newyorker--2020-04-29--How Benjamin Netanyahu Has Managed the Pandemic for Political Gain

If Prime Minister Benjamin Netanyahu has a message for President Donald Trump , it ’ s that there ’ s a politically astute way of handling a pandemic .
Since the most recent Israeli election , on March 2nd , Netanyahu has amplified the state of emergency .
He has kept the spotlight on himself , but mainly he has absorbed the reflected prestige of the epidemiologists who have kept the infection rate in Israel comparatively low .
( As of Tuesday , there was a daily infection rate of about twenty-eight people per million , about the same rate @ @ @ @ @ @ @ made sure that he was the one to announce lockdowns and short-term financial assistance to the desperate , all the while complaining about judicial officials impugning his authority and thereby weakening the plan .
He has attacked the “ deep state ” while taking credit for its work .
The emergency in the foreground has let Netanyahu , in the background , do as he pleased .
The lesson may be too late , or too subtle , for Trump , but for Netanyahu it has worked just fine .
On April 20th @ @ @ @ @ @ @ Gantz , the leader of the Blue and White Party , formerly his key opponent , to form an “ emergency government of national unity.
” After three inconclusive elections in seventeen months , during which neither man found enough support to form a government , Gantz controlled a slight majority in the Knesset , the Israeli Parliament .
But by last week he looked sidelined—a more decent , less divisive man , perhaps , but eclipsed by Netanyahu ’ s management of the crisis .
Gantz ’ s allies believed that he @ @ @ @ @ @ @ solidarity—that if he refused to join a Netanyahu-led government , prompting a fourth election , it would be held against him .
After signing the agreement , Gantz insisted that forming a coalition with Netanyahu— “ working from within , ” as he put it—meant both fighting the pandemic and “ safeguarding ” democracy .
But it ’ s not clear how the terms of the agreement relate to the emergency , other than by preëmpting the costs of another election ; it ’ s also hard to tell whether “ working from @ @ @ @ @ @ @ blunting some of Netanyahu ’ s most outrageous efforts to suborn an independent judiciary while allowing him to carry on , under indictment for bribery and breach of trust , and leaving an ultra-nationalist , theocratic government in place .
“ This is not a ‘ unity ’ government ; it is Netanyahu ’ s fifth government , in which there ’ s an annex called Blue and White , ” Avigdor Lieberman , the secular hard-liner who had become Gantz ’ s erstwhile partner , told the news Web site Ynet .
@ @ @ @ @ @ @ Gantz a distinguished job.
” The coalition agreement stipulates two equal blocs , each with sixteen ministers and eight deputies .
Gantz , a former chief of staff of the Army , will be the defense minister and also—in a newly created position—the Alternate Prime Minister .
He will , according to the agreement , rotate into the premiership after eighteen months , after which time Netanyahu will hold the Alternate title for the same period .
In effect , each leader will hold a veto over the policies or appointments of the @ @ @ @ @ @ @ , even favorable to Gantz , given that Netanyahu ’ s bloc , at fifty-nine Knesset seats , is now more than three times bigger than Blue and White ’ s .
( When Gantz struck his deal with Netanyahu , nearly half its members in the Knesset quit and formed Yesh Atid/Telem , a new alliance merging their old party names . )
But the most recent poll shows that , among Blue and White voters , support for Gantz ’ s move has dropped to just over forty per cent from @ @ @ @ @ @ @ , now that the terms of the agreement have sunk in .
Netanyahu , after all , is going on trial , ostensibly on May 24th , so an agreement that allows him to stay in office and hands him a veto over future judicial appointments looks like a gift .
He ’ ll have a say , for example , over nominations for the next attorney general and state attorney .
He ’ ll also have a say over the ideological complexion of high-court judges who may well be tasked with hearing @ @ @ @ @ @ @ status quo is precisely what Netanyahu ’ s Likud Party aims to preserve—in civil society , in the occupied territories , and in the region .
Gantz even agreed to let Netanyahu “ bring to the cabinet any agreement reached with the United States regarding the application of sovereignty ” over the West Bank by early July ; that would likely mean the annexation of large sections that include the Jordan Valley .
In this context , each leader having a veto means that Gantz and Netanyahu can knock each other ’ s @ @ @ @ @ @ @ moves steadily in Netanyahu ’ s direction .
Gantz vows that he will be able to protect “ freedom of expression , the media , and the rule of law , ” because Blue and White will gain control of the Communications and Justice Ministries .
There will be a Blue and White justice minister , Avi Nissenkorn , who will also be the chair of the Knesset ’ s Legislative Affairs Committee .
But he will be shadowed by a Likud deputy chair , with whom he ’ ll have to seek @ @ @ @ @ @ @ and White will get first crack at the Foreign Ministry , but Netanyahu , meanwhile , will choose his own Ambassador to Washington .
Nor will Gantz have direct administrative responsibilities involving public health , the pandemic ’ s economic impact , or privacy issues .
The Health Ministry will stay in the hands of a Likud ally , although the current minister , the ultra-Orthodox leader Yaakov Litzman , has announced his intention to resign .
Litzman , who himself became infected with the coronavirus , was inept in his handling of @ @ @ @ @ @ @ to adopt distancing measures , became centers of contagion .
( As much as forty per cent of the population of the ultra-Orthodox town of Bnei Brak may have been infected . )
The critical Finance Ministry , meanwhile , will stay with Likud , as will the Interior Security Ministry , which commands the police .
As for privacy , in mid-March , using emergency powers , Netanyahu recruited the Shin Bet , the Israeli equivalent of the F.B.I.
, for the fight against the pandemic , authorizing its use of mobile-phone-tracking @ @ @ @ @ @ @ citizens .
On Monday , the Supreme Court ruled that the Knesset must pass legislation regulating this technology if the practice is to continue .
Gantz has not spoken publicly on the issue , though the threat to basic freedoms seems self-evident .
Meanwhile , the Education Ministry is being offered again to the national-Orthodox , ultra-rightist settler party Yemina .
The Interior Ministry will stay with the ultra-Orthodox Shas Party , which applies rigid interpretations of Jewish law to issues of immigration , marriage , burial , and dietary strictures .
The @ @ @ @ @ @ @ responsible for advancing or killing all legislation , will be one of Netanyahu ’ s closest associates .
Gantz has also agreed to a weird constitutional work-around .
To establish the position of Alternate Prime Minister , the Knesset must pass new legislation—an amendment to the basic law of government that would distinguish the position from that of other ministers .
Otherwise , Netanyahu , as a minister under indictment , would be legally required to resign .
Should the Supreme Court rule , within the government ’ s first six months , @ @ @ @ @ @ @ , due to the indictment , or that the amendment or supporting provisions contradict other basic laws , the Knesset would be dispersed and a new election called .

If Prime Minister Benjamin Netanyahu has a message for President Donald Trump, it’s that there’s a politically astute way of handling a pandemic. Since the most recent Israeli election, on March 2nd, Netanyahu has amplified the state of emergency. He has kept the spotlight on himself, but mainly he has absorbed the reflected prestige of the epidemiologists who have kept the infection rate in Israel comparatively low. (As of Tuesday, there was a daily infection rate of about twenty-eight people per million, about the same rate as in Germany.) He has made sure that he was the one to announce lockdowns and short-term financial assistance to the desperate, all the while complaining about judicial officials impugning his authority and thereby weakening the plan. He has attacked the “deep state” while taking credit for its work. The emergency in the foreground has let Netanyahu, in the background, do as he pleased.
The lesson may be too late, or too subtle, for Trump, but for Netanyahu it has worked just fine. On April 20th, he signed an agreement with Benny Gantz, the leader of the Blue and White Party, formerly his key opponent, to form an “emergency government of national unity.” After three inconclusive elections in seventeen months, during which neither man found enough support to form a government, Gantz controlled a slight majority in the Knesset, the Israeli Parliament. But by last week he looked sidelined—a more decent, less divisive man, perhaps, but eclipsed by Netanyahu’s management of the crisis. Gantz’s allies believed that he risked seeming like a disruptor of social solidarity—that if he refused to join a Netanyahu-led government, prompting a fourth election, it would be held against him.
After signing the agreement, Gantz insisted that forming a coalition with Netanyahu—“working from within,” as he put it—meant both fighting the pandemic and “safeguarding” democracy. But it’s not clear how the terms of the agreement relate to the emergency, other than by preëmpting the costs of another election; it’s also hard to tell whether “working from within” means much more than simply blunting some of Netanyahu’s most outrageous efforts to suborn an independent judiciary while allowing him to carry on, under indictment for bribery and breach of trust, and leaving an ultra-nationalist, theocratic government in place. “This is not a ‘unity’ government; it is Netanyahu’s fifth government, in which there’s an annex called Blue and White,” Avigdor Lieberman, the secular hard-liner who had become Gantz’s erstwhile partner, told the news Web site Ynet. “The agreement gives Netanyahu immunity and Gantz a distinguished job.”
The coalition agreement stipulates two equal blocs, each with sixteen ministers and eight deputies. Gantz, a former chief of staff of the Army, will be the defense minister and also—in a newly created position—the Alternate Prime Minister. He will, according to the agreement, rotate into the premiership after eighteen months, after which time Netanyahu will hold the Alternate title for the same period. In effect, each leader will hold a veto over the policies or appointments of the other.
This sounded fair at first, even favorable to Gantz, given that Netanyahu’s bloc, at fifty-nine Knesset seats, is now more than three times bigger than Blue and White’s. (When Gantz struck his deal with Netanyahu, nearly half its members in the Knesset quit and formed Yesh Atid/Telem, a new alliance merging their old party names.) But the most recent poll shows that, among Blue and White voters, support for Gantz’s move has dropped to just over forty per cent from almost sixty per cent a week ago, now that the terms of the agreement have sunk in. Netanyahu, after all, is going on trial, ostensibly on May 24th, so an agreement that allows him to stay in office and hands him a veto over future judicial appointments looks like a gift. He’ll have a say, for example, over nominations for the next attorney general and state attorney. He’ll also have a say over the ideological complexion of high-court judges who may well be tasked with hearing an eventual appeal.
Besides, the status quo is precisely what Netanyahu’s Likud Party aims to preserve—in civil society, in the occupied territories, and in the region. Gantz even agreed to let Netanyahu “bring to the cabinet any agreement reached with the United States regarding the application of sovereignty” over the West Bank by early July; that would likely mean the annexation of large sections that include the Jordan Valley. In this context, each leader having a veto means that Gantz and Netanyahu can knock each other’s hand off the brake while the train moves steadily in Netanyahu’s direction.
Gantz vows that he will be able to protect “freedom of expression, the media, and the rule of law,” because Blue and White will gain control of the Communications and Justice Ministries. There will be a Blue and White justice minister, Avi Nissenkorn, who will also be the chair of the Knesset’s Legislative Affairs Committee. But he will be shadowed by a Likud deputy chair, with whom he’ll have to seek agreement to advance any legislation. Blue and White will get first crack at the Foreign Ministry, but Netanyahu, meanwhile, will choose his own Ambassador to Washington.
Nor will Gantz have direct administrative responsibilities involving public health, the pandemic’s economic impact, or privacy issues. The Health Ministry will stay in the hands of a Likud ally, although the current minister, the ultra-Orthodox leader Yaakov Litzman, has announced his intention to resign. Litzman, who himself became infected with the coronavirus, was inept in his handling of the crisis as ultra-Orthodox neighborhoods, slow to adopt distancing measures, became centers of contagion. (As much as forty per cent of the population of the ultra-Orthodox town of Bnei Brak may have been infected.) The critical Finance Ministry, meanwhile, will stay with Likud, as will the Interior Security Ministry, which commands the police.
As for privacy, in mid-March, using emergency powers, Netanyahu recruited the Shin Bet, the Israeli equivalent of the F.B.I., for the fight against the pandemic, authorizing its use of mobile-phone-tracking technology to do contact tracing of infected citizens. On Monday, the Supreme Court ruled that the Knesset must pass legislation regulating this technology if the practice is to continue. Gantz has not spoken publicly on the issue, though the threat to basic freedoms seems self-evident. Meanwhile, the Education Ministry is being offered again to the national-Orthodox, ultra-rightist settler party Yemina. The Interior Ministry will stay with the ultra-Orthodox Shas Party, which applies rigid interpretations of Jewish law to issues of immigration, marriage, burial, and dietary strictures. The speaker of the Knesset, who is responsible for advancing or killing all legislation, will be one of Netanyahu’s closest associates.
Gantz has also agreed to a weird constitutional work-around. To establish the position of Alternate Prime Minister, the Knesset must pass new legislation—an amendment to the basic law of government that would distinguish the position from that of other ministers. Otherwise, Netanyahu, as a minister under indictment, would be legally required to resign. Should the Supreme Court rule, within the government’s first six months, that Netanyahu cannot remain Prime Minister, due to the indictment, or that the amendment or supporting provisions contradict other basic laws, the Knesset would be dispersed and a new election called.
Even if the government survives those challenges, Netanyahu could well decide, when his eighteen months are up, that he’d rather call another election than see Gantz in his place, especially if criminal proceedings against him have not yet run their course. Gantz believes that he’s inserted a poison pill against that eventuality into the agreement: it requires that the Alternate automatically become Prime Minister of a transitional government until a new election. But Netanyahu would have had another year and a half to make the criminal proceedings against him seem routine. “Netanyahu is acting like his trial is a forgettable nuisance—his lawyer seems to be preparing not at all,” the journalist Lily Galili told me. “He’d love nothing more than to run against the ‘leftist’ Supreme Court, or as an anti-élitist insurgent.”
Nor does Gantz appear intent on preëmpting annexations in the West Bank. In recent months, he has said that such moves must be coördinated with Jordan and Egypt, which is a way of dismissing them out of hand. (His agreement with Netanyahu refers, vaguely, to refraining from actions that would likely foil existing peace agreements.) Yet Gantz now seems willing to allow the question of annexation to hinge on a nod from the Trump Administration. There seems little chance that Trump, looking for votes among pro-Israel evangelicals and older Jewish Americans, will disapprove, especially given his “deal of the century” in the region, which has already called for annexations.


newyorker--2020-04-29--Pence Starts Wearing Mask After Fauci Says It Will Protect Him from Women

WASHINGTON ( The Borowitz Report ) —Vice-President Mike Pence has started wearing a mask after Anthony Fauci told him that @ @ @ @ @ women , Fauci has confirmed .
After seeing video of a maskless Pence touring the @ @ @ @ @ , Fauci said , “ I knew I had to come up with something fast @ @ @ @ @ Pence .
Fauci immediately got on the phone with the Vice-President and informed him that @ @ @ @ @ demonstrated that a mask is “ an effective female-repellent.
” “ I told him that @ @ @ @ @ him from 99.99 per cent of all women , ” Fauci said .
“ He @ @ @ @ @ an official statement , the Vice-President thanked Fauci for his excellent advice and indicated that @ @ @ @ @ mask at all times , including at home .

WASHINGTON (The Borowitz Report)—Vice-President Mike Pence has started wearing a mask after Anthony Fauci told him that it will protect him from women, Fauci has confirmed.
After seeing video of a maskless Pence touring the Mayo Clinic, on Tuesday, Fauci said, “I knew I had to come up with something fast” to get through to Pence.
Fauci immediately got on the phone with the Vice-President and informed him that “clinical research” had demonstrated that a mask is “an effective female-repellent.”
“I told him that wearing a mask would protect him from 99.99 per cent of all women,” Fauci said. “He seemed very impressed.”
In an official statement, the Vice-President thanked Fauci for his excellent advice and indicated that he would start wearing a mask at all times, including at home.


newyorker--2020-04-29--What We Don’t Know About the Coronavirus

We think of COVID-19 as a disease of the respiratory tract .
When future generations look back on this pandemic , its iconic symbol will probably be the ventilator .
But , although respiratory problems are at the core of the disease , COVID-19 has revealed itself to be more than a straightforward viral pneumonia .
Doctors around the world—including in the emergency department where we work , at Mount Sinai Hospital , in Manhattan—have learned the hard way that the coronavirus doesn ’ t confine its ravages to the lungs .
COVID-19 can push kidneys into failure , send @ @ @ @ @ @ @ catastrophic overdrive , and cause blood clots that impede circulation to the lungs , heart , or brain .
It ’ s a disease of remarkable complexity , which even the most experienced doctors are struggling to understand .
On blogs , podcasts , and # medtwitter , members of the medical community have been trading stories and theories about COVID-19 ’ s intricacies .
Often , their conversation has followed the methodology of critical-care doctors .
Physicians who work in I.C.U.s tend to talk not about symptoms or diseases—chest pain , diabetes—but @ @ @ @ @ @ @ and interact in complex ways .
System by system , a picture of COVID-19 is emerging .
Clarifying it may mean the difference between life and death for thousands of people in the months to come .
The shortness of breath that ’ s most characteristic of COVID-19 is reasonably well understood .
It originates in the gossamer air sacs of the lungs , called alveoli , where blood and air are separated by such thin membranes that oxygen and carbon dioxide can pass into and out of the bloodstream , respectively .
@ @ @ @ @ @ @ in the neighborhood of six hundred million alveoli .
Severe COVID-19 causes many of them to either collapse or fill with fluid .
The virus attacks the cells lining the alveoli ; our overactive immune systems , in trying to fight the virus , may be damaging them as well .
The result is that not enough oxygen gets into the blood .
Doctors trying to solve this problem have two basic tools at their disposal : oxygen and pressure .
They can give patients concentrated oxygen beyond the usual twenty-one per cent @ @ @ @ @ @ @ Alternatively , using a CPAP machine or ventilator , they can create a kind of sustained air pressure within the lungs— “ positive end-expiratory pressure , ” or PEEP—which keeps the alveoli open , and thus more receptive to oxygen , at moments when the lungs would ordinarily be emptier of air .
( Imagine breathing in and out while leaning through the window of a moving car : that lungs-full-of-air feeling is PEEP . )
Doctors have also been improving oxygenation by “ proning ” patients—that is , periodically turning them onto @ @ @ @ @ @ @ of gravity to match areas of air-filled lung with areas of higher blood flow .
All this makes straightforward mechanical sense .
Still , mysteries hover around the certainties .
Doctors track the “ oxygen saturation ” of patients with COVID-19—they monitor the percentage of hemoglobin molecules in the bloodstream that are currently carrying oxygen .
Ordinarily , in patients with healthy lungs , an oxygen-saturation level below ninety per cent is cause for grave concern : when vital organs such as the heart and brain become starved for oxygen , the risk @ @ @ @ @ @ @ finding , bizarrely , that some COVID-19 patients can remain subjectively comfortable even when their saturation levels fall far below these ranges .
This “ silent hypoxemia ” is frightening for physicians , who associate such low numbers with imminent death .
And it ’ s deeply mystifying , since the numbers seem implausible .
Is silent hypoxemia a sign that , even though a patient feels relatively well , the bottom is about to drop out ?
Or is the virus somehow interfering with the blood ’ s hemoglobin , or with @ @ @ @ @ @ @ us when we need more oxygen ?
Theories abound .
Meanwhile , silent hypoxemia complicates the decision to intubate .
In the early days of COVID-19 treatment , low oxygen saturation that failed to improve was generally seen as an indication that intubation was necessary right away .
But in early March reports of comfortable patients with discordantly low saturation rates began spreading rapidly among doctors online .
One particularly arresting image , posted on Twitter by a New York City emergency-medicine physician , shows a patient calmly reading on her phone while @ @ @ @ @ @ @ of just fifty-four per cent .
Until we better understand the physiology behind silent hypoxemia , and why some people experience it and others do not , we will have no choice but to live with the mystery , scrutinizing some patients who have oxygen levels in the seventies and eighties , and whom we might have rushed to intubate in the past .
Within hours of a viral invasion , the body ’ s immune system swings into action .
The “ innate ” immune system , which recognizes protein structures common @ @ @ @ @ @ @ by releasing a family of chemical distress signals called cytokines .
They spread from the site of the infection , instructing the body to raise its temperature and divert blood flow to the affected area ; they also activate other immune-system cells , which begin developing antibodies specifically targeting the invaders .
Without cytokines , the immune system would slumber while infections wreak havoc .
But the cytokine system has a weakness .
Some pathogens can provoke it in a perverse way , so that it goads the immune system as a whole @ @ @ @ @ @ @ known as a cytokine storm , fever and inflammation spike out of control .
It ’ s unclear why some patients might experience this phenomenon while others do not .
Faced with a cytokine storm in a patient , a doctor can try to modulate the immune system ’ s response .
The problem is striking the right balance .
While some patients may benefit from a degree of medically induced immunosuppression , there are others for whom such an intervention could cause great harm .
Some hospitals have begun cautiously administering steroids @ @ @ @ @ @ @ .
But high-quality clinical-trial data about such treatments won ’ t be ready for a long time .
Moreover , even if early results are encouraging , we will still have to distinguish between those patients who will benefit from immunosuppression and those who won ’ t .
In the past , physicians have interpreted elevated blood levels of the protein ferritin as a sign that a cytokine storm is in progress .
Some are now using that analysis in the treatment of COVID-19 .
Only time will tell if they ’ re @ @

COVID-19 has been shown to damage multiple organ systems, including the lungs, the heart, the kidneys, and the brain.
We think of COVID-19 as a disease of the respiratory tract. When future generations look back on this pandemic, its iconic symbol will probably be the ventilator. But, although respiratory problems are at the core of the disease, COVID-19 has revealed itself to be more than a straightforward viral pneumonia. Doctors around the world—including in the emergency department where we work, at Mount Sinai Hospital, in Manhattan—have learned the hard way that the coronavirus doesn’t confine its ravages to the lungs. COVID-19 can push kidneys into failure, send the body’s immune system into catastrophic overdrive, and cause blood clots that impede circulation to the lungs, heart, or brain. It’s a disease of remarkable complexity, which even the most experienced doctors are struggling to understand.
On blogs, podcasts, and #medtwitter, members of the medical community have been trading stories and theories about COVID-19’s intricacies. Often, their conversation has followed the methodology of critical-care doctors. Physicians who work in I.C.U.s tend to talk not about symptoms or diseases—chest pain, diabetes—but about organ systems, which can malfunction and interact in complex ways. System by system, a picture of COVID-19 is emerging. Clarifying it may mean the difference between life and death for thousands of people in the months to come.
The shortness of breath that’s most characteristic of COVID-19 is reasonably well understood. It originates in the gossamer air sacs of the lungs, called alveoli, where blood and air are separated by such thin membranes that oxygen and carbon dioxide can pass into and out of the bloodstream, respectively. Between them, the lungs have somewhere in the neighborhood of six hundred million alveoli. Severe COVID-19 causes many of them to either collapse or fill with fluid. The virus attacks the cells lining the alveoli; our overactive immune systems, in trying to fight the virus, may be damaging them as well. The result is that not enough oxygen gets into the blood.
Doctors trying to solve this problem have two basic tools at their disposal: oxygen and pressure. They can give patients concentrated oxygen beyond the usual twenty-one per cent that is found in normal air. Alternatively, using a CPAP machine or ventilator, they can create a kind of sustained air pressure within the lungs—“positive end-expiratory pressure,” or PEEP—which keeps the alveoli open, and thus more receptive to oxygen, at moments when the lungs would ordinarily be emptier of air. (Imagine breathing in and out while leaning through the window of a moving car: that lungs-full-of-air feeling is PEEP.) Doctors have also been improving oxygenation by “proning” patients—that is, periodically turning them onto their stomachs. Such positioning takes advantage of gravity to match areas of air-filled lung with areas of higher blood flow.
All this makes straightforward mechanical sense. Still, mysteries hover around the certainties. Doctors track the “oxygen saturation” of patients with COVID-19—they monitor the percentage of hemoglobin molecules in the bloodstream that are currently carrying oxygen. Ordinarily, in patients with healthy lungs, an oxygen-saturation level below ninety per cent is cause for grave concern: when vital organs such as the heart and brain become starved for oxygen, the risk of death skyrockets. But doctors are finding, bizarrely, that some COVID-19 patients can remain subjectively comfortable even when their saturation levels fall far below these ranges. This “silent hypoxemia” is frightening for physicians, who associate such low numbers with imminent death. And it’s deeply mystifying, since the numbers seem implausible.
Is silent hypoxemia a sign that, even though a patient feels relatively well, the bottom is about to drop out? Or is the virus somehow interfering with the blood’s hemoglobin, or with the parts of the brain that warn us when we need more oxygen? Theories abound. Meanwhile, silent hypoxemia complicates the decision to intubate. In the early days of COVID-19 treatment, low oxygen saturation that failed to improve was generally seen as an indication that intubation was necessary right away. But in early March reports of comfortable patients with discordantly low saturation rates began spreading rapidly among doctors online. One particularly arresting image, posted on Twitter by a New York City emergency-medicine physician, shows a patient calmly reading on her phone while her overhead monitor reveals a saturation rate of just fifty-four per cent. Until we better understand the physiology behind silent hypoxemia, and why some people experience it and others do not, we will have no choice but to live with the mystery, scrutinizing some patients who have oxygen levels in the seventies and eighties, and whom we might have rushed to intubate in the past.
COVID-19 is a disease of remarkable complexity, which even the most experienced doctors are struggling to understand. Photograph by Sergio Perez / Reuters
Within hours of a viral invasion, the body’s immune system swings into action. The “innate” immune system, which recognizes protein structures common to many pathogens, reacts first, by releasing a family of chemical distress signals called cytokines. They spread from the site of the infection, instructing the body to raise its temperature and divert blood flow to the affected area; they also activate other immune-system cells, which begin developing antibodies specifically targeting the invaders. Without cytokines, the immune system would slumber while infections wreak havoc. But the cytokine system has a weakness. Some pathogens can provoke it in a perverse way, so that it goads the immune system as a whole into overdrive. In what’s known as a cytokine storm, fever and inflammation spike out of control. It’s unclear why some patients might experience this phenomenon while others do not.
Faced with a cytokine storm in a patient, a doctor can try to modulate the immune system’s response. The problem is striking the right balance. While some patients may benefit from a degree of medically induced immunosuppression, there are others for whom such an intervention could cause great harm. Some hospitals have begun cautiously administering steroids or drugs that inhibit the cytokine IL-6. But high-quality clinical-trial data about such treatments won’t be ready for a long time. Moreover, even if early results are encouraging, we will still have to distinguish between those patients who will benefit from immunosuppression and those who won’t. In the past, physicians have interpreted elevated blood levels of the protein ferritin as a sign that a cytokine storm is in progress. Some are now using that analysis in the treatment of COVID-19. Only time will tell if they’re right.
It’s not only the immune system that must maintain a delicate balance. The bloodstream, too, exists in a perpetual tug-of-war between bleeding and clotting. Too much bleeding, and the smallest trauma can cause hemorrhage, even to the point of death (the danger faced by people with hemophilia); too far in the other direction, and clots will form in the absence of trauma, potentially obstructing blood vessels and causing lethal damage if they travel to the heart, lungs, or brain.
By measuring a blood protein called D-dimer, doctors can get a rough sense of how much excess clotting is happening in the bloodstream. Many infections cause a rise in clotting. But in some COVID-19 patients doctors are seeing jaw-dropping spikes. A few patients appear to have widespread pathologic clotting. One of our patients, a healthy man in his fifties, arrived in our hospital’s I.C.U. with a D-dimer level of a thousand—elevated but unremarkable. But when a doctor attempted to put an I.V. into one of the man’s femoral veins—the largest veins in the legs—he discovered, through use of a bedside ultrasound, that it was filled with clots. The second D-dimer test, performed just hours after the first, registered a level of over ten thousand. The man died several hours later.
It’s possible that cytokine storms are causing overactive clotting. But, whatever the cause turns out to be, clinicians face a challenge. Doctors often give small doses of anticoagulant medication to patients who are admitted to the hospital, simply because lying in bed for an extended period makes clotting more likely. But more extreme levels of clotting demand more aggressive anticoagulation—and doctors must figure out when to administer it and to whom. These medications carry their own risks. The patient suffering from femoral clotting was immediately put on aggressive anticoagulation medication. Yet his death, and the rapid increase in his D-dimer, suggest that successful anticoagulant interventions in other patients may need to come earlier.
Doctors often test critically ill patients for cardiac-specific troponins—proteins in the bloodstream that are normally found only in the muscles of the heart. The presence of such proteins in blood suggests heart damage. Some severe COVID-19 patients have elevated troponin levels; their hearts appear to be damaged. We’re not entirely sure what’s causing the damage, though, and so we don’t know exactly how to treat it.
One major cause of heart damage is oxygen starvation: it’s what happens in a heart attack, when the sudden obstruction of a coronary artery prevents oxygen from reaching heart muscle. Starvation can also occur when failing lungs prevent oxygen from entering the bloodstream, or when sepsis causes such a drop in blood pressure that even properly oxygenated blood can’t get to the heart fast enough. These problems are significant, and, in broad terms, doctors know how to respond to them. There are, however, other possibilities. Perhaps runaway clotting is choking off circulation vessel by vessel. Early reports from China, meanwhile, suggested that the coronavirus could be attacking the heart muscle directly, causing a syndrome known as myocarditis. No one knows for sure what the best treatment for this form of myocarditis might be. Some doctors have reported that steroids can help—and yet steroids also act as an immunosuppressant. In critical care, it’s often hard to bring one organ system into balance without destabilizing another.
A similar story appears to be unfolding around the kidneys. Kidneys serve as filters for the blood, weeding out certain compounds and excreting them in urine, while regulating the precise composition of electrolytes that allow cells to function. Complete kidney failure is a death sentence if it’s not quickly addressed. Unfortunately, many critically ill COVID-19 patients are developing it. Just as ventilators are substituting for failing lungs, so dialysis machines are taking over for failing kidneys. The hardest-hit areas of the country are facing shortages of the resources needed for dialysis: dialysis machines, the fluid used in the dialysis process, and dialysis-trained nurses.
We don’t yet know how kidney injury plays out in COVID-19 patients. It’s likely that some people will recover their kidney function, while others could lose it permanently. We also don’t know why people are going into kidney failure in the first place. As with the heart, it’s possible that oxygen starvation is the problem. But some clinicians argue that the virus is attacking kidney cells directly—and there is biopsy data out of China that supports this thesis, too.
Still other organ systems may be involved in COVID-19. The ACE-2 receptor protein, which is used by the coronavirus to enter human cells, resides not just in the respiratory tract but also on cells in the stomach, intestines, liver, kidneys, and brain. There are reports of coronavirus patients with encephalitis—a potentially fatal inflammation of the brain—and signs of an increased incidence of stroke. In our hospital, we have seen several COVID-19 patients suffering from a severe complication of diabetes called diabetic ketoacidosis, despite having no history as diabetics.
Last month, we screened for COVID-19 by asking about fever and cough. Now we know that the disease manifests in other ways, or sometimes proceeds with no symptoms at all. One patient recently arrived in the E.R. reporting three days of watery diarrhea and a day of nausea and vomiting; she said that she felt weak but hadn’t experienced fevers, chills, sweats, or respiratory symptoms. Her oxygen saturation was in the low nineties; her chest X-ray was consistent with COVID-19.
For us, and for many doctors we know, cases like these have become subjects of consuming fascination. During our few free moments, we share patients’ sky-high D-dimer levels and swap theories about the sources of their discordant oxygen readings. In the absence of data from randomized, prospective trials, we search for answers on colleagues’ Twitter accounts, in interviews with Chinese or Italian physicians, and in our patients’ charts. Our colleagues at Mount Sinai are actively embarking on dozens of research projects, ranging from ventilator-management strategies to social determinants of COVID-19 mortality, but months will pass before these projects give us objective insight into the disease. The desperate desire for clarity is evident at every level of the medical profession. Earlier this month, The New England Journal of Medicine published an observational, fifty-three-patient study of the antiviral drug remdesivir; many observers criticized the journal for publishing it, because the trial had neither a control group nor randomization, and so no meaningful statistical conclusions could be drawn from its results. (Even its authors noted that actual measurement of the drug’s efficacy would require “ongoing randomized, placebo-controlled trials.”)
And yet, as the historian of science Lorraine Daston writes in a recent essay, it’s natural to cast about for answers at the dawn of a pandemic. “At moments of extreme scientific uncertainty,” Daston writes, “observation, usually treated as the poor relation of experiment and statistics in science, comes into its own.” Confronting a new disease, doctors have no choice but to turn to “suggestive single cases, striking anomalies, partial patterns.” Slowly, as our ideas about “what works and what doesn’t” help tell us “what to test, what to count,” the picture clarifies. Until then, “we are back in the seventeenth century, the age of ground-zero empiricism, and observing as if our lives depended on it.” One patient at a time, we have to work our way into the present.
More Medical Dispatches


newyorker--2020-04-30--Corporate Jargon Adjusted for Quarantine

Think at least six feet outside the box .
Don ’ t touch base until we understand more about how this virus is transmitted .
We have too much skin in the game , and not nearly enough of it is covered .
If you ever need to talk , my door is never open—but my Zoom camera is always on , even when it ’ s off .
Make hay but also bread , because what else do you have to post on Instagram ?
Let ’ s unpack that idea , wipe it down , and burn the @ @ @ @ @ @ @ the low-hanging fruit , whenever it ’ s available again—it ’ s been out of stock for weeks .
This is our window of opportunity , though , sadly , it faces a wall .
If we think big picture , we ’ ll have something else to look at .
An ocean scene might be nice .
I ’ m in pocket until my shipment of gloves arrives .
That was a big win—let ’ s play Clue next .
Why don ’ t we hit the ground running before sunrise , @ @ @ @ @ @ @ bring nothing to the table in order to lower the risk of contamination .
Get your ducks in a row , because I need to see some cute animals right about now .
Let ’ s never go back to the drawing board—someone sneezed on it .
We ’ re trailblazers , because the population density is too great everywhere else .
A one-size-fits-all approach won ’ t work , unless it ’ s a Niagara Falls poncho and it ’ s the only thing that ’ s clean .
There are a @ @ @ @ @ @ @ jigsaw puzzle , and a few already got swept under the couch .
I have a lot on my plate and it ’ s mostly kidney beans , because that ’ s all I bought .
The landscape is changing , I think—I ’ m not really sure , I haven ’ t left the house in three weeks .
Stop comparing apples to oranges , you know how much I miss fruit .
Let ’ s get the ball rolling—it ’ s my only friend and source of comfort .
At the @ @ @ @ @ @ @ s only been a day ?
!

Think at least six feet outside the box.
Let’s take eighteen steps back.
Don’t touch base until we understand more about how this virus is transmitted.
We have too much skin in the game, and not nearly enough of it is covered.
If you ever need to talk, my door is never open—but my Zoom camera is always on, even when it’s off.
Make hay but also bread, because what else do you have to post on Instagram?
Let’s unpack that idea, wipe it down, and burn the box it came in.
Go for the low-hanging fruit, whenever it’s available again—it’s been out of stock for weeks.
This is our window of opportunity, though, sadly, it faces a wall.
If we think big picture, we’ll have something else to look at. An ocean scene might be nice.
I’m in pocket until my shipment of gloves arrives.
That was a big win—let’s play Clue next.
Why don’t we hit the ground running before sunrise, when fewer people are out.
I bring nothing to the table in order to lower the risk of contamination.
Get your ducks in a row, because I need to see some cute animals right about now.
Let’s never go back to the drawing board—someone sneezed on it.
We’re trailblazers, because the population density is too great everywhere else.
A one-size-fits-all approach won’t work, unless it’s a Niagara Falls poncho and it’s the only thing that’s clean.
There are a lot of moving parts in this thousand-piece jigsaw puzzle, and a few already got swept under the couch.
I have a lot on my plate and it’s mostly kidney beans, because that’s all I bought.
The landscape is changing, I think—I’m not really sure, I haven’t left the house in three weeks.
Stop comparing apples to oranges, you know how much I miss fruit.
Let’s get the ball rolling—it’s my only friend and source of comfort.
At the end of the day, it’s only been a day?!


newyorker--2020-04-30--How to Combat Climate Depression

How to Combat Climate Depression

If there existed some kind of gauge for measuring ambient sadness , I imagine the needle would now be pinned to the far end of the red .
Some of us are mourning the deaths of those we loved ; more are terrified for the ailing ; more still lie abed trying to figure out whether their job will last another month , or what to do about the one they just lost .
The Times reports that the pandemic has become a “ grim slog ” for New Yorkers .
Even away from the epicenter , the pervading uncertainty @ @ @ @ @ @ @ seem drab .
But here ’ s the worse news : even before the coronavirus descended , that ’ s how the world looked to an awful lot of Americans , especially younger ones .
Seventh Generation , the recycled-paper-towel and household-products company , commissioned a survey , released in April .
It showed that seventy-one per cent of millennials and sixty-seven per cent of Generation Z feel that climate change has negatively affected their mental health .
How upset were they ?
Four in five people in the eighteen-to-twenty-three age cohort “ @ @ @ @ @ @ @ want—to have children of their own as a result of climate change.
” Even if the survey were off by fifty per cent , that would still be an astonishing number .
I spend a lot of time with young people , and I find much the same thing : they ’ re far more aware of the science behind climate change than their elders are , and they know what it means .
They understand that if we can ’ t check the rise in temperatures soon , we will see an @ @ @ @ @ @ @ , those have already begun in large parts of the world .
Year after year on the West Coast , summer has become the season of wildfire smoke , lingering for weeks in the air above our major cities .
We ’ ve always had hurricanes , but they drop more rain than we ’ ve ever seen before .
If you anticipated that your life was going to be punctuated by one major disaster after another , would you be eager to have kids ?
It ’ s worth remembering that the @ @ @ @ @ @ @ hemisphere—the Zika virus , which caused microcephaly in some babies—prompted the health ministers of several countries to urge women to forgo pregnancy for a year or more .
This is bad news , and not just because babies are wonderful .
A society that becomes this disconsolate is a society that could veer chaotically in almost any direction .
Yet this same cohort of young people , to its enormous credit , is leading the constructive response to our dilemma : eighty-five per cent of millennials report that they are actively fighting climate @ @ @ @ @ @ @ what I see on the ground , but their discouragement will grow if their elders continue to oppose serious change .
That ’ s why Joe Biden needs both to win in November and then to demonstrate that he ’ s more committed to climate action than he ’ s seemed so far .
( It was a relief to see him podcasting with the governor of Washington and climate champion Jay Inslee on Earth Day , and to think about Inslee or people like him populating the next Cabinet . )
The @ @ @ @ @ @ @ depression may also be the only way to combat the Depression now threatening our economy : an all-encompassing , society-wide effort to build out renewable energy , retrofit houses and offices for energy efficiency , and safeguard and nurture our remaining working ecosystems .
If we don ’ t do it fast , then the gloom of young people will be justified—and it ’ s hard to think of a more powerful indictment of older generations than that .
Their childlessness must not be our legacy .
I got to know Jane Kleeb @ @ @ @ @ @ @ of the fight against the Keystone XL pipeline .
She remains a general in this battle , but she ’ s also become a force in electoral politics , chairing the Nebraska Democratic Party and serving as treasurer of Our Revolution , an offshoot of Bernie Sanders ’ s 2016 campaign .
Her new book is “ Harvest the Vote : How Democrats Can Win Again in Rural America.
” “ Keystone ’ s under construction.
” “ Federal court stops Keystone.
” Is the pipeline going to be built , and what @ @ @ @ @ @ @ slow it down ?
Not an inch of the risky Keystone XL pipeline will ever touch our land and water here in Nebraska , because of the lawsuits and grassroots actions we are leading .
The last ten years of our fight have been a roller coaster for the unlikely alliance of farmers , ranchers , tribal nations , and climate advocates who have been the heroes in stopping this pipeline .
Every voter , no matter your political stripe , should ask candidates from county boards and mayors to state legislatures and @ @ @ @ @ @ @ XL pipeline .
If they do , try to persuade them otherwise , by telling them our stories about how this pipeline hurts our communities—or vote for someone else , or run for office yourself .
Elected officials at every level can take actions to stop the pipeline , by denying local construction permits , enacting bans on eminent domain for private gain , and honoring treaties with tribal nations .
If TC Energy and President Trump try to ram this pipeline through by breaking environmental laws , trampling on property rights , @ @ @ @ @ @ @ we will need everyone supporting us on the ground as we collectively put our bodies on the line to protect the land and water .
Joe Biden might not be where I want him to be on all aspects of a climate plan , but I know this : if he ’ s elected , he will revoke Trump ’ s permit for the Keystone XL pipeline .
We need everyone “ all in ” on electing Biden so we can protect our land and water .
If we believe in climate action @ @ @ @ @ @ @ new pipelines .
You ’ re in charge of the Nebraska Democratic Party .
What ’ s the mood among activists out on the prairies , as you head into the state ’ s primary , especially after looking north to Wisconsin ’ s election earlier this month ?
We are nervous , scared , and worried that no one is looking out for us .
Governor [ Pete ] Ricketts is keeping the polls open here on May 12th , and we never had a stay-at-home order .
In one of our @ @ @ @ @ @ @ around fifty per cent of the people who have been tested are confirmed to have COVID-19 .
But , because the Democratic Party has largely ignored rural communities for the last thirty years , we do not have enough Democrats elected at the state and federal level to give voice to the issues that affect rural communities .
And this just continues a cycle of mutual neglect , where Democrats ignore rural voters and , in turn , rural voters do not vote for Democrats .
The irony is , of course , @ @ @ @ @ @ @ , family farms being bought up by industrial agriculture , no real progress on rural broadband—are bread-and-butter issues for Democrats .
Our party has a proud history of standing up for the little guy against big corporations .
It seems our party stops at the borders and dirt roads of our red and rural states , having given up on us decades ago .
How many electoral votes will Biden get out of the Cornhusker State ?
Nebraska and Maine are the only two states that split up their electoral votes by congressional @ @ @ @ @ @ @ this question with zero , some pundits who watched Barack Obama secure an electoral vote in our “ blue dot ” of Omaha ’ s Second Congressional District back in 2008 would say it is possible to get that one electoral vote again in 2020 .
I am fully confident we can win both C.D.-1 and C.D.-2 ’ s electoral votes for Biden while also sending the first Democratic women to Congress from our state .
But , to do so , we need to take a page out of our organizing on @ @ @ @ @ @ @ groups at the heart of our efforts—in the context of electoral politics , that is funding and listening to the state party .
We know the candidates , the grassroots advocates , and the issues that motivate voters the best .
Funding the fighters on the front lines is always the answer to victory .
Julian Popov , of the European Climate Foundation , lays out a plan in the Financial Times for green economic recovery .
“ Fast distribution of cash will be essential , ” he writes .

Photograph by Ike Edeani for The New Yorker
Subscribers to The Climate Crisis newsletter received this piece in their in-boxes. Sign up to receive future installments.
If there existed some kind of gauge for measuring ambient sadness, I imagine the needle would now be pinned to the far end of the red. Some of us are mourning the deaths of those we loved; more are terrified for the ailing; more still lie abed trying to figure out whether their job will last another month, or what to do about the one they just lost. The Times reports that the pandemic has become a “grim slog” for New Yorkers. Even away from the epicenter, the pervading uncertainty brews a fog that makes the future seem drab.
But here’s the worse news: even before the coronavirus descended, that’s how the world looked to an awful lot of Americans, especially younger ones. Seventh Generation, the recycled-paper-towel and household-products company, commissioned a survey, released in April. It showed that seventy-one per cent of millennials and sixty-seven per cent of Generation Z feel that climate change has negatively affected their mental health. How upset were they? Four in five people in the eighteen-to-twenty-three age cohort “aren’t planning—or didn’t want—to have children of their own as a result of climate change.” Even if the survey were off by fifty per cent, that would still be an astonishing number.
I spend a lot of time with young people, and I find much the same thing: they’re far more aware of the science behind climate change than their elders are, and they know what it means. They understand that if we can’t check the rise in temperatures soon, we will see an ongoing series of crises. In fact, those have already begun in large parts of the world. Year after year on the West Coast, summer has become the season of wildfire smoke, lingering for weeks in the air above our major cities. We’ve always had hurricanes, but they drop more rain than we’ve ever seen before. If you anticipated that your life was going to be punctuated by one major disaster after another, would you be eager to have kids? It’s worth remembering that the last big novel disease to hit our hemisphere—the Zika virus, which caused microcephaly in some babies—prompted the health ministers of several countries to urge women to forgo pregnancy for a year or more.
This is bad news, and not just because babies are wonderful. A society that becomes this disconsolate is a society that could veer chaotically in almost any direction. Yet this same cohort of young people, to its enormous credit, is leading the constructive response to our dilemma: eighty-five per cent of millennials report that they are actively fighting climate change. Again, that squares with what I see on the ground, but their discouragement will grow if their elders continue to oppose serious change. That’s why Joe Biden needs both to win in November and then to demonstrate that he’s more committed to climate action than he’s seemed so far. (It was a relief to see him podcasting with the governor of Washington and climate champion Jay Inslee on Earth Day, and to think about Inslee or people like him populating the next Cabinet.)
The only way to combat this kind of depression may also be the only way to combat the Depression now threatening our economy: an all-encompassing, society-wide effort to build out renewable energy, retrofit houses and offices for energy efficiency, and safeguard and nurture our remaining working ecosystems. If we don’t do it fast, then the gloom of young people will be justified—and it’s hard to think of a more powerful indictment of older generations than that. Their childlessness must not be our legacy.
Passing the Mic
I got to know Jane Kleeb when we worked together at the start of the fight against the Keystone XL pipeline. She remains a general in this battle, but she’s also become a force in electoral politics, chairing the Nebraska Democratic Party and serving as treasurer of Our Revolution, an offshoot of Bernie Sanders’s 2016 campaign. Her new book is “Harvest the Vote: How Democrats Can Win Again in Rural America.”
“Keystone’s under construction.” “Federal court stops Keystone.” Is the pipeline going to be built, and what should people do if they want to slow it down?
Not an inch of the risky Keystone XL pipeline will ever touch our land and water here in Nebraska, because of the lawsuits and grassroots actions we are leading. The last ten years of our fight have been a roller coaster for the unlikely alliance of farmers, ranchers, tribal nations, and climate advocates who have been the heroes in stopping this pipeline. Every voter, no matter your political stripe, should ask candidates from county boards and mayors to state legislatures and Congress if they support building the Keystone XL pipeline. If they do, try to persuade them otherwise, by telling them our stories about how this pipeline hurts our communities—or vote for someone else, or run for office yourself. Elected officials at every level can take actions to stop the pipeline, by denying local construction permits, enacting bans on eminent domain for private gain, and honoring treaties with tribal nations. If TC Energy and President Trump try to ram this pipeline through by breaking environmental laws, trampling on property rights, and violating treaties with tribal nations, we will need everyone supporting us on the ground as we collectively put our bodies on the line to protect the land and water. Joe Biden might not be where I want him to be on all aspects of a climate plan, but I know this: if he’s elected, he will revoke Trump’s permit for the Keystone XL pipeline. We need everyone “all in” on electing Biden so we can protect our land and water. If we believe in climate action, then we cannot keep building new pipelines.
You’re in charge of the Nebraska Democratic Party. What’s the mood among activists out on the prairies, as you head into the state’s primary, especially after looking north to Wisconsin’s election earlier this month?
We are nervous, scared, and worried that no one is looking out for us. Governor [Pete] Ricketts is keeping the polls open here on May 12th, and we never had a stay-at-home order. In one of our communities with a larger meatpacking plant, around fifty per cent of the people who have been tested are confirmed to have COVID-19. But, because the Democratic Party has largely ignored rural communities for the last thirty years, we do not have enough Democrats elected at the state and federal level to give voice to the issues that affect rural communities. And this just continues a cycle of mutual neglect, where Democrats ignore rural voters and, in turn, rural voters do not vote for Democrats. The irony is, of course, that the issues rural communities face—hospitals closing, family farms being bought up by industrial agriculture, no real progress on rural broadband—are bread-and-butter issues for Democrats. Our party has a proud history of standing up for the little guy against big corporations. It seems our party stops at the borders and dirt roads of our red and rural states, having given up on us decades ago.
How many electoral votes will Biden get out of the Cornhusker State?
Nebraska and Maine are the only two states that split up their electoral votes by congressional district. While most non-Nebraskans would answer this question with zero, some pundits who watched Barack Obama secure an electoral vote in our “blue dot” of Omaha’s Second Congressional District back in 2008 would say it is possible to get that one electoral vote again in 2020. I am fully confident we can win both C.D.-1 and C.D.-2’s electoral votes for Biden while also sending the first Democratic women to Congress from our state. But, to do so, we need to take a page out of our organizing on the Keystone XL pipeline and keep front-line groups at the heart of our efforts—in the context of electoral politics, that is funding and listening to the state party. We know the candidates, the grassroots advocates, and the issues that motivate voters the best. Funding the fighters on the front lines is always the answer to victory.
Climate School
Julian Popov, of the European Climate Foundation, lays out a plan in the Financial Times for green economic recovery. “Fast distribution of cash will be essential,” he writes.


newyorker--2020-04-30--The Italian Supermodel Who Was Already Hiding in Her Apartment

Most of us , when we arrive at a particularly trying moment in life , begin to indulge in escapism .
Who hasn ’ t dreamed of extracting themselves from all obligation , moving to a remote island , throwing their cell phone into the ocean , and leading a life of ascetic satisfaction ?
Usually , the impulse is fleeting .
But for Benedetta Barzini , a seventy-six-year-old supermodel turned professor , this kind of longing is a full-bore obsession .
Barzini , who was born into great wealth , was thrust into the world of modelling as a @ @ @ @ @ @ @ was the first Italian woman to appear on the cover of Vogue .
With her slyly knowing gaze , Cleopatran features , and delicate gait , she became élite at the exact moment that fashion was becoming a world ; she rubbed elbows with Andy Warhol ’ s Factory crowd and posed regularly for Richard Avedon and Irving Penn .
All along , though , she knew that her youth—and professional value—was marching toward expiration .
Eventually , Barzini became disillusioned with the very idea of beauty and with the constant stream of @ @ @ @ @ @ @ As she grew older , this disillusionment intensified into a rage that could only be eased by one thing : total separation from the material world .
“ I want to disappear , ” she likes to say , holed up in her detritus-strewn apartment , in Milan , where she smokes cigarettes and vapes compulsively .
“ I want to disappear and never come back.
” This desire is the subject of “ The Disappearance of My Mother , ” a new documentary by Barzini ’ s son , the young Italian @ @ @ @ @ @ @ of his life trying to escape the shadow of his mother .
( He recently told me that her charisma “ took a toll on her children.
” ) But as with many filmmakers and storytellers—I ’ m thinking of Sarah Polley and Jacob Bernstein , both of whom made excellent documentaries about their families—the subject closest to him was also a source of inspiration , and one that became impossible to ignore .
In 2014 , Barrese began filming his mother , at first in her classroom at the Polytechnic Institute of @ @ @ @ @ @ @ disappear ” became more pronounced , he began to shape a film around it .
The result is a sombre and lean portrait of an old woman ’ s relationship to her celebrity and to society at large .
Barzini has a Scrooge-like attitude to most things : beauty , money , the media , commercialism , holidays .
But , above all , she detests images , and that hostility is the central conflict of the documentary .
Much of the film is about Barzini ’ s resistance to its production .
@ @ @ @ @ @ @ apartment as her son films .
“ Go fuck yourself , ” she tells him at one point , when she discovers that he ’ s secretly been filming her while she rests under her comforter .
Of course , underneath all of this conflict is an agonizing paradox : the more that Barzini retreats from a conventional human life , the more she becomes reduced to a mere set of images .
In February , when the film made its début on streaming platforms , Barzini seemed like a cranky , stubborn @ @ @ @ @ @ @ as COVID-19 descended ruthlessly on Italy ’ s elderly population , her urge to disappear took on a new significance .
In the film ’ s most discomfiting scenes , she ’ s plagued by health problems—the movie lingers on her smoker ’ s cough and features a scene in which she discusses recent doctors ’ appointments for an infection .
The pandemic has preyed upon many of Barzini ’ s peers , and the strict lockdowns imposed in Italy and elsewhere have created their own sort of disappearance for billions of people @ @ @ @ @ @ @ quarantine was affecting Barzini .
For one , she ’ s a high-risk person living in one of the disease ’ s epicenters .
And yet the times seemed to align eerily with her fantasies , creating a world without commerce , social expectation , or human interaction .
Was lockdown a relief or a greater form of constriction ?
On a recent morning , I Skyped with Barzini and her son , who were in their respective apartments in Milan .
Daily death tolls in Italy were reaching a peak .
The @ @ @ @ @ @ @ , two weeks prior , police had stopped them from sitting on a park bench .
“ I ’ m feeling like shit !
” Barzini announced immediately , with a big grin and a lit cigarette in her hand .
Given her ailing health in the film , I was alarmed—did she mean she had symptoms ?
No , she said—but the lockdown was making her feel even more suffocated by the world around her .
“ It ’ s like living out of the world [ but still ] inside your @ @ @ @ @ @ @ It ’ s very uncertain .
We ’ re both stuck.
” I asked her how she ’ d been passing the time .
“ I don ’ t do a damn thing , ” she said .
“ Thinking of all the things I could be doing , but I just don ’ t want to do them.
” When I asked Barzini about her desire to disappear , and if quarantine might fulfill or transform that desire , she responded firmly .
“ No , ” she said .
“ I @ @ @ @ @ @ @ s one place in the world where one can go and be away from what the Western world has done to the world .
I ’ m still sort of searching for that corner in the world , where I ’ d like to forget about who I was and what I did .
I just want to be away from here.
” Barrese gently interrupted to remind his mother that , in many ways , quarantine was its own corner of the world .
And her new way of life—hermetic , static—was @ @ @ @ @ @ @ It ’ s what you ’ ve already been doing , ” he said .
“ For so long , you ’ ve been living in this place , away from people.
” Barzini , who can turn anything into a polemic , dug in .
“ It ’ s not enough , ” she said .
“ They ’ re out there with their greed .
White men are greedy .
This could be the long lost island , but it isn ’ t. ” Her answer reminded me of a moment @ @ @ @ @ @ @ of My Mother , ” when Barzini and her son discuss a plot to stage her disappearance .
After a tense back-and-forth , they agree to take her to the sea , and Barrese films his mother rowing a boat into the horizon .
It ’ s a moving scene , but only a simulation .
Barzini returns to her home in Milan , all the more downtrodden , driven by the need to divorce herself from civilization .
At one point , as though trolling him , she tells her son , @ @ @ @ @ @ @ Ben .
Maybe I just want to die.
” Though she hems and haws over her escape , she seems more invested in the idea of it , which provides an outlet for her depression and dismay .
Much has been made of the way that quarantine is halting our lives .
It ’ s upending commerce ; it ’ s killing off jobs ; it ’ s separating us from loved ones .
It ’ s interrupting art , sports , weddings , semesters .
These untimely pauses generate immense psychic space @ @ @ @ @ @ @ this is over , we imagine , we ’ ll travel the world .
We ’ ll try new restaurants .
We ’ ll get back to work .
But “ The Disappearance of My Mother ” suggests another possibility : that stasis and discontent is the way of the world , and that , even if things return to normal , there will still be much to hide from , and much to reject .
When this is over , Barzini will return to her passion—the process of finding a corner of @ @ @ @ @ @ @ if not physically then emotionally .
“ It ’ s slow and progressive , ” she told me , speaking of her plans .
“ But it ’ s constant .
”

Most of us, when we arrive at a particularly trying moment in life, begin to indulge in escapism. Who hasn’t dreamed of extracting themselves from all obligation, moving to a remote island, throwing their cell phone into the ocean, and leading a life of ascetic satisfaction? Usually, the impulse is fleeting. But for Benedetta Barzini, a seventy-six-year-old supermodel turned professor, this kind of longing is a full-bore obsession. Barzini, who was born into great wealth, was thrust into the world of modelling as a teen-ager, in the nineteen-sixties, and was the first Italian woman to appear on the cover of Vogue. With her slyly knowing gaze, Cleopatran features, and delicate gait, she became élite at the exact moment that fashion was becoming a world; she rubbed elbows with Andy Warhol’s Factory crowd and posed regularly for Richard Avedon and Irving Penn. All along, though, she knew that her youth—and professional value—was marching toward expiration. Eventually, Barzini became disillusioned with the very idea of beauty and with the constant stream of imagery that tried to capture it. As she grew older, this disillusionment intensified into a rage that could only be eased by one thing: total separation from the material world. “I want to disappear,” she likes to say, holed up in her detritus-strewn apartment, in Milan, where she smokes cigarettes and vapes compulsively. “I want to disappear and never come back.”
This desire is the subject of “The Disappearance of My Mother,” a new documentary by Barzini’s son, the young Italian filmmaker Beniamino Barrese. Barrese spent most of his life trying to escape the shadow of his mother. (He recently told me that her charisma “took a toll on her children.”) But as with many filmmakers and storytellers—I’m thinking of Sarah Polley and Jacob Bernstein, both of whom made excellent documentaries about their families—the subject closest to him was also a source of inspiration, and one that became impossible to ignore. In 2014, Barrese began filming his mother, at first in her classroom at the Polytechnic Institute of Milan. As her desire to “disappear” became more pronounced, he began to shape a film around it. The result is a sombre and lean portrait of an old woman’s relationship to her celebrity and to society at large. Barzini has a Scrooge-like attitude to most things: beauty, money, the media, commercialism, holidays. But, above all, she detests images, and that hostility is the central conflict of the documentary. Much of the film is about Barzini’s resistance to its production. We watch her puttering angrily around her apartment as her son films. “Go fuck yourself,” she tells him at one point, when she discovers that he’s secretly been filming her while she rests under her comforter. Of course, underneath all of this conflict is an agonizing paradox: the more that Barzini retreats from a conventional human life, the more she becomes reduced to a mere set of images.
In February, when the film made its début on streaming platforms, Barzini seemed like a cranky, stubborn eccentric. But in subsequent weeks, as COVID-19 descended ruthlessly on Italy’s elderly population, her urge to disappear took on a new significance. In the film’s most discomfiting scenes, she’s plagued by health problems—the movie lingers on her smoker’s cough and features a scene in which she discusses recent doctors’ appointments for an infection. The pandemic has preyed upon many of Barzini’s peers, and the strict lockdowns imposed in Italy and elsewhere have created their own sort of disappearance for billions of people. I wondered, then, how quarantine was affecting Barzini. For one, she’s a high-risk person living in one of the disease’s epicenters. And yet the times seemed to align eerily with her fantasies, creating a world without commerce, social expectation, or human interaction. Was lockdown a relief or a greater form of constriction?
On a recent morning, I Skyped with Barzini and her son, who were in their respective apartments in Milan. Daily death tolls in Italy were reaching a peak. The last time they had seen each other, two weeks prior, police had stopped them from sitting on a park bench. “I’m feeling like shit!” Barzini announced immediately, with a big grin and a lit cigarette in her hand. Given her ailing health in the film, I was alarmed—did she mean she had symptoms? No, she said—but the lockdown was making her feel even more suffocated by the world around her. “It’s like living out of the world [but still] inside your world,” she groaned. “It’s very uncertain. We’re both stuck.” I asked her how she’d been passing the time. “I don’t do a damn thing,” she said. “Thinking of all the things I could be doing, but I just don’t want to do them.”
When I asked Barzini about her desire to disappear, and if quarantine might fulfill or transform that desire, she responded firmly. “No,” she said. “I don’t know if there’s one place in the world where one can go and be away from what the Western world has done to the world. I’m still sort of searching for that corner in the world, where I’d like to forget about who I was and what I did. I just want to be away from here.” Barrese gently interrupted to remind his mother that, in many ways, quarantine was its own corner of the world. And her new way of life—hermetic, static—was not much different from before. “It’s what you’ve already been doing,” he said. “For so long, you’ve been living in this place, away from people.”
Barzini, who can turn anything into a polemic, dug in. “It’s not enough,” she said. “They’re out there with their greed. White men are greedy. This could be the long lost island, but it isn’t.” Her answer reminded me of a moment toward the end of “The Disappearance of My Mother,” when Barzini and her son discuss a plot to stage her disappearance. After a tense back-and-forth, they agree to take her to the sea, and Barrese films his mother rowing a boat into the horizon. It’s a moving scene, but only a simulation. Barzini returns to her home in Milan, all the more downtrodden, driven by the need to divorce herself from civilization. At one point, as though trolling him, she tells her son, “I don’t know, Ben. Maybe I just want to die.” Though she hems and haws over her escape, she seems more invested in the idea of it, which provides an outlet for her depression and dismay.
Much has been made of the way that quarantine is halting our lives. It’s upending commerce; it’s killing off jobs; it’s separating us from loved ones. It’s interrupting art, sports, weddings, semesters. These untimely pauses generate immense psychic space for fantasizing about the future. When this is over, we imagine, we’ll travel the world. We’ll try new restaurants. We’ll get back to work. But “The Disappearance of My Mother” suggests another possibility: that stasis and discontent is the way of the world, and that, even if things return to normal, there will still be much to hide from, and much to reject. When this is over, Barzini will return to her passion—the process of finding a corner of the world and disappearing into it, if not physically then emotionally. “It’s slow and progressive,” she told me, speaking of her plans. “But it’s constant.”


newyorker--2020-04-30--Kim Gordon on Instagram, Ambition, and Los Angeles

Kim Gordon was born in upstate New York , in 1953 , but was raised on the West Side of Los Angeles , where her father taught in the sociology department at U.C.L.A.
, and her mother worked as a seamstress .
She moved to New York City in 1980 , with designs on becoming an artist .
In 1981 , Gordon and the guitarists Lee Ranaldo and Thurston Moore started Sonic Youth , an experimental rock band that inadvertently helped usher in the alternative-boom of the early nineteen-nineties .
Gordon was the kind of cool—vaguely aloof , impossibly chic @ @ @ @ @ @ @ me feel equal parts terrified and enamored .
During a time when it was still somewhat anomalous to see women playing in rock bands , and especially in bands as esoteric and adventurous as Sonic Youth , Gordon was a beacon .
She was also an avant-garde polymath .
Gordon produced Hole ’ s début album , “ Pretty on the Inside , ” co-founded X-girl , a streetwear brand for women ( the actress Chloë Sevigny was its official face ) , formed a series of musical side projects , and eventually @ @ @ @ @ @ @ , and collages in galleries around the world .
Around 2011 , her marriage to Moore fell apart , and Sonic Youth went on an indefinite hiatus .
Four years later , Gordon published “ Girl in A Band , ” a thoughtful , occasionally scathing memoir that recounts her formative years in Sonic Youth , her relationship with Moore , the birth of her daughter , and the origins of her art practice .
She has spent the last several years performing as half of Body/Head , with the experimental musician Bill @ @ @ @ @ @ @ at age sixty-six , she released her first solo album , “ No Home Record.
” In April , Gordon and I began a correspondence , and she shared her thoughts on Instagram , Los Angeles , overpriced coffee , and canvassing for Bernie Sanders .
This interview has been condensed and edited .
Kim , I ’ ll start with the obvious question : where have you hunkered down , what is it like there , and how are you coping with the pandemic ?
Has this experience begun to change the @ @ @ @ @ @ @ ?
I ’ ve had some mysterious vertigo the last couple days .
I hope it ’ s just stress and not a brain tumor , which is where my mind usually goes .
It ’ s so easy to become instantly paranoid and anxious over every little sniffle or allergy-induced sneeze .
I ’ m on the East Side of Los Angeles , where I live .
So I ’ m close to the hills , which are beautiful to look at , and , up until recently , I could go @ @ @ @ @ @ @ ’ m not in New York , I remember the camaraderie that 9/11 inspired , and the way that only New Yorkers can come together .
It ’ s funny the way some liberals are fawning over Andrew Cuomo , but it ’ s reassuring to see someone take control .
He is impressive .
But Gavin Newsom is the man !
I try every day to do some sort of exercise—the Ryan Heffington dance sessions on Instagram , the occasional GST Body class on Zoom , the six-minute New York Times workout @ @ @ @ @ @ @ have a house to live in , I can afford to buy food , and I don ’ t have to immediately worry about income—even though I don ’ t have an income right now .
Basically everyone I know is out of work and doesn ’ t qualify for any unemployment , because we ’ re all freelance musicians , or people who work in the industry .
It ’ s pretty grim for [ visual ] artists , too .
It ’ s a bit hard to get motivated to make @ @ @ @ @ @ @ shows that may not happen .
But it ’ s still a refuge of sorts—just to be able to zone out on something that isn ’ t about the pandemic .
I joined the Criterion Channel , finally , so I feel like I have license to watch amazing movies that I never got to see .
I want to keep soaking up humanity in various forms .
Even though it was released last year , your newest album , “ No Home Record , ” feels so eerily appropriate for this time @ @ @ @ @ @ @ it constantly .
You ’ ve said the title was based on Chantal Akerman ’ s final film , “ No Home Movie , ” which is about life , death , survival , and , to an extent , domesticity .
You made “ No Home Record ” in a period of personal transition—you were in the process of moving back to Los Angeles , your home town , and staying at an Airbnb .
This period now , too , feels incredibly liminal—we ’ re between things , although no one @ @ @ @ @ @ @ yet .
Can you talk a little bit about how you came to make and title the record ?
I was reading about the concept of home in a book by Trisha Low .
She was writing about feeling displaced both emotionally and physically from her original culture , in Singapore .
She came to the U.S. for an education , as her father had .
But her father returned to Singapore , whereas she now exists in a culture in a country that she is both part of and not part of @ @ @ @ @ @ @ Akerman films “ No Home Movie ” and “ Jeanne Dielman , ” but in her diaristic mode of writing .
As I was thinking about how I fit into the L.A. landscape or not , and where my home really was since the breakup of my marriage , I began to look at L.A. as a sort of Dada landscape .
A friend of mine who moved here a few years ago has a great response when people ask him how he likes living in L.A .
He says he ’ s @ @ @ @ @ @ @ is an apt way of putting it .
I became more aware of patterns around my neighborhood , like people—millennials—going to the four-dollar coffee places , and seeing the elaborate , ritualistic making of coffee every morning .
Things like that exist in New York and other “ woke ” places , but somehow everything in L.A. looks like a stage .
It ’ s the distance—the voyeuristic , out-a-car-window experience .
I feel like even the proliferation of yoga and pilates studios is more hidden in New York .
New York is @ @ @ @ @ @ @ whereas L.A. wears its sex on its sleeve .
To answer your question , I just liked the idea of making a negative title , as that ’ s not supposed to be a good idea .
I know you canvassed for Bernie Sanders earlier this year .
What was that experience like for you—were you recognized ?
—and , while you were knocking on doors , did you learn or hear anything that surprised or moved you ?
Mostly I was in Hispanic neighborhoods .
I only went out a few times @ @ @ @ @ @ @ and barking dogs , but some people who were home and answered were incredibly receptive , and it was more gratifying than phone banking .
A lot of moderate liberals seem to vote more on identity politics than real issues .
For the working-class Hispanics , young people , and working-class blacks , the importance of , say , Medicare for All is a real thing that would make their lives less stressful .
If you lose your job , you lose your health insurance .
That ’ s happening now on a @ @ @ @ @ @ @ to make sure people had the right ballots to vote by mail , since independents have to ask for a Democratic ballot to vote .
It was interesting seeing the different sort of compounds people had in certain neighborhoods in the Valley .
It felt very rustic—almost like another country .

Kim Gordon was born in upstate New York, in 1953, but was raised on the West Side of Los Angeles, where her father taught in the sociology department at U.C.L.A., and her mother worked as a seamstress. She moved to New York City in 1980, with designs on becoming an artist. In 1981, Gordon and the guitarists Lee Ranaldo and Thurston Moore started Sonic Youth, an experimental rock band that inadvertently helped usher in the alternative-boom of the early nineteen-nineties. Gordon was the kind of cool—vaguely aloof, impossibly chic, intimidatingly smart—that made young women like me feel equal parts terrified and enamored. During a time when it was still somewhat anomalous to see women playing in rock bands, and especially in bands as esoteric and adventurous as Sonic Youth, Gordon was a beacon.
She was also an avant-garde polymath. Gordon produced Hole’s début album, “Pretty on the Inside,” co-founded X-girl, a streetwear brand for women (the actress Chloë Sevigny was its official face), formed a series of musical side projects, and eventually began to show her drawings, paintings, and collages in galleries around the world. Around 2011, her marriage to Moore fell apart, and Sonic Youth went on an indefinite hiatus. Four years later, Gordon published “Girl in A Band,” a thoughtful, occasionally scathing memoir that recounts her formative years in Sonic Youth, her relationship with Moore, the birth of her daughter, and the origins of her art practice. She has spent the last several years performing as half of Body/Head, with the experimental musician Bill Nace, and, in 2019, at age sixty-six, she released her first solo album, “No Home Record.”
In April, Gordon and I began a correspondence, and she shared her thoughts on Instagram, Los Angeles, overpriced coffee, and canvassing for Bernie Sanders. This interview has been condensed and edited.
Kim, I’ll start with the obvious question: where have you hunkered down, what is it like there, and how are you coping with the pandemic? Has this experience begun to change the ways you think about or consume art?
I’ve had some mysterious vertigo the last couple days. I hope it’s just stress and not a brain tumor, which is where my mind usually goes. It’s so easy to become instantly paranoid and anxious over every little sniffle or allergy-induced sneeze. I’m on the East Side of Los Angeles, where I live. So I’m close to the hills, which are beautiful to look at, and, up until recently, I could go there for walks. Even though I’m not in New York, I remember the camaraderie that 9/11 inspired, and the way that only New Yorkers can come together. It’s funny the way some liberals are fawning over Andrew Cuomo, but it’s reassuring to see someone take control. He is impressive. But Gavin Newsom is the man!
I try every day to do some sort of exercise—the Ryan Heffington dance sessions on Instagram, the occasional GST Body class on Zoom, the six-minute New York Times workout. I’m lucky that I have a house to live in, I can afford to buy food, and I don’t have to immediately worry about income—even though I don’t have an income right now. Basically everyone I know is out of work and doesn’t qualify for any unemployment, because we’re all freelance musicians, or people who work in the industry. It’s pretty grim for [visual] artists, too. It’s a bit hard to get motivated to make art right now, to work on shows that may not happen. But it’s still a refuge of sorts—just to be able to zone out on something that isn’t about the pandemic. I joined the Criterion Channel, finally, so I feel like I have license to watch amazing movies that I never got to see. I want to keep soaking up humanity in various forms.
Even though it was released last year, your newest album, “No Home Record,” feels so eerily appropriate for this time; I’ve been listening to it constantly. You’ve said the title was based on Chantal Akerman’s final film, “No Home Movie,” which is about life, death, survival, and, to an extent, domesticity. You made “No Home Record” in a period of personal transition—you were in the process of moving back to Los Angeles, your home town, and staying at an Airbnb. This period now, too, feels incredibly liminal—we’re between things, although no one quite knows how to define the parameters yet. Can you talk a little bit about how you came to make and title the record?
I was reading about the concept of home in a book by Trisha Low. She was writing about feeling displaced both emotionally and physically from her original culture, in Singapore. She came to the U.S. for an education, as her father had. But her father returned to Singapore, whereas she now exists in a culture in a country that she is both part of and not part of. She was talking about the Chantal Akerman films “No Home Movie” and “Jeanne Dielman,” but in her diaristic mode of writing.
As I was thinking about how I fit into the L.A. landscape or not, and where my home really was since the breakup of my marriage, I began to look at L.A. as a sort of Dada landscape. A friend of mine who moved here a few years ago has a great response when people ask him how he likes living in L.A. He says he’s collaged into it, which I think is an apt way of putting it. I became more aware of patterns around my neighborhood, like people—millennials—going to the four-dollar coffee places, and seeing the elaborate, ritualistic making of coffee every morning. Things like that exist in New York and other “woke” places, but somehow everything in L.A. looks like a stage. It’s the distance—the voyeuristic, out-a-car-window experience. I feel like even the proliferation of yoga and pilates studios is more hidden in New York. New York is sexy that way, and mysterious, whereas L.A. wears its sex on its sleeve.
To answer your question, I just liked the idea of making a negative title, as that’s not supposed to be a good idea.
I know you canvassed for Bernie Sanders earlier this year. What was that experience like for you—were you recognized?—and, while you were knocking on doors, did you learn or hear anything that surprised or moved you?
Mostly I was in Hispanic neighborhoods. I only went out a few times. There were a lot of gates and barking dogs, but some people who were home and answered were incredibly receptive, and it was more gratifying than phone banking. A lot of moderate liberals seem to vote more on identity politics than real issues. For the working-class Hispanics, young people, and working-class blacks, the importance of, say, Medicare for All is a real thing that would make their lives less stressful. If you lose your job, you lose your health insurance. That’s happening now on a colossal scale. We were mainly trying to make sure people had the right ballots to vote by mail, since independents have to ask for a Democratic ballot to vote. It was interesting seeing the different sort of compounds people had in certain neighborhoods in the Valley. It felt very rustic—almost like another country.
There’s a kind of evergreen conversation about how and when art and politics should intersect, and how effective art can be at enacting cultural change. Ideally, this is a conversation every American—and not just artists—should be having with themselves: what role do I play, if any, in shaping the future of the human race? But I nonetheless wonder: how do you think about the role of the artist in a time of crisis?