people in S.’s hospital have tested positive. S. also fought, successfully, for the ability to test every new patient who is admitted to the unit. “And still we are taking a huge risk, because we know the test has thirty per cent false negatives,” S. said. For patients who have tested positive, S. waits for two consecutive negative tests before the person is allowed to move to the non-COVID part of the unit. The hospital administration is unhappy with this practice, S. told me, because it is more stringent than Centers for Disease Control guidelines.
Testing new patients is crucial, because people in inpatient psych units are likely to be coming from precarious living situations, or no home at all—no place to self-isolate or even wash their hands. Unlike most people who come to a regular emergency room, psychiatric patients are mobile, and often highly energized; they don’t necessarily receive close physical examinations on arrival. They are also likely to have other, compounding medical conditions. The very illness that brings them to a psychiatric hospital may make it harder for them to follow hygiene, self-distancing, and other preventive guidelines, which increases the risk to them and everyone around them.
C. told me that new patients can be quarantined—isolated to a room with a security detail—only if they have symptoms of the coronavirus infection, including a fever of at least a hundred and two degrees. “It costs a lot of money” to quarantine, C. told me, especially because state regulations require constant one-on-one monitoring of people who are confined to their rooms. In one case, C. fought the hospital’s administration to quarantine a new patient who was coughing and running fever of a mere ninety-nine degrees.
Worse, unlike S., C. has no access to in-house testing. When patients develop symptoms, they have to be taken to a nearby general hospital for testing, a process that also involves, at minimum, a driver and a member of the security staff. C. himself was the first person to show symptoms of COVID-19 at his facility, on Friday, March 20th, a few hours after seeing his last patient of the day. The state Department of Health denied C. a test because he had not been exposed to anyone who was confirmed to be infected with the coronavirus, nor had he travelled to a country that the state then viewed as high-risk. “I was lucky,” C. told me. “I found an urgent care that had tests, and they were fast—I had my result in two days.” He paid a hundred and twenty-five dollars for the test, and the results were positive. C., who is still recovering from COVID-19, has since directed twelve of his colleagues to the same urgent care for testing. At least thirty other workers at his hospital have tested positive, and one worker and nine patients have died from complications of the virus. But because of the difficulty of obtaining testing, these numbers tell us little about the prevalence of infection at this large state hospital. Meanwhile, the hospital is badly understaffed, in part, C. told me, because people are afraid to come to work.
In late March, as the coronavirus crisis was gaining momentum in New York, Governor Andrew Cuomo ordered hospitals in the state to increase capacity. As part of this effort, psychiatric units of general hospitals began moving their patients to state hospitals; in turn, the state hospitals moved patients to transitional facilities, and those facilities began discharging patients sooner than planned—often sending them to residential programs or halfway houses, where they would be most at risk for the coronavirus infection, and in all cases sending them into the community at a terrifying time.
The peak of COVID-19 hospitalizations will therefore almost certainly be followed by what psychiatrists call “increased acuity”: more people with mental-health issues coming to the emergency rooms of the same general hospitals that have freed up the beds that used to be reserved for psych patients. “This is where we are now: the beginning of acuity,” K. told me.
In 2017, the journalist Ron Powers published a book about the American mental-health-care system, “No One Cares About Crazy People.” The title was borrowed from a memo written by an administrative aide to Scott Walker, who was the governor of Wisconsin at the time; the corollary is that no one seems to care much about those who take care of crazy people, either. “What has really kept me awake at night is that there is always, always less consideration for psychiatric services than for medical services,” G. said. The doctors I interviewed only half-jokingly referred to themselves and their patients as distinct from “real doctors” and “real patients.” K., the medical director of a psychiatric unit at a large nonprofit hospital, told me that its administration has encouraged psychiatrists to save hospital-provided N95 masks by using telemedicine. Hospital guidelines further dictate that N95s be used only during invasive medical procedures. “But we have a lot of very, very sick patients—psychotic, manic—coming to the emergency department,” K. said. One of the ways in which psychiatric patients express distress and agitation is by spitting. “We have one window that was all covered with spit from this one patient. We are holding the patient down, he is spitting on us, and we are still just wearing surgical masks,” K. said.


newyorker--2020-04-22--Noel Marshall’s “Roar”: Humans Were Harmed in the Making of This Film

“ Roar , ” the 1981 movie starring Tippi Hedren , Noel Marshall , who was then her husband , and a large group of lions and tigers , opens with the ultimate spoiler by omission : a title card declaring that , despite appearances to the contrary , no animal was harmed in the course of its production .
The credits say nothing about the protection of humans , who both appear to be , and were , injured while making the film .
Hedren , in her autobiography , goes into detail about the horrors of the shoot @ @ @ @ @ @ @ family home in California—the animals were theirs .
The story of its making , which Hedren details in her autobiography , is a tale of reckless obsession , of folie à deux that was then shared with many—including the couple ’ s children—but one need know nothing of the actual story to realize that awful things took place while “ Roar ” was being made , because they ’ re an inseparable part of the action .
What makes the tale , and the movie—which was long unreleased in the U.S. , came @ @ @ @ @ @ @ now streaming through Alamo Drafthouse ( which is splitting revenue with local art houses ) —all the stranger is that the movie , with all its real blood , plays like warmhearted , often antic comedy .
Hedren ’ s autobiography is , above all , historically significant , for her detailing of the sexual abuse that she endured from Alfred Hitchcock when they worked together on “ The Birds ” and “ Marnie.
” When she rebuffed him , he threatened to ruin her career .
She writes , “ I was @ @ @ @ @ @ @ challenging as the two I did for him.
” Her career nonetheless continued , if not quite so illustriously , and , in 1969 , when she was filming “ Satan ’ s Harvest ” on location in Zimbabwe , she and Marshall took a side trip to a game preserve in Mozambique .
There , Hedren and Marshall visited a house that was inhabited by thirty lions ; Marshall , as Hedren recalls , said the fateful words : “ You know , we ought to make a movie about this.
” @ @ @ @ @ @ @ film in the form of a dramatic feature .
They brought lions into their own Los Angeles home in order to test the premise , and bought land and built a compound in Soledad Canyon to accommodate a menagerie .
“ Our lions , tigers , elephant , leopards , and panthers ( actually leopards in black coats rather than spotted ones ) were joined by a few cougars , ” Hedren writes .
Even while the family went into a test phase , with just a handful of lion cubs in their @ @ @ @ @ @ @ as Hedren writes , “ their teeth are virtual petri dishes of bacteria , ” and “ being bitten is inevitable.
” The couple brainstormed a story , one that also included their dedication to the protection of wildlife , and Marshall wrote it up as a script .
All along , Hedren and the couple ’ s children ( from previous marriages ) were slated to act in it—her daughter , Melanie Griffith , and his sons Jerry and John .
When no actor could be found who was willing to take @ @ @ @ @ @ @ lead—which also required close contact with the animals—Marshall decided to do it himself .
( The cast of animals , Hedren writes , grew to include “ 132 big cats , one elephant , three aoudad sheep , and a collection of ostriches , flamingos , marabou , storks , and black swans.
” Marshall plays a scientist named Hank , who lives with the subjects of his study—lions , tigers , leopards , and other wild animals—at his compound in Tanzania .
His wife , Madelaine ( Hedren ) , and their @ @ @ @ @ @ @ the film , Melanie , Jerry , and John ) , who ’ ve been living in Chicago , are en route for their first visit to the compound .
But before Madelaine and the children arrive , Hank heads off on a work-related trip , and when they show up , they find themselves alone in a house with the animals ; they ’ re terrified , and they struggle to evade and fend off the beasts , who push ( and bite and paw and claw and stomp ) back .
@ @ @ @ @ @ @ , occupying land roamed by wild animals , plan to shoot the animals down , starting with the ones kept by Hank , whose research grant is threatened by the settlers ’ hostility .
From the start of the film , when Hank , along with an indigenous African friend and associate named Mativo ( Kyalo Mativo ) , is puttering around the compound , the dangers that the animals present—even to the ostensibly experienced scientist—are apparent .
The joke of a lion ’ s affinity for Mativo ’ s jacket is connected @ @ @ @ @ @ @ lion , which soon turns serious when his hand gets mauled .
Soon thereafter , members of the committee evaluating Hank ’ s grant proposal show up in boats—which are capsized by his swimming tigers , who then maul and bloody the members .
The sight of blood in “ Roar ” —and it ’ s not uncommon—is shocking and unambiguously real ; no prop person can approximate the color , the shine , and the spread of it , just as no actor can simulate the authentic shock of injury .
Watching @ @ @ @ @ @ @ I felt exactly as I did the first time I saw real blood in a news photo , at the age of eight ( of the boxer Henry Cooper , who ’ d just lost a bout to Muhammad Ali ) : the viewing itself seemed to leave the screen and penetrate my very skin .
It also seemed , simply , wrong : the sense of horror is both tactile and moral .
The cast and crew of “ Roar ” endured monstrous dangers both on-camera and off .
Melanie Griffith , @ @ @ @ @ @ @ surgery .
Hedren contracted gangrene and needed skin grafts .
Marshall , mauled repeatedly , had blood poisoning .
The cinematographer Jan de Bont—who ultimately directed “ Speed ” and “ Twister ” —had his scalp torn off and needed a hundred and twenty stitches .
At times , Hedren felt that Marshall was heedless of her well-being ; yet she writes that she “ was into it every bit as much as he was , ” and writes of the film ’ s production as an “ obsessive , addictive drama.
” @ @ @ @ @ @ @ into the movie—and despite Hedren ’ s and the children ’ s obvious terror , as well as that of Mativo , of other cast members , and of Marshall himself—the movie ’ s depiction of this violence and this pain is scattershot , and is played for laughs .
The scene of Hank bloodied in Mativo ’ s company is frolicsome ; the scene of the members being bloodied is nearly gleeful .
Then comes the movie ’ s main set piece , occurring when Madelaine and the children reach the house @ @ @ @ @ @ @ empty ; they enter , looking for Hank , not realizing that , perched above them on the second floor and looking down from its balcony , a crowd of lions and tigers is watching them .
Then , a swarm of lions and tigers waiting outside bursts in on them , soon joined by the ones upstairs , who pursue and terrify the family .
In these sequences , “ Roar ” feels like a home-invasion movie , like “ The Birds ” ( the film that made Hedren a star ) @ @ @ @ @ @ @ face to face with the animals , the visitors are terrified and , in their efforts to flee them and fend them off , they create situations that are as terrifying as they are absurd .
Lions and tigers break down doors and break through walls ; as one son hides in a closet that a lion wrenches open , another son hides in a cabinet that a lion knocks over , and Melanie hides in a cabinet that the animals then knock over and stomp to splinters before clawing at her .

“Roar,” the 1981 movie starring Tippi Hedren, Noel Marshall, who was then her husband, and a large group of lions and tigers, opens with the ultimate spoiler by omission: a title card declaring that, despite appearances to the contrary, no animal was harmed in the course of its production. The credits say nothing about the protection of humans, who both appear to be, and were, injured while making the film. Hedren, in her autobiography, goes into detail about the horrors of the shoot, which took place largely at her family home in California—the animals were theirs. The story of its making, which Hedren details in her autobiography, is a tale of reckless obsession, of folie à deux that was then shared with many—including the couple’s children—but one need know nothing of the actual story to realize that awful things took place while “Roar” was being made, because they’re an inseparable part of the action. What makes the tale, and the movie—which was long unreleased in the U.S., came out briefly in 2015, and is now streaming through Alamo Drafthouse (which is splitting revenue with local art houses)—all the stranger is that the movie, with all its real blood, plays like warmhearted, often antic comedy.
Hedren’s autobiography is, above all, historically significant, for her detailing of the sexual abuse that she endured from Alfred Hitchcock when they worked together on “The Birds” and “Marnie.” When she rebuffed him, he threatened to ruin her career. She writes, “I was never offered another role as deep and challenging as the two I did for him.” Her career nonetheless continued, if not quite so illustriously, and, in 1969, when she was filming “Satan’s Harvest” on location in Zimbabwe, she and Marshall took a side trip to a game preserve in Mozambique. There, Hedren and Marshall visited a house that was inhabited by thirty lions; Marshall, as Hedren recalls, said the fateful words: “You know, we ought to make a movie about this.”
Hedren and Marshall decided to make the film in the form of a dramatic feature. They brought lions into their own Los Angeles home in order to test the premise, and bought land and built a compound in Soledad Canyon to accommodate a menagerie. “Our lions, tigers, elephant, leopards, and panthers (actually leopards in black coats rather than spotted ones) were joined by a few cougars,” Hedren writes. Even while the family went into a test phase, with just a handful of lion cubs in their house, they faced daily dangers; as Hedren writes, “their teeth are virtual petri dishes of bacteria,” and “being bitten is inevitable.”
The couple brainstormed a story, one that also included their dedication to the protection of wildlife, and Marshall wrote it up as a script. All along, Hedren and the couple’s children (from previous marriages) were slated to act in it—her daughter, Melanie Griffith, and his sons Jerry and John. When no actor could be found who was willing to take the risks involved in playing the male lead—which also required close contact with the animals—Marshall decided to do it himself. (The cast of animals, Hedren writes, grew to include “132 big cats, one elephant, three aoudad sheep, and a collection of ostriches, flamingos, marabou, storks, and black swans.”
Marshall plays a scientist named Hank, who lives with the subjects of his study—lions, tigers, leopards, and other wild animals—at his compound in Tanzania. His wife, Madelaine (Hedren), and their three twentysomething children (called, in the film, Melanie, Jerry, and John), who’ve been living in Chicago, are en route for their first visit to the compound. But before Madelaine and the children arrive, Hank heads off on a work-related trip, and when they show up, they find themselves alone in a house with the animals; they’re terrified, and they struggle to evade and fend off the beasts, who push (and bite and paw and claw and stomp) back. Meanwhile, local white settlers and poachers, occupying land roamed by wild animals, plan to shoot the animals down, starting with the ones kept by Hank, whose research grant is threatened by the settlers’ hostility.
From the start of the film, when Hank, along with an indigenous African friend and associate named Mativo (Kyalo Mativo), is puttering around the compound, the dangers that the animals present—even to the ostensibly experienced scientist—are apparent. The joke of a lion’s affinity for Mativo’s jacket is connected to Hank’s frolic with a lion, which soon turns serious when his hand gets mauled. Soon thereafter, members of the committee evaluating Hank’s grant proposal show up in boats—which are capsized by his swimming tigers, who then maul and bloody the members. The sight of blood in “Roar”—and it’s not uncommon—is shocking and unambiguously real; no prop person can approximate the color, the shine, and the spread of it, just as no actor can simulate the authentic shock of injury. Watching the movie for the first time, I felt exactly as I did the first time I saw real blood in a news photo, at the age of eight (of the boxer Henry Cooper, who’d just lost a bout to Muhammad Ali): the viewing itself seemed to leave the screen and penetrate my very skin. It also seemed, simply, wrong: the sense of horror is both tactile and moral.
The cast and crew of “Roar” endured monstrous dangers both on-camera and off. Melanie Griffith, mauled near the eye, needed plastic surgery. Hedren contracted gangrene and needed skin grafts. Marshall, mauled repeatedly, had blood poisoning. The cinematographer Jan de Bont—who ultimately directed “Speed” and “Twister”—had his scalp torn off and needed a hundred and twenty stitches. At times, Hedren felt that Marshall was heedless of her well-being; yet she writes that she “was into it every bit as much as he was,” and writes of the film’s production as an “obsessive, addictive drama.”
Yet despite the real-life gore that went into the movie—and despite Hedren’s and the children’s obvious terror, as well as that of Mativo, of other cast members, and of Marshall himself—the movie’s depiction of this violence and this pain is scattershot, and is played for laughs. The scene of Hank bloodied in Mativo’s company is frolicsome; the scene of the members being bloodied is nearly gleeful. Then comes the movie’s main set piece, occurring when Madelaine and the children reach the house, which appears to them to be empty; they enter, looking for Hank, not realizing that, perched above them on the second floor and looking down from its balcony, a crowd of lions and tigers is watching them. Then, a swarm of lions and tigers waiting outside bursts in on them, soon joined by the ones upstairs, who pursue and terrify the family. In these sequences, “Roar” feels like a home-invasion movie, like “The Birds” (the film that made Hedren a star) reënacted with wildcats. Finally finding themselves face to face with the animals, the visitors are terrified and, in their efforts to flee them and fend them off, they create situations that are as terrifying as they are absurd. Lions and tigers break down doors and break through walls; as one son hides in a closet that a lion wrenches open, another son hides in a cabinet that a lion knocks over, and Melanie hides in a cabinet that the animals then knock over and stomp to splinters before clawing at her.
Yet, if the first time looms with the possibility of tragedy, the family’s subsequent encounters with Hank’s animals play like bumptious farce. An elephant lifts Madelaine on its trunk and drops her in the water before destroying the little boat in which she and the children seek to escape. Wildcats tear apart suitcases, a radio, a skateboard; family members hide in barrels, and Marshall films from inside them looking out. The soundtrack is covered with bouncy and playful music that would be more appropriate for slapstick, and Hedren even notes, in her memoir, that Marshall’s explicit intention, when conceiving these scenes, was to borrow from “some of the old silent-movie Mack Sennett comedies.” “Roar” is Marshall’s only film as a director, and his inexperience shows, above all, in the incoherence of its tone. The movie has an appropriately chaotic, and inescapable, quasi-documentary feel to it, and the action is captured with a discerning and unflinching camera eye by de Bont, a skilled and experienced cinematographer. But the story is a blend of documentary and fiction, an autofiction that meshes family life with a fabricated plot, and Marshall doesn’t quite seem aware of the forms he’s using.
Nonetheless, he uses “Roar” to put forth a single, big idea with a blinkered rigidity that comes through unambiguously. That idea is the plausibility of humans and wild animals living together harmoniously—despite the fact that the horrors of the shoot seem to contradict it. Only fear, suspicion, and resistance, the movie insists, make the animals dangerous—when they’re treated like beasts, they behave like beasts, and when they’re treated like companions, they act like companions, too. Early on, Hank even tells Mativo, bluntly, “The closer you’d get to them, the more they’d like you and the safer you’d be”—yet he himself is soon thereafter bloodied. The editing and the music conspire, absurdly, to encourage viewers to disbelieve their eyes—or, rather, to minimize the obvious dangers they’re witnessing, in the interest of buying into the film’s happy ending, in which the interspecies family achieves a peaceful coexistence. “Roar” reminds me of such fervently political films as King Vidor’s “The Fountainhead” and Mikhail Kalatozov’s “I Am Cuba,” which also overheat with the narrow fury of their advocacy; “Roar” is similarly heavy with the hectic energy of ideology—yet, unlike those movies, it’s chaotically, incoherently so, overflowing with loose ends that lead back to the production itself
Two extraordinary scenes, early in the film, find Hank explaining the psychology, the virtual sociology of lions—their territoriality, their family relations, the connection between the quest for food and long-standing rivalries within the pride. They’re scenes of experience, of devotion, of curiosity, even of love—the scenes that stand like the real-life backstory to the movie and set the entire enterprise into motion. The key line of the movie comes when the four newly arrived family members, having gone to sleep in an empty room, awaken to find themselves surrounded by lions. Moments later, the panic-stricken Madelaine is horrified to find the children frolicking with the animals, and Melanie retorts, “Mom, if they wanted to get us, they would have done it while we were asleep.” Tossed off casually, having an instantaneously soothing effect, this line stands in for all the talk that must have taken place during the shoot, among the family and the crew, about the very real perils they were facing. The real story of “Roar” lies in its outtakes, its making-of, the experience of its production; as it stands, it’s less a meta-movie than a documentation of a delusion.


newyorker--2020-04-22--They Wore Surgical Masks for the First Earth Day, Too

Subscribers to The Climate Crisis newsletter received this piece in their in-boxes .
Sign up to receive future installments .
Happy Earth Day !
Welcome to this extended edition of The Climate Crisis newsletter !
I hope you choose the green surgical mask when it ’ s time to walk the dog !
Actually , looking back over photos of the first Earth Day , fifty years ago , I was struck by how many participants were , in fact , wearing surgical masks .
And not just for the symbolism : it ’ s startling to recall just how @ @ @ @ @ @ @ Belt cities ( which hadn ’ t yet fully rusted ) suffered air-pollution levels comparable to Beijing ’ s in recent years ; Los Angeles and smog were synonymous .
The air in Mobile , Alabama , was so bad that it was costing people almost four years of their lives .
So it wasn ’ t hard to get people marching : estimates of participation in that first glorious day run at twenty million , or ten per cent of the American population at the time .
That may make it the @ @ @ @ @ @ @ .
All that marching worked : the shift in the Zeitgeist forced Richard Nixon to sign one law after another , from the Clean Water Act to the Endangered Species Act .
And those laws worked : air pollution has dropped by more than sixty per cent across America since 1970 , and life expectancy has grown by 1.5 years on average as a result .
Thanks to those people who took to the streets , you get to live an extra eighteen months .
Now those gains are under threat .
Even @ @ @ @ @ @ @ the threat of particulate air pollution , the Trump Administration last week blocked rules that would have tightened standards on particulates .
( Air pollution reportedly kills more than fifty thousand Americans a year—more people than the country has lost so far to the coronavirus . )
Lobbyists turned bureaucrats are rushing to gut whatever environmental regulations they can , and not just in the U.S.—also last week , a memo surfaced in Ottawa showing the Canadian Association of Petroleum Producers making the same kind of demands .
But the bigger problem is @ @ @ @ @ @ @ to do the easy and obvious stuff , and we didn ’ t transform our systems—or our outlooks—in fundamental ways .
Instead of pollution that you can see ( and smell ) , in this century we ’ re increasingly dealing with what the President might call an “ invisible enemy ” : the carbon-dioxide molecule , with its devilish determination to trap heat that would otherwise radiate back out to space .
The damage it does is far greater than , say , carbon with one oxygen atom .
Carbon monoxide was @ @ @ @ @ @ @ but you could control it with a catalytic converter ; indeed , a catalytic converter turns some of that carbon monoxide into carbon dioxide .
This time , there ’ s no easy technical fix , just turning off the fossil fuels and replacing them with renewable energy .
But that means turning off the giant companies that dominate the hydrocarbon economy .
That ’ s not an argument about science—that ’ s a fight about power .
And so we need , once more , to be in the streets .
We @ @ @ @ @ @ @ this month .
So many people will be spending the next three days , instead , at Earth Day Live , doing their best to grow this movement online .
I first wrote about Nicole Poindexter , the C.E.O .
of Energicity , for The New Yorker in 2017 , in an article about renewable energy in Africa .
I visited her in central Ghana , where she and her team were working to bring solar power to villages .
She comes from a standard finance background , and attended Harvard Business School @ @ @ @ @ @ @ extraordinary niche to fill in West Africa .
Energicity , a startup she co-founded in 2015 , is a utility company that uses small solar arrays to build out electric networks for villages .
She ’ s currently based in Sierra Leone .
This interview has been condensed for clarity .
What ’ s your most compelling project at the moment , and how ’ s it going ?
We are currently ramping up in Sierra Leone to provide a hundred thousand people in rural villages with solar-powered electricity through our mini-grids .
@ @ @ @ @ @ @ deployed to serve ten thousand people and twenty-one health-care clinics that can take care of patients through the COVID-19 pandemic .
What do Americans most misunderstand about energy development in the developing world ?
There are just so many things , but I ’ d say the biggest is that people doubt that solar power , and solar-powered mini-grids , are a meaningful part of the solution to the energy challenges in Africa .
First , people don ’ t understand the magnitude and the urgency of the problem .
Over six hundred @ @ @ @ @ @ @ .
Without electricity , learning is hard , health care harder , and participating in the modern economy—from agriculture to Bitcoin—impossible .
Each day , African people lose their dreams and their lives because they don ’ t have access to something that is so ubiquitous in the U.S. that we barely think about it .
This is a problem we need to address now , and people ranging from Bill Gates to African governments will say that we need to rely on big fossil-fuel-powered plants to provide electricity , and big transmission-line @ @ @ @ @ @ @ The problem is that those projects often take a minimum of ten years to deploy , they are polluting and contribute to climate change , and they are expensive .
The important advantage is that we ’ re clean , and reduce environmental impacts , and we can provide electricity now .
While most of the companies in our industry are small , serving collectively hundreds of thousands , with proper funding , we can move fast .
And , as we mature , we can easily be providing power to tens of @ @ @ @ @ @ @ compare with governments in terms of doing this work , and is there a need for new investors to keep it growing ?
A lot of people and , particularly , a lot of governments in Africa really think that the government should have the leading role in providing electricity .
The reality is , if you look at the path that we took in the United States , the majority of our electricity infrastructure was developed by private companies .
Private entrepreneurs ( Edison , Westinghouse , etc . )
brought innovation @ @ @ @ @ @ @ capital to build one of the most transformative pieces of infrastructure ever .
But I am a firm believer in government regulation of electricity to make sure the prices are fair , services are quality and safe , and pollution is minimized .
With a problem of this scale—that , honestly , the world still doesn ’ t know how to solve—entrepreneurs bring the necessary innovation , resources , and urgency to solve it .
And , absolutely , we need more investors !
I ’ m just finishing a round of fund-raising @ @ @ @ @ @ @ it ’ s been a slog .
To put some color on it , a friend of mine who is a leader in the clean-energy space introduced me to several leading impact investors ( hundreds of millions under management ) and across the board they said , “ We don ’ t know enough to invest in Africa.
” With six hundred million people who need electricity , and a planet that needs us to do it with innovative clean-energy technologies , the world needs many more bold , transformative investors .
The @ @ @ @ @ @ @ literary history of environmentalism , from Rachel Carson to Pope Francis .
( The photos are great , too—including , yes , a vintage shot of Earth Day protesters in surgical masks . )

Subscribers to The Climate Crisis newsletter received this piece in their in-boxes. Sign up to receive future installments.
Happy Earth Day! Welcome to this extended edition of The Climate Crisis newsletter! I hope you choose the green surgical mask when it’s time to walk the dog!
Actually, looking back over photos of the first Earth Day, fifty years ago, I was struck by how many participants were, in fact, wearing surgical masks. And not just for the symbolism: it’s startling to recall just how dirty America was in 1970. Rust Belt cities (which hadn’t yet fully rusted) suffered air-pollution levels comparable to Beijing’s in recent years; Los Angeles and smog were synonymous. The air in Mobile, Alabama, was so bad that it was costing people almost four years of their lives.
So it wasn’t hard to get people marching: estimates of participation in that first glorious day run at twenty million, or ten per cent of the American population at the time. That may make it the biggest day of political action in history. All that marching worked: the shift in the Zeitgeist forced Richard Nixon to sign one law after another, from the Clean Water Act to the Endangered Species Act. And those laws worked: air pollution has dropped by more than sixty per cent across America since 1970, and life expectancy has grown by 1.5 years on average as a result. Thanks to those people who took to the streets, you get to live an extra eighteen months.
Now those gains are under threat. Even as we’ve learned more about the threat of particulate air pollution, the Trump Administration last week blocked rules that would have tightened standards on particulates. (Air pollution reportedly kills more than fifty thousand Americans a year—more people than the country has lost so far to the coronavirus.) Lobbyists turned bureaucrats are rushing to gut whatever environmental regulations they can, and not just in the U.S.—also last week, a memo surfaced in Ottawa showing the Canadian Association of Petroleum Producers making the same kind of demands.
But the bigger problem is that, after 1970, we chose to do the easy and obvious stuff, and we didn’t transform our systems—or our outlooks—in fundamental ways. Instead of pollution that you can see (and smell), in this century we’re increasingly dealing with what the President might call an “invisible enemy”: the carbon-dioxide molecule, with its devilish determination to trap heat that would otherwise radiate back out to space. The damage it does is far greater than, say, carbon with one oxygen atom. Carbon monoxide was a component of that L.A. smog, but you could control it with a catalytic converter; indeed, a catalytic converter turns some of that carbon monoxide into carbon dioxide. This time, there’s no easy technical fix, just turning off the fossil fuels and replacing them with renewable energy. But that means turning off the giant companies that dominate the hydrocarbon economy. That’s not an argument about science—that’s a fight about power.
And so we need, once more, to be in the streets. We can’t, of course, this month. So many people will be spending the next three days, instead, at Earth Day Live, doing their best to grow this movement online.
Passing the Mic
I first wrote about Nicole Poindexter, the C.E.O. of Energicity, for The New Yorker in 2017, in an article about renewable energy in Africa. I visited her in central Ghana, where she and her team were working to bring solar power to villages. She comes from a standard finance background, and attended Harvard Business School, but she’s found an extraordinary niche to fill in West Africa. Energicity, a startup she co-founded in 2015, is a utility company that uses small solar arrays to build out electric networks for villages. She’s currently based in Sierra Leone. This interview has been condensed for clarity.
What’s your most compelling project at the moment, and how’s it going?
We are currently ramping up in Sierra Leone to provide a hundred thousand people in rural villages with solar-powered electricity through our mini-grids. At this point, we’ve deployed to serve ten thousand people and twenty-one health-care clinics that can take care of patients through the COVID-19 pandemic.
What do Americans most misunderstand about energy development in the developing world?
There are just so many things, but I’d say the biggest is that people doubt that solar power, and solar-powered mini-grids, are a meaningful part of the solution to the energy challenges in Africa. First, people don’t understand the magnitude and the urgency of the problem. Over six hundred million people do not have electricity here. Without electricity, learning is hard, health care harder, and participating in the modern economy—from agriculture to Bitcoin—impossible. Each day, African people lose their dreams and their lives because they don’t have access to something that is so ubiquitous in the U.S. that we barely think about it.
This is a problem we need to address now, and people ranging from Bill Gates to African governments will say that we need to rely on big fossil-fuel-powered plants to provide electricity, and big transmission-line projects to deliver power to people. The problem is that those projects often take a minimum of ten years to deploy, they are polluting and contribute to climate change, and they are expensive.
The important advantage is that we’re clean, and reduce environmental impacts, and we can provide electricity now. While most of the companies in our industry are small, serving collectively hundreds of thousands, with proper funding, we can move fast. And, as we mature, we can easily be providing power to tens of millions of people.
How do entrepreneurs compare with governments in terms of doing this work, and is there a need for new investors to keep it growing?
A lot of people and, particularly, a lot of governments in Africa really think that the government should have the leading role in providing electricity. The reality is, if you look at the path that we took in the United States, the majority of our electricity infrastructure was developed by private companies. Private entrepreneurs (Edison, Westinghouse, etc.) brought innovation, consistency of delivery, and private capital to build one of the most transformative pieces of infrastructure ever. But I am a firm believer in government regulation of electricity to make sure the prices are fair, services are quality and safe, and pollution is minimized. With a problem of this scale—that, honestly, the world still doesn’t know how to solve—entrepreneurs bring the necessary innovation, resources, and urgency to solve it.


Quarantine Conversation Starters

With so much tragic news each day , it can be hard to connect positively with friends .
Yet psychologists say that lighthearted conversation is more essential now than ever .
Here are some conversation starters to boost the mood !
“ Watched anything good lately ?
Not ‘ Tiger King ’ —I watched that already .
And not any major news outlet for the past six hundred hours—I also watched that.
” “ It ’ s so nice to see a human mouth !
What other human mouths have you seen today ?
” “ I love your houseplants @ @ @ @ @ @ @ you ?
” ( If no houseplants : “ Is that a wall behind you ?
” ) “ How are your kids handling remote learning ?
I had to teach mine all fifty states and when each major metropolis will exhaust its essential resources.
” “ Have you been outside recently ?
Were there trees ?
Did they rustle in a breeze ?
” “ I love your shirt !
What else are you wearing ?
Pants ?
Shoes ?
” “ Have you taken up any new hobbies ?
I never @ @ @ @ @ @ @ I love to curl up on the couch and knit rolls and rolls of toilet paper !
” “ Do you think you could draw a gym from memory ?
” “ I had a dream last night that I was at a restaurant , and , when the waiter poured my water , his hand accidentally brushed against mine , and I woke up sobbing for our lost world .
Have you had any weird dreams lately ?
” “ What do you think of the new Zoom updates ?
Which Zoom @ @ @ @ @ @ @ I saw a fun thing at the grocery store last week .
Oh , sorry , I told you this already .
Have you seen anything fun at the grocery store recently ?
” “ What ’ s , like , the craziest thing you ’ ve used to sanitize your doorknobs ?
” “ What ’ s the commute like from your bed to your desk ?
” “ Travelled anywhere new in your apartment lately ?
” “ What book have you been reading without absorbing anything because Dr. Fauci is @ @ @ @ @ @ @ do you miss touching with your bare hands the most ?
”

With so much tragic news each day, it can be hard to connect positively with friends. Yet psychologists say that lighthearted conversation is more essential now than ever. Here are some conversation starters to boost the mood!
“Watched anything good lately? Not ‘Tiger King’—I watched that already. And not any major news outlet for the past six hundred hours—I also watched that.”
“It’s so nice to see a human mouth! What other human mouths have you seen today?”
“I love your houseplants! Is that a peace lily behind you?” (If no houseplants: “Is that a wall behind you?”)
“How are your kids handling remote learning? I had to teach mine all fifty states and when each major metropolis will exhaust its essential resources.”
“Have you been outside recently? Were there trees? Did they rustle in a breeze?”
“I love your shirt! What else are you wearing? Pants? Shoes?”
“Have you taken up any new hobbies? I never really understood knitting before, but now I love to curl up on the couch and knit rolls and rolls of toilet paper!”
“Do you think you could draw a gym from memory?”
“I had a dream last night that I was at a restaurant, and, when the waiter poured my water, his hand accidentally brushed against mine, and I woke up sobbing for our lost world. Have you had any weird dreams lately?”
“What do you think of the new Zoom updates? Which Zoom update is your favorite?”
“I saw a fun thing at the grocery store last week. Oh, sorry, I told you this already. Have you seen anything fun at the grocery store recently?”
“What’s, like, the craziest thing you’ve used to sanitize your doorknobs?”
“What’s the commute like from your bed to your desk?”
“Travelled anywhere new in your apartment lately?”
“What book have you been reading without absorbing anything because Dr. Fauci is talking?”
“What outside objects do you miss touching with your bare hands the most?”


newyorker--2020-04-22--“For Now, We Wait”: Postponing Cancer Surgery During the Coronavirus Crisis

A few weeks before the coronavirus hit the Eastern Seaboard—a lifetime ago , in other words—my partner ’ s cousin noticed a lump in her breast .
Her mother had survived breast cancer , so the next few steps were no surprise : consultation , biopsy , and , when the biopsy confirmed cancer , rearrangement of her calendar in order to schedule a lumpectomy .
A chef by training , she took all these preliminary steps with calm efficiency , as though assembling a mise en place : all that remained was to actually have the surgery .
It @ @ @ @ @ @ @ my hospital , in Boston , with an exacting breast surgeon I ’ d scrubbed with as an intern .
Then the virus hit , her surgery was deemed “ elective , ” and we got a terse update from her husband via text message : “ Surgery delayed a few months .
Estrogen therapy.
” As soon as the word “ pandemic ” made it into national parlance , in March , surgeons at my hospital were asked to postpone non-urgent visits , convert to virtual visits when possible , and cancel @ @ @ @ @ @ @ goals : to minimize contact between people under stay-at-home orders , to free up space in the health-care system for an expected surge of critically ill coronavirus patients , and to reduce use of personal protective equipment , or P.P.E .
Any surgery would , by necessity , use up masks and eye shields , and also temporarily take up an operating-room ventilator , which physicians might need when the surge hit .
Surgery had to be carefully considered , and , if possible , deferred .
In medical terms , elective doesn @ @ @ @ @ @ @ , rather , implies that surgery can be safely delayed without major medical consequences to the patient .
In my specialty—I ’ m in my final year of residency in ear , nose , and throat surgery—many procedures are unequivocally elective .
Nobody argues that face-lifts or hearing implants are anything but elective .
Emergencies such as hemorrhages , airway obstructions , or ear infections that spread to the brain , causing meningitis , are easy to define as “ emergent.
” But “ urgent ” surgeries , which are neither elective nor @ @ @ @ @ @ @ the COVID-19 restrictions , are a gray area .
At the hospitals where I work , defining them has so far been left up to individual surgeons .
Near the front desk of the operating room in my hospital , a big screen called “ the board ” displays the day ’ s cases , with cheerful color coördination indicating whether the patient is in the room ( green ) , the surgery has begun ( aquamarine ) , it is finishing up ( royal blue ) , or the patient has been @ @ @ @ @ @ @ pink ) .
Not everyone agreed with the cancellation strategy : an attending physician I work with worried that it could create an insurmountable backlog of surgeries ; we should be increasing our volume , he argued .
But he complied , and cases started to fall off the board , leaving an odd void .
Paradoxically , doing our part meant not doing the thing we had been trained to do , and this hit hard at some surgeons ’ professional identity .
“ I am not built for sitting at home @ @ @ @ @ @ @ told me .
“ I became a surgeon because I wanted to help people.
” She was devastated at having to call her patients , many of whom had upended their lives in order to schedule surgery , to tell them that their cases would be delayed indefinitely .
Over all , I was proud that my institution was taking the COVID-19 crisis seriously : clearly , not everyone was .
Though no one talked about it , the cancellations had financial consequences for the surgeons , whose revenue depends on their productivity @ @ @ @ @ @ @ highly dependent on surgical volume ; and for the operating-room staff , who might face layoffs or furloughs if surgeries aren ’ t being performed .
An anesthesiologist friend in another state ranted to me about a surgeon who insisted that an operation for a benign enlarged prostate was a “ life-saving procedure.
” ( It is not . )
Other institutions were pilloried in the news for proceeding with cosmetic procedures despite a clear mandate from the American College of Surgeons .
“ It ’ s like the Wild West out here @ @ @ @ @ @ @ We look at the cases for the day and it ’ s , like , ‘ What are they thinking ?
’ ” At first , all cancer operations seemed to fall into the “ urgent ” category .
Untreated cancers can grow vigorously , and in the head and neck , where we operate , they can invade important adjacent structures , causing life-threatening bleeding or paralysis of important nerves or becoming so bulky that they cause suffocation or prevent a patient from swallowing .
Even in the age of chemotherapy and @ @ @ @ @ @ @ of head and neck cancers .
Furthermore , the difference between a “ resectable ” cancer , meaning one that can be surgically removed , and an “ unresectable ” one , meaning one that has invaded areas that would be too dangerous to remove , can be as little as a few weeks .
It was hard to argue that a patient with a large tumor in his mouth shouldn ’ t have his scheduled surgery .
Anyway , the argument went , it ’ s cancer surgery : it ’ s @ @ @ @ @ @ @ a patient contracting COVID-19 in the hospital after the operation was also a concern : patients with cancer who undergo major surgery require several days , even weeks , to recover , and could be exposed to the virus during that hospitalization .
Becoming infected while recovering from surgery could be devastating .
I hadn ’ t thought as much about postponing elective surgeries as a way to protect doctors and nurses , but , during my last week as chief resident , a report from Stanford began to circulate suggesting that the @ @ @ @ @ @ @ as the airway , oral cavity , and nasopharynx—were higher risk for COVID-19 spread than we had anticipated .
At the same time , we began to understand that many patients could be asymptomatic carriers , so our preoperative-symptom screening was likely missing infected patients .
Other head-and-neck surgeons across the country were cancelling all but emergency cases , or requiring preoperative COVID-19 testing , or using N95 respirators for any surgery that involved the airway or the mucous membranes of the mouth or nose .
“ I need you to feel free @ @ @ @ @ @ @ do any of the cases today , ” a senior surgeon wrote to me , out of the blue , in late March .
“ I completely respect your choice.
” Assisting him had never been optional before ; suddenly , every operation seemed to carry overwhelming risk .
But it soon became moot .
After the Stanford report came out , every case in our hospital was cancelled for the rest of the week .
The board became a lonely purple background .
The following morning , I walked through the preoperative @ @ @ @ @ @ @ seeking a more comfortable mask than those handed out at the hospital entrance .
I would have to wear it for twelve hours straight , so finding one that fit didn ’ t seem like an extravagance .
One of the nurses called me over with panic in her eyes .
“ Do you know if anyone is operating today ?
” she asked , and , when I shook my head , she pressed , “ Are you sure ?
” “ No cases , ” I replied .
Her blue eyes @ @ @ @ @ @ @ to check in for surgery .
I can ’ t get a hold of anyone .
Can you talk to them ?
”

A few weeks before the coronavirus hit the Eastern Seaboard—a lifetime ago, in other words—my partner’s cousin noticed a lump in her breast. Her mother had survived breast cancer, so the next few steps were no surprise: consultation, biopsy, and, when the biopsy confirmed cancer, rearrangement of her calendar in order to schedule a lumpectomy. A chef by training, she took all these preliminary steps with calm efficiency, as though assembling a mise en place: all that remained was to actually have the surgery. It was to happen on a Monday at my hospital, in Boston, with an exacting breast surgeon I’d scrubbed with as an intern. Then the virus hit, her surgery was deemed “elective,” and we got a terse update from her husband via text message: “Surgery delayed a few months. Estrogen therapy.”
As soon as the word “pandemic” made it into national parlance, in March, surgeons at my hospital were asked to postpone non-urgent visits, convert to virtual visits when possible, and cancel elective surgeries. These measures had several goals: to minimize contact between people under stay-at-home orders, to free up space in the health-care system for an expected surge of critically ill coronavirus patients, and to reduce use of personal protective equipment, or P.P.E. Any surgery would, by necessity, use up masks and eye shields, and also temporarily take up an operating-room ventilator, which physicians might need when the surge hit. Surgery had to be carefully considered, and, if possible, deferred.
In medical terms, elective doesn’t mean “unnecessary” but, rather, implies that surgery can be safely delayed without major medical consequences to the patient. In my specialty—I’m in my final year of residency in ear, nose, and throat surgery—many procedures are unequivocally elective. Nobody argues that face-lifts or hearing implants are anything but elective. Emergencies such as hemorrhages, airway obstructions, or ear infections that spread to the brain, causing meningitis, are easy to define as “emergent.” But “urgent” surgeries, which are neither elective nor emergencies, but which are permissible under the COVID-19 restrictions, are a gray area. At the hospitals where I work, defining them has so far been left up to individual surgeons.
Near the front desk of the operating room in my hospital, a big screen called “the board” displays the day’s cases, with cheerful color coördination indicating whether the patient is in the room (green), the surgery has begun (aquamarine), it is finishing up (royal blue), or the patient has been transported to the post-anesthesia care unit (pink). Not everyone agreed with the cancellation strategy: an attending physician I work with worried that it could create an insurmountable backlog of surgeries; we should be increasing our volume, he argued. But he complied, and cases started to fall off the board, leaving an odd void.
Paradoxically, doing our part meant not doing the thing we had been trained to do, and this hit hard at some surgeons’ professional identity. “I am not built for sitting at home,” a colleague at another hospital told me. “I became a surgeon because I wanted to help people.” She was devastated at having to call her patients, many of whom had upended their lives in order to schedule surgery, to tell them that their cases would be delayed indefinitely.
Over all, I was proud that my institution was taking the COVID-19 crisis seriously: clearly, not everyone was. Though no one talked about it, the cancellations had financial consequences for the surgeons, whose revenue depends on their productivity; for the institution, which is highly dependent on surgical volume; and for the operating-room staff, who might face layoffs or furloughs if surgeries aren’t being performed. An anesthesiologist friend in another state ranted to me about a surgeon who insisted that an operation for a benign enlarged prostate was a “life-saving procedure.” (It is not.) Other institutions were pilloried in the news for proceeding with cosmetic procedures despite a clear mandate from the American College of Surgeons. “It’s like the Wild West out here,” my colleague griped. “We look at the cases for the day and it’s, like, ‘What are they thinking?’ ”
At first, all cancer operations seemed to fall into the “urgent” category. Untreated cancers can grow vigorously, and in the head and neck, where we operate, they can invade important adjacent structures, causing life-threatening bleeding or paralysis of important nerves or becoming so bulky that they cause suffocation or prevent a patient from swallowing. Even in the age of chemotherapy and immunotherapy, surgery is a primary treatment of head and neck cancers. Furthermore, the difference between a “resectable” cancer, meaning one that can be surgically removed, and an “unresectable” one, meaning one that has invaded areas that would be too dangerous to remove, can be as little as a few weeks. It was hard to argue that a patient with a large tumor in his mouth shouldn’t have his scheduled surgery. Anyway, the argument went, it’s cancer surgery: it’s not elective.
But the risk of a patient contracting COVID-19 in the hospital after the operation was also a concern: patients with cancer who undergo major surgery require several days, even weeks, to recover, and could be exposed to the virus during that hospitalization. Becoming infected while recovering from surgery could be devastating.
I hadn’t thought as much about postponing elective surgeries as a way to protect doctors and nurses, but, during my last week as chief resident, a report from Stanford began to circulate suggesting that the anatomic areas regularly encountered by head-and-neck surgeons—such as the airway, oral cavity, and nasopharynx—were higher risk for COVID-19 spread than we had anticipated. At the same time, we began to understand that many patients could be asymptomatic carriers, so our preoperative-symptom screening was likely missing infected patients. Other head-and-neck surgeons across the country were cancelling all but emergency cases, or requiring preoperative COVID-19 testing, or using N95 respirators for any surgery that involved the airway or the mucous membranes of the mouth or nose.
“I need you to feel free to say you would prefer not to do any of the cases today,” a senior surgeon wrote to me, out of the blue, in late March. “I completely respect your choice.” Assisting him had never been optional before; suddenly, every operation seemed to carry overwhelming risk. But it soon became moot. After the Stanford report came out, every case in our hospital was cancelled for the rest of the week. The board became a lonely purple background.
The following morning, I walked through the preoperative area at six o’clock, seeking a more comfortable mask than those handed out at the hospital entrance. I would have to wear it for twelve hours straight, so finding one that fit didn’t seem like an extravagance. One of the nurses called me over with panic in her eyes. “Do you know if anyone is operating today?” she asked, and, when I shook my head, she pressed, “Are you sure?” “No cases,” I replied. Her blue eyes widened. “A patient just tried to check in for surgery. I can’t get a hold of anyone. Can you talk to them?”
When I walked through the doors to the waiting room—using my elbow to press the button on the wall—I found an immaculately dressed elderly woman, with a full face of makeup and tidy hair, despite the early hour. I recognized her name; she had been scheduled to undergo surgery to remove a salivary-gland cancer before the cancellations. Her husband sat next to her, in an uncomfortable chair of blond wood; the waiting room, normally bustling, was empty but for the two of them. I introduced myself, and, not wanting to beat around the bush, jumped into an apology. “I’m so sorry to have to tell you this,” I said, my stomach in my throat, “but your surgery was cancelled. I’m so sorry that the message didn’t get to you in time. It’s because of the coronavirus—it’s not safe. We aren’t doing any surgeries today.” They’d woken up before dawn; they had driven for hours. But they took the news in stride.
In caring for patients with head or neck cancer, surgeons are used to having to make tough decisions. Usually these choices have to do with how much functionality a patient is willing to lose in exchange for the possibility of a cure. Are they willing to breathe through a permanent hole in their neck? To potentially never swallow food again? To donate part of a bone in their leg in order to rebuild their jaw? But the questions that COVID-19 is forcing us to ask are different, both in nature and in implication. Should we perform an urgent cancer operation on a patient with underlying pulmonary disease, when there is a possibility that the patient may need an I.C.U. bed after surgery? Is it ethical to delay that case, when the tumor may grow and strangle the patient, potentially forcing an emergency airway intervention with no time for COVID-19 testing?
One of the inpatients I saw daily had undergone a laryngectomy—a surgery that removes the entire voice box and leaves a permanent hole in the neck, called a stoma, through which the patient breathes. He was a week into his recovery in the hospital when he started to have severe belly pain. Blood and other tests revealed no clear explanation; COVID-19 was on everyone’s mind.
I put on my respirator, gown, gloves, and the goggles I’d dug out of my closet, and walked into his room. When I threaded a swab through his nostril to test for the virus, he coughed, phlegm coming up through his stoma. I stopped cold. There’s no easy way to put a mask on a stoma to prevent viral particles from going into the air—if he indeed had COVID-19, had his surgery unwittingly turned him into an unstoppable spreader of the virus? But would it have been ethical to cancel his surgery and refer him instead for chemotherapy and radiation, risking potential exposure five days a week at treatment appointments? He tested negative for COVID-19; my worry persisted.
Although the numbers of cases, consults, and inpatients were lower than what I was used to during my last week on service in March, every decision that I made was fraught, and required at least double or triple the amount of time I normally need to think it through. By the end of the week, some cases had been rescheduled after the patients underwent COVID-19 testing, and, in the operating room, I was at once soothed by the partial return to normalcy and anxious because of it, knowing that the recommended P.P.E. for airway surgery was changing every day.
That week, I saw a consult for a patient who had come to the hospital coughing up blood; the bleeding had required a transfusion, but had since slowed. Later, the patient was found to be COVID-19-positive, and at some point someone looked in his mouth and noted a tumor on the back of his tongue—likely a cancer, almost certainly the cause of his bleeding. His COVID-19 symptoms were worsening. My team was asked to figure out what to do next about the tumor.
In normal times, how to treat him would have been obvious: the attending on call and I would take the patient to the operating room, biopsy the tumor, and do what is called a direct laryngoscopy to survey the remainder of the patient’s mouth, throat, and voice box for other cancers. Then we would consult with our head-and-neck-tumor board to formulate a treatment plan. But this situation was different. Would it be ethical to expose the entire operating-room staff to an aerosol-generating biopsy when the patient had stopped bleeding, seemed to be in no imminent risk from his tumor, and was COVID-19-positive with worsening symptoms? On the other hand, given that his bleeding was so extensive that it had required a transfusion, should the case count as “emergent”?
I spoke with several of my attendings and other doctors caring for him, and together we came up with a plan. If the patient’s tumor started to hemorrhage, forcing our hand, we would intubate him, pack his mouth with gauze to stanch the bleeding, and take him to the operating room for biopsy and cautery. But if he didn’t have bleeding requiring intervention, and if he survived COVID-19, we would take him to the operating room for a biopsy when he cleared his viral infection. Every day, I check his chart and wonder whether we are doing the right thing. At times, it feels like we’ve found the only logical response to this problem; other times, it feels like stalling. Like our patients, we are in a holding pattern: the chef takes her hormone therapy, the case board stays mostly empty, and my patient with the tongue tumor remains hospitalized. For now, we wait.
More Medical Dispatches


newyorker--2020-04-22--The Street Life of Seoul, Rearranged by Coronavirus

The only time the streets of Seoul are ever as deserted as they are now is during the Lunar New Year holidays , when it can seem as though the entire population has embarked on a mass exodus , emptying out onto the highways and the high-speed rails , leaving behind only a ringing silence .
This is the rare occasion that life here grinds to a near-complete halt .
For a city of ten million that is always illuminated and in motion—almost pathologically busy—such abrupt barrenness is always unnerving .
Miraculously , in the current pandemic , Seoul hasn @ @ @ @ @ @ @ There has been no official lockdown , no restrictions on movement .
The present vacancy is entirely voluntary , encouraged by the government ’ s aggressive social-distancing campaign , as well as the shock of witnessing how a single super-spreader paralyzed the southeastern city of Daegu—South Korea ’ s COVID-19 epicenter—in a matter of days .
In the absence of other people , the senses wander to other things : an emboldened pigeon sitting square in the middle of a dead-quiet street , looking slightly bewildered , perhaps wondering where everyone has gone @ @ @ @ @ @ @ the shrieks of children playing leak out from apartment verandas onto empty playgrounds .
In public spaces in the city center , loudspeakers issue automated COVID-19 safety announcements from loudspeakers to straggling passersby .
The film above shows scenes from Seoul , which , like so many other cities , has been coming to terms with the strange new realities of life in the COVID-19 pandemic : atop the Dongdaemun Design Plaza , a hulking spaceship of a landmark where Seoul ’ s semi-annual Fashion Week is held , two children in masks @ @ @ @ @ @ @ faces ride scooters as their father pensively trails behind ; in twos and threes , people steal a moment with the cherry blossoms , which have bloomed and then withered while the pandemic raged ; in an empty airport hall , a lone guard sits at the entrance with a heat-sensing camera as a solitary visitor , without a suitcase or other accoutrements of travel , wanders in .
For the past two months , Seoul has held its breath like this , bracing for a wave of its own .
Recent signs @ @ @ @ @ @ @ April 20th , Seoul recorded zero new patients for the first time in forty-seven days , prompting the government to ease some of its social-distancing recommendations .
In the city ’ s public parks , people can be seen strolling , biking , or simply sitting still and looking off into the distance .
Most of them are still maintaining a two-metre safety distance .
These parks have been a precious reprieve from our straitened daily orbits—a reminder that life , though rearranged beyond recognition , will go on .
• How to @ @ @ @ @ @ @ a sick housemate to the pros and cons of ordering food .
• Can survivors help cure the disease and rescue the economy ?
• The long crusade of Dr. Anthony Fauci , the infectious-disease expert pinned between Donald Trump and the American people .
• The success of Hong Kong and Singapore in stemming the spread holds lessons for how to contain it in the United States .
• The coronavirus is likely to spread for more than a year before a vaccine is widely available .
• With each new virus @ @ @ @ @ @ @ treatment .
Can we prepare antivirals to combat the next global crisis ?
• How pandemics have propelled public-health innovations , prefigured revolutions , and redrawn maps .
• What to read , watch , cook , and listen to under coronavirus quarantine.p

The only time the streets of Seoul are ever as deserted as they are now is during the Lunar New Year holidays, when it can seem as though the entire population has embarked on a mass exodus, emptying out onto the highways and the high-speed rails, leaving behind only a ringing silence. This is the rare occasion that life here grinds to a near-complete halt. For a city of ten million that is always illuminated and in motion—almost pathologically busy—such abrupt barrenness is always unnerving.
Miraculously, in the current pandemic, Seoul hasn’t actually ever really closed. There has been no official lockdown, no restrictions on movement. The present vacancy is entirely voluntary, encouraged by the government’s aggressive social-distancing campaign, as well as the shock of witnessing how a single super-spreader paralyzed the southeastern city of Daegu—South Korea’s COVID-19 epicenter—in a matter of days.
In the absence of other people, the senses wander to other things: an emboldened pigeon sitting square in the middle of a dead-quiet street, looking slightly bewildered, perhaps wondering where everyone has gone. In residential neighborhoods like mine, the shrieks of children playing leak out from apartment verandas onto empty playgrounds. In public spaces in the city center, loudspeakers issue automated COVID-19 safety announcements from loudspeakers to straggling passersby.
The film above shows scenes from Seoul, which, like so many other cities, has been coming to terms with the strange new realities of life in the COVID-19 pandemic: atop the Dongdaemun Design Plaza, a hulking spaceship of a landmark where Seoul’s semi-annual Fashion Week is held, two children in masks that are slightly too large for their faces ride scooters as their father pensively trails behind; in twos and threes, people steal a moment with the cherry blossoms, which have bloomed and then withered while the pandemic raged; in an empty airport hall, a lone guard sits at the entrance with a heat-sensing camera as a solitary visitor, without a suitcase or other accoutrements of travel, wanders in. For the past two months, Seoul has held its breath like this, bracing for a wave of its own. Recent signs have been hopeful: on Monday, April 20th, Seoul recorded zero new patients for the first time in forty-seven days, prompting the government to ease some of its social-distancing recommendations.
In the city’s public parks, people can be seen strolling, biking, or simply sitting still and looking off into the distance. Most of them are still maintaining a two-metre safety distance. These parks have been a precious reprieve from our straitened daily orbits—a reminder that life, though rearranged beyond recognition, will go on.
A Guide to the Coronavirus


newyorker--2020-04-22--An Earth Day Reminder of How the Republicans Have Forsaken the Environment

The idea for Earth Day came to Gaylord Nelson all of a sudden one day in the middle of 1969 .
That summer , “ teach-ins ” about the Vietnam War were all the rage .
It occurred to Nelson , then the junior U.S. senator from Wisconsin : How about a “ teach-in ” about the environment ?
To attract the widest possible audience , Nelson , a Democrat , invited Representative Pete McCloskey , a Republican from California , to co-chair the event .
The response was way more enthusiastic than either man had anticipated : on April @ @ @ @ @ @ @ Americans—a tenth of the country ’ s population—took to the streets .
It was the largest public demonstration in U.S. history , and , as Jamie Henn , one of the founders of 350.org , has put it , it “ had bite.
” By the end of the year , a Republican President , Richard Nixon , had created the Environmental Protection Agency and the National Oceanic and Atmospheric Administration .
This was followed in relatively short order by the passage of the Clean Air Act , the Clean Water Act , @ @ @ @ @ @ @ of these measures were approved with overwhelming bipartisan support .
Today , as Earth Day turns fifty , it ’ s hard to imagine more dolorous circumstances for the occasion .
COVID-19 has forced online ( or cancelled ) virtually all the celebrations and protests that had been planned for the anniversary .
The Trump Administration has barely even taken the day off from gutting the nation ’ s environmental regulations .
( Last week , the Administration weakened rules governing the emission of mercury and other toxic chemicals from power plants ; @ @ @ @ @ @ @ standards for cars and light trucks . )
Meanwhile , in Congress , environmental protection has become such a thoroughly partisan issue that across-the-aisle collaborations like Nelson and McCloskey ’ s are rarer than Amur leopards .
Owing to this divide , environmental problems that have emerged since 1970 have simply gone unaddressed .
Congress has not passed—or even really come close to passing—a single piece of legislation aimed at addressing climate change .
( All the steps taken by the Obama Administration to try to curb carbon emissions were done through regulation @ @ @ @ @ @ @ when such legislative action is most needed , ” James Morton Turner , a professor at Wellesley College , and Andrew Isenberg , a professor at the University of Kansas , have written , it has become “ almost politically unimaginable.
” How and why this happened is the subject of Turner and Isenberg ’ s recent book , “ The Republican Reversal : Conservatives and the Environment from Nixon to Trump.
” The two trace the G.O.P.
’ s turn against conservation to Ronald Reagan , who equated environmentalism with pessimism , @ @ @ @ @ @ @ .
Reagan combined a sunny faith in the future with an equally sunny indifference to facts .
Running for President in 1980 , he claimed that acid rain was not caused by power-plant and auto emissions , as scientists had shown , but by the eruption of Mt .
St. Helens , in Washington State , earlier that year .
Also during the campaign , he declared that “ eighty per cent of our air pollution stems from hydrocarbons released by vegetation.
” Once elected , Reagan appointed Anne Gorsuch—an inexperienced ideologue ( @ @ @ @ @ @ @ Court Justice Neil Gorsuch—to head the E.P.A .
Among her first moves was to propose slashing the agency ’ s budget by more than forty per cent .
One staffer complained that morale was so low there was “ no known scientific method to measure it.
” Since Reagan , control of the White House has , of course , swung between the parties , as has control of Congress .
Throughout the swings , anti-environmentalism has only become that much more entrenched in G.O.P .
politics .
( McCloskey , it ’ @ @ @ @ @ @ @ affiliation from Republican to Democrat , in 2007 , at the age of seventy-nine . )
A great deal of money has changed hands to help change minds ; according to the Web site Open Secrets , which tracks federal campaign contributions , the oil-and-gas industry contributed nearly twenty-four million dollars to House and Senate Republicans during the past election cycle , compared with five million to Democrats .
But , according to Turner and Morton , money is only part of the equation ; the other part is votes .
For Republican @ @ @ @ @ @ @ to , say , back legislation to limit climate change : “ Neither their corporate donors nor evangelicals nor the struggling Rust Belt workers who voted for Trump in 2016 see any advantage to it.
” The situation is such that , as Aaron Huertas , who works with WeCanVote.US , recently pointed out , were Democrats inclined to pass meaningful climate legislation , they ’ d need to win not just the Presidency this fall but also a filibuster-proof majority in the Senate .
Can this situation be changed ?
Certainly the @ @ @ @ @ @ @ happen to be concerned about such things—are stark .
What the original Earth Day showed is that , when Americans are mobilized , remarkable things are possible .
What the past few years have shown is that Americans can be mobilized by the most remarkable falsehoods .
To say that the future of the world depends on which of these tendencies prevails is at this point , unfortunately , no exaggeration .

The idea for Earth Day came to Gaylord Nelson all of a sudden one day in the middle of 1969. That summer, “teach-ins” about the Vietnam War were all the rage. It occurred to Nelson, then the junior U.S. senator from Wisconsin: How about a “teach-in” about the environment?
To attract the widest possible audience, Nelson, a Democrat, invited Representative Pete McCloskey, a Republican from California, to co-chair the event. The response was way more enthusiastic than either man had anticipated: on April 22, 1970, some twenty million Americans—a tenth of the country’s population—took to the streets. It was the largest public demonstration in U.S. history, and, as Jamie Henn, one of the founders of 350.org, has put it, it “had bite.” By the end of the year, a Republican President, Richard Nixon, had created the Environmental Protection Agency and the National Oceanic and Atmospheric Administration. This was followed in relatively short order by the passage of the Clean Air Act, the Clean Water Act, and the Endangered Species Act. All of these measures were approved with overwhelming bipartisan support.
Today, as Earth Day turns fifty, it’s hard to imagine more dolorous circumstances for the occasion. COVID-19 has forced online (or cancelled) virtually all the celebrations and protests that had been planned for the anniversary. The Trump Administration has barely even taken the day off from gutting the nation’s environmental regulations. (Last week, the Administration weakened rules governing the emission of mercury and other toxic chemicals from power plants; late last month, it weakened fuel-efficiency standards for cars and light trucks.)
Meanwhile, in Congress, environmental protection has become such a thoroughly partisan issue that across-the-aisle collaborations like Nelson and McCloskey’s are rarer than Amur leopards. Owing to this divide, environmental problems that have emerged since 1970 have simply gone unaddressed. Congress has not passed—or even really come close to passing—a single piece of legislation aimed at addressing climate change. (All the steps taken by the Obama Administration to try to curb carbon emissions were done through regulation.) Precisely at the “moment when such legislative action is most needed,” James Morton Turner, a professor at Wellesley College, and Andrew Isenberg, a professor at the University of Kansas, have written, it has become “almost politically unimaginable.”
How and why this happened is the subject of Turner and Isenberg’s recent book, “The Republican Reversal: Conservatives and the Environment from Nixon to Trump.” The two trace the G.O.P.’s turn against conservation to Ronald Reagan, who equated environmentalism with pessimism, and pessimism with a lack of patriotism.
Reagan combined a sunny faith in the future with an equally sunny indifference to facts. Running for President in 1980, he claimed that acid rain was not caused by power-plant and auto emissions, as scientists had shown, but by the eruption of Mt. St. Helens, in Washington State, earlier that year. Also during the campaign, he declared that “eighty per cent of our air pollution stems from hydrocarbons released by vegetation.” Once elected, Reagan appointed Anne Gorsuch—an inexperienced ideologue (and the mother of the future Supreme Court Justice Neil Gorsuch)—to head the E.P.A. Among her first moves was to propose slashing the agency’s budget by more than forty per cent. One staffer complained that morale was so low there was “no known scientific method to measure it.”
Since Reagan, control of the White House has, of course, swung between the parties, as has control of Congress. Throughout the swings, anti-environmentalism has only become that much more entrenched in G.O.P. politics. (McCloskey, it’s worth noting, switched his party affiliation from Republican to Democrat, in 2007, at the age of seventy-nine.) A great deal of money has changed hands to help change minds; according to the Web site Open Secrets, which tracks federal campaign contributions, the oil-and-gas industry contributed nearly twenty-four million dollars to House and Senate Republicans during the past election cycle, compared with five million to Democrats.
But, according to Turner and Isenberg, money is only part of the equation; the other part is votes. For Republican politicians, there’s no incentive to, say, back legislation to limit climate change: “Neither their corporate donors nor evangelicals nor the struggling Rust Belt workers who voted for Trump in 2016 see any advantage to it.” The situation is such that, as Aaron Huertas, who works with WeCanVote.US, recently pointed out, were Democrats inclined to pass meaningful climate legislation, they’d need to win not just the Presidency this fall but also a filibuster-proof majority in the Senate.
Can this situation be changed? Certainly the hour is late and the facts—if you happen to be concerned about such things—are stark. What the original Earth Day showed is that, when Americans are mobilized, remarkable things are possible. What the past few years have shown is that Americans can be mobilized by the most remarkable falsehoods. To say that the future of the world depends on which of these tendencies prevails is at this point, unfortunately, no exaggeration.