theatlantic--2020-04-20--The Utter Futility of Biden’s China Rhetoric

Adam Serwer : Trump is inciting a coronavirus culture war to save himself The Biden camp ’ s logic is easy to understand .
Trump has made China the primary scapegoat for his failures .
His supporters are running ads under the hashtag # BeijingBiden .
So Biden and his strategists are meeting fire with fire .
They ’ re answering the charge that the former vice president is soft on China by saying that Trump is .
This form of ideological jujitsu comes naturally to Democrats of Biden ’ s generation , who in the 1990s tried to turn @ @ @ @ @ @ @ painting them as antibusiness , anti-military , and pro-criminal during the Nixon and Reagan eras .
In 1992 , Bill Clinton ran for president promising to cut taxes .
In 2000 , Al Gore proposed to spend more on the military than George W. Bush .
And in 1994 , after successfully shepherding Clinton ’ s crime bill through the Senate , Biden crowed , “ The liberal wing of the Democratic Party is now for 60 new death penalties … The liberal wing of the Democratic Party is for 125,000 new state @ @ @ @ @ @ @ to see the conservative wing of the Democratic Party.
” In the 1990s , beating the GOP at its own game was at times politically shrewd .
Clinton ’ s ghoulish enthusiasm for the death penalty—which in 1992 led him to leave the campaign trail to oversee the execution of the mentally disabled murderer Ricky Ray Rector—probably helped inoculate him from the soft-on-crime attacks that had helped sink Michael Dukakis in 1988 .
Still , Biden ’ s decision to try to out-hawk Trump on China has three major problems .
First , @ @ @ @ @ @ @ , it could stoke anti-Chinese racism .
Third , it doesn ’ t even make long-term sense politically .
Republicans , who promoted economic integration with China in the past , are now committing themselves to a cold war with China .
If Democrats think that ’ s a political environment in which they ’ ll thrive , they ’ re making a big mistake .
First , the policy .
The implication of Biden ’ s new ad is that China didn ’ t give Trump timely information about the COVID-19 outbreak @ @ @ @ @ @ @ enough on China ’ s leaders .
The commercial mocks Trump ’ s praise for Xi Jinping and is filled with supposedly damning images of Trump and Xi together .
By contrast , it shows Biden vowing , “ I would be on the phone with China making it clear : We are going to need to be in your country .
You have to be open .
You have to be clear .
We have to know what ’ s going on.
” In other words , Biden would boss the Chinese @ @ @ @ @ @ @ , the ‘ USA virus ’ is a geopolitical ploy This is a jingoistic fantasy .
China is a rival superpower run by an authoritarian and fiercely nationalistic regime .
Biden can ’ t force it to comply .
When Beijing has given the United States valuable information about virus outbreaks in the past , it ’ s because American presidents spent time and money building joint U.S.-Chinese initiatives and took pains to make China ’ s leaders feel like equals .
In 2009 , Biden ’ s then-boss , Barack Obama , @ @ @ @ @ @ @ leader Hu Jintao in Beijing—in the kind of scene Biden mocks in his ad—and said the two governments should “ build upon our mutual interests and engage on the basis of equality and mutual respect.
” The two leaders announced that they would “ deepen cooperation on global public health issues , including Influenza A ( H1N1 ) prevention , surveillance , reporting and control.
” As the Rand Corporation ’ s Jennifer Huang Bouey has noted , this cooperation hastened the development of an H1N1 vaccine .
In suggesting that Biden could @ @ @ @ @ @ @ , no less—the Biden campaign is peddling a lie about how public-health cooperation with China actually works .

If he wants to attack Donald Trump’s response to COVID-19, Joe Biden has an embarrassment of options. The presumptive Democratic nominee could slam Trump for ignoring his own advisers’ warnings about the potential severity of the virus. Biden could skewer the president for his administration’s inability to develop a coronavirus test. He could blast the Trump administration for failing to adequately stockpile personal protective equipment. He could condemn the large quantities of misinformation that Trump has propagated about the disease.
For the moment, however, Biden has chosen a different angle: He’s attacking Trump for knuckling under to Beijing. Yesterday, the Biden campaign unveiled an ad—filled with menacing images of Chinese soldiers—claiming that “Trump rolled over for the Chinese.” It follows another spot, paid for by the pro-Biden super PAC American Bridge 21st Century, depicting the incumbent as a stooge for Beijing. “Everyone knew they lied about the virus—China,” a narrator declares, against the backdrop of a fluttering Chinese flag. “President Trump gave China his trust.” On Friday, the Biden adviser Antony Blinken told reporters that “the president praised China and President Xi more than 15 times.”
Adam Serwer: Trump is inciting a coronavirus culture war to save himself
The Biden camp’s logic is easy to understand. Trump has made China the primary scapegoat for his failures. His supporters are running ads under the hashtag #BeijingBiden. So Biden and his strategists are meeting fire with fire. They’re answering the charge that the former vice president is soft on China by saying that Trump is.
This form of ideological jujitsu comes naturally to Democrats of Biden’s generation, who in the 1990s tried to turn the tables on Republicans who had been painting them as antibusiness, anti-military, and pro-criminal during the Nixon and Reagan eras. In 1992, Bill Clinton ran for president promising to cut taxes. In 2000, Al Gore proposed to spend more on the military than George W. Bush. And in 1994, after successfully shepherding Clinton’s crime bill through the Senate, Biden crowed, “The liberal wing of the Democratic Party is now for 60 new death penalties … The liberal wing of the Democratic Party is for 125,000 new state prison cells … I’d like to see the conservative wing of the Democratic Party.”
In the 1990s, beating the GOP at its own game was at times politically shrewd. Clinton’s ghoulish enthusiasm for the death penalty—which in 1992 led him to leave the campaign trail to oversee the execution of the mentally disabled murderer Ricky Ray Rector—probably helped inoculate him from the soft-on-crime attacks that had helped sink Michael Dukakis in 1988. Still, Biden’s decision to try to out-hawk Trump on China has three major problems. First, it promotes bad foreign policy. Second, it could stoke anti-Chinese racism. Third, it doesn’t even make long-term sense politically. Republicans, who promoted economic integration with China in the past, are now committing themselves to a cold war with China. If Democrats think that’s a political environment in which they’ll thrive, they’re making a big mistake.
First, the policy. The implication of Biden’s new ad is that China didn’t give Trump timely information about the COVID-19 outbreak, because Trump wasn’t tough enough on China’s leaders. The commercial mocks Trump’s praise for Xi Jinping and is filled with supposedly damning images of Trump and Xi together. By contrast, it shows Biden vowing, “I would be on the phone with China making it clear: We are going to need to be in your country. You have to be open. You have to be clear. We have to know what’s going on.” In other words, Biden would boss the Chinese around.
Renée DiResta: For China, the ‘USA virus’ is a geopolitical ploy
This is a jingoistic fantasy. China is a rival superpower run by an authoritarian and fiercely nationalistic regime. Biden can’t force it to comply. When Beijing has given the United States valuable information about virus outbreaks in the past, it’s because American presidents spent time and money building joint U.S.-Chinese initiatives and took pains to make China’s leaders feel like equals. In 2009, Biden’s then-boss, Barack Obama, stood on a stage with the Chinese leader Hu Jintao in Beijing—in the kind of scene Biden mocks in his ad—and said the two governments should “build upon our mutual interests and engage on the basis of equality and mutual respect.” The two leaders announced that they would “deepen cooperation on global public health issues, including Influenza A (H1N1) prevention, surveillance, reporting and control.” As the Rand Corporation’s Jennifer Huang Bouey has noted, this cooperation hastened the development of an H1N1 vaccine. In suggesting that Biden could bludgeon China into submission—in a phone call, no less—the Biden campaign is peddling a lie about how public-health cooperation with China actually works.
The second problem with Biden’s attempt at ideological jujitsu is that, as with the crime bill, vulnerable people may get hurt. Democratic presidential candidates have bashed China before. But this isn’t an ordinary moment. The coronavirus—and Trump’s racist rhetoric about it—have sparked a horrifying rise in attacks on Chinese Americans and other Asian Americans. To his credit, Biden has condemned Trump’s “xenophobia and fear-mongering.” Without meaning to, however, his new ads may exacerbate it.
Read: Chinese Americans have seen this before
A presidential candidate can, of course, attack the Chinese government without attacking Chinese Americans. But doing so requires some rhetorical finesse—something the Biden ad lacks. The ad doesn’t say that Trump “rolled over” for “Xi Jinping” or the “Chinese government” or even “China.” It says he rolled over for “the Chinese.” As a result, Kaiser Kuo, editor at large of the website SupChina, told me, the ad may contribute to a political “race to the bottom,” in which “Asian Americans will suffer even more terribly from racism.”
Were the Biden camp’s anti-China ads a surefire winner with voters, Machiavellians might justify them as a necessary evil. But for Democrats, posturing as more anti-China than the GOP is a poor long-term bet.
For Republicans—such as Trump, Tom Cotton, Marco Rubio, and Josh Hawley—stoking antagonism toward China makes ideological sense. The GOP is the party of military spending, national sovereignty, and white anxiety. For decades, Republicans have been looking for a new Ronald Reagan to lead them to victory over a new evil empire. They’ve tried Iraq, Iran, and North Korea. But China is the most credible candidate yet: a nonwhite, non-Christian, nominally Communist power that really can challenge America’s dominance in the world.
Shadi Hamid: China is avoiding blame by trolling the world
Democrats are by nature the party that advocates spending on health care and education rather than on military confrontation. Democrats are the people who now say, in some polls, that climate change is their second-highest priority. You can’t view the climate threat as existential and simultaneously embrace a cold war that keeps the world’s two largest emitters of carbon dioxide from cooperating. Hawks won’t find the Democrats’ anti-China posturing credible. Even if a few Never Trumpers abandon the GOP in 2020, they’ll eventually come home to Cotton’s or Rubio’s or Nikki Haley’s more respectable militarism. And in trying to out-jingo the GOP, Democrats will alienate their Millennial activist base.
By 2005, after two decades of Democrats like Biden and Clinton seeking to beat the GOP at its own game, the historian Rick Perlstein wrote a short book entitled The Stock Ticker and the Superjumbo. Perlstein argued that for a political party, as for a corporation (“Superjumbo” is a reference to Boeing’s competition with Airbus), short-term gyrations in response to the vagaries of the market (the “stock ticker”) can have devastating long-term effects if they undermine its core identity. Clinton—who passed free-trade deals, deregulated the financial markets, cut welfare benefits, signed legislation against gay marriage, and helped fill America’s jails—won two presidential elections. But toward the end of his tenure, Democrats controlled fewer Senate seats and fewer state legislatures than they had in 50 years, and fewer governorships than they had in 30 years. Clinton had won; the Democratic Party had lost.
By attacking Trump for being insufficiently nationalist rather than being insufficiently internationalist, Biden is hastening a geopolitical confrontation that threatens progressive goals. And he’s sowing doubts about what the Democratic Party actually believes. He’s choosing short-term advantage over long-term principle.
This is what supporters of Bernie Sanders were worried about, and Biden is proving them right.


theatlantic--2020-03-11--What Will You Do If You Start Coughing?

What Will You Do If You Start Coughing?

Read : You ’ re likely to get the coronavirus None of this is meant to cause panic .
Panic is not useful .
But as we all begin to comprehend the nature and extent of the new virus and its spread , questions should arise about what to do with those early , familiar symptoms .
At what point should you ask for testing ?
When do you need to self-quarantine , and for how long ?
Who needs to be in a hospital , and who can ride things out at home ?
If you ’ re sick @ @ @ @ @ @ @ a crowded clinic or emergency department , possibly shedding virus that infects others ?
Should you stay home , maybe using telemedicine , and risk infecting roommates or family members ?
The source of most panic is uncertainty .
While much remains uncertain in the realm of virology and immunology , other sources of anxiety could be mitigated .
Everyone could have clarity and certainty on those fundamental questions , or at least on the most immediately pressing : What should I do if I start to feel sick ?
In an ideal @ @ @ @ @ @ @ of illness—or even after a concerning exposure—everyone would go get a quick test .
It could assure them that they ’ re okay to go to work , or to go to a public gathering , or even to go home .
If a test were positive , that person ’ s close contacts would be alerted of an anonymous exposure .
They would be advised to come get tested .
The process would be fast , easy , ubiquitous , and free .
Given the nature and spread of this particular virus @ @ @ @ @ @ @ to tracking and containment has proven infeasible .
Even if perfect tests were widely available , and everyone agreed to get tested as soon as possible whenever they felt sick , demand for screening and evaluation would overload existing doctors ’ offices and hospitals .
Emergency funds could theoretically be used to set up makeshift screening clinics in parking lots and public spaces .
After being screened , some people could be escorted to a hospital for further treatment and evaluation .
Others could be reassured that they were clear and go back @ @ @ @ @ @ @ advised to self-isolate at home until the illness passes , and to call , text , or return if symptoms escalated .
The best possible monitoring and communication will nonetheless prove vital to determining who needs hospital beds in the midst of a rapidly spreading , temperamental disease .
Without it , to simply tell people to “ stay at home if you ’ re sick ” will be inadequate .
Most cases of COVID-19 are reportedly “ mild , ” but that term can be misleading .
As the World Health Organization @ @ @ @ @ @ @ a “ mild ” case of COVID-19 is not equivalent to a mild cold .
Expect it to be much worse : fever and coughing , sometimes pneumonia—anything short of requiring oxygen .
“ Severe ” cases require supplemental oxygen , sometimes via a breathing tube and a ventilator .
“ Critical ” cases involve “ respiratory failure or multi-organ failure .
”

Information about the novel coronavirus is rapidly changing. As a result, some of the information or advice in this article may be out-of-date. You can find The Atlantic’s most current COVID-19 coverage here
Updated at 4:04 p.m. ET on March 11, 2020.
COVID-19 is not the flu. We have a vaccine for the flu. We have anti-viral medications designed to treat the flu. We have a sense of what to expect when we catch the flu, and when it’s necessary to seek medical attention. Doctors have experience treating the flu, and tests to help diagnose the flu, right there in the office, while you wait.
To hear more feature stories, get the Audm iPhone app.
Against the new disease, we have none of this. This coronavirus is unknown to our species. Once it breaks into one of our cells, the extent of its spread through the body seems to vary significantly. The experience can slowly progress from the familiar—cough, congestion, fever—to a life-threatening inflammatory response as the virus spreads down into the lungs, filling the airways with fluid. Survivors can have permanent scarring in the lungs. The virus can also spread into other organs, causing liver damage or gastrointestinal disease. These effects can play out over longer periods than in the flu, sometimes waxing and waning. Some patients have begun to feel better, then fallen critically ill. The disease can be fatal despite receiving optimal medical care.
Read: You’re likely to get the coronavirus
None of this is meant to cause panic. Panic is not useful. But as we all begin to comprehend the nature and extent of the new virus and its spread, questions should arise about what to do with those early, familiar symptoms. At what point should you ask for testing? When do you need to self-quarantine, and for how long? Who needs to be in a hospital, and who can ride things out at home? If you’re sick, should you bring your illness into a crowded clinic or emergency department, possibly shedding virus that infects others? Should you stay home, maybe using telemedicine, and risk infecting roommates or family members?
The source of most panic is uncertainty. While much remains uncertain in the realm of virology and immunology, other sources of anxiety could be mitigated. Everyone could have clarity and certainty on those fundamental questions, or at least on the most immediately pressing: What should I do if I start to feel sick?
In an ideal outbreak scenario, at the first signs of illness—or even after a concerning exposure—everyone would go get a quick test. It could assure them that they’re okay to go to work, or to go to a public gathering, or even to go home. If a test were positive, that person’s close contacts would be alerted of an anonymous exposure. They would be advised to come get tested. The process would be fast, easy, ubiquitous, and free.
Given the nature and spread of this particular virus, though, this textbook public-health approach to tracking and containment has proven infeasible. Even if perfect tests were widely available, and everyone agreed to get tested as soon as possible whenever they felt sick, demand for screening and evaluation would overload existing doctors’ offices and hospitals.
Emergency funds could theoretically be used to set up makeshift screening clinics in parking lots and public spaces. After being screened, some people could be escorted to a hospital for further treatment and evaluation. Others could be reassured that they were clear and go back to work. Still others could be advised to self-isolate at home until the illness passes, and to call, text, or return if symptoms escalated.
A series of tents in a field adjacent to University Clinical Hospital in Wroclaw, Poland, now precedes the entrance to the emergency department (Agencja Gazeta / Krzysztof Cwik / Reuters).
The best possible monitoring and communication will nonetheless prove vital to determining who needs hospital beds in the midst of a rapidly spreading, temperamental disease. Without it, to simply tell people to “stay at home if you’re sick” will be inadequate. Most cases of COVID-19 are reportedly “mild,” but that term can be misleading. As the World Health Organization adviser Bruce Aylward clarified last week, a “mild” case of COVID-19 is not equivalent to a mild cold. Expect it to be much worse: fever and coughing, sometimes pneumonia—anything short of requiring oxygen. “Severe” cases require supplemental oxygen, sometimes via a breathing tube and a ventilator. “Critical” cases involve “respiratory failure or multi-organ failure.”
The disease can sometimes escalate unexpectedly, and even healthy young patients will need people checking in on them. They may be fine at home initially, but would need to know precisely what to watch out for, and when to seek care. People who do require medical supervision—but not hospital care—need a place to go and stay. This could include people with escalating symptoms or underlying risk factors. Even patients with a mild case will need places to self-isolate if they live with others who have not yet been infected, especially if those people are older or immunocompromised.
Read: What you can do right now about the coronavirus
China addressed this issue by mandating that sick people in Wuhan go into quarantine for two weeks, at one of the dozens of hastily adapted or constructed emergency facilities that look almost like military field hospitals. People are given food, beds, and medical monitoring. They can socialize with other sick people, and they can be transferred to a hospital if that becomes necessary.
In the U.S. and most other countries, the process of removing oneself from society for two weeks is not so straightforward—or even possible, for many people. The Centers for Disease Control and Prevention has ordered some mandatory two-week quarantines, but so far only for a few hundred travelers. The contained have passed their days at military bases, of which the country has 15 with designated space for quarantines. The capacity for housing and feeding larger numbers of people is nowhere near what may be needed. In February the Pentagon “ramped up” the military bases in preparation to quarantine 1,000 people.
Though mandatory quarantining at large scales would be infeasible (and legally treacherous), governments might at least offer facilities for people who have nowhere else to go when they get sick. To that end, Washington State’s public-health officials have already procured an Econolodge. Others could anticipate similar needs and secure local hotels, or retro-fit empty stadiums or dead malls, or even cruise ships at port. Ideally the accommodations would be nicer than military bases and would not feel punitive—or else people will not use them.
Given the expanding global recommendations to avoid large gatherings and limit travel, such arrangements might also keep the hospitality industry from collapsing.
Read: We can still avoid the worst-case scenario
If all of this were happening, the United States might be able to avoid the sort of widespread shutdowns of cities, businesses, and institutions that are playing out in Italy, China, and elsewhere. But it is not happening. People who are sick are told only to go home. A shortage of tests means that many people are staying home who do not need to. Many others are going out because they can’t afford to stay home and miss work. Many don’t have health insurance, or fear the costs of being hospitalized. There is a strong financial incentive to conceal symptoms, to try to keep working and caring for children, and by consequence spreading the virus.
As of last week, at Prohealth clinics in central Connecticut, patients who arrive with a fever and respiratory symptoms are instructed to wait in their car and call the clinic to announce their arrival. Then a doctor or nurse dons a full shield mask, a gown, and gloves and comes out to the parking lot. The patient is to roll down a window and be evaluated on the spot. If a flu test shows no sign of the flu, the patient is to wait in the car while the clinic contacts the state health department.
Health officials are then faced with a challenge. What to do with this person, sick and alone in their car, and not allowed into their own doctor’s office? This is where a test for the coronavirus would be of use. Until this week, though, the state of Connecticut had received only one coronavirus testing kit from the CDC. Testing capacity is increasing now, in partnership with private labs. But as of Monday afternoon, an ongoing Atlantic investigation could only confirm that 4,384 tests had been conducted nationally.
This number is projected to increase quickly, but not instantly. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said in an interview with JAMA that aired on Monday: “The goal over the next week or two is to get to the point of having a million diagnostic tests ready for shipment.”
A doctor prepares a test kit at a drive-in coronavirus check at a hospital in Germany. (Gross Gerau / Reuters)
Expectations are tempered; a similar promise from Vice President Mike Pence of 1.5 million tests by the end of last week did not come to pass. But even when these tests eventually are available, some limitations will have to be realized. Among them, these are diagnostic tests, not screening tests—a distinction that should shape expectations about the role doctors will play in helping manage this viral disease.
The difference comes down to a metric known as sensitivity of the test: how many people who have the virus will indeed test positive. No medical test is perfect. Some are too sensitive, meaning that the result may say you’re infected when you’re actually not. Others aren’t sensitive enough, meaning they don’t detect something that is actually there.
The latter is the model for a diagnostic test. These tests can help to confirm that a sick person has the virus; but they can’t always tell you that a person does not. When people come into a clinic or hospital with severe flu-like symptoms, a positive test for the new coronavirus can seal the diagnosis. Screening mildly ill people for the presence of the virus is, however, a different challenge.
“The problem in a scenario like this is false negatives,” says Albert Ko, the chair of epidemiology of microbial diseases at the Yale School of Public Health. If you wanted to use a test to, for example, help you decide whether an elementary-school teacher can go back to work without infecting his whole class, you really need a test that will almost never miss the virus.
“The sensitivity can be less than 100 percent and still be very useful,” Ko says, in many cases. But as that number falls, so does the usefulness of any given result. In China, the sensitivity of tests has been reported to be as low as 30 to 60 percent—meaning roughly half of the people who actually had the virus had negative test results. Using repeated testing was found to increase the sensitivity to 71 percent. But that means a negative test still couldn’t fully reassure someone like the teacher that he definitely doesn’t have the virus. At that level of sensitivity, Ko says, “if you’re especially risk-averse, do you just say: ‘If you have a cold, stay home’?”
“An inaccurate test—one prone to false positive or false negative results, can be worse than no test at all,” Ian Lipkin, an epidemiology professor at Columbia University, told me in an email. The CDC has not shared the exact sensitivity of the testing process it has been using. When Fauci was asked about it on Monday, he once again hedged. “If it’s positive, you absolutely can make a decision,” he said. If it’s not, that’s a judgment call. Usually a second test is recommended, and it depends on the patient’s symptoms, exposures, and how sick they appear to be.
The tests involve other variables, too. Samples must be taken using a long cotton swab that goes into the back of the patient’s nose (or mouth, though this seems to be a less sensitive method). In either case, sometimes you just don’t get enough mucus on the swab. It can be hard to know if that was the cause of a negative test result when results come in from the lab a day later.
Read: The official coronavirus numbers are wrong, and everyone knows it
In attempt to increase sensitivity of the testing process, China not only swabbed people multiple times, but also added CT scans for an additional clue. The scans can sometimes help identify the unique patterns of lung damage caused by the virus, says Howard Forman, who practices radiology in the emergency department at Yale–New Haven Hospital. But scanning is a slow process to do at large scales, and it’s costly and involves exposure to radiation. “You would need dedicated scanners as well, so as not to contaminate other patients,” he told me. “So it becomes very difficult to use CT for high-level screening.”
Given the number of variables, widespread screening tests for the virus are not looming on the horizon as a way to obviate the urgent need for social distancing.
Some hope is being placed in biotech companies that are working to develop quick, mobile tests that could give results anywhere—be it at a doctor’s office or in a modified parking lot. “The goal would be to allow people to know if they have a cold or if they have the virus and need to self-quarantine, right there in the doctor’s office,” says William Brody, a radiologist and former president of Johns Hopkins University. He is currently working on one such project with Hong Cai, a molecular biologist, at a small company called Mesa. The duo told me this is, at best, months away from being tested widely. Even then, its sensitivity will remain to be seen, and will likely be less than that of the current, slower tests. But Hong says her team is working as expeditiously as possible to solve the problem.
In the absence of a quick, sensitive, ubiquitous screening test that can decisively rule out coronavirus infection—and send healthy people back out into the world to work and to live— we face unique challenges. The World Health Organization is lately signaling that a declaration of pandemic is imminent. Leaders point to dramatic shutdown and mass quarantine measures taken in China in laudatory terms—as evidence that lives can be saved, and this is how. Other countries are already following China’s example. Italy has banned weddings and funerals as the number of cases exploded in recent days. Japan has closed schools for a month. France has banned large public gatherings, and Iraq has banned even small ones. The United Nations has canceled all in-person meetings to address climate change.
For now at least, it seems, minimizing damage will involve sweeping and imprecise action. To shut down a city, or a country, is to gamble that incurring disastrous economic consequences in the short term will prevent even more disastrous consequences in the longer term. In the nightmare scenario that everyone is trying to avoid, the disease spreads so quickly that a country’s health-care system is overwhelmed, and people go untreated amid panic and chaos.
A pandemic is like a slow-motion hurricane that will hit the entire world. If the same amount of rain and wind is to hit us in any scenario, better to have it come over the course of a day than an hour. People will suffer either way, but spreading the damage out will allow as many people as possible to care for one another.
Slowing the disease requires asking people to isolate themselves and, in most cases, stop working. Most of the world cannot shelter in place for long without income. When people are asked to survive alone—without the cultural, social, and financial inputs that typically keep us alive—new ways of attending to basic needs become immediately necessary. “For people who can’t afford time off work, we absolutely need to come up with out-of-the-box solutions right now,” Ko says.
Among them is the idea that everyone receive cash, immediately. People need to feel able to skip work and still make rent and feed their family. They need cash without strings attached, and they need it now, not via a complex omnibus economic stimulus package next month. With each day that such bills are debated by skeptical senators, people will continue to go into their communities, out of a need to work, spreading the disease simply because they have no other choice.
Planning for emergency cash transfers is underway in Hong Kong, where permanent residents are to receive the equivalent of $1,282 later this year, in an effort to keep both the economy and people alive.* In response to a month of nationwide school closures in Japan, the government is paying out $80 per worker per day to help cover child care or the costs of staying home to parent. Other government payments could be conditional on taking sick leave—a sort of emergency national sick-leave policy, whereby your employer might simply have to verify that you did indeed miss work for two weeks. Or, as with President George W. Bush’s $152 billion economic-stimulus bill in 2008, people could simply get a check in the mail.
Read: The problem with telling sick workers to stay home
“There’s precedent internationally for this idea,” says Natalie Foster, who studies economic policy at the nonprofit Economic Security Project. She says the cash could easily come in the form of earned-income tax credits. “We have an entire tax system that has been doing this for decades … We could expand and modernize it for this precarious moment.”
“Unconditional or conditional cash transfers may be wise in a situation like this, where you’re asking people to stay home to protect themselves and others,” says Paul Farmer, a global-health professor at Harvard Medical School. “If people know there will be support, and other things like soup kitchens and nursing care at home, those would make a big difference overall in suffering involved with an illness like this. If people feel like Hey, we got you, they would be a lot less lonely and frightened. Pandemics bind us together, and often not in great ways. But sometimes in great ways.”


theatlantic--2020-02-27--Coronavirus Could Break Iranian Society

Coronavirus Could Break Iranian Society

It is difficult to overstate what a disaster these numbers express—not just for Iran , but for everyone .
Qom is a seat of Shiite learning , the spiritual omphalos of Iran , and as a result , it draws the pious from all over the Shiite world .
I profiled a Lebanese cleric in Paraguay for The Atlantic in 2009 ; his previous address had been in a seminary in Qom .
On the streets of Qom , you hear Persian spoken in many accents , including Tajik and Afghan .
In some restaurants , servers will address you @ @ @ @ @ @ @ al-Sadr , a revered Iraqi ayatollah , look down at you as eat your kebab .
Qom feels like a Shiite Disneyland , filled with religious attractions ( with junk food for sale between stations ) , and that comparison might be the best way for Americans to understand the gravity of this outbreak .
What if we found out that thousands of people at Disney World all had a highly contagious , sometimes fatal illness—and that vacationers had been coming and going , returning to their home city , for weeks ?
@ @ @ @ @ @ @ and disadvantages of authoritarianism in dealing with a disaster like this .
China can lock down a city , quarantining tens of millions at a time , and it can marshal its top experts , allowing them to wage a campaign against the disease with the absolute authority of a caesar .
But it can ’ t avail itself of the benefits of public trust , including transparent and honest accounts of the disease and its toll .
In Iran , it appears that the government has all the disadvantages of an unfree @ @ @ @ @ @ @ advantages .
Watch this incredible video , at once comic and horrifying , of a top Iranian health official , Iraj Harirchi , assuring the public that the situation is being addressed , while sweating and coughing on colleagues and his audience because he has contracted the coronavirus : Nor is he the only top official to have been infected : Today , Masoumeh Ebtekar , Iran ’ s vice president and a notoriously cruel member of the group of Iranians who held U.S. diplomats hostage in 1979 , announced that she , @ @ @ @ @ @ @ to reports , she met with Iranian President Hassan Rouhani and his cabinet just yesterday , potentially exposing the entire senior leadership of Iran to the disease .
Harirchi stated that the government refuses to impose quarantines , because they are premodern and ineffective .
Mohammad Saeedi , the head of the shrine in Qom and a local representative of the country ’ s supreme leader , not only opposes a quarantine but begged people to visit the shrine , calling it a “ place of healing.
” Ariana A. Berengaut : Democracies @ @ @ @ @ @ @ point , incompetence and evil become indistinguishable .
I feel like we have passed this point several times in the past few years , and Iran ’ s leadership in particular keeps passing it over and over , like a Formula 1 car doing laps .
Last month ’ s accidental downing of a civilian airliner exposed one form of fatal incompetence , followed by an abortive effort to cover it up .
Iranians are understandably primed to wonder whether this disaster is similar , a tragedy of malign incompetence that is expanding @ @ @ @ @ @ @ contain .

Picture the following sacred but unhygienic scene: Pilgrims from a dozen countries converge on one small city. They stay in cramped hotels, using communal toilets and eating meals together. For their main ritual, they converge on the tomb of a woman, the sister of a holy man, and as they get closer, they feel with rising intensity grief over her death and the deaths of her kin. The grief is a commandment: Each tear, according to one tradition, will be transformed in the afterlife into a pearl, and an angel will compensate them for their tears with a bucket of pearls that will be signs of their devotion when they arrive at the gate of paradise. But for now the bodily fluids are flowing, wiped away occasionally by bare hands, and the crowd is getting denser. A metal cage surrounds the tomb itself, and when the weeping pilgrims reach it, they interlace their fingers with its bars, and many press their face against it, fogging up the shiny metal with their breath. Some linger for minutes, some for seconds. In a single day, many thousands pass through the same cramped space—breathing the same air, touching the same surfaces, trading new and exotic diseases.
Read: You’re likely to get the coronavirus
The city is Qom, Iran, and two days ago, a local health official declared on Iranian television that the coronavirus was burning through the community. The situation, he said, is grim. Iran claims that, countrywide, 26 people have died from the coronavirus illness (known as COVID-19), out of 245 total infections. All acknowledge that Qom is the center of infection, but many doubt that the numbers are accurate. Another official, a member of Iran’s Parliament from Qom, said last weekend that his city had already lost 50 people to COVID-19. That figure, assuming it’s accurate, suggests that if COVID-19 is as deadly in Iran as it is elsewhere and kills 2.3 percent of its victims, another 2,000 people have the disease in Qom alone.
It is difficult to overstate what a disaster these numbers express—not just for Iran, but for everyone. Qom is a seat of Shiite learning, the spiritual omphalos of Iran, and as a result, it draws the pious from all over the Shiite world. I profiled a Lebanese cleric in Paraguay for The Atlantic in 2009; his previous address had been in a seminary in Qom. On the streets of Qom, you hear Persian spoken in many accents, including Tajik and Afghan. In some restaurants, servers will address you in Arabic, and posters of Muhammad al-Sadr, a revered Iraqi ayatollah, look down at you as eat your kebab. Qom feels like a Shiite Disneyland, filled with religious attractions (with junk food for sale between stations), and that comparison might be the best way for Americans to understand the gravity of this outbreak. What if we found out that thousands of people at Disney World all had a highly contagious, sometimes fatal illness—and that vacationers had been coming and going, returning to their home city, for weeks?
Zeynep Tufekci has written about the advantages and disadvantages of authoritarianism in dealing with a disaster like this. China can lock down a city, quarantining tens of millions at a time, and it can marshal its top experts, allowing them to wage a campaign against the disease with the absolute authority of a caesar. But it can’t avail itself of the benefits of public trust, including transparent and honest accounts of the disease and its toll. In Iran, it appears that the government has all the disadvantages of an unfree society, and none of the compensating advantages. Watch this incredible video, at once comic and horrifying, of a top Iranian health official, Iraj Harirchi, assuring the public that the situation is being addressed, while sweating and coughing on colleagues and his audience because he has contracted the coronavirus:
Nor is he the only top official to have been infected: Today, Masoumeh Ebtekar, Iran’s vice president and a notoriously cruel member of the group of Iranians who held U.S. diplomats hostage in 1979, announced that she, too, has the disease. According to reports, she met with Iranian President Hassan Rouhani and his cabinet just yesterday, potentially exposing the entire senior leadership of Iran to the disease.
Harirchi stated that the government refuses to impose quarantines, because they are premodern and ineffective. Mohammad Saeedi, the head of the shrine in Qom and a local representative of the country’s supreme leader, not only opposes a quarantine but begged people to visit the shrine, calling it a “place of healing.”
Ariana A. Berengaut: Democracies are better at fighting outbreaks
At some point, incompetence and evil become indistinguishable. I feel like we have passed this point several times in the past few years, and Iran’s leadership in particular keeps passing it over and over, like a Formula 1 car doing laps. Last month’s accidental downing of a civilian airliner exposed one form of fatal incompetence, followed by an abortive effort to cover it up. Iranians are understandably primed to wonder whether this disaster is similar, a tragedy of malign incompetence that is expanding beyond the government’s ability to contain.
The quarantine measures that Iran has rejected are imperfect, and they would stigmatize Qom unfairly. But the current situation of what appears to be virtually uncontrolled pathogen spread is accelerating the epidemic, and right now the most valuable commodity is time—time to stockpile medicine, improve diagnosis and treatment, and teach the world how to react to a plague that may kill millions. The quarantine in China seems to be buying us time. The lack of one in Iran is spending it away.
Quarantine is from the Italian word for 40, because during outbreaks of the Black Death, ships entering Venice had to wait 40 days before sailors and goods could come ashore. (The Black Death, curiously enough, seems to have found its first footing in none other than the Hubei province of China, also the epicenter of COVID-19. It killed roughly a third of the population of Europe.) Forty days is a long time, longer than any of the quarantines currently being imposed on individuals traveling from outbreak sites.
But any amount of waiting can be stressful, even in a place much more competently run than Iran. Earlier this month, I visited Hong Kong. Everyone wore masks. In public, no one crowded into my personal space on buses or in narrow pedestrian alleys. Shopkeepers came outside every quarter hour or so to wipe down the doorknobs and door buzzers of their shops, in case the last customer had left a viral particle. The burden of containing the coronavirus felt collective, and heavy. Hong Kong has a strong sense of identity and group responsibility, which has up until now kept it sane. I could take just a few days of it. Only in the middle of the night, when I knew I would encounter no one up close, did I feel comfortable—and not like some kind of norm-violating monster—walking around with my face exposed to the air.
Iranians are under immense stress already, from economic, political, and military pressure. They do not trust their government. The daily stress of worrying, literally every few minutes, whether you will accidentally kill yourself by picking your nose or opening a door may prove, additively, too much for a society to bear. Urging visits to Qom, I fear, is the reaction of a government that has at last recognized its own limitations and has, at some level, embraced the virus. These crazy reactions greatly increase the chances that you will soon embrace it too.


theatlantic--2020-02-27--The Opioid Epidemic Might Be Much Worse Than We Thought

Read : The true cause of the opioid epidemic So the researchers set out to try to determine the real causes behind those unspecified drug overdoses .
In the process , they uncovered something unsettling about how deaths are tracked in the U.S. : The way that a given county investigates deaths matters , and it could be dramatically shifting our nationwide estimates of the number of people who die of everything including opioids , childbirth , and the new coronavirus .
Hill worked with Boslett and a doctoral candidate , Alina Denham , to come up with a model @ @ @ @ @ @ @ drug overdoses were caused by opioids .
To do it , they set aside some of the death records in which the type of drug was known and created a model that would predict the drug , given other things that were known about that person : the county they lived in , their sex , where they died , other health conditions that contributed to the person ’ s death , and so on .
For opioid deaths , that meant factoring in whether the person had other characteristics typically associated with @ @ @ @ @ @ @ to opioids or having chronic pain .
By applying the model to the “ unspecified ” overdose deaths , they were able to predict that 72 percent of those were actually from opioids .
In fact , they estimate in a new study in the journal Addiction , there were more than 99,000 additional opioid deaths from 1999 to 2016 than had been previously documented , raising the national death toll by about 28 percent , to 453,300 .
What ’ s more , the discrepancies varied widely by state .
In Alabama @ @ @ @ @ @ @ and Indiana , Hill and her team estimated that the number of deaths from opioid overdoses was actually double the previous estimates .
“ This paper is a very strong one , ” says Atheendar Venkataramani , a health-policy professor at the University of Pennsylvania , who was not involved in the study .
It suggests that “ if you just follow the vital statistics alone , we ’ re probably underestimating the true number of opioid deaths.
” Hill and her team suspect that ’ s because of differences in how counties @ @ @ @ @ @ @ essence , whether a given county uses a coroner or a medical examiner to investigate deaths matters .
Medical examiners are doctors specially trained in pathology and forensics , but coroners can be general practitioners or even laypeople with no medical training .
For coroners , “ in many places , like the state of Pennsylvania , the only requirements are to be a legal adult with no felony convictions who has lived in the county for one year and to complete a basic training course , ” Jordan Kisner wrote this week @ @ @ @ @ @ @ Meanwhile , as Kisner pointed out , the United States has a dire shortage of medical examiners .
Because of this low standard of training , Denham explains , “ you would think [ coroners ] would not be able to identify opioid involvement in a death as well as a medical doctor trained in it would.
” That inference seems to be held up by data : The states that had a lot of unclassified drug-overdose deaths , Hill and her colleagues found , tended to use coroners in their death investigations @

It can be hard to comprehend the true scope of something as disastrous as the opioid epidemic. Perhaps that’s why it’s been compared with falling 747s and crashing cars. But in fact, knowing exactly how many people have perished is crucial to stopping the deaths.
That’s why Elaine Hill and Andrew Boslett, economists at the University of Rochester, were so concerned when they found that many potential opioid deaths aren’t counted as such. In the fall of 2018, Hill and Boslett were studying how deaths from overdoses of opioids, such as heroin or OxyContin, were influenced by the decline of coal mining and the rise of shale gas fracking. But when they began looking at death records of Americans who had died of drug overdoses, they noticed that in more than 20 percent of the cases, the record said the type of drug could not be specified, perhaps because an autopsy had not been performed. In other words, the person had died of a drug overdose, but the death record didn’t say which drug.
Hill and Boslett realized that such a high rate of unknowns wouldn’t work for the phenomenon they were trying to study. “Our lab wants to make as strong of a claim as possible, given evidence that maybe an economic shock … had an effect on drug-overdose rates,” Boslett says. “We want to know that the estimates we’re using on local drug-overdose rates are correct, or as correct as possible.”
Read: The true cause of the opioid epidemic
So the researchers set out to try to determine the real causes behind those unspecified drug overdoses. In the process, they uncovered something unsettling about how deaths are tracked in the U.S.: The way that a given county investigates deaths matters, and it could be dramatically shifting our nationwide estimates of the number of people who die of everything including opioids, childbirth, and the new coronavirus.
Hill worked with Boslett and a doctoral candidate, Alina Denham, to come up with a model to estimate how many of those unspecified drug overdoses were caused by opioids. To do it, they set aside some of the death records in which the type of drug was known and created a model that would predict the drug, given other things that were known about that person: the county they lived in, their sex, where they died, other health conditions that contributed to the person’s death, and so on. For opioid deaths, that meant factoring in whether the person had other characteristics typically associated with opioid overdose, such as being addicted to opioids or having chronic pain. By applying the model to the “unspecified” overdose deaths, they were able to predict that 72 percent of those were actually from opioids.
In fact, they estimate in a new study in the journal Addiction, there were more than 99,000 additional opioid deaths from 1999 to 2016 than had been previously documented, raising the national death toll by about 28 percent, to 453,300. What’s more, the discrepancies varied widely by state. In Alabama, Mississippi, Pennsylvania, Louisiana, and Indiana, Hill and her team estimated that the number of deaths from opioid overdoses was actually double the previous estimates.
Addiction
“This paper is a very strong one,” says Atheendar Venkataramani, a health-policy professor at the University of Pennsylvania, who was not involved in the study. It suggests that “if you just follow the vital statistics alone, we’re probably underestimating the true number of opioid deaths.”
Hill and her team suspect that’s because of differences in how counties across the U.S. investigate deaths. In essence, whether a given county uses a coroner or a medical examiner to investigate deaths matters. Medical examiners are doctors specially trained in pathology and forensics, but coroners can be general practitioners or even laypeople with no medical training. For coroners, “in many places, like the state of Pennsylvania, the only requirements are to be a legal adult with no felony convictions who has lived in the county for one year and to complete a basic training course,” Jordan Kisner wrote this week in The New York Times Magazine. Meanwhile, as Kisner pointed out, the United States has a dire shortage of medical examiners.
Because of this low standard of training, Denham explains, “you would think [coroners] would not be able to identify opioid involvement in a death as well as a medical doctor trained in it would.” That inference seems to be held up by data: The states that had a lot of unclassified drug-overdose deaths, Hill and her colleagues found, tended to use coroners in their death investigations.
Read: The doctors whose patients are already dead
The undercounting of opioid deaths is important because “you need to know the scale of a problem to know how to intervene in the problem,” Venkataramani says. Dealing with a crisis like opioid addiction—or coronavirus, for that matter—requires lawmakers and public-health workers to make choices about where to direct precious funding and resources. If the severity of the opioid epidemic is underestimated, local public-health departments could be shortchanged, and even more lives could be lost. This is particularly important in the case of infectious diseases like coronavirus, where knowing the total number of deaths can help public-health officials estimate its lethality.
Especially in the case of addiction, so much of illness happens outside the public eye that it’s sometimes only when someone dies that her neighbors or the government see exactly what she was going through. The tragedy of epidemics like opioid abuse is that nothing can be done to help the dead. But the dead can help others—if the things that killed them are accurately reported. Having a better grasp of just how many people are dying from various ailments is crucial for policy makers to help those who are still living.