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Tag Archives: Pandemic

The “Swiss Cheese Model” for Pandemic Defense

The “Swiss cheese model” of accident causation (more accurately called Emmental or Emmentaler cheese model [104]) originated with James T. Reason and Rob Lee in the 1990s (and was potentially influenced by other researchers).

As applied to COVID-19, this model recognizes the additive success of using multiple preventive interventions to reduce the risk of SARS-CoV-2 infection. No single slice of cheese (public health strategy) is perfect or sufficient at preventing the spread of SARS-CoV-2. Each slice has holes (inherent weaknesses or limitations) with variable number, size, and location over circumstances or time, which may allow viral transmission. SARS-CoV-2 infection occurs when multiple holes happen to align at the same time permitting a trajectory of successful transmission. When several interventions are used together and consistently and properly, the weaknesses in any one of them should be offset by the strengths of another.

The preventive interventions can be broken into personal and shared, although some interventions may be both. The order of the slices and holes in the illustration are not reflective of the degree of effectiveness of the interventions, given that the scenarios of transmission are variable and complex.

The black rats eating the slices of cheese represent factors undermining prevention efforts while the extra cheese represents a source of factors and opportunities favoring prevention efforts.

Source : BMC Infectious Disease

Chart: Is Your Government Ready for Another Pandemic?

Source : Statistica

What It Means When Epidemic Prevention Becomes a ‘War’

Yang Zheng wrote . . . . . . . . .

In her book “Illness as Metaphor,” Susan Sontag explores the various ways society has sought to understand diseases through metaphoric expressions, and how those metaphors are translated into a politics that governs the lives of the ill. One of the most common metaphors she analyzes has been all but inescapable during the current pandemic: illness prevention and treatment as a kind of “warfare.”

This language isn’t limited to COVID-19. As Sontag found after being diagnosed with breast cancer, the spread of cancerous cells through the body is often likened to a process of “invasion” and “colonization”; the purpose of treatment is to “kill” the invasive pathogens or tumors. “When a patient’s body is considered to be under attack, the only treatment is counterattack,” she writes.

The widespread use of these metaphors can be traced to the popularization of germ theory in the late 19th century. At the time, scientists understood their work as identifying “evil” pathogens that invade the body and cause illness. Their job was to “defend” the body, “counterattack,” and “destroy” the intruder.

Warfare as a metaphor for illness long predates the 19th century, however. In traditional Chinese medicine, illness is frequently likened to a kind of assault. “The Inner Canon of the Yellow Emperor,” compiled more than 2,000 years ago, states that diseases are caused by a series of invasions by “external evil.” Over the centuries, military metaphors became entrenched in TCM theory and practice, often expressed through binary opposites like “internal righteousness” and external evil.

In the first half of the 20th century, the gradual influx of Western medical knowledge introduced new military metaphors for disease to China, where they gradually combined with their TCM counterparts to create an attitude of militant hostility toward illness. Medical workers became frontline “soldiers,” the immune system was seen a kind of fortification, and drugs were humanity’s weapons in the fight against disease.

After the founding of the People’s Republic in 1949, military metaphors were almost de rigueur in Chinese mainstream media coverage of illness, especially during times of political turmoil or epidemics. In an analysis of articles on disease published in the People’s Daily between 1946 and 2019, I found the use of military metaphors peaked during both the Cultural Revolution and the 2002-2003 SARS outbreak. I also found that the use of aggressive language, such as calls to “eliminate” or “battle” a disease, were more common than expressions like “build lines of defense” or “resist the epidemic.” Military metaphors of all kinds were accompanied by collective subjects — “we,” “everyone,” and “all the people” — that emphasized the masses over the individual.

This tendency has carried over into the current pandemic. Facing an outbreak of unprecedented scale, China has relied on militarized language to mobilize public opinion and secure people’s cooperation in epidemic prevention work. In COVID-19 articles published on the official Weibo social media account of the People’s Daily, military metaphors were second in importance only to terms directly describing COVID-19 itself. The purpose of these metaphors is clear: uniting the Chinese people and improving national morale in the “battle” against the coronavirus.

But the overuse of military metaphors can also bring about social problems. As Sontag notes in a later essay, “AIDS and Its Metaphors”, “Military metaphors contribute to the stigmatizing of certain illnesses and, by extension, of those who are ill.” The excessive use of military metaphors can lead people to see patients, as well as diseases and pathogens, as enemies who need to be isolated and “eliminated.” It can also lead to unnecessary levels of stress in society, as people grapple with the pressure of a protracted “war” against an illness or pathogen. This may negatively impact pandemic prevention work in the long term.

Source : Sixth Tone

14.9 million Excess Deaths Associated with the COVID-19 Pandemic in 2020 and 2021

New estimates from the World Health Organization (WHO) show that the full death toll associated directly or indirectly with the COVID-19 pandemic (described as “excess mortality”) between 1 January 2020 and 31 December 2021 was approximately 14.9 million (range 13.3 million to 16.6 million).

“These sobering data not only point to the impact of the pandemic but also to the need for all countries to invest in more resilient health systems that can sustain essential health services during crises, including stronger health information systems,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO is committed to working with all countries to strengthen their health information systems to generate better data for better decisions and better outcomes.”

Excess mortality is calculated as the difference between the number of deaths that have occurred and the number that would be expected in the absence of the pandemic based on data from earlier years.

Excess mortality includes deaths associated with COVID-19 directly (due to the disease) or indirectly (due to the pandemic’s impact on health systems and society). Deaths linked indirectly to COVID-19 are attributable to other health conditions for which people were unable to access prevention and treatment because health systems were overburdened by the pandemic. The estimated number of excess deaths can be influenced also by deaths averted during the pandemic due to lower risks of certain events, like motor-vehicle accidents or occupational injuries.

Most of the excess deaths (84%) are concentrated in South-East Asia, Europe, and the Americas. Some 68% of excess deaths are concentrated in just 10 countries globally. Middle-income countries account for 81% of the 14.9 million excess deaths (53% in lower-middle-income countries and 28% in upper-middle-income countries) over the 24-month period, with high-income and low-income countries each accounting for 15% and 4%, respectively.

The estimates for a 24-month period (2020 and 2021) include a breakdown of excess mortality by age and sex. They confirm that the global death toll was higher for men than for women (57% male, 43% female) and higher among older adults. The absolute count of the excess deaths is affected by the population size. The number of excess deaths per 100,000 gives a more objective picture of the pandemic than reported COVID-19 mortality data.

“Measurement of excess mortality is an essential component to understand the impact of the pandemic. Shifts in mortality trends provide decision-makers information to guide policies to reduce mortality and effectively prevent future crises. Because of limited investments in data systems in many countries, the true extent of excess mortality often remains hidden,” said Dr Samira Asma, Assistant Director-General for Data, Analytics and Delivery at WHO. “These new estimates use the best available data and have been produced using a robust methodology and a completely transparent approach.”

“Data is the foundation of our work every day to promote health, keep the world safe, and serve the vulnerable. We know where the data gaps are, and we must collectively intensify our support to countries, so that every country has the capability to track outbreaks in real-time, ensure delivery of essential health services, and safeguard population health,” said Dr Ibrahima Socé Fall, Assistant Director-General for Emergency Response.

The production of these estimates is a result of a global collaboration supported by the work of the Technical Advisory Group for COVID-19 Mortality Assessment and country consultations.

This group, convened jointly by the WHO and the United Nations Department of Economic and Social Affairs (UN DESA), consists of many of the world’s leading experts, who developed an innovative methodology to generate comparable mortality estimates even where data are incomplete or unavailable.

This methodology has been invaluable as many countries still lack capacity for reliable mortality surveillance and therefore do not collect and generate the data needed to calculate excess mortality. Using the publicly available methodology, countries can use their own data to generate or update their own estimates.

“The United Nations system is working together to deliver an authoritative assessment of the global toll of lives lost from the pandemic. This work is an important part of UN DESA’s ongoing collaboration with WHO and other partners to improve global mortality estimates,” said Mr Liu Zhenmin, United Nations Under-Secretary-General for Economic and Social Affairs.

Mr Stefan Schweinfest, Director of the Statistics Division of UN DESA, added: “Data deficiencies make it difficult to assess the true scope of a crisis, with serious consequences for people’s lives. The pandemic has been a stark reminder of the need for better coordination of data systems within countries and for increased international support for building better systems, including for the registration of deaths and other vital events.”

Source : WHO

How Will COVID End? Experts Look to Past Epidemics for Clues

Mike Stobbe wrote . . . . . . . . .

Two years into the COVID-19 pandemic, most of the world has seen a dramatic improvement in infections, hospitalizations and death rates in recent weeks, signaling the crisis appears to be winding down. But how will it end? Past epidemics may provide clues.

The ends of epidemics are not as thoroughly researched as their beginnings. But there are recurring themes that could offer lessons for the months ahead, said Erica Charters of the University of Oxford, who studies the issue.

“One thing we have learned is it’s a long, drawn-out process” that includes different types of endings that may not all occur at the same time, she said. That includes a “medical end,” when disease recedes, the “political end,” when government prevention measures cease, and the “social end,” when people move on.

The COVID-19 global pandemic has waxed and waned differently in different parts of the world. But in the United States, at least, there is reason to believe the end is near.

About 65% of Americans are fully vaccinated, and about 29% are both vaccinated and boosted. Cases have been falling for nearly two months, with the U.S. daily average dropping about 40% in the last week alone. Hospitalizations also have plummeted, down nearly 30%. Mask mandates are vanishing — even federal health officials have stopped wearing them — and President Joe Biden has said it’s time for people to return to offices and many aspects of pre-pandemic life.

But this pandemic has been full of surprises, lasting more than two years and causing nearly 1 million deaths in the U.S. and more than 6 million around the world. Its severity has been surprising, in part because many people drew the wrong lesson from a 2009-2010 flu pandemic that turned out to be nowhere as deadly as initially feared.

“We got all worried but then nothing happened (in 2009), and I think that was what the expectation was” when COVID-19 first emerged, said Kristin Heitman, a Maryland-based researcher who collaborated with Charters.

That said, some experts offered takeaways from past epidemics that may inform how the end of the COVID-19 pandemic may play out.


Before COVID-19, influenza was considered the most deadly pandemic agent. A 1918-1919 flu pandemic killed 50 million people around the world, including 675,000 in the U.S., historians estimate. Another flu pandemic in 1957-1958 killed an estimated 116,000 Americans, and another in 1968 killed 100,000 more.

A new flu in 2009 caused another pandemic, but one that turned out not to be particularly dangerous to the elderly — the group that tends to die the most from flu and its complications. Ultimately, fewer than 13,000 U.S. deaths were attributed to that pandemic.

The World Health Organization in August 2010 declared the flu had moved into a post-pandemic period, with cases and outbreaks moving into customary seasonal patterns.

In each case, the pandemics waned as time passed and the general population built immunity. They became the seasonal flu of subsequent years. That kind of pattern is probably what will happen with the coronavirus, too, experts say.

“It becomes normal,” said Matthew Ferrari, director of Penn State’s Center for Infectious Disease Dynamics. “There’s a regular, undulating pattern when there’s a time of year when there’s more cases, a time of year when there’s less cases. Something that’s going to look a lot like seasonal flu or the common cold.”


In 1981, U.S. health officials reported a cluster of cases of cancerous lesions and pneumonia in previously healthy gay men in California and New York. More and more cases began to appear, and by the next year officials were calling the disease AIDS, for acquired immune deficiency syndrome.

Researchers later determined it was caused by HIV — human immunodeficiency virus — which weakens a person’s immune system by destroying cells that fight disease and infection. For years, AIDS was considered a terrifying death sentence, and in 1994 it became the leading cause of death for Americans ages 25 to 44.

But treatments that became available in the 1990s turned it into a manageable chronic condition for most Americans. Attention shifted to Africa and other parts of the world, where it was not controlled and is still considered an ongoing emergency.

Pandemics don’t end with a disease ebbing uniformly across the globe, Charters said. “How a pandemic ends is generally by becoming multiple (regional) epidemics,” she said.


In 2015, Brazil suffered an outbreak of infections from Zika virus, spread by mosquitoes that tended to cause only mild illness in most adults and children. But it became a terror as it emerged that infection during pregnancy could cause a birth defect that affected brain development, causing babies to be born with unusually small heads.

By late that year, mosquitoes were spreading it in other Latin American countries, too. In 2016, the WHO declared it an international public health emergency, and a U.S. impact became clear. The Centers for Disease Control and Prevention received reports of 224 cases of Zika transmission by mosquitoes in the continental United States and more than 36,000 in U.S. territories — the vast majority in Puerto Rico.

But the counts fell dramatically in 2017 and virtually disappeared shortly after, at least in the U.S. Experts believe the epidemic died as people developed immunity. “It just sort of burned out” and the pressure for making a Zika vaccine available in the U.S. ebbed, said Dr. Denise Jamieson, a former CDC official who was a key leader in the agency’s responses to Zika.

It’s possible Zika will be a dormant problem for years but outbreaks could occur again if the virus mutates or if larger numbers of young people come along without immunity. With most epidemics, “there’s never a hard end,” said Jamieson, who is now chair of gynecology and obstetrics at Emory University’s medical school.


The Geneva-based WHO declared COVID-19 a pandemic on March 11, 2020, and it will decide when enough countries have seen a sufficient decline in cases — or, at least, in hospitalizations and deaths — to say the international health emergency is over.

The WHO has not yet announced target thresholds. But officials this week responded to questions about the possible end of the pandemic by noting how much more needs to be accomplished before the world can turn the page.

COVID-19 cases are waning in the U.S., and dropped globally in the last week by 5%. But cases are rising in some places, including the United Kingdom, New Zealand and Hong Kong.

People in many countries need vaccines and medications, said Dr. Carissa Etienne, director of the Pan American Health Organization, which is part of the WHO.

In Latin America and the Caribbean alone, more than 248 million people have not yet had their first dose of COVID-19 vaccine, Etienne said during a press briefing with reporters. Countries with low vaccination rates likely will see future increases in illnesses, hospitalizations and deaths, she said.

“We are not yet out of this pandemic,” said Dr. Ciro Ugarte, PAHO’s director of health emergencies. “We still need to approach this pandemic with a lot of caution.”

Source : AP

Bill Gates Says COVID Risks Have ‘Dramatically Reduced’ But Another Pandemic Is Coming

Karen Gilchrist wrote . . . . . . . . .

Speaking to CNBC’s Hadley Gamble at Germany’s annual Munich Security Conference, Gates, co-chair of the Bill & Melinda Gates Foundation, said that a potential new pandemic would likely stem from a different pathogen to that of the coronavirus family.

But he added that advances in medical technology should help the world do a better job of fighting it — if investments are made now.

“We’ll have another pandemic. It will be a different pathogen next time,” Gates said.

Two years into the coronavirus pandemic, Gates said the worst effects have faded as huge swathes of the global population have gained some level of immunity. Its severity has also waned with the latest omicron variant.

Is it possible to prevent the next pandemic? If every country does what Australia did, says Bill Gates
However, Gates said that in many places that was due to virus itself, which creates a level of immunity, and has “done a better job of getting out to the world population than we have with vaccines.”

“The chance of severe disease, which is mainly associated with being elderly and having obesity or diabetes, those risks are now dramatically reduced because of that infection exposure,” he said.

Gates said it was already “too late” to reach the World Health Organization’s goal to vaccinate 70% of the global population by mid-2022. Currently 61.9% of the world population has received at least one dose of a Covid-19 vaccine.

He added that the world should move faster in the future to develop and distribute vaccines, calling on governments to invest now.

“Next time we should try and make it, instead of two years, we should make it more like six months,” Gates said, adding that standardized platforms, including messenger RNA (mRNA) technology, would make that possible.

“The cost of being ready for the next pandemic is not that large. It’s not like climate change. If we’re rational, yes, the next time we’ll catch it early.”

Gates, through the Bill & Melinda Gates Foundation, has partnered with the U.K.’s Wellcome Trust to donate $300 million to the Coalition for Epidemic Preparedness Innovations, which helped form the Covax program to deliver vaccines to low- and middle-income countries.

The CEPI is aiming to raise $3.5 billion in an effort cut the time required to develop a new vaccine to just 100 days.

Source : MSN

Chart: Major Global Pandemic with at least 100,000 Estimated Deaths

Surprise! The Pandemic Has Made People More Science Literate

Max G. Levy wrote . . . . . . . . .

For three generations, Betsy Sneller’s family has sipped something they call “Cold Drink.” It’s a sweet mix of leftover liquids, stuff like orange juice and the remnants from cans of fruit, a concept devised by Sneller’s grandmother during the Great Depression. “All the little dregs get mixed together, and it tastes like a fruity concoction,” Sneller says. Cold Drink is an idea—and a name—born from crisis.

Sneller is now a sociolinguist at Michigan State University who studies how language changes in real time. For nearly two years, Sneller has analyzed weekly audio diaries from Michiganders to understand how the pandemic has influenced language in people of all ages, a project initially called MI COVID Diaries. “We find very commonly that people will come up with terms to reflect the social realities that they’re living through,” they say. “New words were coming up almost every week.” As Covid-19 sank its spikes into daily life, people added words and phrases to their vocabularies. Flatten the curve. Antibodies. Covidiots. “Shared crises, like the coronavirus pandemic, cause these astronomical leaps in language change,” Sneller says.

But Sneller has also noticed a more substantive trend emerging: People are internalizing, using, and remembering valuable scientific information. “Because the nature of this crisis is so science-oriented, we’re seeing that a broad swath of people are becoming a little bit more literate in infectious diseases,” they say.

Alright, alright, but there’s an elephant in this room. Misinformation and disinformation are undeniably eroding trust in institutions, including health authorities and news media. Conspiracy theories are shaping public health discourse, pushing ineffective and even dangerous treatments, and poisoning efforts to implement evidence-based policies like masking and vaccination. “It’s worrisome,” says Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania. “In a pandemic, it doesn’t take a high percent of the population holding misbeliefs to have behavioral effects that affect the communities at large.”

But this does not tell the whole story of science literacy over the past year, she feels. Not only are people increasing their scientific vocabularies, but they are learning important concepts from biology and public health. Students are showing more interest in the roles of scientists and health workers. The messy trial-and-error of the pandemic is showing nonscientists what the process of science really looks like—and we may all be better off for it. “We had an opportunity during the pandemic to increase science knowledge,” says Jamieson. “And in fact, it produced science knowledge. That’s good news—not bad.”

WHEN A HEALTH crisis strikes, people tend to get better at learning how to stay healthy. “We do perhaps become overall more sophisticated about what’s a risk and what to avoid,” says Allan Brandt, who teaches the history of medicine and public health at Harvard and has studied the HIV/AIDS epidemic and the tobacco industry’s misinformation campaigns about the risks of smoking.

Experts like Brandt are interested in how these crises coincide with the rise of scientific approaches to social problems. Scientific literacy—the degree to which communities understand salient concepts in science—plays an essential role in that. Understanding the link between fossil fuels and pollution, or simply knowing how to read a drug label, can improve someone’s health. And when people understand the relevant science, they become more likely to support science funding, or accept community health measures. (“Belief shapes action,” says Jamieson.)

But science—especially new science—routinely faces pushback. Early in the AIDS epidemic, scientists discovered HIV, the virus that causes the disease. “There were people here in the United States, all around the world, who said, ‘Well, I know that they identified this virus, and they’re saying it causes AIDS, but I don’t believe that’s true,’” says Brandt.

“It’s not surprising,” he continues. “In pandemics, there’s always these kinds of debates. But very quickly people did become convinced.”

Although it may feel like Covid-19 has plagued us forever, in reality scientists are only two years into the twin processes of understanding the disease and educating the public about it. Jamieson’s team at the Annenberg Public Policy Center has conducted surveys on scientific knowledge throughout the pandemic. They have asked participants for their thoughts on the effectiveness of vaccines, masks, and other behaviors. And, despite the maelstrom of misbeliefs working against knowledge, Jamieson finds that people are in fact learning. In two surveys of about 800 random Americans taken in July and November of 2020, the majority of respondents said they accepted that wearing masks helps prevent the spread of respiratory disease. That number jumped from 79 to 85 percent over the five-month period. In a separate survey from March and April of this year, 75 percent said that getting the Covid-19 vaccine is safer than getting the virus. “Most people are getting the answers right,” Jamieson says. “And they didn’t have any of those answers before Covid because these answers are Covid-specific.”

Still, that’s not 100 percent. But to Jamieson, it’s a surprising number worth celebrating. “People don’t just accept new vaccines,” she says. “If they did, we’d have higher uptake of the HPV vaccine. We’d have higher uptake of the flu vaccine. That’s a sign that they learned something.”

Vaccine-hesitant participants in Jamieson’s study showed that they learned something new about public health, too. The 2021 survey took place after the Pfizer and Moderna vaccines received emergency use authorization from the FDA, but before the Pfizer shot had received full approval. “People said to us, ‘It hasn’t been authorized yet. No, wait a minute! I didn’t mean that. It hasn’t been approved yet,’” says Jamieson. “They now know something about the approval process and the authorization process.”

This exposure to new terminology has kept Sneller intrigued with the linguistics project. “One thing that strikes me is how scientifically literate especially our teenage participants are about things like mRNA vaccines,” Sneller says. In their weekly audio diaries, participants talk about their day-to-day lives, and some teens talk about mRNA vaccines and how they differ from other formulations. That is cutting-edge science, not something that’s long been a part of schools’ curriculums. “That’s happening directly because of the pandemic,” Sneller says.

Young kids are learning more health science, too. Early in the pandemic, researchers surveyed kids aged 7 to 12 from the United Kingdom, Sweden, Brazil, Spain, Canada, and Australia. The team created an online survey to ask kids and their parents what they knew about the outbreak—and what they wanted to know. “Really early on, kids were saying, ‘When will a vaccine be available?’” says Lucy Bray, a pediatric nurse and professor of children’s health literacy at Edge Hill University in the UK, who led the study. The kids asked why the pandemic started. They asked if their family would be safe. “Really sensible, quite informed questions,” she says.

Bray published the results this year, taking the title from one of the children’s responses: “People play it down and tell me it can’t kill people, but I know people are dying each day.” Her study found that many children knew that the virus is dangerous and spreads quickly, despite their parents shielding them from death rates. (Danger and contagiousness were the two most frequent responses, each appearing over 20 percent of the time.) “Parents became a huge filter for whatever information these children received,” says Bray. But kids could overhear conversations, or catch headlines. “Children are really really good at piecing together bits of snippets of information.”

The fact that kids of all ages are learning more about biology, immunology, and public health is not trivial. “What I hope is an upside of all this science is that we will change the workforce,” says Susanne Haga, a geneticist who studies bioethics and health education at the Duke University School of Medicine, and who wrote an article in May 2020 predicting such a change. The pandemic has exposed young people to lesser-known career paths, such as virology, epidemiology, and biological engineering. “There’s lots and lots of interesting jobs—jobs where there really is a dearth of specialists—that they might pursue. And that would be fantastic,” Haga says.

According to the Association of American Medical Colleges, over the past decade the number of applications to medical schools rose less than 3 percent per year. But in the 2020-2021 cycle, applications were up 18 percent. Some top schools saw over 50 percent more applications. (Bray has also published pictures drawn by children during the pandemic from her study. Many depicted admiration of health care workers and scientists.)

Many experts think the pandemic also introduced people to the role of public health workers in society—not just doctors and nurses but sanitarians, lab technicians, epidemiologists, and others. “Back when I was in graduate school, we had this exercise in a health education class where you had to go around and pick 10 people out of your social network and ask them what public health was,” says Cynthia Baur, an expert in health literacy with the University of Maryland. “And the answer always was: ‘People don’t know what public health is.’”

America’s public health sector is chronically underfunded. Even before the pandemic, a forum of public experts determined that a $4.5 billion annual funding boost from Congress, state, and local governments would be required to support “core capabilities,” such as threat monitoring, education, and hazard preparedness. Between 2010 and 2020, the public health workforce shrank by about 56,000 people—and in 2020 state health officials estimated that 25 percent are eligible to retire. “My impression is people have learned more about what public health is,” says Baur. “Whether or not that has given them a favorable impression—that’s a different matter.”

Everyone who is paying attention to the pandemic is seeing the complexities of medicine, virology, and public health, adds Haga. “Nothing is 100 percent absolute,” she says, referring to the inability of Covid-19 researchers to make quick, definitive predictions about what is still an unsettled science. Science lives in uncertainty, and appreciating that uncertainty is itself an element of literacy. After all, scientists and doctors are learning, too. They learned that we can relax with Lysol-ing our Cap’n Crunch boxes. They accepted that while not a panacea, masks unquestionably help prevent disease transmission. They built consensus (perhaps too slowly) that SARS-CoV-2 is airborne. Now, we’re seeing people monitoring data on how dangerous or contagious the new Omicron variant is, says Baur: “People should expect this information to change not just daily, but even hourly. That’s how fast the science is evolving.”

That is real science—warts and all. And whether we’re interested in science or not, “we’re getting a front seat to the way in which research and development works,” says Cary Funk, director of science and society research at the Pew Research Center. People seem to be paying attention. And Funk’s data reveals that the crash course has been frustrating for many of them. In September, her team published survey results that show mixed reactions to changes in public health guidance on things like masking and travel restrictions: 61 percent said the frequent changes “made sense,” 53 percent said it “confused” them, and 55 percent said it made them “wonder if public health officials were holding back important information.” (Respondents could select more than one statement.)

But Funk’s team has also found evidence of encouraging changes in the public’s science knowledge. In 2019, before the pandemic, they published a report called “What Americans Know About Science.” The survey measured people’s knowledge of certain facts; for example, 79 percent of respondents knew that “antibiotic resistance was a major concern of antibiotic overuse,” and 68 percent knew that “oil, natural gas, and coal are fossil fuels.”

But the team also wanted to find out something more philosophical—how well people grasp what science is. Back in 2019, 67 percent of respondents understood that scientific results are supposed to be “continually tested and updated over time”—that science is iterative. The researchers wondered: Would the pandemic change that?

This year, 71 percent of American respondents said they understand science to be iterative, according to Pew’s new data. That change seems small, but it’s real. Other indicators, such as whether people can identify a hypothesis, have not shown the same progress. That constant flux of science may have caused more people to understand what science really is: a process.

Funk’s work is ongoing, as are other efforts to track science’s role in society. “The center is going to keep its eye on how trust in scientists is changing over time,” she says. Despite increased partisanship and extremism in the U.S., Funk’s preliminary results in a recent survey suggest that trust in scientists has grown: A higher percentage of American adults have a “great deal” of trust in scientists now than before the pandemic. (The boost seems to be primarily driven by Democrats, since the political divide in responses has actually gotten larger.) “Overall, the American public has increased levels of confidence in scientists to act in the public interest,” she says.

And Jamieson’s results suggest the same story. About 77 percent of Americans surveyed by Annenberg in June were confident that the FDA provides trustworthy information, up from 71 percent in August 2020. Responses for the CDC remained flat, but high, at around 76 percent. “Despite the amount of misinformation and deliberate deception,” she says, “confidence overall in the agencies that communicate health science—CDC, FDA, NIH, and Anthony Fauci—has remained surprisingly high.”

The researchers are not sure how much of this learning will stick. It’s just too hard to answer while we’re still knee-deep in crisis. For Sneller, the most consistent lesson to emerge from the diaries project is how adaptable young people are. “Both in terms of their understanding of the pandemic, their scientific literacy—but also in terms of general resilience,” Sneller says of their spirit during difficult times.

And, in a way, researchers measuring scientific literacy are trying to understand resilience too. The resilience of science against unprecedented threats to health. The resilience of trust—in institutions and in each other. The resilience of facts in a crisis.

Source : WIRED

Chart: The Swiss Cheese Model of Respiratory Pandemic Defense

See large image . . . . . .

Source : The New York Times

Pandemic Lessons From the Era of ‘Les Miserables’

Feargus O’Sullivan wrote . . . . . . . . .

Following disease outbreaks in the 19th century, Paris reimagined its streets, building the wide boulevards that the city is known for today.

When cholera first arrived in Paris in March 1832, some refused to let it affect their social lives.

The German poet Heinrich Heine, then living in the city, describes a masked ball held just as the first cases were announced, at which revelers danced the chahut, the high-kicking dance that later evolved into the Can-Can. Suddenly hit by shivering cold, one dancer dressed as a harlequin removed his mask, and struck horror into the crowd: his face had turned violet. This was a sign of the so-called “blue death,” caused by extreme dehydration as cholera bacteria spread in the small intestine. Some laughed and assumed it was face paint, but soon other dancers fell ill around him and were rushed to hospital. They died so quickly that some were buried still wearing the costumes they were dancing in just hours before.

Heine’s description, written for a German newspaper, may have been embroidered hearsay, but the terror that cholera struck in Parisians — and the speed at which it spread — were nonetheless real enough. The disease had arrived in Europe, says Ed Cohen, author of “A Body Worth Defending : Immunity, Biopolitics, and the Apotheosis of the Modern Body” as a form of “colonial blowback” from India. It was part of a global pandemic spread along trade routes between European states and the growing network of colonial possessions they were seizing in South Asia, where cholera was endemic.

It likely came via Britain to Paris, where during 169 days of public health crisis, it killed 18,500 people, or roughly 2% of the city’s population, including French Prime Minister Casimir Pierre Périer. Delivering a swift, grisly death to around half of those who contracted it, cholera also brought Paris’ economy to a standstill. Anyone who could, fled, while those who remained sometimes adopted elaborate (and, it turned out, futile) protective costumes to stave off infection. The strain of the epidemic even catalyzed a small insurrection against France’s new constitutional monarchy, where a small band of rebels clashed with troops in Paris’ most cholera-stricken districts, an event later remembered in the climactic scene of Victor Hugo’s Les Miserables.

A Plan for Rebirth

This acute shock has uncomfortable echoes of today’s pandemic, much like Amsterdam’s experience of bubonic plague in the 17th century. It is what happened afterwards, however, that might be most relevant today. Paris’ cholera epidemic may have hit hard, but, as a new study exploring the city’s post-pandemic housing market shows, it was followed by a swift economic recovery. Housing prices did drop sharply during the pandemic itself, the study by Marc Francke of Amsterdam Business School and Matthijs Korevaar of Rotterdam’s Erasmus School of Economics notes. But by 1836, four years after the pandemic hit, property price growth in cholera-hit areas regained parity with areas that had been largely spared.

As in 17th century Amsterdam, one reason for this recovery was the metropolis’ magnetic draw, which saw migrants fleeing penury in the French countryside prepared to take health risks to access Paris’ economic opportunities. The study also highlights another vital factor in the recovery. The pandemic sparked a major rethink of how Paris should be planned and built.

From an irregular city of narrow medieval lanes — hard to clean and easy to block and barricade by discontents such as the rebels of 1832 — Paris was reimagined as a place of wide, regular avenues and boulevards, re-plotted to ease flows of citizens, of traffic, of soldiers and police, of garbage and of sewage. In doing so, Paris became a template emulated across the world: the quintessential example of how health crises that shake cities to their core can ultimately provoke a vigorous rebirth.

A New Geography of Death

This transformation of Paris stems partly from the perplexity of medical researchers seeking to find patterns in the aftermath of the cholera pandemic. An official commission appointed by the government that looked at data on who had died and where noticed that the disease’s spread seemed to have ignored many of the factors then widely believed to influence contagion and mortality. Mapped across the Paris street plan, there was no apparent co-relation between the death toll and the age or sex of victims.

Deaths did not — as assumptions dating back as far as Hippocrates might have anticipated — cluster in places of either high or low elevation, or where conditions were notably hotter, colder or damper than average. Ignoring both physical boundaries such as ridges and political boundaries such as boroughs, the official report noted, cholera seemed to be selective striking “only one quartier of an arrondissement in four, and in this quartier only some streets and in these streets only some houses.” So what was behind it?

A secondary set of metrics made things much clearer. Here, the researchers looked at population density, where certain professions lived, whether prisons or barracks were nearby, and crucially, whether or not the housing was “insalubrious.” The co-relations between these factors and higher death rates were striking: Cholera may not have been acting the way they had expected an infectious disease to, but it was clearly hitting the poor and badly housed. In one notoriously crowded street near Paris’ City Hall, there were 304 fatalities alone. “Wherever a wretched population found itself encumbered in dirty, cramped lodgings” the researchers concluded, “there also the epidemic multiplied its victims.”

This linkage of poverty and mortality was, of course, not entirely new. The researchers’ data did nonetheless spark a new interest in urban planning as a sanitary measure that, while it did not yet grasp the true cause of cholera (bacteria passed via contaminated drinking water), did likely improve public health.

Already by 1833, the city had started work that expanded its sewers by 14 kilometers — a small amount that nonetheless increased the network overall by a third. This redevelopment accelerated under the influence of the Count de Rambuteau, who that year became the city’s prefect, the predecessor office to the current mayoralty. Promising to give Parisians “water, air and shade” Rambuteau greatly multiplied the number of drinking fountains, switched oil-fueled street lamps for gas, and initiated a replanning of the city that he hoped would widen streets and transform the urban map.

Sweeping the Map Clean

This drive was arguably as political as it was sanitary. In the years between 1801 and 1831, Paris’ population had increased by almost a third. Without a physical expansion of the city, this meant that impoverished Parisians packed its core at ever higher densities. Paris’ (and France’s) rulers had also changed three times during the period, with a revolution establishing France as a constitutional monarchy in 1830. This conflict had seen groups within the Parisian elite harness the insurrectionary power of this newly expanded population to further their own ends. Some in the winning camp worried that, now that the bottle was uncorked, the same forces might in turn ultimately topple them.

A desire to rid Paris of dingy, insanitary corners was thus not solely powered by a drive against cholera, but also by fear of the ever-growing mass of people who inhabited the places where the disease appeared to thrive. “It has been impossible for the commission not to believe that there exists a certain type of population,” read the 1834 post-pandemic report, “which, like a certain kind of place, favors the development of cholera, rendering it more intense and its effects more deadly.”

These poorer, disease-prone Parisians were thus seen by the authorities as not solely the most likely victims of the disease, but also as sort of potential infectious agent that could erupt to cause chaos and even threaten the body politic. Reconstruction in inner Paris would thus initiate a long, slow process of low income displacement, in which poorer Parisians shifted away from the city’s heart, where its main institutions were located, to peripheral, slightly less dense neighborhoods such as Belleville, then later on to today’s suburbs.

Despite Prefect Rambuteau’s zeal, this drive to open up Paris initially stalled, largely because of landlord resistance. The city did demolish a narrowly planned, densely built section on the Seine’s right bank where cholera hit particularly hard, replacing it with today’s Rue Rambuteau, a broad street linking the Marais district with the city’s main produce market at Les Halles. On the left bank the city also got the Rue Soufflot, which used demolition and reconstruction to create a now famously photogenic vista in front of the Panthéon.

Initially, that’s as far as things went, as the authorities found their redevelopment plans stymied by a lack of firm expropriation laws, and a court system primarily sympathetic to appeals by landlords. It was still possible in 1845 for socialist Victor Considerant to call Paris “a vast workshop for putrefaction, where poverty, plague and illnesses work in concert, where light and air scarcely penetrate.”

Considerant wasn’t entirely wrong: In 1849, Cholera struck Paris again, killing marginally more people than it had in 1832. But even while it proved just as deadly, Paris’ next pandemic did serve to validate Rambuteau’s efforts. In the areas he had demolished on the right bank, as Francke and Korevaar’s study notes, death rates were notably lower than they had been during the previous pandemic.

This success, along with a more muscular approach to expropriation, helped to power the next, considerably more effective replanning of Paris in the 1850s under Baron Haussmann, which finally and definitively created the architecturally uniform Paris of concentric boulevards and axial avenues, of yellow limestone, wrought iron and austerely pruned trees we know today. This can hardly be deemed an architecture of fear, but somewhere in its roots still lurks the shock of a sickly, bluish face at a ball.

The Perils of Inaction

In a period when many cities are starting to emerge from another pandemic, Paris’ swift recovery might be encouraging. Included toward the end of Francke and Korevaar’s study, however, is an acknowledgement that Paris’ revival was not necessarily an automatic reflex. This is borne out by the example of London, the study notes, which experienced a localized and much smaller cholera outbreak in 1854.

This outbreak has since become legendary, because its exploration by epidemiologist John Snow succeeded in pinpointing cholera’s transmission via fecally contaminated water: Snow managed to trace back cases in the Soho neighborhood to a single faulty water pump. But while the investigation of London’s outbreak advanced medical knowledge, a paper published last year found that it did little to improve conditions in the affected area, largely due to official inaction. While London in general made great leaps in sanitation and housing conditions in the later 19th century, Soho itself gained no notably improved infrastructure. Its poor reputation ever more entrenched following the crisis, Soho’s rents dropped further and its courtyards and alleys retained a reputation for poverty and criminality well into the 1960s.

Paris’ example may suggest that thinking hard in the aftermath of a public health crisis can see cities thrive. Just across the channel, however, the experience of Victorian Soho is a warning of the stagnation that can linger in the absence of meaningful action.

Source : Bloomberg