theatlantic--2020-06-04--Listen: How Limiting Protests Will Spread the Virus

Wells : So I ’ ve been scrubbing my hands raw for nothing .
Hamblin : No , I wouldn ’ t say that .
I think that the most common form of transmission is prolonged indoor close contact .
So between relatives , family members , cell mates , and people who live in nursing homes .
It is not from randomly touching a subway pole .
Wells : It just means that masks are even more important .
Hamblin : I would say so , yeah .
When you ’ re protesting , outdoor transmission seems to be @ @ @ @ @ @ @ restaurants now , inside churches , at a choir practice that show when groups get together in enclosed spaces indoors , and especially when they are singing and/or presumably yelling or chanting , that ’ s a dangerous scenario .
But it becomes much less dangerous when you ’ re outdoors and you ’ re moving around .
Read : So , what can we do now ?
Wells : There are no studies showing outdoor transmission ?
Hamblin : Not to my knowledge .
If you ’ re out having a picnic @ @ @ @ @ @ @ hour and you ’ re real close to them , absolutely .
You could definitely transmit it to them .
But it is just much , much more safe than being indoors .
The complicating thing I think about protesting too is that the idea is that when people are singing in a choir practice , you ’ re spewing a lot into the air .
And a lot of people doing that simultaneously does increase the amount of respiratory droplets that are going to be floating around .
Wells : Right .
@ @ @ @ @ @ @ reading that epidemiologists are like , Wait two weeks and we ’ re going to see a spike all across the country .
So they must expect that this isn ’ t completely safe .
Hamblin : I think you can do it safely .
I think there ’ s going to be a lot of people who end up making conversation with someone , or getting up in someone ’ s face and having some kind of confrontation , or scenarios like that where there could be an act of transmission .
@ @ @ @ @ @ @ and don ’ t fall into old ways of not social distancing just because you ’ re in this new headspace , then it can be done very safely .
Wells : So basically the key is just keep distance when you can and wear a mask ?
Hamblin : It ’ s complicated like usual , but also [ protesting ] is not inherently what ’ s going to drive spikes in transmission .
Wells : Then why are epidemiologists talking about spikes in two weeks ?
Hamblin : Well , I @ @ @ @ @ @ @ situations .
And it feels like the urgency of this moment is such that everything else is irrelevant .
And I think that ’ s where you start to worry about transmission .
So , without adjudicating that , I would just say that for people who are worried that they can ’ t participate , there are ways to do it safely , and even if you want to be absolutely safe , I think there are ways to be at the periphery and be in supportive roles to people who are @ @ @ @ @ @ @ scenarios get intense and people feel threatened or caught up in a moment of urgency that they lose the sense of ability to protest safely .
And that comes often from the escalation from people who are policing the protests .

Protests responding to the killing of George Floyd have now spread to every state in the country and even internationally.
Public-health experts have warned that the protests will lead to a spike in coronavirus infections, but what role does the policing of the protests play in that dynamic? The staff writer James Hamblin and the executive producer Katherine Wells discuss on the podcast Social Distance:
Listen to the episode here:
Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published.
What follows is an edited and condensed transcript of their conversation.
Katherine Wells: So we’ve actually gotten a question from a listener, Jenn, about the protests. She wrote in and asked, “Could you talk about how safe it is health-wise to take part in the protests?” I mean, we’ve been sort of talking for months about how the most important thing is to stay away from other people. Why don’t we do an overview of what we know about the science of transmission?
James Hamblin: Yeah, at the very beginning [of the pandemic], when we were uncertain of most everything, it seemed that most transmission was happening from surfaces. But it seems to be less of a factor in transmission than previously assumed.
Wells: So I’ve been scrubbing my hands raw for nothing.
Hamblin: No, I wouldn’t say that. I think that the most common form of transmission is prolonged indoor close contact. So between relatives, family members, cell mates, and people who live in nursing homes. It is not from randomly touching a subway pole.
Wells: It just means that masks are even more important.
Hamblin: I would say so, yeah. When you’re protesting, outdoor transmission seems to be extremely limited. There are studies in restaurants now, inside churches, at a choir practice that show when groups get together in enclosed spaces indoors, and especially when they are singing and/or presumably yelling or chanting, that’s a dangerous scenario. But it becomes much less dangerous when you’re outdoors and you’re moving around.
Read: So, what can we do now?
Wells: There are no studies showing outdoor transmission?
Hamblin: Not to my knowledge. If you’re out having a picnic and you sit with someone for an hour and you’re real close to them, absolutely. You could definitely transmit it to them. But it is just much, much more safe than being indoors. The complicating thing I think about protesting too is that the idea is that when people are singing in a choir practice, you’re spewing a lot into the air. And a lot of people doing that simultaneously does increase the amount of respiratory droplets that are going to be floating around.
Wells: Right. I mean, I’ve been reading that epidemiologists are like, Wait two weeks and we’re going to see a spike all across the country. So they must expect that this isn’t completely safe.
Hamblin: I think you can do it safely. I think there’s going to be a lot of people who end up making conversation with someone, or getting up in someone’s face and having some kind of confrontation, or scenarios like that where there could be an act of transmission. If you are careful to avoid that and don’t fall into old ways of not social distancing just because you’re in this new headspace, then it can be done very safely.
Wells: So basically the key is just keep distance when you can and wear a mask?
Hamblin: It’s complicated like usual, but also [protesting] is not inherently what’s going to drive spikes in transmission.
Wells: Then why are epidemiologists talking about spikes in two weeks?
Hamblin: Well, I think these are really emotional and charged situations. And it feels like the urgency of this moment is such that everything else is irrelevant. And I think that’s where you start to worry about transmission. So, without adjudicating that, I would just say that for people who are worried that they can’t participate, there are ways to do it safely, and even if you want to be absolutely safe, I think there are ways to be at the periphery and be in supportive roles to people who are marching. It’s when these scenarios get intense and people feel threatened or caught up in a moment of urgency that they lose the sense of ability to protest safely. And that comes often from the escalation from people who are policing the protests.
Wells: Right. I’ve seen several instances of protesters kind of being boxed in or actually pushed together by police.
Hamblin: Yeah, you saw that on the Brooklyn Bridge and the Manhattan Bridge. That’s an area where the police are actually forcing people into close proximity.
Wells: They’re also arresting people and taking people to jail, which we’ve talked about is a dangerous place for transmission. So you may not be completely in control of your ability to distance.
Hamblin: Yeah, they were loading people on buses. There were a lot of stories of bus drivers refusing. And that’s an interesting dynamic—to have police just sort of trying to commandeer buses to become paddy wagons. But yeah, forcing a bunch of people onto a bus is definitely an unsafe scenario. That’s kind of directly antithetical to everything that has been said before in terms of directives.
Wells: It is a strange time for messaging from the government, isn’t it? I think one of the arguments from protesters might be: What we’re protesting against is also an existential health threat.
Hamblin: Right. And as you see and hear at the protests, it’s largely about police violence, but it’s about inequity of all sorts, including disparities in how COVID-19 has played out, who has gotten tested, who’s gotten hit hardest by the disease, and who has access to care. I think when people have been left to feel really disempowered and disenfranchised and helpless, they become willing to take on more risk.
Wells: So we’ve talked about how anyone participating in the protest might think about safety. Are there things that the government or police forces could do to make these protests safer?
Hamblin: Yeah, it’s similar to my feeling about policing parks, really. The notion that these things should be contained in the small spaces and small periods of time will also create density. Theoretically, the more that you could allow people to be spaced out and to safely protest, the less transmission you would see. Whereas the mutual escalation and earlier curfews and deployment of more and more force to draw stricter boundaries and to arrest more people—that’s the cycle that I’m really worried about.
Wells: It’s hard to understand the rationale here. It’s like all of this stuff we’ve been doing to try to slow the spread is actually being reversed in some way.
Hamblin: Right. What I’m really worried about is that escalation. It requires really deft leadership to be able to de-escalate and to be able to give people a lot of space and time and support to safely protest and not give in to the temptation of whatever posturing it is that says you’re going to crack down and force people into small spaces and arrest them and give them less space and give them less time to be out in the world. And I mean, that seems to be the universal dynamic here: There’s some instance of looting or a police van is burned or something, and the political reaction has to be: We’re going to clamp down real hard. That makes people act out more, but it also drives people more into higher-risk transmission scenarios, either because they’re in jail or because they’re in a very confined protest space or they’re trapped on a bridge or they’re in a bus being held.
Wells: Right. So that’s actually where the transmission is going to happen, not necessarily people walking down a wide avenue.
Hamblin: Yeah. People in D.C. have told me that the grocery stores are suddenly way more crowded because everybody’s trying to get in before 7:00 p.m. in that window between ending work at 5:00 p.m. or 6:00 p.m. and having to make sure you have everything you need by 7:00 p.m and that you’ve gone for your walk or your run and walked the dog. Suddenly things are very crowded.
Wells: So it’s not necessarily the protests themselves that are going to cause the spike, but the reaction to the protests is definitely creating situations where we’re going to see transmission.


theatlantic--2020-06-04--COVID-19 Can Last for Several Months

COVID-19 Can Last for Several Months

For Vonny LeClerc , day one was March 16 .
Hours after British Prime Minister Boris Johnson instated stringent social-distancing measures to halt the SARS-CoV-2 coronavirus , LeClerc , a Glasgow-based journalist , arrived home feeling shivery and flushed .
Over the next few days , she developed a cough , chest pain , aching joints , and a prickling sensation on her skin .
After a week of bed rest , she started improving .
But on day 12 , every old symptom returned , amplified and with reinforcements : She spiked an intermittent fever , lost her sense @ @ @ @ @ @ @ to breathe .
To hear more feature stories , get the Audm iPhone app .
When I spoke with LeClerc on day 66 , she was still experiencing waves of symptoms .
“ Before this , I was a fit , healthy 32-year-old , ” she said .
“ Now I ’ ve been reduced to not being able to stand up in the shower without feeling fatigued .
I ’ ve tried going to the supermarket and I ’ m in bed for days afterwards .
It ’ s like nothing I @ @ @ @ @ @ @ her best efforts , LeClerc has not been able to get a test , but “ every doctor I ’ ve spoken to says there ’ s no shadow of a doubt that this has been COVID , ” she said .
Today is day 80 .
Some have been diagnosed through tests , while others , like LeClerc , have been told by their doctors that they almost certainly have COVID-19 .
Still , many long-haulers have faced disbelief from friends and medical professionals because they don ’ t conform to the @ @ @ @ @ @ @ have questioned how they could possibly be so sick for so long , or whether they ’ re just stressed or anxious .
“ It feels like no one understands , ” said Chloe Kaplan from Washington , D.C. , who works in education and is on day 78 .
“ I don ’ t think people are aware of the middle ground , where it knocks you off your feet for weeks , and you neither die nor have a mild case.
” The notion that most cases are mild and brief @ @ @ @ @ @ @ and elderly need isolate themselves , and that everyone else can get infected and be done with it .
“ It establishes a framework in which ‘ not hiding ’ from the disease looks a manageable and sensible undertaking , ” writes Felicity Callard , a geographer at the University of Glasgow , who is on day 77 .
As the pandemic discourse turns to talk of a second wave , long-haulers who are still grappling with the consequences of the first wave are frustrated .
“ I ’ ve been very concerned @ @ @ @ @ @ @ ’ t taking this seriously because they think you ’ re either asymptomatic or dead , ” said Hannah Davis , an artist from New York City , who is on day 71 .
“ This middle ground has been hellish.
” Read : What will you do if you start coughing ?
It “ has been like nothing else on Earth , ” said Paul Garner , who has previously endured dengue fever and malaria , and is currently on day 77 of COVID-19 .
Garner , an infectious-diseases professor at the @ @ @ @ @ @ @ a renowned organization that reviews scientific evidence on preventing and treating infections .
He tested negative on day 63 .
He had waited to get a COVID-19 test partly to preserve them for health-care workers , and partly because , at one point , he thought he was going to die .
“ I knew I had the disease ; it couldn ’ t have been anything else , ” he told me .
I asked him why he thought his symptoms had persisted .
“ I honestly don ’ t know , @ @ @ @ @ @ @ ’ t understand what ’ s happening in my body.
” On March 17 , a day after LeClerc came down with her first symptoms , SARS-CoV-2 sent Fiona Lowenstein to the hospital .
Nine days later , after she was discharged , she started a Slack support group for people struggling with the disease .
The group , which is affiliated with a wellness organization founded by Lowenstein called Body Politic , has been a haven for long-haulers .
One channel for people whose symptoms have lasted longer than 30 days has @ @ @ @ @ @ @ The protests will spread the coronavirus “ The group was a savior for me , ” said Gina Assaf , a design consultant in Washington , D.C. , who is now on day 77 .
She and other members with expertise in research and survey design have now sampled 640 people from the Body Politic group and beyond .
Their report is neither representative nor peer-reviewed , but it provides a valuable snapshot of the long-hauler experience .
Of those surveyed , about three in five are between the ages of 30 and @ @ @ @ @ @ @ been hospitalized , while another 38 percent have visited the ER but were not admitted .
About a quarter have tested positive for COVID-19 and almost half have never been tested at all .
Some became sick in mid-March , when their home countries were severely short on tests .
( Most survey respondents live in the U.S. and the U.K. ) Others were denied testing because their symptoms didn ’ t match the standard set .
Angela Meriquez Vázquez , a children ’ s activist in Los Angeles , had gastrointestinal problems @ @ @ @ @ @ @ but because she didn ’ t have a cough and her fever hadn ’ t topped 100 degrees Fahrenheit , she didn ’ t meet L.A. ’ s testing criteria .
By the time those criteria were loosened , Vázquez was on day 14 .
She got a test , and it came back negative .
( She is now on day 69 . )
A quarter of respondents in the Body Politic survey have tested negative , but that doesn ’ t mean they don ’ t have COVID-19 .
Diagnostic tests @ @ @ @ @ @ @ percent of the time , and these false negatives become more likely a week after a patient ’ s first symptoms appear .
In the Body Politic survey , respondents with negative test results were tested a week after those with positive ones , on average , but the groups did not differ in their incidence of 60 different symptoms over time .
Those matching patterns strongly suggest that those with negative tests are indeed dealing with the same disease .
They also suggest that the true scope of the pandemic has been @ @ @ @ @ @ @ widespread lack of testing but because many people who are getting tested are receiving false negatives .
Read : Why the coronavirus is so confusing COVID-19 affects many different organs—that much is now clear .
But in March , when many long-haulers were first falling sick with gut , heart , and brain problems , the disease was still regarded as a mainly respiratory one .
To date , the only neurological symptom that the Centers for Disease Control and Prevention lists in its COVID-19 description is a loss of taste or smell @ @ @ @ @ @ @ among the long-haulers who answered the Body Politic survey .
As many people reported “ brain fogs ” and concentration challenges as coughs or fevers .
Some have experienced hallucinations , delirium , short-term memory loss , or strange vibrating sensations when they touch surfaces .
Others are likely having problems with their sympathetic nervous system , which controls unconscious processes like heartbeats and breathing : They ’ ll be out of breath even when their oxygen level is normal , or experience what feel like heart attacks even though EKG readings and @ @ @ @ @ @ @ wax , wane , and warp over time .
“ It really is a grab bag , ” said Davis , who is a co-author of the Body Politic survey .
“ Every day you wake up and you might have a different symptom.
” It ’ s not clear why this happens .
Akiko Iwasaki , an immunologist at Yale , offers three possibilities .
Long-haulers might still harbor infectious virus in some reservoir organ , which is missed by tests that use nasal swabs .
Or persistent fragments of viral genes @ @ @ @ @ @ @ be triggering a violent immune overreaction , as if “ you ’ re reacting to a ghost of a virus , ” Iwasaki says .
More likely , the virus is gone but the immune system , having been provoked by it , is stuck in a lingering overactive state .
It ’ s hard to distinguish between these hypotheses , because SARS-CoV-2 is new and because the aftermath of viral infections is poorly understood .
Many diseases cause long-lasting symptoms , but these might go unnoticed as trends unless epidemics are especially @ @ @ @ @ @ @ with Ebola has some long-term chronic complication , from subtle to obviously debilitating , ” says Craig Spencer of the Columbia University Medical Center , who caught the virus himself in 2014 .
Some of those persistent problems had been noted during early Ebola outbreaks , but weren ’ t widely appreciated until 28,600 people were infected in West Africa from 2013 to 2016 .
The sheer scale of the COVID-19 pandemic , which reached more than 6 million confirmed cases worldwide in a matter of months , means that long-haulers are now @ @ @ @ @ @ @ shape their own narrative .
As the pandemic continues , long-haulers are navigating a landscape of uncertainty and fear with a map whose landmarks don ’ t reflect their surroundings .
If your symptoms last for longer than two weeks , for how long should you expect to be sick ?
If they differ from the official list , how do you know which ones are important ?
“ I ’ m acutely aware of my body at all times of the day , ” LeClerc told me .
“ It shrinks your @ @ @ @ @ @ @ to your surroundings.
” If you ’ re still symptomatic , could you conceivably infect someone else if you leave your home ?
Garner , the infectious-disease expert , is confident that this far out , he ’ s not shedding live virus anymore .
But Meg Hamilton , who is a nursing student in Odenton , Maryland—and , full disclosure , my sister-in-law—said that her local health department considered her to be contagious as long as she had a fever ; she is on day 56 , and has only had a @ @ @ @ @ @ @ that she and her partner , who live in different apartments , talked through the risks and decided to reunite on day 59 .
Until then , she had been dealing with two months of COVID-19 alone .
The isolation of the pandemic has been hard enough for many healthy people .
But it has exacerbated the foggy minds , intense fatigue , and perpetual fear of erratic symptoms that long-haulers are also dealing with .
“ It plays with your head , man , ” Garner said .
Some feel guilt over @ @ @ @ @ @ @ “ mild.
” Some start doubting or blaming themselves .
In her fourth week of fever , Hamilton began obsessively worrying that she had been using her thermometer incorrectly .
“ I also felt like I wasn ’ t being mentally strong enough , and by allowing myself to say that I don ’ t feel good , I was prolonging the fever , ” she said .
Then there ’ s the matter of who to tell—and when .
At first , Hamilton kept the news from her parents .
She didn @ @ @ @ @ @ @ and she assumed she ’ d be better in two weeks .
But as two weeks became three , then four , then five , the omission started feeling like an outright lie .
Her concern that they would be worried morphed into concern that they would be mad .
( She finally told them last week ; they took it well . )
Other long-haulers have been frustrated by their friends ’ and families ’ inability to process a prolonged illness .
“ People know how to react to you having it @ @ @ @ @ @ @ LeClerc said .
But when symptoms are rolling instead of abating , “ people don ’ t have a response they can reach for.
” They ask if she ’ s improving , in expectation that the answer is yes .
When the answer is instead a list of ever-changing symptoms , they stop asking .
Others pivot to disbelief .
“ I ’ ve had messages saying this is all in your head , or it ’ s anxiety , ” LeClerc said .
Read : Friends are breaking up over social @ @ @ @ @ @ @ and nurses .
Davis described her memory loss and brain fog to a neurologist , who told her she had ADHD .
“ You feel really scared : These are people you ’ re trying to get serious help from , and they don ’ t even understand your reality , ” she said .
Vázquez said her physicians repeatedly told her she was just having panic attacks—but she knows herself well enough to discount that .
“ My anxiety is thought-based , ” but with COVID-19 , “ the physical symptoms happen @ @ @ @ @ @ @ Akrami , a neuroscience professor at University College London , said two doctors suggested that she was stressed , while a fellow neuroscientist told her to calm down and take antidepressants .
“ I ’ m a very calm person , and something is wrong in my body , ” said Akrami , who is now on day 79 , and is also a co-author on the Body Politic survey .
“ As a scientist , I understand there are so many unknowns about the virus , but as a patient , I @ @ @ @ @ @ @ said , “ is like being in a tunnel.
” To be sure , many health-care workers are also exhausted , having spent several months fighting a new disease that they barely understand , without enough masks and other protective supplies .
But well before the pandemic , the health-care profession had a long history of medical gaslighting—downplaying a patient ’ s physical suffering as being all in their head , or caused by stress or anxiety .
Such dismissals particularly affect women , who are “ less likely to be perceived as @ @ @ @ @ @ @ ” said LeClerc .
And they ’ re especially common when women have subjective symptoms like pain or fatigue , as most long-haulers do .
When Garner wrote about those same symptoms for the British Medical Journal ’ s blog , “ I had an unbelievable feeling of relief , ” Callard , the geographer , told me .
“ Since he ’ s a guy and a professor of infectious disease , he has the kind of epistemic authority that will be harder to discount.
” Read : The doctor doesn ’ @ @ @ @ @ @ @ media is starting to .
Garner ’ s descriptions of his illness are similar to those of many long-haulers who have been taken less seriously .
“ It wasn ’ t like he wrote those posts in some arcane language that ’ s steeped in authority , ” said Sarah Ramey , a musician and author in Washington , D.C. “ If you took his words , put my name on them , and put them up on Medium , people would say , ‘ Ugh , who is this person and what @ @ @ @ @ @ @ Ramey can empathize with long-haulers .
In her memoir , The Lady ’ s Handbook for Her Mysterious Illness , she writes about her 17-year ordeal of excruciating pain , crushing fatigue , gastro-catastrophes , and medical gaslighting .
“ Being isolated and homebound , incredible economic insecurity , the government not doing enough , testing not being up to snuff—all of that is the lived experience of someone like me for decades , ” she says .
“ The illness itself is horrible and ravaging , but being told you ’ ve @ @ @ @ @ @ @ again , is by far the worst of it.
” Formally , Ramey has myalgic encephalomyelitis/chronic fatigue syndrome ( ME/CFS ) and complex regional pain syndrome .
Informally , she ’ s part of a group she has dubbed WOMIs—women with mysterious illnesses .
Such conditions include ME/CFS , fibromyalgia , and postural orthostatic tachycardia syndrome .
They disproportionately affect women ; have unclear causes , complex but debilitating symptoms , and no treatments ; and are hard to diagnose and easy to dismiss .
According to the Institute of Medicine , 836,000 @ @ @ @ @ @ @ alone have ME/CFS .
Between 84 and 91 percent are undiagnosed .
That clusters of ME/CFS have followed many infectious outbreaks is noteworthy .
In such events , some people get better quickly , others are sick for longer with postviral fatigue , and still others are suffering months or years later .
In one Australian study , 11 percent of people infected with Ross River virus , Epstein-Barr virus , or the bacterium behind Q fever were diagnosed with ME/CFS after six months .
In a study of 233 Hong Kong residents @ @ @ @ @ @ @ , about 40 percent had chronic-fatigue problems after three years or so , and 27 percent met the CDC ’ s criteria for ME/CFS .
Many different acute pathogens seem to trigger the same inflammatory responses that culminate in the same chronic endgame .
Many individuals in this community are worried about COVID-19 , according to Ramey : “ You ’ ve got this highly infectious virus sweeping around the world , and it would be unusual if you didn ’ t see a big uptick in ME/CFS cases.
” ME/CFS is typically @ @ @ @ @ @ @ or more , and the new coronavirus has barely been infecting humans for that long .
Still , many of the long-haulers ’ symptoms “ sound exactly like those that patients in our community experience , ” says Jennifer Brea , the executive director of the advocacy group # MEAction .
LeClerc , Akrami , and others have noted that their symptoms reappear when they try to regain a measure of agency by cleaning , working out , or even doing yoga .
This is post-exertional malaise—the defining feature of ME/CFS .
It @ @ @ @ @ @ @ follows activity as light as a short walk .
It ’ s also distinct from mere exhaustion : You can ’ t just push through it , and you ’ ll feel much worse if you try .
The ME/CFS community has learned that resting as much as possible in the early months of postviral fatigue is crucial .
Garner learned that lesson the hard way .
After writing that “ my disease has lifted , ” he did a high-intensity workout , and was bedridden for three days .
He is now @ @ @ @ @ @ @ his sister , who has had the disease .
“ We have much to learn from that community , ” he says .
The symptoms of ME/CFS have long been trivialized ; its patients disbelieved ; its researchers underfunded .
The condition is especially underdiagnosed among black and brown communities , who are also disproportionately likely to be infected and killed by COVID-19 .
If the pandemic creates a large population of people who have symptoms that are similar to those of ME/CFS , it might trigger research into this and other overlooked @ @ @ @ @ @ @ already planning studies of COVID-19 patients to see if any become ME/CFS patients—and why .
Brea says she would welcome such a development .
But she also feels “ a lot of grief for people who may have to walk that path , [ and ] grief for the time we could have spent over the last four decades researching this so we ’ d have a better understanding of how to treat patients now.
” Some long-haulers will get better .
The Body Politic Slack support group has a victories channel , @ @ @ @ @ @ @ the road to recovery .
Such stories were scarce last month , but more have appeared in the past weeks .
The celebrations are always tentative , though .
Good days are intermingled with terrible ones .
“ It ’ s a reverse-circling of the drain , ” Vázquez said .
“ It has gotten better , but I track that trajectory in weeks , not days.
” The COVID-19 dashboard from Johns Hopkins shows that about 2.7 million people around the world have “ recovered ” from the disease .
But recovery @ @ @ @ @ @ @ a switch .
For some , it will take more time than the entire duration of the pandemic thus far .
Some survivors will have scar tissue from the coronavirus ’ s assault on their lungs .
Some will still be weak after lengthy stays in ICUs or on ventilators .
Some will eventually be diagnosed with ME/CFS .
Whatever the case , as the pandemic progresses , the number of people with medium-to-long-term disabilities will increase .
“ Some science fiction—and more than a few tech bros—have led us to believe in @ @ @ @ @ @ @ Shew of Virginia Tech , who studies the intersection between technology and disability .
“ But whether through environmental catastrophe , or new viruses , we can expect more , exacerbated , and new disabilities.
” In the early 1950s , polio permanently disabled tens of thousands of people in the U.S. every year , most of whom were children or teenagers who “ saw their futures as able and healthy , ” Shew says .
In the ’ 60s and ’ 70s , those survivors became pioneers of the disability-rights movement in @ @ @ @ @ @ @ an even larger survivor cohort .
Perhaps , collectively , they can push for a better understanding of neglected chronic diseases , and an acceptance of truths that the existing disability community have long known .
That health and sickness are not binary .
That medicine is as much about listening to patients ’ subjective experiences as it is about analyzing their organs .
That being a survivor is something you must also survive .

For Vonny LeClerc, day one was March 16.
Hours after British Prime Minister Boris Johnson instated stringent social-distancing measures to halt the SARS-CoV-2 coronavirus, LeClerc, a Glasgow-based journalist, arrived home feeling shivery and flushed. Over the next few days, she developed a cough, chest pain, aching joints, and a prickling sensation on her skin. After a week of bed rest, she started improving. But on day 12, every old symptom returned, amplified and with reinforcements: She spiked an intermittent fever, lost her sense of taste and smell, and struggled to breathe.
To hear more feature stories, get the Audm iPhone app.
When I spoke with LeClerc on day 66, she was still experiencing waves of symptoms. “Before this, I was a fit, healthy 32-year-old,” she said. “Now I’ve been reduced to not being able to stand up in the shower without feeling fatigued. I’ve tried going to the supermarket and I’m in bed for days afterwards. It’s like nothing I’ve ever experienced before.” Despite her best efforts, LeClerc has not been able to get a test, but “every doctor I’ve spoken to says there’s no shadow of a doubt that this has been COVID,” she said. Today is day 80.
COVID-19 has existed for less than six months, and it is easy to forget how little we know about it. The standard view is that a minority of infected people, who are typically elderly or have preexisting health problems, end up in critical care, requiring oxygen or a ventilator. About 80 percent of infections, according to the World Health Organization, “are mild or asymptomatic,” and patients recover after two weeks, on average. Yet support groups on Slack and Facebook host thousands of people like LeClerc, who say they have been wrestling with serious COVID-19 symptoms for at least a month, if not two or three. Some call themselves “long-termers” or “long-haulers.”
Read: Why some people get sicker than others
I interviewed nine of them for this story, all of whom share commonalities. Most have never been admitted to an ICU or gone on a ventilator, so their cases technically count as “mild.” But their lives have nonetheless been flattened by relentless and rolling waves of symptoms that make it hard to concentrate, exercise, or perform simple physical tasks. Most are young. Most were previously fit and healthy. “It is mild relative to dying in a hospital, but this virus has ruined my life,” LeClerc said. “Even reading a book is challenging and exhausting. What small joys other people are experiencing in lockdown—yoga, bread baking—are beyond the realms of possibility for me.”
Even though the world is consumed by concern over COVID-19, the long-haulers have been largely left out of the narrative and excluded from the figures that define the pandemic. I can pull up an online dashboard that reveals the numbers of confirmed cases, hospitalizations, deaths, and recoveries—but LeClerc falls into none of those categories. She and others are trapped in a statistical limbo, uncounted and thus overlooked.
Some have been diagnosed through tests, while others, like LeClerc, have been told by their doctors that they almost certainly have COVID-19. Still, many long-haulers have faced disbelief from friends and medical professionals because they don’t conform to the typical profile of the disease. People have questioned how they could possibly be so sick for so long, or whether they’re just stressed or anxious. “It feels like no one understands,” said Chloe Kaplan from Washington, D.C., who works in education and is on day 78. “I don’t think people are aware of the middle ground, where it knocks you off your feet for weeks, and you neither die nor have a mild case.”
The notion that most cases are mild and brief bolsters the belief that only the sick and elderly need isolate themselves, and that everyone else can get infected and be done with it. “It establishes a framework in which ‘not hiding’ from the disease looks a manageable and sensible undertaking,” writes Felicity Callard, a geographer at the University of Glasgow, who is on day 77. As the pandemic discourse turns to talk of a second wave, long-haulers who are still grappling with the consequences of the first wave are frustrated. “I’ve been very concerned by friends and family who just aren’t taking this seriously because they think you’re either asymptomatic or dead,” said Hannah Davis, an artist from New York City, who is on day 71. “This middle ground has been hellish.”
Read: What will you do if you start coughing?
It “has been like nothing else on Earth,” said Paul Garner, who has previously endured dengue fever and malaria, and is currently on day 77 of COVID-19. Garner, an infectious-diseases professor at the Liverpool School of Tropical Medicine, leads a renowned organization that reviews scientific evidence on preventing and treating infections. He tested negative on day 63. He had waited to get a COVID-19 test partly to preserve them for health-care workers, and partly because, at one point, he thought he was going to die. “I knew I had the disease; it couldn’t have been anything else,” he told me. I asked him why he thought his symptoms had persisted. “I honestly don’t know,” he said. “I don’t understand what’s happening in my body.”
On March 17, a day after LeClerc came down with her first symptoms, SARS-CoV-2 sent Fiona Lowenstein to the hospital. Nine days later, after she was discharged, she started a Slack support group for people struggling with the disease. The group, which is affiliated with a wellness organization founded by Lowenstein called Body Politic, has been a haven for long-haulers. One channel for people whose symptoms have lasted longer than 30 days has more than 3,700 members.
Read: The protests will spread the coronavirus
“The group was a savior for me,” said Gina Assaf, a design consultant in Washington, D.C., who is now on day 77. She and other members with expertise in research and survey design have now sampled 640 people from the Body Politic group and beyond. Their report is neither representative nor peer-reviewed, but it provides a valuable snapshot of the long-hauler experience.
Of those surveyed, about three in five are between the ages of 30 and 49. About 56 percent have not been hospitalized, while another 38 percent have visited the ER but were not admitted. About a quarter have tested positive for COVID-19 and almost half have never been tested at all. Some became sick in mid-March, when their home countries were severely short on tests. (Most survey respondents live in the U.S. and the U.K.) Others were denied testing because their symptoms didn’t match the standard set. Angela Meriquez Vázquez, a children’s activist in Los Angeles, had gastrointestinal problems and lost her sense of smell, but because she didn’t have a cough and her fever hadn’t topped 100 degrees Fahrenheit, she didn’t meet L.A.’s testing criteria. By the time those criteria were loosened, Vázquez was on day 14. She got a test, and it came back negative. (She is now on day 69.)
A quarter of respondents in the Body Politic survey have tested negative, but that doesn’t mean they don’t have COVID-19. Diagnostic tests for SARS-CoV-2 miss infections up to 30 percent of the time, and these false negatives become more likely a week after a patient’s first symptoms appear. In the Body Politic survey, respondents with negative test results were tested a week after those with positive ones, on average, but the groups did not differ in their incidence of 60 different symptoms over time. Those matching patterns strongly suggest that those with negative tests are indeed dealing with the same disease. They also suggest that the true scope of the pandemic has been underestimated, not just because of the widespread lack of testing but because many people who are getting tested are receiving false negatives.
Read: Why the coronavirus is so confusing
COVID-19 affects many different organs—that much is now clear. But in March, when many long-haulers were first falling sick with gut, heart, and brain problems, the disease was still regarded as a mainly respiratory one. To date, the only neurological symptom that the Centers for Disease Control and Prevention lists in its COVID-19 description is a loss of taste or smell. But other neurological symptoms are common among the long-haulers who answered the Body Politic survey.
As many people reported “brain fogs” and concentration challenges as coughs or fevers. Some have experienced hallucinations, delirium, short-term memory loss, or strange vibrating sensations when they touch surfaces. Others are likely having problems with their sympathetic nervous system, which controls unconscious processes like heartbeats and breathing: They’ll be out of breath even when their oxygen level is normal, or experience what feel like heart attacks even though EKG readings and chest X-rays are clear. These symptoms wax, wane, and warp over time. “It really is a grab bag,” said Davis, who is a co-author of the Body Politic survey. “Every day you wake up and you might have a different symptom.”
It’s not clear why this happens. Akiko Iwasaki, an immunologist at Yale, offers three possibilities. Long-haulers might still harbor infectious virus in some reservoir organ, which is missed by tests that use nasal swabs. Or persistent fragments of viral genes, though not infectious, may still be triggering a violent immune overreaction, as if “you’re reacting to a ghost of a virus,” Iwasaki says. More likely, the virus is gone but the immune system, having been provoked by it, is stuck in a lingering overactive state.
It’s hard to distinguish between these hypotheses, because SARS-CoV-2 is new and because the aftermath of viral infections is poorly understood. Many diseases cause long-lasting symptoms, but these might go unnoticed as trends unless epidemics are especially large. “Nearly every single person with Ebola has some long-term chronic complication, from subtle to obviously debilitating,” says Craig Spencer of the Columbia University Medical Center, who caught the virus himself in 2014. Some of those persistent problems had been noted during early Ebola outbreaks, but weren’t widely appreciated until 28,600 people were infected in West Africa from 2013 to 2016.
Read: A hidden COVID-19 risk factor: your boss
The sheer scale of the COVID-19 pandemic, which reached more than 6 million confirmed cases worldwide in a matter of months, means that long-haulers are now finding one another in sufficient numbers to shape their own narrative.
As the pandemic continues, long-haulers are navigating a landscape of uncertainty and fear with a map whose landmarks don’t reflect their surroundings. If your symptoms last for longer than two weeks, for how long should you expect to be sick? If they differ from the official list, how do you know which ones are important? “I’m acutely aware of my body at all times of the day,” LeClerc told me. “It shrinks your entire world to an almost reptilian response to your surroundings.”
If you’re still symptomatic, could you conceivably infect someone else if you leave your home? Garner, the infectious-disease expert, is confident that this far out, he’s not shedding live virus anymore. But Meg Hamilton, who is a nursing student in Odenton, Maryland—and, full disclosure, my sister-in-law—said that her local health department considered her to be contagious as long as she had a fever; she is on day 56, and has only had a few normal temperature readings. Davis said that she and her partner, who live in different apartments, talked through the risks and decided to reunite on day 59. Until then, she had been dealing with two months of COVID-19 alone.
The isolation of the pandemic has been hard enough for many healthy people. But it has exacerbated the foggy minds, intense fatigue, and perpetual fear of erratic symptoms that long-haulers are also dealing with. “It plays with your head, man,” Garner said. Some feel guilt over being incapacitated even though their cases are “mild.” Some start doubting or blaming themselves. In her fourth week of fever, Hamilton began obsessively worrying that she had been using her thermometer incorrectly. “I also felt like I wasn’t being mentally strong enough, and by allowing myself to say that I don’t feel good, I was prolonging the fever,” she said.
Then there’s the matter of who to tell—and when. At first, Hamilton kept the news from her parents. She didn’t want them to worry, and she assumed she’d be better in two weeks. But as two weeks became three, then four, then five, the omission started feeling like an outright lie. Her concern that they would be worried morphed into concern that they would be mad. (She finally told them last week; they took it well.)
Other long-haulers have been frustrated by their friends’ and families’ inability to process a prolonged illness. “People know how to react to you having it or to you getting better,” LeClerc said. But when symptoms are rolling instead of abating, “people don’t have a response they can reach for.” They ask if she’s improving, in expectation that the answer is yes. When the answer is instead a list of ever-changing symptoms, they stop asking. Others pivot to disbelief. “I’ve had messages saying this is all in your head, or it’s anxiety,” LeClerc said.
Read: Friends are breaking up over social distancing
Many such messages come from doctors and nurses. Davis described her memory loss and brain fog to a neurologist, who told her she had ADHD. “You feel really scared: These are people you’re trying to get serious help from, and they don’t even understand your reality,” she said. Vázquez said her physicians repeatedly told her she was just having panic attacks—but she knows herself well enough to discount that. “My anxiety is thought-based,” but with COVID-19, “the physical symptoms happen first,” she said.
Athena Akrami, a neuroscience professor at University College London, said two doctors suggested that she was stressed, while a fellow neuroscientist told her to calm down and take antidepressants. “I’m a very calm person, and something is wrong in my body,” said Akrami, who is now on day 79, and is also a co-author on the Body Politic survey. “As a scientist, I understand there are so many unknowns about the virus, but as a patient, I need acknowledgment.” Every day, Akrami said, “is like being in a tunnel.”
To be sure, many health-care workers are also exhausted, having spent several months fighting a new disease that they barely understand, without enough masks and other protective supplies. But well before the pandemic, the health-care profession had a long history of medical gaslighting—downplaying a patient’s physical suffering as being all in their head, or caused by stress or anxiety. Such dismissals particularly affect women, who are “less likely to be perceived as credible witnesses to our own experiences,” said LeClerc. And they’re especially common when women have subjective symptoms like pain or fatigue, as most long-haulers do. When Garner wrote about those same symptoms for the British Medical Journal’s blog, “I had an unbelievable feeling of relief,” Callard, the geographer, told me. “Since he’s a guy and a professor of infectious disease, he has the kind of epistemic authority that will be harder to discount.”
Read: The doctor doesn’t listen to her. But the media is starting to.
Garner’s descriptions of his illness are similar to those of many long-haulers who have been taken less seriously. “It wasn’t like he wrote those posts in some arcane language that’s steeped in authority,” said Sarah Ramey, a musician and author in Washington, D.C. “If you took his words, put my name on them, and put them up on Medium, people would say, ‘Ugh, who is this person and what is she talking about?’”
Ramey can empathize with long-haulers. In her memoir, The Lady’s Handbook for Her Mysterious Illness, she writes about her 17-year ordeal of excruciating pain, crushing fatigue, gastro-catastrophes, and medical gaslighting. “Being isolated and homebound, incredible economic insecurity, the government not doing enough, testing not being up to snuff—all of that is the lived experience of someone like me for decades,” she says. “The illness itself is horrible and ravaging, but being told you’ve made it up, over and over again, is by far the worst of it.”
Formally, Ramey has myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and complex regional pain syndrome. Informally, she’s part of a group she has dubbed WOMIs—women with mysterious illnesses. Such conditions include ME/CFS, fibromyalgia, and postural orthostatic tachycardia syndrome. They disproportionately affect women; have unclear causes, complex but debilitating symptoms, and no treatments; and are hard to diagnose and easy to dismiss. According to the Institute of Medicine, 836,000 to 2.5 million people in the U.S. alone have ME/CFS. Between 84 and 91 percent are undiagnosed.
That clusters of ME/CFS have followed many infectious outbreaks is noteworthy. In such events, some people get better quickly, others are sick for longer with postviral fatigue, and still others are suffering months or years later. In one Australian study, 11 percent of people infected with Ross River virus, Epstein-Barr virus, or the bacterium behind Q fever were diagnosed with ME/CFS after six months. In a study of 233 Hong Kong residents who survived the SARS epidemic of 2003, about 40 percent had chronic-fatigue problems after three years or so, and 27 percent met the CDC’s criteria for ME/CFS. Many different acute pathogens seem to trigger the same inflammatory responses that culminate in the same chronic endgame. Many individuals in this community are worried about COVID-19, according to Ramey: “You’ve got this highly infectious virus sweeping around the world, and it would be unusual if you didn’t see a big uptick in ME/CFS cases.”
Read: The zombie diseases of climate change
ME/CFS is typically diagnosed when symptoms persist for six months or more, and the new coronavirus has barely been infecting humans for that long. Still, many of the long-haulers’ symptoms “sound exactly like those that patients in our community experience,” says Jennifer Brea, the executive director of the advocacy group #MEAction.
LeClerc, Akrami, and others have noted that their symptoms reappear when they try to regain a measure of agency by cleaning, working out, or even doing yoga. This is post-exertional malaise—the defining feature of ME/CFS. It’s a severe multi-organ crash that follows activity as light as a short walk. It’s also distinct from mere exhaustion: You can’t just push through it, and you’ll feel much worse if you try. The ME/CFS community has learned that resting as much as possible in the early months of postviral fatigue is crucial. Garner learned that lesson the hard way. After writing that “my disease has lifted,” he did a high-intensity workout, and was bedridden for three days. He is now reading literature about ME/CFS and listening to his sister, who has had the disease. “We have much to learn from that community,” he says.
The symptoms of ME/CFS have long been trivialized; its patients disbelieved; its researchers underfunded. The condition is especially underdiagnosed among black and brown communities, who are also disproportionately likely to be infected and killed by COVID-19. If the pandemic creates a large population of people who have symptoms that are similar to those of ME/CFS, it might trigger research into this and other overlooked diseases. Several teams of scientists are already planning studies of COVID-19 patients to see if any become ME/CFS patients—and why. Brea says she would welcome such a development. But she also feels “a lot of grief for people who may have to walk that path, [and] grief for the time we could have spent over the last four decades researching this so we’d have a better understanding of how to treat patients now.”
Graeme Wood: What’s behind the COVID-19 racial disparity?
Some long-haulers will get better. The Body Politic Slack support group has a victories channel, where people post about promising moments on the road to recovery. Such stories were scarce last month, but more have appeared in the past weeks. The celebrations are always tentative, though. Good days are intermingled with terrible ones. “It’s a reverse-circling of the drain,” Vázquez said. “It has gotten better, but I track that trajectory in weeks, not days.” The COVID-19 dashboard from Johns Hopkins shows that about 2.7 million people around the world have “recovered” from the disease. But recovery is not a simple matter of flipping a switch. For some, it will take more time than the entire duration of the pandemic thus far.
Some survivors will have scar tissue from the coronavirus’s assault on their lungs. Some will still be weak after lengthy stays in ICUs or on ventilators. Some will eventually be diagnosed with ME/CFS. Whatever the case, as the pandemic progresses, the number of people with medium-to-long-term disabilities will increase. “Some science fiction—and more than a few tech bros—have led us to believe in a nondisabled future,” says Ashley Shew of Virginia Tech, who studies the intersection between technology and disability. “But whether through environmental catastrophe, or new viruses, we can expect more, exacerbated, and new disabilities.”
In the early 1950s, polio permanently disabled tens of thousands of people in the U.S. every year, most of whom were children or teenagers who “saw their futures as able and healthy,” Shew says. In the ’60s and ’70s, those survivors became pioneers of the disability-rights movement in the U.S.
Perhaps COVID-19 will similarly galvanize an even larger survivor cohort. Perhaps, collectively, they can push for a better understanding of neglected chronic diseases, and an acceptance of truths that the existing disability community have long known. That health and sickness are not binary. That medicine is as much about listening to patients’ subjective experiences as it is about analyzing their organs. That being a survivor is something you must also survive.


theatlantic--2020-06-04--I Can’t Breathe: Braving Tear Gas in a Pandemic

Now some of the millions of people who turned out in the streets to protest the killing of black people by the police with apparent impunity are being suffocated , momentarily , by clouds of gas .
Many are protected by little more than cloth masks because , in a pandemic , how do you get respirators ?
If doctors can not find them , millions of protesters aren ’ t going to be able to procure them .
The response to being teargassed follows a typical pattern : shock , outrage , gear up .
In the summer of @ @ @ @ @ @ @ beginning of its latest protest wave , when tear gas landed near the crowds , there would often be panic and screaming ( a bad way to gulp air ! )
and confused running ( which can be dangerous by itself ) .
Only a few months later , Hong Kong ’ s frontline protesters showed up clad in standard-issue global protester gear : respirators , helmets , and long sleeves .
They also learned the trick beloved by many movements : using heat-resistant gloves to toss canisters back at the police or @ @ @ @ @ @ @ they swatted the canisters back at the police with badminton rackets .
When the police charged to arrest them , they ran so that they could fight another day , but they almost never ran from the gas .
Extreme soccer fans , used to having rowdy interactions with the police , have also learned to acclimate to the gas and gear up .
These fans can become frontline fighters of protest movements , as the so-called ultras ( devoted soccer fans ) did during the Arab Spring , or as the left-leaning @ @ @ @ @ @ @ in Gezi Park protests in 2013 .
In one remarkable video from those protests , Çarşı soccer fans in their home neighborhood of Beşiktaş , Istanbul , can be seen chanting defiantly in the middle of gas so thick that the police aren ’ t visible , although it ’ s possible to make out the protesters ’ middle fingers .
In a non-pandemic world , tear gas will disperse marchers for a week or two while they gear up , but it will shock and anger them for years , something I @ @ @ @ @ @ @ global fraternity of the teargassed—such a common experience that I titled my book on 21st-century social movements Twitter and Tear Gas .
The indignation and rage that follow the experience can propel people from being casual participants to lifelong activists .
For many people , tear gas is their first interaction with state violence .
It ’ s the first time they ’ ve been treated like an insect , usually by police geared up like robocops .
That warlike stance is a strong escalatory agent in a protest .
It ’ s @ @ @ @ @ @ @ will fuel escalation .
This is confirmed by decades of research : Combative and belligerent police action is often pivotal to starting and escalating a cycle of violence .
After decades of research , I ’ ve personally concluded that perhaps the single most effective police action for crowd control would be for the police to show up dressed like humans , not terminators .
But crowd control is often not the point of state violence .
Its goal is usually to put people in their place , to “ dominate , ” @ @ @ @ @ @ @ Viewed through that lens , it ’ s no wonder that tear gas is a tool of choice .
Tear gas will enrage , but not deter .
It will hurt and maim , but not de-escalate .

The first time I was teargassed, in Istanbul, Turkey, I thought I was going to die. Overwhelming pain flooded my eyes, nose, throat, and lungs. I couldn’t breathe. The most recent time I was teargassed, in November in Hong Kong, I paused to assess the situation, and nonchalantly reached for my mask in my backpack.
I had ducked into a building in the middle of Hong Kong’s swirling protests and had walked out, unexpectedly, into a cloud of tear gas. I wasn’t calm because I had somehow mutated to become resistant to tear gas. But like every protester in sustained political movements, I had been through the experience enough times to know what to expect. I knew about the first moment of existential horror, the shock of losing one’s breath, and the deep indignation of being gassed like an insect. I knew how to acclimate, adjust, and gear up. If you’re teargassed repeatedly, as I have been as an academic researching protest movements, you learn how to hold your breath and close your eyes. You learn how to avoid gulping a huge amount of wretched air in sheer panic, and how to quickly move toward an area with less concentrated gas. Most important, you learn to acquire a full-face respirator that keeps the gas out.
Being teargassed during a pandemic, as so many have been this past week in the United States, is a different experience. Tear gas is a major irritant to one’s throat, nose, and lungs, the very places the coronavirus attaches to in order to start its silent invasion. The U.S. Army found that recruits who were exposed to tear gas—to ensure that their first shocking experience with the weapon was in a controlled environment—had more respiratory illnesses in the following days. A study from Turkey similarly found chronic respiratory problems, persisting for years, among activists, journalists, and students frequently exposed to tear gas. Many reported ongoing dyspnea—the medical term for “I can’t breathe.”
Now some of the millions of people who turned out in the streets to protest the killing of black people by the police with apparent impunity are being suffocated, momentarily, by clouds of gas. Many are protected by little more than cloth masks because, in a pandemic, how do you get respirators? If doctors cannot find them, millions of protesters aren’t going to be able to procure them.
The response to being teargassed follows a typical pattern: shock, outrage, gear up. In the summer of 2019 in Hong Kong, at the beginning of its latest protest wave, when tear gas landed near the crowds, there would often be panic and screaming (a bad way to gulp air!) and confused running (which can be dangerous by itself). Only a few months later, Hong Kong’s frontline protesters showed up clad in standard-issue global protester gear: respirators, helmets, and long sleeves. They also learned the trick beloved by many movements: using heat-resistant gloves to toss canisters back at the police or to dunk them in water. Sometimes they swatted the canisters back at the police with badminton rackets. When the police charged to arrest them, they ran so that they could fight another day, but they almost never ran from the gas.
Extreme soccer fans, used to having rowdy interactions with the police, have also learned to acclimate to the gas and gear up. These fans can become frontline fighters of protest movements, as the so-called ultras (devoted soccer fans) did during the Arab Spring, or as the left-leaning “Çarşı/Beşiktaş soccer club” fans did in Gezi Park protests in 2013. In one remarkable video from those protests, Çarşı soccer fans in their home neighborhood of Beşiktaş, Istanbul, can be seen chanting defiantly in the middle of gas so thick that the police aren’t visible, although it’s possible to make out the protesters’ middle fingers.
In a non-pandemic world, tear gas will disperse marchers for a week or two while they gear up, but it will shock and anger them for years, something I heard from many protesters among the growing global fraternity of the teargassed—such a common experience that I titled my book on 21st-century social movements Twitter and Tear Gas. The indignation and rage that follow the experience can propel people from being casual participants to lifelong activists.
For many people, tear gas is their first interaction with state violence. It’s the first time they’ve been treated like an insect, usually by police geared up like robocops. That warlike stance is a strong escalatory agent in a protest. It’s common sense: Aggression from the police will fuel escalation. This is confirmed by decades of research: Combative and belligerent police action is often pivotal to starting and escalating a cycle of violence. After decades of research, I’ve personally concluded that perhaps the single most effective police action for crowd control would be for the police to show up dressed like humans, not terminators. But crowd control is often not the point of state violence. Its goal is usually to put people in their place, to “dominate,” as the president has called for. Viewed through that lens, it’s no wonder that tear gas is a tool of choice. Tear gas will enrage, but not deter. It will hurt and maim, but not de-escalate.
Tear gas is among the so-called cluster of nonlethal weapons—also including rubber bullets and water cannons—but those are anything but when shot directly at people, a too-common occurrence, rather than upward at a 45-degree angle, as they are supposed to be used. Already, two U.S. journalists have lost an eye this week, one from a tear-gas-canister strike, the other from a foam bullet.
In one incident in Miami, witnessed by reporters, the protester LaToya Ratlieff had been kneeling on the ground, urging the police in riot gear in front of her to stop teargassing the protesters. She was teargassed anyway. Choking, she stumbled, and another woman tried to lead her to safety, a moment captured in a photo by a reporter. Moments later, as Ratlieff was walking away, a police officer took direct aim at her—with no warning. Someone yelled at him to stop, but he fired anyway, hitting her with a projectile. Ratlieff, a black woman, was lucky by the standards of how these things usually go. Though her eye socket and skull were cracked, she will likely not lose her eye. She joins many victims around the world who have suffered from concussions, skull fractures, blindness, and even death due to such deliberate direct shots. Many human-rights organizations have repeatedly called for banning or greatly limiting their use, but they have made little progress. That’s why I keep my helmet on at all times in protest areas, and if tear gas is being fired, I’ll put on my shatterproof goggles before reaching for my gas mask.
But during a pandemic, the risk isn’t just flying rubber bullets or tear-gas canisters. The protesters descending on America’s streets this past week face an extra risk from the coronavirus, especially if they’re crowded into buses, jails, or other detention spaces—the very settings, indoors, crowded, and unventilated, that we now know lead to super-spreader events. Epidemiologists have been providing harm-reduction advice on how to protest as safely as possible. Wear a mask. Keep distance. Protesters can chant and yell, which produce the respiratory droplets that spread the virus. Maybe more signs and drums, less chanting. Stick with a small group to reduce unknown contacts. Given that this virus doesn’t seem to spread as effectively outdoors, a properly distanced protest with people wearing masks may be a relatively low-risk event. But that’s only if everyone cooperates—including the authorities. There have been videos of police pulling down protesters’ masks in order to pepper-spray them, of people being teargassed against steep hillsides that trap them, making them unable to escape the suffocating cloud. Many protesters report being shoved into packed buses, being housed in crowded garages, and being kept in jails without medical attention or the ability to distance. That’s one way to create new super-spreader events.
Some conservative commentators, especially those who oppose the ongoing lockdown policies, have been expressing frustration that beachgoers and park attendees have been scolded and shamed both by the media and on social media, while protesters have mainly received sympathy. They have a point; the scolding and shaming of park-goers and beachgoers was way overdone. But protesting police brutality and structural racism is an essential activity.
Most important, protesting is not about avoiding all risk. Protesting is about putting yourself out there despite all the risk, from the police and the virus, to engage in an act of shared vulnerability to make a political point: This will not stand. While I do keep my helmet on when interviewing protesters, I keep my mask in my backpack. A full-face mask also blocks eye contact and looks alien. If my interview subjects may be unpleasantly shocked by the sudden bang of tear-gas particles enveloping us, I don’t want to be more protected than they are.
And that’s the most remarkable part of these protests, now in their second sustained week nationwide. It’s not that the protesters are unaware of the risks; it’s that they are out there in spite of these risks, to say that black lives matter. Eric Garner couldn’t breathe. George Floyd couldn’t breathe. And now, by showing up day after day, even amid a widespread crackdown, the protesters are facing the risk of not just the tear gas that will cut off their breath, but also the very disease whose hallmark is dyspnea, the inability to breathe.


Amanda Mull

Amanda Mull is a staff writer at The Atlantic .
• The Girlboss Has Left the Building American workplaces are facing a reckoning .
So what comes next ?
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But now it ’ s looking very wise .
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But the real consequences won ’ t be clear for weeks .
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• The state is about to find out how many people need to lose their lives to shore up the economy .
• Generation C Has Nowhere to Turn Recent history suggests young people could see their careers derailed , finances shattered , and social lives upended .
• Isolation Is Changing How You Look If you ’ @ @ @ @ @ @ @ of sorts , it might be time to experiment with a box of hair dye .
• During a pandemic , terror and tedium can go hand in hand .
• What do fake Eames chairs , extra legroom , and $ 40 scented candles have in common ?
• How You Should Get Food During the Pandemic The coronavirus makes an age-old dilemma much more fraught : Order in , or cook at home ?
• When the public panics , service workers are the first to deal with it .
• @ @ @ @ @ @ @ Stay Home Even with the coronavirus spreading , lax labor laws and little sick leave mean that many people can ’ t afford to skip work .

Amanda Mull is a staff writer at The Atlantic.
Before joining the magazine in 2018, Amanda wrote for publications including New York magazine, Rolling Stone, Vox, and Elle. At The Atlantic, Amanda covers health—in the broadest possible sense of the word—and writes “ Material World ,” a regular column on American consumerism.
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Derek Thompson

Derek Thompson is a staff writer at The Atlantic , where he writes about economics , technology , and the media .
He is the author of Hit Makers and the host of the podcast Crazy/Genius • The Overlooked Role of Guns in the Police-Reform Debate Something is weirdly absent from the general discussion about police violence in America : the weapon most commonly used to inflict it .
• American policing is a gnarl of overlapping services that should be demilitarized and disentangled .
• What Does the Shocking Unemployment Report Really Mean ?
No one is sure whether @ @ @ @ @ @ @ beginning of a glorious summer of economic recovery .
• In the time that U.S. deaths have increased from 100 to more than 100,000 , the S & P 500 has gone up 20 percent .
• Social Distancing Is Not Enough We will need a comprehensive strategy to reduce the sort of interactions that can lead to more infections .
• We Can Prevent a Great Depression .
It ’ ll Take $ 10 Trillion .
Don ’ t think of that number as “ big ” or “ bold.
” Just @ @ @ @ @ @ @ for a once-in-a-century economic affliction .
• The Dumbing Down of the American Restaurant Tom Colicchio , the celebrity chef , thinks 50 percent of restaurants may not survive the pandemic , and that they ’ re going to have to change .
• Seven weeks ago , South Korea and the U.S. had the same number of virus deaths .
Today , South Korea has fewer than 300 , and the U.S. has more than 70,000 .
• The big will get bigger as mom-and-pops perish and shopping goes virtual .
In @ @ @ @ @ @ @ become more boring .
In the long term , they might just become interesting again .
• Shake Shack Is Not the Problem Shake Shack , Ruth ’ s Chris Steak House , and other big companies are getting millions in government loan money while mom-and-pops go broke .
But whose fault is that ?
• The Economy Is Ruined .
It Didn ’ t Have to Be This Way .
Almost 10 million Americans have already filed for unemployment benefits .
Congress can still act to stem the tide .
• All @ @ @ @ @ @ @ winning the war against COVID-19 ?
In the fog of pandemic , we simply don ’ t know .

Derek Thompson is a staff writer at The Atlantic and the author of the Work in Progress newsletter.
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theatlantic--2020-04-23--Israel Shows Us the Future of Protest

Israel Shows Us the Future of Protest

In some ways , Hong Kong ’ s democracy movement was particularly well suited to this moment .
Social media had already proved to be an integral part of the movement ’ s leaderless structure .
It also proved a useful way of avoiding the violent crackdowns and repression that many protesters experienced on the streets .
“ When political movements have been repressed in the past … people take digital refuge , ” Samuel Brannen , a senior fellow at the Center for Strategic and International Studies , told me .
In the case of Hong Kong , he @ @ @ @ @ @ @ hid their identities ; they went to encrypted communications.
” Of course , some notable differences exist between physical street protests and their online alternatives .
The obvious one is that digital campaigns don ’ t have a physical impact in the way street protests do .
Though online rallies can be viewed by anyone anywhere in the world , they can not tangibly disrupt—those who don ’ t want to see a demonstration can simply choose to ignore it , something , for example , commuters in central London could not do @ @ @ @ @ @ @ the city last year .
Governments , meanwhile , have less incentive to respond to an online campaign than they do to a physical one happening on their doorstep .
Moreover , while online petitions can gauge public support for an issue , they can ’ t showcase it in the same way .
Absent images of scores of people flooding streets or surrounding buildings , these digital campaigns are unlikely to attract the same level of press coverage either .
Still , keeping a movement solely online has some advantages .
Unlike @ @ @ @ @ @ @ don ’ t have to worry about seeking government permits to assemble , nor do they have to fear a physical crackdown .
What ’ s more , they are not geographically confined : Online rallies can span an entire city , country , or even the globe , depending on who ’ s taking part .
Social media has the added advantage of ensuring that a particular message can spread further and faster than ever before .
Though the internet does offer some alternatives for protest movements , online activism isn ’ @ @ @ @ @ @ @ street protests aren ’ t just a method of signaling dissent , but the dominant form .
Such has been the case in Algeria , where twice-weekly demonstrations against the country ’ s military-backed regime were called off last month for the first time in a year to comply with lockdown measures .
The Algerian government has since imposed a year-long ban on street protests and imprisoned many of the movement ’ s participants , prompting human-rights activists to accuse the government of exploiting the pandemic to quell dissent .
“ That ’ @ @ @ @ @ @ @ regular public protest had really been the kind of tentpole , ” Jonathan Pinckney , a program officer at the U.S. Institute of Peace , whose research focuses on nonviolent action , democratization , and political violence , told me .
“ Everything had revolved around those Tuesday and Friday protests , so that ’ s a situation where I think it will likely be challenging for the movement to adapt.
” The democratic threat facing protests in Algeria exists elsewhere .
In Hungary , for example , Prime Minister Viktor Orbán has @ @ @ @ @ @ @ by decree indefinitely , giving him the power to prevent public demonstrations .
In the Philippines , President Rodrigo Duterte authorized a shoot-to-kill order for those who defy the country ’ s coronavirus lockdown , including would-be protesters .
In places such as these , the digital sphere offers a safe alternative to physical protests .
But in some parts of the world , the online sphere can prove to be just as vulnerable .
This is particularly true in authoritarian states , where online surveillance and internet shutdowns are commonplace .
“ @ @ @ @ @ @ @ that happens in Iran that ’ s just online that few of us see through a variety of different platforms , ” Brannen said , noting that “ the Iranian government is looking heavily to the Chinese and the Russians to help support and stamp out that digital piece .
”

Rabin Square in Tel Aviv has always been a popular site for demonstration. Israelis gathered on this expansive plaza to protest the Gaza War in 2014 and to demand LGBT rights in 2018. It is also where, over the weekend, more than 2,000 people gathered to decry the policies of Prime Minister Benjamin Netanyahu.
This most recent protest was unlike any of its predecessors, though. For one, its attendees had their faces covered. And rather than packing the square with people shoulder to shoulder, this demonstration aimed to spread people out, assembling them on designated marks at least six feet apart. The physical distance gave the impression of a much larger protest, as attendees took up the entirety of a space that has previously accommodated tens of thousands. Some sported face masks with crime minister written on them. Others wielded placards and flags.
Such an image might have been unthinkable only a few months ago. But as with seemingly all things, the coronavirus has changed that. Today, mass protests have had to adapt to a world of social distancing, in which the large-scale rallies emblematic of global movements have been discouraged or, in some places, banned. The pandemic hasn’t spelled the end for mass protest, though; rather, the outbreak has changed it.
Read: Would you sacrifice your privacy to get out of quarantine?
Prior to the pandemic, the world was experiencing an unprecedented level of mobilization. Dubbed “the year of the street protest,” 2019 saw millions of people take to the streets in 114 countries. Including the prodemocracy demonstrations in Hong Kong and the anti-government protests in Iraq, many of these grassroots movements seemed unstoppable. But then came the coronavirus. People began trading large gatherings for social distancing, and protest signs were swapped for face masks. No one yet knows when mass demonstrations will resume, if indeed some of them will be able to return at all.
The world hasn’t been completely devoid of public protest, however. As many as 405 demonstrations occurred worldwide within the first week of April—though this was a 60 percent drop from that period last year, according to data from the Armed Conflict Location & Event Data Project. The majority of these protests were related to the coronavirus in one way or another, and many took place in smaller groups or from balconies and vehicles, in an apparent effort to observe social-distancing rules.
But these aren’t the only ways that demonstrations have adapted to the new normal. Around the world, protesters have figured out how to mobilize while also keeping apart. In Brazil, millions have taken to banging pots and pans from their windows and balconies to signal their discontent with Jair Bolsonaro’s handling of the pandemic. (The Brazilian president, who has emerged as the leader of the coronavirus-denial movement, opposes social distancing and even joined a protest calling for an end to lockdown measures meant to curb the virus’s spread.) In Israel and Russia, virtual rallies have flourished, with thousands of people “attending” through mobile apps and online platforms such as Facebook Live. In Lebanon, where anti-government demonstrations emerged six months ago, people have returned to the streets—only this time protesting from the comfort and safety of their cars.
The climate movement, which attracted millions of marchers around the world last year, has found refuge in the digital sphere, hosting a three-day “global digital mobilization” this week in commemoration of Earth Day. Swedish climate activist Greta Thunberg, who reportedly came down with COVID-19 symptoms last month, also encouraged her followers to “adapt to the new circumstances” by shifting to online strikes. Indeed, a group of U.S. and U.K. academics has identified more than 100 new methods of nonviolent activism adopted during the pandemic, including car rallies, labor strikes, and consumer boycotts.
For prodemocracy organizers in Hong Kong, the shift to digital happened early. When cases of COVID-19 first began appearing in the city in late January, mass demonstrations were quickly put on hiatus. “People learned their lesson from SARS,” Eric Lai, the vice convener of the Civil Human Rights Front, told me, referring to the epidemic that devastated the city in 2003. Though the outbreak of the coronavirus inhibited protesters’ ability to gather as normal, Lai said it didn’t put a damper on their momentum. “People stopped organizing and attending mass protests, but there are still online campaigns,” he said. “The Telegram channels and groups, the Facebook pages—these are all ongoing as well.”
In some ways, Hong Kong’s democracy movement was particularly well suited to this moment. Social media had already proved to be an integral part of the movement’s leaderless structure. It also proved a useful way of avoiding the violent crackdowns and repression that many protesters experienced on the streets. “When political movements have been repressed in the past … people take digital refuge,” Samuel Brannen, a senior fellow at the Center for Strategic and International Studies, told me. In the case of Hong Kong, he added, “they retooled; they hid their identities; they went to encrypted communications.”
Read: The common element uniting worldwide protests
Of course, some notable differences exist between physical street protests and their online alternatives. The obvious one is that digital campaigns don’t have a physical impact in the way street protests do. Though online rallies can be viewed by anyone anywhere in the world, they cannot tangibly disrupt—those who don’t want to see a demonstration can simply choose to ignore it, something, for example, commuters in central London could not do when climate-change protests took over parts of the city last year. Governments, meanwhile, have less incentive to respond to an online campaign than they do to a physical one happening on their doorstep. Moreover, while online petitions can gauge public support for an issue, they can’t showcase it in the same way. Absent images of scores of people flooding streets or surrounding buildings, these digital campaigns are unlikely to attract the same level of press coverage either.
Still, keeping a movement solely online has some advantages. Unlike with a traditional demonstration, online activists don’t have to worry about seeking government permits to assemble, nor do they have to fear a physical crackdown. What’s more, they are not geographically confined: Online rallies can span an entire city, country, or even the globe, depending on who’s taking part. Social media has the added advantage of ensuring that a particular message can spread further and faster than ever before.
Though the internet does offer some alternatives for protest movements, online activism isn’t easily employed everywhere—especially in places where street protests aren’t just a method of signaling dissent, but the dominant form. Such has been the case in Algeria, where twice-weekly demonstrations against the country’s military-backed regime were called off last month for the first time in a year to comply with lockdown measures. The Algerian government has since imposed a year-long ban on street protests and imprisoned many of the movement’s participants, prompting human-rights activists to accuse the government of exploiting the pandemic to quell dissent.
“That’s a movement in particular where the regular public protest had really been the kind of tentpole,” Jonathan Pinckney, a program officer at the U.S. Institute of Peace, whose research focuses on nonviolent action, democratization, and political violence, told me. “Everything had revolved around those Tuesday and Friday protests, so that’s a situation where I think it will likely be challenging for the movement to adapt.” The democratic threat facing protests in Algeria exists elsewhere. In Hungary, for example, Prime Minister Viktor Orbán has passed legislation that enables him to govern by decree indefinitely, giving him the power to prevent public demonstrations. In the Philippines, President Rodrigo Duterte authorized a shoot-to-kill order for those who defy the country’s coronavirus lockdown, including would-be protesters. In places such as these, the digital sphere offers a safe alternative to physical protests. But in some parts of the world, the online sphere can prove to be just as vulnerable. This is particularly true in authoritarian states, where online surveillance and internet shutdowns are commonplace. “There is a huge level of protest that happens in Iran that’s just online that few of us see through a variety of different platforms,” Brannen said, noting that “the Iranian government is looking heavily to the Chinese and the Russians to help support and stamp out that digital piece.”
Read: We are living in a failed state
Though the evolution to digital mobilization has proved a vital work-around for some movements, those relying on it admit that it’s not a panacea.“For me, online protests are for the purposes of sustaining the momentum and the solidarity,” Lai, the Hong Kong protest organizer, said. They aren’t necessarily as capable as their physical counterparts of holding the government to account or preventing it from taking further action against the prodemocracy movement. The latter was reinforced over the weekend, when Hong Kong police arrested 15 activists for their alleged part in the past year’s demonstrations. The way Lai sees it, “the government wants to take the opportunity of this coronavirus to introduce more repressive measures.” Ventus Lau, another demonstration organizer in Hong Kong, agreed, noting that while online protests may attract some engagement, they are “not a very good replacement for real rallies.”