In our Corner series, we now dig into this important subject: Is my probability of getting infected with the COVID-19 virus higher in an airliner cabin than in other places?
We look at simulations of how the virus travels when we breathe/cough and how the virus load propagates in an airliner cabin. Then we talk about infection probabilities compared with other environments.
Lindsey Burke and Jonathan Butcher:
The U.S. Department of Education opened its doors on May 4, 1980. Forty years after its establishment, academic achievement remains largely unimproved, and gaps in achievement outcomes between low-income children and their higher-income peers persist. Elevating education to Cabinet-level status has not led to education excellence; rather, it has codified education decision making in Washington among government officials who have less knowledge than state and local school leaders of the needs of local schools. Devolving the department and housing remaining programs at other agencies can make space for a return to education subsidiarity, enabling local actors to determine which policies meet local needs. Remaining federal involvement should focus primarily on gathering education statistics. In the spirit of the “Education at a Crossroads” report published in 1998, this Backgrounder maps out a plan for eliminating the agency and restoring state, local, and parental control of education.
“The promise of bringing medical recordkeeping into the digital age was to maintain a live record of a live patient, enabling clinicians to track patient care across hospital systems and over time. Instead, we’ve been saddled with systems that cut into patient care (clinicians typically spend an hour feeding documentation into a computer for every hour they spend with patients) and, often, are too fragmented to allow a patient’s file to follow her from one medical center to another. The E.M.R., as a colleague of mine put it, is “electronic in the same sense that your grandfather’s radio is electronic.” The energized, improvisatory role of medical Twitter inevitably draws attention to what our balky, billion-dollar systems should have been providing—to the cost, in dollars and lives, of the rapid clinical learning that we’ve forgone.
It’s hardly news that our E.M.R. systems have failed medicine, and yet an executive order from New York State, issued at the end of March by Governor Andrew Cuomo, amounted to a grim epitaph: “Health care providers are relieved of recordkeeping requirements to the extent necessary for health care providers to perform tasks as may be necessary to respond to the covid-19 outbreak. . . . Any person acting reasonably and in good faith under this provision shall be afforded absolute immunity from liability.” A system designed to expedite and improve the delivery of health care was officially recognized as an obstacle.
“When the tide goes out,” Warren Buffett once said, “you discover who has been swimming naked.” The pandemic has been merciless in what it has exposed. In many cases, the weaknesses in our medical system were ones that had already been the subject of widespread attention, such as the national scandal of health-care coverage that leaves millions of Americans uninsured. In others, they shouldhave been the subject of widespread attention, because we had plenty of warning. Again and again, in the past several weeks, we’ve heard of shortages—shortages of protective gear, of ventilators, of pharmaceuticals. Yet, even before the crisis, medicine was dealing with troubling scarcities of needed drugs and support systems. Last summer, long before the pandemic, pulmonologists were raising concerns about a lack of oxygen supplies—the result of cost-cutting measures by suppliers of durable medical equipment. Competitive-bidding programs drove margins down so low that more than forty per cent of such companies—responsible for the supply of portable oxygen tanks and concentrators—went out of business. Inventory diminished; delivery times increased. Patients suffered. Neeta Thakur, a pulmonologist and researcher at the University of California in San Francisco, told me about the byzantine process (involving “ten to fifteen disconnected steps”) that was required in order for a patient to receive oxygen at home—a patient who is then at the mercy of the intermittent delivery schedules of understocked venders. The problem builds into a failure cascade: if patients cannot be discharged from the hospital because they cannot have oxygen at home, the resultant logjam delays the treatment of other patients who need those beds for acute care.”
Yet, taxpayers have spent $38B+ (!) on back door electronic medical record subsidies since 2011…..
“My problem with contact tracing apps is that they have absolutely no value,” Bruce Schneier, a privacy expert and fellow at the Berkman Klein Center for Internet & Society at Harvard University, told BuzzFeed News. “I’m not even talking about the privacy concerns, I mean the efficacy. Does anybody think this will do something useful? … This is just something governments want to do for the hell of it. To me, it’s just techies doing techie things because they don’t know what else to do.”
I haven’t blogged about this because I thought it was obvious. But from the tweets and emails I have received, it seems not.
This is a classic identification problem, and efficacy depends on two things: false positives and false negatives.
Assume you take the app out grocery shopping with you and it subsequently alerts you of a contact. What should you do? It’s not accurate enough for you to quarantine yourself for two weeks. And without ubiquitous, cheap, fast, and accurate testing, you can’t confirm the app’s diagnosis. So the alert is useless.
Similarly, assume you take the app out grocery shopping and it doesn’t alert you of any contact. Are you in the clear? No, you’re not. You actually have no idea if you’ve been infected.
In the spring of 1822 an employee in one of the world’s first offices – that of the East India Company in London – sat down to write a letter to a friend. If the man was excited to be working in a building that was revolutionary, or thrilled to be part of a novel institution which would transform the world in the centuries that followed, he showed little sign of it. “You don’t know how wearisome it is”, wrote Charles Lamb, “to breathe the air of four pent walls, without relief, day after day, all the golden hours of the day between ten and four.” His letter grew ever-less enthusiastic, as he wished for “a few years between the grave and the desk”. No matter, he concluded, “they are the same.”
The world that Lamb wrote from is now long gone. The infamous East India Company collapsed in ignominy in the 1850s. Its most famous legacy, British colonial rule in India, disintegrated a century later. But his letter resonates today, because, while other empires have fallen, the empire of the office has triumphed over modern professional life.
The dimensions of this empire are awesome. Its population runs into hundreds of millions, drawn from every nation on Earth. It dominates the skylines of our cities – their tallest buildings are no longer cathedrals or temples but multi-storey vats filled with workers. It delineates much of our lives. If you are a hardworking citizen of this empire you will spend more waking hours with the irritating colleague to your left whose spare shoes invade your footwell than with your husband or wife, lover or children.
Or rather you used to. This spring, almost overnight, the world’s offices emptied. In New York and Paris, in Madrid and Milan, they ready themselves for commuters who never come. Empty lifts slide up and down announcing floor numbers to empty vestibules; water coolers hum and gurgle, cooling water that no one will drink. For the moment, office life is over.
Even before coronavirus struck, the reign of the office had started to look a little shaky. A combination of rising rents, the digital revolution and increased demands for flexible working meant its population was slowly emigrating to different milieux. More than half of the American workforce already worked remotely, at least some of the time. Across the world, home working had been rising steadily for a decade. Pundits predicted that it would increase further. No one imagined that a dramatic spike would come so soon.
You can argue that the openness of the web has been dying for the past decade. For the web, death comes in the form of a centralization of control and power, and arbitrary authoritarian changes made for the “greater good.”
The current state of our fear for the safety of public health has created the perfect event to push the pendulum out of balance.
Let there be no mistake in our minds, the actions that my fellow technologists, and associated companies, are taking, and pushing, are things that society as a whole will feel in the not so distant future.
The scariest part for me is that as a technologists, I have seen first hand what an organization can do with unfettered access to data, when the checks and balances are lost, when we believe we are the ones capable of dictating what is good for society, on their behalf, without choice, and what a little power can do to any person.
What further amplifies the concern is that it is not government that is driving this “big brother” state of affairs, its big tech. These are entities that are not elected officials, but corporations that transcend physical and logical boundaries. They have the ability to influence what you see, what you think, and they have the ability to choose sides.
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This was not a case of individuals selling snake oil. They were sharing their observations, and opinions. Right or wrong, is not the point. It’s the process of normal debate and discourse. They were also seasoned medical professionals.
Shortly after its release, it was removed from the platform. Because it didn’t conform to the guidance from the World Health Organization (WHO). Say what?
It seems a far stretch to remove their content simply because it doesn’t conform to WHO, and goes contrary to spirt of the examples Susan provided. In essence, YouTube is saying you are not allowed to disagree with WHO, at all; do so, and your content will be removed. But what if they are wrong? Are we not allowed to question that?
Once it’s demonstrated that a company has this level of power, how, who, draws the distinction between what government policies they conform with, and which you don’t? What happens when society as a whole disagrees? How do you say yes to state government, but not Federal? How do you tell China, Cuba, North Korea they are wrong for their censorship when we do the same thing?
Craig Timberg, Drew Harwell and Alauna Safarpour:
A major source of skepticism about the infection-tracing apps is distrust of Google, Apple and tech companies generally, with a majority expressing doubts about whether they would protect the privacy of health data. A 57 percent majority of smartphone users report having a “great deal” or a “good amount” of trust in public health agencies, and 56 percent trust universities. That compares with 47 percent who trust health insurance companies and 43 percent who trust tech companies like Google and Apple.
“I don’t feel like they have a good track record of taking care of people’s privacy and data. And I don’t want to give them more if I don’t trust them,” said Brent Weight, 43, a Republican-leaning independent voter who runs a small trucking company in Rigby, Idaho. “Seems like every other day you’re hearing of a data breach in a big company, and they’re losing credit card information and everything else. For them to just tell us it’s going to be safe and anonymized, I’m not going to take them at face value.”
Among Americans overall, 41 percent say they both have a smartphone and are willing to use an infection-tracking app, the poll finds. Oxford University researchers have suggested that 60 percent of a country’s population would need to use a coronavirus-tracking app like this to stop the viral spread. Reduced adoption could limit its effectiveness in slowing new infections and deaths.
Twenty biomedical companies. Seventy nations. An aggressive search for COVID-19 treatments and vaccines is underway worldwide. Yet even 21st-century technology can’t match one man who curbed a major influenza pandemic spreading across the United States in 1957.
Pioneering virologist Maurice Hilleman, now oft-forgotten, detected that pandemic from across the globe, convinced reluctant U.S. health officials to take notice, and single-handedly fostered a vaccine that became publicly available. All in just four months.
An irascible, no-holds-barred Montana farm boy born in the midst of the 1918-19 influenza pandemic, Hilleman survived diphtheria and Great Depression-era poverty to earn a PhD in microbiology and chemistry at the University of Chicago. Practical and impatient, he turned down the prestige of academia and primarily worked in industry, at the pharmaceutical company E. R. Squibb & Sons and later Merck & Co, where he led vaccine research for 25 years.
An iconoclast who slung swear words like the proverbial sailor, Hilleman helped develop an astounding 40 vaccines: to prevent measles, mumps, rubella, pneumonia, meningitis, hepatitis A and B, and other infectious diseases. The measles vaccine alone has saved an estimated one million lives a year. “Maurice’s genius was in developing vaccines, reliably reproducing them, and [taking charge] of all pharmaceutical facets, from research to marketplace,” biographer Paul A. Offit, MD, told the British Medical Journal for Hilleman’s obituary in 2005. The New York Times later noted that researchers credit him with “saving more lives than any other scientist in the 20th century.”
Saul J Weiner, Shiyuan Wang, Brendan Kelly, Gunjan Sharma, Alan Schwartz:
Accurate documentation in the medical record is essential for quality care; extensive documentation is required for reimbursement. At times, these 2 imperatives conflict. We explored the concordance of information documented in the medical record with a gold standard measure.
Materials and Methods
We compared 105 encounter notes to audio recordings covertly collected by unannounced standardized patients from 36 physicians, to identify discrepancies and estimate the reimbursement implications of billing the visit based on the note vs the care actually delivered.
Results
There were 636 documentation errors, including 181 charted findings that did not take place, and 455 findings that were not charted. Ninety percent of notes contained at least 1 error. In 21 instances, the note justified a higher billing level than the gold standard audio recording, and in 4, it underrepresented the level of service (P = .005), resulting in 40 level 4 notes instead of the 23 justified based on the audio, a 74% inflated misrepresentation.
$37,920,077,070 in Taxpayer Electronic Medical Record Subsidies: 2009 – January 2018
The Bloomberg viral ironies did not end there. During his campaign, his prior folk wisdom emerged in a series of embarrassing videos of past sermons. In one, he lectured an Oxford audience about the banality and rote of farming, ancient and modern, claiming that he “could teach anybody to be a farmer.” Information technology, Bloomberg insisted, required “a lot more gray matter.” During the lockdowns in Manhattan, the country did not need any more multibillionaires with brains full of “gray matter” capitalizing Chinese communist government companies, but instead needed innovative farmers—you could call them “anybodies”—to keep sending a sheltered-in-place America the most diverse, safe, plentiful, and cheap food in the world.
The apparently consensually led China touted by Bloomberg has lied about the birth, origins, spread, and infectiousness of covid-19; sent over one million of its citizens into U.S. airports after Beijing knew that the virus was communicable; had countless more circumvent U.S. restrictions; falsely declared that the U.S. military created the virus; threatened to cut off shipments of medical supplies produced in China by U.S.–Chinese joint ventures; and caused several thousand American deaths while causing trillions of dollars’ worth of economic damage.
Not having control of the supply of needed medical appurtenances and medicines may be the Boomers’ version of the Greatest Generation’s waking up on December 8, 1941, and realizing that there was nothing in the American arsenal comparable to the Japanese Mitsubishi A6M “Zero” fighter or Type 93 “Long Lance” torpedo—and would not be for the months of hard fighting and dying ahead. Likewise, Beijing now enjoys enormous advantages in the short term as it inventories all the ways the American military, government, and consumers are China-dependent. Whether China has woken a sleeping giant in the manner of the earlier Japanese, or just a purring kitten, remains to be seen. One test will be whether we begin to recalibrate key American industries or unleash Adam Schiff to conduct yet another congressional investigation against his nemesis Donald Trump.
Before the epidemic, critics of globalization could not convince our best and brightest that enriching autocracies by asymmetrical trade policies would not eventually turn China into Jackson Hole or Palm Beach. Doubters of America’s China policy complained that running up staggering American trade deficits with China would hardly lure China into the family of nations—at least in the manner of Barack Obama, who in 2014 once boasted that his new outreach initiatives with Beijing, inter alia, would “help affected countries to strengthen capacity-building on health and epidemic prevention so as to place the epidemic under control as soon as possible.” How has China’s envisioned “epidemic prevention” and “control” worked out?
So the virus confirmed what many Americans had long suspected at home as well. “Trump Derangement Syndrome” was no longer a Republican talking point, but was exposed as a psychosis with real consequences for the entire country. In the initial weeks of January, when Trump was told by the who, the Centers for Disease Control, Dr. Anthony Fauci, and most foreign and American leaders that the virus, like the earlier Chinese-born sars virus, was containable, the President, like they had at times, compared it to a bad flu. But by January 31 he had reversed course earlier than many of his future critics, rejected the earlier insistence of experts that xenophobia, racism, and chauvinism, and not the virus, were the real enemies, and issued travel restrictions—the one step that stopped some fifteen to twenty thousand Chinese nationals from arriving daily into the United States, including on direct flights from ground zero in Wuhan. Altogether over a million Chinese had arrived in October, November, December, and January. After the restrictions were enacted, many more found ways to enter the United States on connecting flights from non-embargoed nations in Europe and Asia.
No matter. House Speaker Nancy Pelosi claimed Trump’s response to the virus had been “deadly” and later added, “As the president fiddles, people are dying.” At about the same time, she tried to delay passage of a joint congressional bailout bill intended to keep endangered small business and the unemployed afloat as she scrambled to insert funding for the Kennedy Center and Planned Parenthood.