Life under covid has messed with our brains. Luckily, they were designed to bounce back.
Dana Smith – July 16, 2021
Orgies are back. Or at least that’s what advertisers want you to believe. One commercial for chewing gum—whose sales tanked during 2020 because who cares what your breath smells like when you’re wearing a mask—depicts the end of the pandemic as a raucous free-for-all with people embracing in the streets and making out in parks.
The reality is a little different. Americans are slowly coming out of the pandemic, but as they reemerge, there’s still a lot of trauma to process. It’s not just our families, our communities, and our jobs that have changed; our brains have changed too. We’re not the same people we were 18 months ago.
During the winter of 2020, more than 40% of Americans reported symptoms of anxiety or depression, double the rate of the previous year. That number dropped to 30% in June 2021 as vaccinations rose and covid-19 cases fell, but that still leaves nearly one in three Americans struggling with their mental health. In addition to diagnosable symptoms, plenty of people reported experiencing pandemic brain fog, including forgetfulness, difficulty concentrating, and general fuzziness.
Now the question is, can our brains change back? And how can we help them do that?
How stress affects the brain
Every experience changes your brain, either helping you to gain new synapses—the connections between brain cells—or causing you to lose them. This is known as neuroplasticity, and it’s how our brains develop through childhood and adolescence. Neuroplasticity is how we continue to learn and create memories in adulthood, too, although our brains become less flexible as we get older. The process is vital for learning, memory, and general healthy brain function.
But many experiences also cause the brain to lose cells and connections that you wanted or needed to keep. For instance, stress—something almost everyone experienced during the pandemic—can not only destroy existing synapses but also inhibit the growth of new ones.
One way stress does this is by triggering the release of hormones called glucocorticoids, most notably cortisol. In small doses, glucocorticoids help the brain and body respond to a stressor (think: fight or flight) by changing heart rate, respiration, inflammation, and more to increase one’s odds of survival. Once the stressor is gone, the hormone levels recede. With chronic stress, however, the stressor never goes away, and the brain remains flooded with the chemicals. In the long term, elevated levels of glucocorticoids can cause changes that may lead to depression, anxiety, forgetfulness, and inattention.
Scientists haven’t been able to directly study these types of physical brain changes during the pandemic, but they can make inferences from the many mental health surveys conducted over the last 18 months and what they know about stress and the brain from years of previous research.
For example, one study showed that people who experienced financial stressors, like a job loss or economic insecurity, during the pandemic were more likely to develop depression. One of the brain areas hardest hit by chronic stress is the hippocampus, which is important for both memory and mood. These financial stressors would have flooded the hippocampus with glucocorticoids for months, damaging cells, destroying synapses, and ultimately shrinking the region. A smaller hippocampus is one of the hallmarks of depression.
Chronic stress can also alter the prefrontal cortex, the brain’s executive control center, and the amygdala, the fear and anxiety hub. Too many glucocorticoids for too long can impair the connections both within the prefrontal cortex and between it and the amygdala. As a result, the prefrontal cortex loses its ability to control the amygdala, leaving the fear and anxiety center to run unchecked. This pattern of brain activity (too much action in the amygdala and not enough communication with the prefrontal cortex) is common in people who have post-traumatic stress disorder (PTSD), another condition that spiked during the pandemic, particularly among frontline health-care workers.
The social isolation brought on by the pandemic was also likely detrimental to the brain’s structure and function. Loneliness has been linked to reduced volume in the hippocampus and amygdala, as well as decreased connectivity in the prefrontal cortex. Perhaps unsurprisingly, people who lived alone during the pandemic experienced higher rates of depression and anxiety.
Finally, damage to these brain areas affects people not only emotionally but cognitively as well. Many psychologists have attributed pandemic brain fog to chronic stress’s impact on the prefrontal cortex, where it can impair concentration and working memory.
So that’s the bad news. The pandemic hit our brains hard. These negative changes ultimately come down to a stress-induced decrease in neuroplasticity—a loss of cells and synapses instead of the growth of new ones. But don’t despair; there’s some good news. For many people, the brain can spontaneously recover its plasticity once the stress goes away. If life begins to return to normal, so might our brains.
“In a lot of cases, the changes that occur with chronic stress actually abate over time,” says James Herman, a professor of psychiatry and behavioral neuroscience at the University of Cincinnati. “At the level of the brain, you can see a reversal of a lot of these negative effects.”
“If you create for yourself a more enriched environment where you have more possible inputs and interactions and stimuli, then [your brain] will respond to that.”
Rebecca Price, associate professor of psychiatry and psychology at the University of Pittsburgh
In other words, as your routine returns to its pre-pandemic state, your brain should too. The stress hormones will recede as vaccinations continue and the anxiety about dying from a new virus (or killing someone else) subsides. And as you venture out into the world again, all the little things that used to make you happy or challenged you in a good way will do so again, helping your brain to repair the lost connections that those behaviors had once built. For example, just as social isolation is bad for the brain, social interaction is especially good for it. People with larger social networks have more volume and connections in the prefrontal cortex, amygdala, and other brain regions.
Even if you don’t feel like socializing again just yet, maybe push yourself a little anyway. Don’t do anything that feels unsafe, but there is an aspect of “fake it till you make it” in treating some mental illness. In clinical speak, it’s called behavioral activation, which emphasizes getting out and doing things even if you don’t want to. At first, you might not experience the same feelings of joy or fun you used to get from going to a bar or a backyard barbecue, but if you stick with it, these activities will often start to feel easier and can help lift feelings of depression.
Rebecca Price, an associate professor of psychiatry and psychology at the University of Pittsburgh, says behavioral activation might work by enriching your environment, which scientists know leads to the growth of new brain cells, at least in animal models. “Your brain is going to react to the environment that you present to it, so if you are in a deprived, not-enriched environment because you’ve been stuck at home alone, that will probably cause some decreases in the pathways that are available,” she says. “If you create for yourself a more enriched environment where you have more possible inputs and interactions and stimuli, then [your brain] will respond to that.” So get off your couch and go check out a museum, a botanical garden, or an outdoor concert. Your brain will thank you.
Exercise can help too. Chronic stress depletes levels of an important chemical called brain-derived neurotrophic factor (BDNF), which helps promote neuroplasticity. Without BDNF, the brain is less able to repair or replace the cells and connections that are lost to chronic stress. Exercise increases levels of BDNF, especially in the hippocampus and prefrontal cortex, which at least partially explains why exercise can boost both cognition and mood.
Not only does BDNF help new synapses grow, but it may help produce new neurons in the hippocampus, too. For decades, scientists thought that neurogenesis in humans stopped after adolescence, but recent research has shown signs of neuron growth well into old age (though the issue is still hotly contested). Regardless of whether it works through neurogenesis or not, exercise has been shown time and again to improve people’s mood, attention, and cognition; some therapists even prescribe it to treat depression and anxiety. Time to get out there and start sweating.
Turn to treatment
There’s a lot of variation in how people’s brains recover from stress and trauma, and not everyone will bounce back from the pandemic so easily.
“Some people just seem to be more vulnerable to getting into a chronic state where they get stuck in something like depression or anxiety,” says Price. In these situations, therapy or medication might be required.
Some scientists now think that psychotherapy for depression and anxiety works at least in part by changing brain activity, and that getting the brain to fire in new patterns is a first step to getting it to wire in new patterns. A review paper that assessed psychotherapy for different anxiety disorders found that the treatment was most effective in people who displayed more activity in the prefrontal cortex after several weeks of therapy than they did beforehand—particularly when the area was exerting control over the brain’s fear center.
Other researchers are trying to change people’s brain activity using video games. Adam Gazzaley, a professor of neurology at the University of California, San Francisco, developed the first brain-training game to receive FDA approval for its ability to treat ADHD in kids. The game has also been shown to improve attention span in adults. What’s more, EEG studies revealed greater functional connectivity involving the prefrontal cortex, suggesting a boost in neuroplasticity in the region.
Now Gazzaley wants to use the game to treat people with pandemic brain fog. “We think in terms of covid recovery there’s an incredible opportunity here,” he says. “I believe that attention as a system can help across the breadth of [mental health] conditions and symptoms that people are suffering, especially due to covid.”
While the effects of brain-training games on mental health and neuroplasticity are still up for debate, there’s abundant evidence for the benefits of psychoactive medications. In 1996, psychiatrist Yvette Sheline, now a professor at the University of Pennsylvania, was the first to show that people with depression had significantly smaller hippocampi than non-depressed people, and that the size of that brain region was related to how long and how severely they had been depressed. Seven years later, she found that if people with depression took antidepressants, they had less volume loss in the region.
That discovery shifted many researchers’ perspectives on how traditional antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), help people with depression and anxiety. As their name suggests, SSRIs target the neurochemical serotonin, increasing its levels in synapses. Serotonin is involved in several basic bodily functions, including digestion and sleep. It also helps to regulate mood, and scientists long assumed that was how the drugs worked as antidepressants. However, recent research suggests that SSRIs may also have a neuroplastic effect by boosting BDNF, especially in the hippocampus, which could help restore healthy brain function in the area. One of the newest antidepressants approved in the US, ketamine, also appears to increase BDNF levels and promote synapse growth in the brain, providing additional support for the neuroplasticity theory.
The next frontier in pharmaceutical research for mental illness involves experimental psychedelics like MDMA and psilocybin, the active ingredient in hallucinogenic mushrooms. Some researchers think that these drugs also enhance plasticity in the brain and, when paired with psychotherapy, can be a powerful treatment.
Not all the changes to our brains from the past year are negative. Neuroscientist David Eagleman, author of the book Livewired: The Inside Story of the Ever-Changing Brain, says that some of those changes may actually have been beneficial. By forcing us out of our ruts and changing our routines, the pandemic may have caused our brains to stretch and grow in new ways.
“This past 14 months have been full of tons of stress, anxiety, depression—they’ve been really hard on everybody,” Eagleman says. “The tiny silver lining is from the point of view of brain plasticity, because we have challenged our brains to do new things and find new ways of doing things. If we hadn’t experienced 2020, we’d still have an old internal model of the world, and we wouldn’t have pushed our brains to make the changes they’ve already made. From a neuroscience point of view, this is most important thing you can do—constantly challenge it, build new pathways, find new ways of seeing the world.”
How to help your brain help itself
While everyone’s brain is different, try these activities to give your brain the best chance of recovering from the pandemic.
Try working out. Exercise increases levels of a protein called BDNF that helps promote neuroplasticity and may even contribute to the growth of new neurons.
Talk to a therapist. Therapy can help you view yourself from a different perspective, and changing your thought patterns can change your brain patterns.
Enrich your environment. Get out of your pandemic rut and stimulate your brain with a trip to the museum, a botanical garden, or an outdoor concert.
Take some drugs—but make sure they’re prescribed! Both classic antidepressant drugs, such as SSRIs, and more experimental ones like ketamine and psychedelics are thought to work in part by boosting neuroplasticity.
Strengthen your prefrontal cortex by exercising your self-control. If you don’t have access to an (FDA-approved) attention-boosting video game, meditation can have a similar benefit.
Jonathan R Goodman, The Conversation – 13 May 2021
A major debate during the pandemic, and in infectious disease research more broadly, is why infected people die. No virus “wants” to kill anyone, as an epidemiologist once said to me. Like any other form of life, a virus’s goal is only to survive and reproduce.
A growing body of evidence instead suggests that the human immune system – which the science writer Ed Yong says is “where intuition goes to die” – may itself be responsible for many people’s deaths.
In an effort to find and kill the invading virus, the body can harm major organs, including the lungs and heart. This has led some doctors to focus on attenuating an infected patient’s immune response to help save them.
This brings up an evolutionary puzzle: what’s the point of the immune system if its overzealousness can kill the same people it evolved to defend?
The answer may lie in humanity’s evolutionary history: immunity may be as much about communication and behavior as it is about cellular biology. And to the degree that researchers can understand these broad origins of the immune system, they may be better positioned to improve responses to it.
The concept of the behavioral immune system is not new. Almost all humans sometimes feel disgust or revulsion – usually because whatever has made us feel that way poses a threat to our health.
And we aren’t alone in these reactions. Research shows that some animals avoid others that are showing symptoms of illness.
However, more recent theoretical research suggests something more: humans, in particular, are likely to show compassion to those showing symptoms of illness or injury.
There’s a reason, this thinking goes, why people tend to exclaim when in pain, rather than just silently pull away from whatever is hurting them, and why fevers are linked to sluggish behavior.
Some psychologists argue that this is because immune responses are as much about communication as they are about self-maintenance. People who received care, over humanity’s history, probably tended to do better than those who tried to survive on their own.
In the broader evolutionary literature, researchers refer to these kinds of displays as “signals”. And like many of the innumerable signals we see across the natural world, immune-related signals can be used – or faked – to exploit the world around us, and each other.
We also see many illustrations of immune-signal use and misuse in human cultures. In The Adventure of the Dying Detective(1913), for example, Sherlock Holmes starves himself for three days to elicit a confession from a murder suspect. The suspect confesses only when he is convinced that his attempt to infect Holmes with a rare disease has been successful, misreading Holmes’s signs of illness.
This is an extreme example, but people feign signals of pain or illness all the time to avoid obligations, to elicit support from others, or even to avoid submitting an article by an agreed deadline. And this is an essential element of any signalling system.
Once a signal, be it a wince or a jaundiced complexion, elicits a response from whoever sees it, that response will start to drive how and why the signal is used.
Even germs use – and abuse – immune signals for their own gain. In fact, some virusesactually hijack our own immune responses, such as coughs and sneezes, to pass themselves on to new hosts, using our own evolved functions to further their interests.
Other germs, like SARS-CoV-2 (the virus that causes COVID-19) and Yersinia pestis (the bacterium that causes plague), can prevent our signalling to others when we are sick and pass themselves on without anyone realizing.
This perspective of immunity – one that takes into account biology, behavior and the social effects of illness – paints a starkly different picture from the more traditional view of the immune system as a collection of biological and chemical defenses against sickness.
Germs use different strategies, just as animals do, to exploit immune signals for their own purposes. And perhaps that’s what has made asymptomatically transmitted COVID-19 so damaging: people can’t rely on reading other people’s immune signals to protect themselves.
Insofar as doctors can predict how a particular infection – whether SARS-CoV-2, influenza, malaria or the next pathogen with pandemic potential – will interact with a patient’s immune system, they’ll be better positioned to tailor treatments for it. Future research will help us sort through the germs that hijack our immune signals – or suppress them – for their own purposes.
Viewing immunity not just as biological, but as a broader signalling system, may help us to understand our complex relationships with pathogens more effectively.
Our model reveals the true course of the pandemic. Here is what to do next
May 15th 2021 8-10 minutos
THIS WEEK we publish our estimate of the true death toll from covid-19. It tells the real story of the pandemic. But it also contains an urgent warning. Unless vaccine supplies reach poorer countries, the tragic scenes now unfolding in India risk being repeated elsewhere. Millions more will die.
Using known data on 121 variables, from recorded deaths to demography, we have built a pattern of correlations that lets us fill in gaps where numbers are lacking. Our model suggests that covid-19 has already claimed 7.1m-12.7m lives. Our central estimate is that 10m people have died who would otherwise be living. This tally of “excess deaths” is over three times the official count, which nevertheless is the basis for most statistics on the disease, including fatality rates and cross-country comparisons.
The most important insight from our work is that covid-19 has been harder on the poor than anyone knew. Official figures suggest that the pandemic has struck in waves, and that the United States and Europe have been hit hard. Although South America has been ravaged, the rest of the developing world seemed to get off lightly.
Our modelling tells another story. When you count all the bodies, you see that the pandemic has spread remorselessly from the rich, connected world to poorer, more isolated places. As it has done so, the global daily death rate has climbed steeply.
Death rates have been very high in some rich countries, but the overwhelming majority of the 6.7m or so deaths that nobody counted were in poor and middle-income ones. In Romania and Iran excess deaths are more than double the number officially put down to covid-19. In Egypt they are 13 times as big. In America the difference is 7.1%.
India, where about 20,000 are dying every day, is not an outlier. Our figures suggest that, in terms of deaths as a share of population, Peru’s pandemic has been 2.5 times worse than India’s. The disease is working its way through Nepal and Pakistan. Infectious variants spread faster and, because of the tyranny of exponential growth, overwhelm health-care systems and fill mortuaries even if the virus is no more lethal.
Ultimately the way to stop this is vaccination. As an example of collaboration and pioneering science, covid-19 vaccines rank with the Apollo space programme. Within just a year of the virus being discovered, people could be protected from severe disease and death. Hundreds of millions of them have benefited.
However, in the short run vaccines will fuel the divide between rich and poor. Soon, the only people to die from covid-19 in rich countries will be exceptionally frail or exceptionally unlucky, as well as those who have spurned the chance to be vaccinated. In poorer countries, by contrast, most people will have no choice. They will remain unprotected for many months or years.
The world cannot rest while people perish for want of a jab costing as little as $4 for a two-dose course. It is hard to think of a better use of resources than vaccination. Economists’ central estimate for the direct value of a course is $2,900—if you include factors like long covid and the effect of impaired education, the total is much bigger. The benefit from an extra 1bn doses supplied by July would be worth hundreds of billions of dollars. Less circulating virus means less mutation, and so a lower chance of a new variant that reinfects the vaccinated.
Supplies of vaccines are already growing. By the end of April, according to Airfinity, an analytics firm, vaccine-makers produced 1.7bn doses, 700m more than the end of March and ten times more than January. Before the pandemic, annual global vaccine capacity was roughly 3.5bn doses. The latest estimates are that total output in 2021 will be almost 11bn. Some in the industry predict a global surplus in 2022.
And yet the world is right to strive to get more doses in more arms sooner. Hence President Joe Biden has proposed waiving intellectual-property claims on covid-19 vaccines. Many experts argue that, because some manufacturing capacity is going begging, millions more doses might become available if patent-owners shared their secrets, including in countries that today are at the back of the queue. World-trade rules allow for a waiver. When invoke them if not in the throes of a pandemic?
We believe that Mr Biden is wrong. A waiver may signal that his administration cares about the world, but it is at best an empty gesture and at worst a cynical one.
A waiver will do nothing to fill the urgent shortfall of doses in 2021. The head of the World Trade Organisation, the forum where it will be thrashed out, warns there may be no vote until December. Technology transfer would take six months or so to complete even if it started today. With the new mRNA vaccines made by Pfizer and Moderna, it may take longer. Supposing the tech transfer was faster than that, experienced vaccine-makers would be unavailable for hire and makers could not obtain inputs from suppliers whose order books are already bursting. Pfizer’s vaccine requires 280 inputs from suppliers in 19 countries. No firm can recreate that in a hurry.
In any case, vaccine-makers do not appear to be hoarding their technology—otherwise output would not be increasing so fast. They have struck 214 technology-transfer agreements, an unprecedented number. They are not price-gouging: money is not the constraint on vaccination. Poor countries are not being priced out of the market: their vaccines are coming through COVAX, a global distribution scheme funded by donors.
In the longer term, the effect of a waiver is unpredictable. Perhaps it will indeed lead to technology being transferred to poor countries; more likely, though, it will cause harm by disrupting supply chains, wasting resources and, ultimately, deterring innovation. Whatever the case, if vaccines are nearing a surplus in 2022, the cavalry will arrive too late.
A needle in time
If Mr Biden really wants to make a difference, he can donate vaccine right now through COVAX. Rich countries over-ordered because they did not know which vaccines would work. Britain has ordered more than nine doses for each adult, Canada more than 13. These will be urgently needed elsewhere. It is wrong to put teenagers, who have a minuscule risk of dying from covid-19, before the elderly and health-care workers in poor countries. The rich world should not stockpile boosters to cover the population many times over on the off-chance that they may be needed. In the next six months, this could yield billions of doses of vaccine.
Countries can also improve supply chains. The Serum Institute, an Indian vaccine-maker, has struggled to get parts such as filters from America because exports were gummed up by the Defence Production Act (DPA), which puts suppliers on a war-footing. Mr Biden authorised a one-off release, but he should be focusing the DPA on supplying the world instead. And better use needs to be made of finished vaccine. In some poor countries, vaccine languishes unused because of hesitancy and chaotic organisation. It makes sense to prioritise getting one shot into every vulnerable arm, before setting about the second.
Our model is not predictive. However it does suggest that some parts of the world are particularly vulnerable—one example is South-East Asia, home to over 650m people, which has so far been spared mass fatalities for no obvious reason. Covid-19 has not yet run its course. But vaccines have created the chance to save millions of lives. The world must not squander it. ■
However differently we register this pandemic we understand it as global; it brings home the fact that we are implicated in a shared world. The capacity of living human creatures to affect one another can be a matter of life or death. Because so many resources are not equitably shared, and so many have only a small or vanished share of the world, we cannot recognize the pandemic as global without facing those inequalities.
Some people work for the common world, keep it going, but are not, for that reason, of it. They might lack property or papers, be sidelined by racism or even disdained as refuse—those who are poor, Black or brown, those with unpayable debts that preclude a sense of an open future.
The shared world is not equally shared. The French philosopher Jacques Rancière refers to “the part of those who have no part”—those for whom participation in the commons is not possible, never was, or no longer is. For it is not just resources and companies in which a share is to be had, but a sense of the common, a sense of belonging to a world equally, a trust that the world is organized to support everyone’s flourishing.
The pandemic has illuminated and intensified racial and economic inequalities at the same time that it heightens the global sense of our obligations to one another and the earth. There is movement in a global direction, one based on a new sense of mortality and interdependency. The experience of finitude is coupled with a keen sense of inequalities: Who dies early and why, and for whom is there no infrastructural or social promise of life’s continuity?
This sense of the interdependency of the world, strengthened by a common immunological predicament, challenges the notion of ourselves as isolated individuals encased in discrete bodies, bound by established borders. Who now could deny that to be a body at all is to be bound up with other living creatures, with surfaces, and the elements, including the air that belongs to no one and everyone?
Within these pandemic times, air, water, shelter, clothing and access to health care are sites of individual and collective anxiety. But all these were already imperiled by climate change. Whether or not one is living a livable life is not only a private existential question, but an urgent economic one, incited by the life-and-death consequences of social inequality: Are there health services and shelters and clean enough water for all those who should have an equal share of this world? The question is made more urgent by conditions of heightened economic precarity during the pandemic, exposing as well the ongoing climate catastrophe for the threat to livable life that it is.
Pandemic is etymologically pandemos, all the people, or perhaps more precisely, the people everywhere, or something that spreads over or through the people. The “demos” is all the people despite the legal barriers that seek to separate them. A pandemic, then, links all the people through the potentials of infection and recovery, suffering and hope, immunity and fatality. No border stops the virus from traveling if humans travel; no social category secures absolute immunity for those it includes.
“The political in our time must start from the imperative to reconstruct the world in common,” argues Cameroonian philosopher Achille Mbembe. If we consider the plundering of the earth’s resources for the purposes of corporate profit, privatization and colonization itself as planetary project or enterprise, then it makes sense to devise a movement that does not send us back to our egos and identities, our cut-off lives.
Such a movement will be, for Mbembe, “a decolonization [which] is by definition a planetary enterprise, a radical openness of and to the world, a deep breathing for the world as opposed to insulation.” The planetary opposition to extraction and systemic racism ought to then deliver us back to the world, or let the world arrive, as if for the first time, a shared place for “deep breathing”—a desire we all now know.
And yet, an inhabitable world for humans depends on a flourishing earth that does not have humans at its center. We oppose environmental toxins not only so that we humans can live and breathe without fear of being poisoned, but also because the water and the air must have lives that are not centered on our own.
As we dismantle the rigid forms of individuality in these interconnected times, we can imagine the smaller part that human worlds must play on this earth whose regeneration we depend upon—and which, in turn, depends upon our smaller and more mindful role.
RIO DE JANEIRO — Rail-thin teenagers hold placards at traffic stops with the word for hunger — fome — in large print. Children, many of whom have been out of school for over a year, beg for food outside supermarkets and restaurants. Entire families huddle in flimsy encampments on sidewalks, asking for baby formula, crackers, anything.
A year into the pandemic, millions of Brazilians are going hungry.
The scenes, which have proliferated in the last months on Brazil’s streets, are stark evidence that President Jair Bolsonaro’s bet that he could protect the country’s economy by resisting public health policies intended to curb the virus has failed.
From the start of the outbreak, Brazil’s president has been skeptical of the disease’s impact, and scorned the guidance of health experts, arguing that the economic damage wrought by the lockdowns, business closures and mobility restrictions they recommended would be a bigger threat than the pandemic to the country’s weak economy.
The virus is ripping through the social fabric, setting wrenching records, while the worsening health crisis pushes businesses into bankruptcy, killing jobs and further hampering an economy that has grown little or not at all for more than six years.
Last year, emergency government cash payments helped put food on the table for millions of Brazilians — but when the money was scaled back sharply this year, with a debt crisis looming, many pantries were left bare.
And about 117 million people, or roughly 55 percent of the country’s population, faced food insecurity, with uncertain access to enough nutrition, in 2020 — a leap from the 85 million who did so two years previous, the study showed.
“The way the government has handled the virus has deepened poverty and inequality,” said Douglas Belchior, the founder of UNEafro Brasil, one of a handful of organizations that have banded together to raise money to get food baskets to vulnerable communities. “Hunger is a serious and intractable problem in Brazil.”
Luana de Souza, 32, was one of several mothers who lined up outside an improvised food pantry on a recent afternoon hoping to score a sack with beans, rice and cooking oil. Her husband had worked for a company that organized events, but lost his job last year — one of eight million people who joined Brazil’s unemployment rolls during the pandemic, driving the rate above 14 percent, according to Brazil’s Institute of Geography and Statistics.
At first the family managed by spending their government assistance carefully, she said, but this year, once the payments were cut, they struggled.
“There is no work,” she said. “And the bills keep coming.”
Brazil’s economy had gone into recession in 2014, and had not recovered when the pandemic hit. Mr. Bolsonaro often invoked the reality of families like Ms. de Souza’s, who cannot afford to stay home without working, to argue that the type of lockdowns governments in Europe and other wealthy nations ordered to curb the spread of the virus were untenable in Brazil.
Last year, as governors and mayors around Brazil signed decrees shutting down nonessential businesses and restricting mobility, Mr. Bolsonaro called those measures “extreme” and warned that they would result in malnutrition.
As a second wave of cases this year led to the collapse of the health care system in several cities, local officials again imposed a raft of strict measures — and found themselves at war with Mr. Bolsonaro.
“People have to have freedom, the right to work,” he said last month, calling the new quarantine measures imposed by local governments tantamount to living in a “dictatorship.”
Early this month, as the daily death toll from the virus sometimes surpassed 4,000, Mr. Bolsonaro acknowledged the severity of the humanitarian crisis facing his country. But he took no responsibility and instead faulted local officials.
“Brazil is at the limit,” he said, arguing that the blame lay with “whoever closed everything.”
But economists said that the argument that restrictions intended to control the virus would worsen Brazil’s economic downturn was “a false dilemma.”
In an open letter addressed to Brazilian authorities in late March, more than 1,500 economists and businesspeople asked the government to impose stricter measures, including lockdown.
“It is not reasonable to expect economic activity to recover from an uncontrolled epidemic,” the experts wrote.
Laura Carvalho, an economist, published a study showing that restrictions can have a negative short-term impact on a country’s financial health, but that, in the long run, it would have been a better strategy.
“If Bolsonaro had carried out lockdown measures, we would have moved earlier from the economic crisis,” said Ms. Carvalho, a professor at the University of São Paulo.
Mr. Bolsonaro’s approach had a broadly destabilizing effect, said Thomas Conti, lecturer at Insper, a business school.
“The Brazilian real was the most devalued currency among all developing countries,” Mr. Conti said. “We are at an alarming level of unemployment, there is no predictability to the future of the country, budget rules are being violated, and inflation grows nonstop.”
The country’s worsening Covid-19 crisis has left Mr. Bolsonaro politically vulnerable. The Senate this month began an inquiry into the government’s handling of the pandemic. The study is expected to document missteps, including the government’s endorsement of drugs that are ineffective to treat Covid-19 and shortages of basic medical supplies, including oxygen. Some of those missteps are likely to be blamed for preventable deaths.
Creomar de Souza, a political analyst and the founder of the consultancy Dharma Politics in Brasília, said the president underestimated the threat the pandemic posed to the country and failed to put together a comprehensive plan to address it.
“They thought it wouldn’t be something serious and figured that the health system would be able to handle it,” he said.
Mr. de Souza said Mr. Bolsonaro has always campaigned and governed combatively, appealing to voters by presenting himself as an alternative to dangerous rivals. His response to the pandemic has been consistent with that playbook, he said.
“The great loss, in addition to the increasing number of victims in this tragedy, is an erosion of governance,” he said. “We’re facing a scenario of high volatility, with a lot of political risks, because the government didn’t deliver on public policies.”
Advocacy and human rights organizations earlier this year started a campaign called Tem Gente Com Fome, or People are Going Hungry, with the aim of raising money from companies and individuals to get food baskets to needy people across the country.
Mr. Belchior, one of the founders, said the campaign was named after a poem by the writer and artist Solano Trindade. It describes scenes of misery viewed as a train in Rio de Janeiro makes its way across poor neighborhoods where the state has been all but absent for decades.
“Families are increasingly pleading for earlier food deliveries,” said Mr. Belchior. “And they’re depending more on community actions than the government.”
Carine Lopes, 32, the president of a community ballet school in Manguinhos, a low-income, working-class district of Rio de Janeiro, has responded to the crisis by turning her organization into an impromptu relief center.
Since the beginning of the pandemic, the price of basic products rose dramatically at nearby stores, she said. The cost of cooking oil more than tripled. A kilogram of rice goes for twice as much. As meat became increasingly prohibitive, Sunday outdoor cookouts became a rarity in the neighborhood.
Long used to fielding calls from parents who desperately wanted a slot for their children at the ballet school, Ms. Lopes has gotten used to a very different appeal. Old acquaintances and strangers text her daily asking about the food baskets the ballet school has been distributing weekly.
“These moms and dads are only thinking about basic things now,” she said. “They call and say: ‘I’m unemployed. I don’t have anything else to eat this week. Is there anything you can give us?’”
When the virus finally recedes, the poorest families will have the hardest time bouncing back, she said.
Ms. Lopes despairs thinking of students who have been unable to tune in to online classes in households that have no internet connection, or where the only device with a screen belongs to a working parent.
“No one will be able to compete for a scholarship with a middle-class student who managed to keep up with classes using their good internet and their tablets,” she said. “Inequality is being exacerbated.”
Ernesto Londoño is the Brazil bureau chief, based in Rio de Janeiro. He was previously an editorial writer and, before joining The Times in 2014, reported for The Washington Post.
Sonia Guajajara, Coordenadora-executiva da Articulação dos Povos Indígenas do Brasil e ex-candidata do PSOL à Vice-Presidência da República (2018)
19 de abril de 2021
Nem sempre deixamos de sentir a dor do outro por falta de empatia; às vezes, isso acontece por puro desconhecimento. A história do Brasil sempre foi muito mal contada. Não desejamos o que passamos a ninguém, nem mesmo aos nossos algozes. São 520 anos de perseguição praticamente ininterrupta. Mas, neste Dia do Índio (19.abr), estamos enfrentando a maior ameaça de nossa existência. E agora não me refiro somente a nós, indígenas. O governo federal atual fez do coronavírus um aliado e põe em risco a vida da população em geral. Hoje, todos sentem como é ser acuado por uma doença que vem de fora, contra a qual não há defesa. Todos mesmo; agora, falo do mundo inteiro.
Nós, indígenas, somos perseguidos em nosso próprio país; neste momento, por causa da Covid-19. Todos nós, brasileiros, corremos o sério risco de sermos marginalizados globalmente. Ninguém em sã consciência nega a importância da Amazônia para a saúde do planeta —e hoje a ciência atesta que a destruição da natureza e as mudanças climáticas podem causar novas pandemias. Mas, além de abusar da caneta para atacar o meio ambiente e os nossos direitos, como de costume, o presidente Jair Bolsonaro vem tentado aliciar e constranger lideranças indígenas. Até Funai e Ibama estão jogando no time rival. Não é apenas um vírus.
A Articulação dos Povos Indígenas do Brasil (Apib) foi criada em 2005 no primeiro Acampamento Terra Livre (ATL), evento que reunia milhares de pessoas de todo o país em Brasília —por causa da pandemia, ele foi realizado virtualmente em 2020 e, neste ano, terá encontros online durante todo o o mês de abril. É fruto da união e auto-organização dos povos, que são as raízes que sustentam esse país e que durante a pandemia recebeu o reconhecimento do Supremo Tribunal Federal (STF) como entidade que pode entrar com ações diretas na principal corte do país.
Com organizações regionais, nossa rede está presente em todas as regiões do país: a Articulação dos Povos Indígenas do Nordeste, Minas Gerais e Espírito Santo (Apoinme), o Conselho do Povo Terena, a Articulação dos Povos Indígenas do Sudeste (Arpinsudeste), a Articulação dos Povos Indígenas do Sul (Arpinsul), a Grande Assembleia do Povo Guarani (Aty Guasu), a Coordenação das Organizações Indígenas da Amazônia Brasileira (Coiab) e a Comissão Guarani Yvyrupa.
No ano passado, a Apib ganhou o Prêmio Internacional Letelier-Moffitt de Direitos Humanos, concedido pelo Instituto de Estudos Políticos de Washington. A organização tem sido chamada a falar em conferências da ONU. Há décadas tem voz ativa em conferências internacionais, junto a organismos como a ONU e a Comissão Interamericana de Direitos Humanos. Enquanto o governo negligencia criminosamente o atendimento aos povos tradicionais durante a pandemia, com seu projeto integracionista, estamos garantindo segurança alimentar, barreiras sanitárias e equipamentos de proteção por meio do Plano Emergência Indígena, construído de forma participativa com todas as organizações de base que compõem nossa grande articulação.
Estamos nas redes, aldeias, universidades, cidades, prefeituras, Câmaras Legislativas federal, estaduais e municipais e seguiremos lutando contra o racismo e a violência. Em um mundo doente e enfrentando um projeto de morte, nossa luta ainda é pela vida, contra todos os vírus que nos matam! Nosso maior objetivo é garantir a posse de nossas terras para preservá-las e manter nossas identidades culturais.
Terras indígenas são bens da União; ou seja, pertencem ao Brasil, a todos os brasileiros. Temos direito a seu usufruto, mas para manter nossos modos de vida tradicionais. Está tudo na Constituição. Conhecemos as mentiras, que agora são as famosas fake news, desde 1500, quando os portugueses chegaram aqui oferecendo amizade e, assim que dávamos as costas, nos apunhalavam. Não trocamos Pindorama por espelhos, conforme ensinavam erroneamente os livros de história de antigamente. Sabemos o real valor das coisas e das pessoas.
O abismo social se aprofunda; a quem isso interessa? Quem acredita que vai ver a cor do dinheiro que será arrancado das ruínas de nossas terras? “Decidimos não morrer”: esta resolução, tomada por nós há mais de cinco séculos, foi reafirmada no Acampamento Terra Livre. Nem todos sabem, mas zelar pelo meio ambiente é um dever constitucional de todo cidadão —é só consultar o artigo 225.
Convidamos todos os brasileiros a firmar esse acordo conosco.
This week, the C.D.C. acknowledged what scientists have been saying for months: The risk of catching the coronavirus from surfaces is low.
April 8, 2021
When the coronavirus began to spread in the United States last spring, many experts warned of the danger posed by surfaces. Researchers reported that the virus could survive for days on plastic or stainless steel, and the Centers for Disease Control and Prevention advised that if someone touched one of these contaminated surfaces — and then touched their eyes, nose or mouth — they could become infected.
Americans responded in kind, wiping down groceries, quarantining mail and clearing drugstore shelves of Clorox wipes. Facebook closed two of its offices for a “deep cleaning.” New York’s Metropolitan Transportation Authority began disinfecting subway cars every night.
“People can be affected with the virus that causes Covid-19 through contact with contaminated surfaces and objects,” Dr. Rochelle Walensky, the director of the C.D.C., said at a White House briefing on Monday. “However, evidence has demonstrated that the risk by this route of infection of transmission is actually low.”
The admission is long overdue, scientists say.
“Finally,” said Linsey Marr, an expert on airborne viruses at Virginia Tech. “We’ve known this for a long time and yet people are still focusing so much on surface cleaning.” She added, “There’s really no evidence that anyone has ever gotten Covid-19 by touching a contaminated surface.”
During the early days of the pandemic, many experts believed that the virus spread primarily through large respiratory droplets. These droplets are too heavy to travel long distances through the air but can fall onto objects and surfaces.
In this context, a focus on scrubbing down every surface seemed to make sense. “Surface cleaning is more familiar,” Dr. Marr said. “We know how to do it. You can see people doing it, you see the clean surface. And so I think it makes people feel safer.”
But over the last year, it has become increasingly clear that the virus spreads primarily through the air — in both large and small droplets, which can remain aloft longer — and that scouring door handles and subway seats does little to keep people safe.
“The scientific basis for all this concern about surfaces is very slim — slim to none,” said Emanuel Goldman, a microbiologist at Rutgers University, who wrote last summer that the risk of surface transmission had been overblown. “This is a virus you get by breathing. It’s not a virus you get by touching.”
The C.D.C. has previously acknowledged that surfaces are not the primary way that the virus spreads. But the agency’s statements this week went further.
“The most important part of this update is that they’re clearly communicating to the public the correct, low risk from surfaces, which is not a message that has been clearly communicated for the past year,” said Joseph Allen, a building safety expert at the Harvard T.H. Chan School of Public Health.
Catching the virus from surfaces remains theoretically possible, he noted. But it requires many things to go wrong: a lot of fresh, infectious viral particles to be deposited on a surface, and then for a relatively large quantity of them to be quickly transferred to someone’s hand and then to their face. “Presence on a surface does not equal risk,” Dr. Allen said.
In most cases, cleaning with simple soap and water — in addition to hand-washing and mask-wearing — is enough to keep the odds of surface transmission low, the C.D.C.’s updated cleaning guidelines say. In most everyday scenarios and environments, people do not need to use chemical disinfectants, the agency notes.
“What this does very usefully, I think, is tell us what we don’t need to do,” said Donald Milton, an aerosol scientist at the University of Maryland. “Doing a lot of spraying and misting of chemicals isn’t helpful.”
Still, the guidelines do suggest that if someone who has Covid-19 has been in a particular space within the last day, the area should be both cleaned and disinfected.
“Disinfection is only recommended in indoor settings — schools and homes — where there has been a suspected or confirmed case of Covid-19 within the last 24 hours,” Dr. Walensky said during the White House briefing. “Also, in most cases, fogging, fumigation and wide-area or electrostatic spraying is not recommended as a primary method of disinfection and has several safety risks to consider.”
And the new cleaning guidelines do not apply to health care facilities, which may require more intensive cleaning and disinfection.
Saskia Popescu, an infectious disease epidemiologist at George Mason University, said that she was happy to see the new guidance, which “reflects our evolving data on transmission throughout the pandemic.”
But she noted that it remained important to continue doing some regular cleaning — and maintaining good hand-washing practices — to reduce the risk of contracting not just the coronavirus but any other pathogens that might be lingering on a particular surface.
Dr. Allen said that the school and business officials he has spoken with this week expressed relief over the updated guidelines, which will allow them to pull back on some of their intensive cleaning regimens. “This frees up a lot of organizations to spend that money better,” he said.
Schools, businesses and other institutions that want to keep people safe should shift their attention from surfaces to air quality, he said, and invest in improved ventilation and filtration.
“This should be the end of deep cleaning,” Dr. Allen said, noting that the misplaced focus on surfaces has had real costs. “It has led to closed playgrounds, it has led to taking nets off basketball courts, it has led to quarantining books in the library. It has led to entire missed school days for deep cleaning. It has led to not being able to share a pencil. So that’s all that hygiene theater, and it’s a direct result of not properly classifying surface transmission as low risk.”
Despite warnings, American and European officials gave up leverage that could have guaranteed access for billions of people. That risks prolonging the pandemic.
In the coming days, a patent will finally be issued on a five-year-old invention, a feat of molecular engineering that is at the heart of at least five major Covid-19 vaccines. And the United States government will control that patent.
The new patent presents an opportunity — and some argue the last best chance — to exact leverage over the drug companies producing the vaccines and pressure them to expand access to less affluent countries.
The question is whether the government will do anything at all.
The rapid development of Covid-19 vaccines, achieved at record speed and financed by massive public funding in the United States, the European Union and Britain, represents a great triumph of the pandemic. Governments partnered with drugmakers, pouring in billions of dollars to procure raw materials, finance clinical trials and retrofit factories. Billions more were committed to buy the finished product.
But this Western success has created stark inequity. Residents of wealthy and middle-income countries have received about 90 percent of the nearly 400 million vaccines delivered so far. Under current projections, many of the rest will have to wait years.
Growing numbers of health officials and advocacy groups worldwide are calling for Western governments to use aggressive powers — most of them rarely or never used before — to force companies to publish vaccine recipes, share their know-how and ramp up manufacturing. Public health advocates have pleaded for help, including asking the Biden administration to use its patent to push for broader vaccine access.
Governments have resisted. By partnering with drug companies, Western leaders bought their way to the front of the line. But they also ignored years of warnings — and explicit calls from the World Health Organization — to include contract language that would have guaranteed doses for poor countries or encouraged companies to share their knowledge and the patents they control.
“It was like a run on toilet paper. Everybody was like, ‘Get out of my way. I’m gonna get that last package of Charmin,’” said Gregg Gonsalves, a Yale epidemiologist. “We just ran for the doses.”
The prospect of billions of people waiting years to be vaccinated poses a health threat to even the richest countries. One example: In Britain, where the vaccine rollout has been strong, health officials are tracking a virus variant that emerged in South Africa, where vaccine coverage is weak. That variant may be able to blunt the effect of vaccines, meaning even vaccinated people might get sick.
Western health officials said they never intended to exclude others. But with their own countries facing massive death tolls, the focus was at home. Patent sharing, they said, simply never came up.
“It was U.S.-centric. It wasn’t anti-global.” said Moncef Slaoui, who was the chief scientific adviser for Operation Warp Speed, a Trump administration program that funded the search for vaccines in the United States. “Everybody was in agreement that vaccine doses, once the U.S. is served, will go elsewhere.”
President Biden and Ursula von der Leyen, the president of the European Union’s executive branch, are reluctant to change course. Mr. Biden has promised to help an Indian company produce about 1 billion doses by the end of 2022 and his administration has donated doses to Mexico and Canada. But he has made it clear that his focus is at home.
“We’re going to start off making sure Americans are taken care of first,” Mr. Biden said recently. “But we’re then going to try and help the rest of the world.”
Pressuring companies to share patents could be seen as undermining innovation, sabotaging drugmakers or picking drawn-out and expensive fights with the very companies digging a way out of the pandemic.
As rich countries fight to keep things as they are, others like South Africa and India have taken the battle to the World Trade Organization, seeking a waiver on patent restrictions for Covid-19 vaccines.
Russia and China, meanwhile, have promised to fill the void as part of their vaccine diplomacy. The Gamaleya Institute in Moscow, for example, has entered into partnerships with producers from Kazakhstan to South Korea, according to data from Airfinity, a science analytics company, and UNICEF. Chinese vaccine makers have reached similar deals in the United Arab Emirates, Brazil and Indonesia.
Addressing patents would not, by itself, solve the vaccine imbalance. Retrofitting or constructing factories would take time. More raw materials would need to be manufactured. Regulators would have to approve new assembly lines.
And as with cooking a complicated dish, giving someone a list of ingredients is no substitute to showing them how to make it.
To address these problems, the World Health Organization created a technology pool last year to encourage companies to share know-how with manufacturers in lower-income nations.
Not a single vaccine company has signed up.
“The problem is that the companies don’t want to do it. And the government is just not very tough with the companies,” said James Love, who leads Knowledge Ecology International, a nonprofit.
Drug company executives told European lawmakers recently that they were licensing their vaccines as quickly as possible, but that finding partners with the right technology was challenging.
“They don’t have the equipment,” Moderna’s chief executive, Stéphane Bancel, said. “There is no capacity.”
But manufacturers from Canada to Bangladesh say they can make vaccines — they just lack patent licensing deals. When the price is right, companies have shared secrets with new manufacturers in just months, ramping up production and retrofitting factories.
It helps when the government sweetens the deal. Earlier this month, Mr. Biden announced that the pharmaceutical giant Merck would help make vaccines for its competitor Johnson & Johnson. The government pressured Johnson & Johnson to accept the help and is using wartime procurement powers to secure supplies for the company. It will also pay to retrofit Merck’s production line, with an eye toward making vaccines available to every adult in the United States by May.
Despite the hefty government funding, drug companies control nearly all of the intellectual property and stand to make fortunes off the vaccines. A critical exception is the patent expected to be approved soon — a government-led discovery for manipulating a key coronavirus protein.
This breakthrough, at the center of the 2020 race for a vaccine, actually came years earlier in a National Institutes of Health lab, where an American scientist named Dr. Barney Graham was in pursuit of a medical moonshot.
‘We’d already done everything’
For years, Dr. Graham specialized in the kind of long, expensive research that only governments bankroll. He searched for a key to unlock universal vaccines — genetic blueprints to be used against any of the roughly two dozen viral families that infect humans. When a new virus emerged, scientists could simply tweak the code and quickly make a vaccine.
In 2016, while working on Middle East Respiratory Syndrome, another coronavirus known as MERS, he and his colleagues developed a way to swap a pair of amino acids in the coronavirus spike protein. That bit of molecular engineering, they realized, could be used to develop effective vaccines against any coronavirus. The government, along with its partners at Dartmouth College and the Scripps Research Institute, filed for a patent, which will be issued this month.
When Chinese scientists published the genetic code of the new coronavirus in January 2020, Dr. Graham’s team had their cookbook ready.
“We kind of knew exactly what we had to do,” said Jason McLellan, one of the inventors, who now works at the University of Texas at Austin. “We’d already done everything.”
Dr. Graham was already working with Moderna on a vaccine for another virus when the outbreak in China inspired his team to change focus. “We just flipped it to coronavirus and said, ‘How fast can we go?’” Dr. Graham recalled.
Within a few days, they emailed the vaccine’s genetic blueprint to Moderna to begin manufacturing. By late February, Moderna had produced enough vaccines for government-run clinical trials.
“We did the front end. They did the middle. And we did the back end,” Dr. Graham said.
Exactly who holds patents for which vaccines won’t be sorted out for months or years. But it is clear now that several of today’s vaccines — including those from Moderna, Johnson & Johnson, Novavax, CureVac and Pfizer-BioNTech — rely on the 2016 invention. Of those, only BioNTech has paid the U.S. government to license the technology. The patent is scheduled to be issued March 30.
Patent lawyers and public health advocates say it’s likely that other companies will either have to negotiate a licensing agreement with the government, or face the prospect of a lawsuit worth billions. The government filed such a lawsuit in 2019 against the drugmaker Gilead over H.I.V. medication.
This gives the Biden administration leverage to force companies to share technology and expand worldwide production, said Christopher J. Morten, a New York University law professor specializing in medical patents.
“We can do this the hard way, where we sue you for patent infringement,” he said the government could assert. “Or just play nice with us and license your tech.”
The National Institutes of Health declined to comment on its discussions with the drugmakers but said it did not anticipate a dispute over patent infringement. None of the drug companies responded to repeated questions about the 2016 patent.
Experts said the government has stronger leverage on the Moderna vaccine, which was almost entirely funded by taxpayers. New mRNA vaccines, such as those from Moderna, are relatively easier to manufacture than vaccines that rely on live viruses. Scientists compare it to an old-fashioned cassette player: Try one tape. If it’s not right, just pop in another.
Moderna expects $18.4 billion in vaccine sales this year, but it is the delivery system — the cassette player — that is its most prized secret. Disclosing it could mean giving away the key to the company’s future.
“There should be no division in order to win this battle,” President Emmanuel Macron of France said.
Yet European governments had backed their own champions. The European Investment Bank lent nearly $120 million to BioNTech, a German company, and Germany bought a $360 million stake in the biotech firm CureVac after reports that it was being lured to the United States.
“We funded the research, on both sides of the Atlantic,” said Udo Bullmann, a German member of the European Parliament. “You could have agreed on a paragraph that says ‘You are obliged to give it to poor countries in a way that they can afford it.’ Of course you could have.”
A People’s Vaccine
In May, the leaders of Pakistan, Ghana, South Africa and others called for governments to support a “people’s vaccine” that could be quickly manufactured and given for free.
They urged the governing body of the World Health Organization to treat vaccines as “global public goods.”
Though such a declaration would have had no teeth, the Trump administration moved swiftly to block it. Intent on protecting intellectual property, the government said calls for equitable access to vaccines and treatments sent “the wrong message to innovators.”
World leaders ultimately approved a watered-down declaration that recognized extensive immunization — not the vaccines themselves — as a global public good.
That same month, the World Health Organization launched the technology-access pool and called on governments to include clauses in their drug contracts guaranteeing equitable distribution. But the world’s richest nations roundly ignored the call.
In the United States, Operation Warp Speed went on a summertime spending spree, disbursing over $10 billion to handpicked companies and absorbing the financial risks of bringing a vaccine to market.
“Our role was to enable the private sector to be successful,” said Paul Mango, a top adviser to the then health secretary, Alex M. Azar II.
The deals came with few strings attached.
Large chunks of the contracts are redacted and some remain secret. But public records show that the government used unusual contracts that omitted its right to take over intellectual property or influence the price and availability of vaccines. They did not let the government compel companies to share their technology.
British and other European leaders made similar concessions as they ordered enough doses to vaccinate their populations multiple times over.
“You have to write the rules of the game, and the place to do that would have been these funding contracts,” said Ellen ’t Hoen, the director of Medicines Law and Policy, an international research group.
By comparison, one of the world’s largest health financiers, the Bill & Melinda Gates Foundation, includes grant language requiring equitable access to vaccines. As leverage, the organization retains some right to the intellectual property.
Dr. Slaoui, who came to Warp Speed after leading research and development at GlaxoSmithKline, is sympathetic to this idea. But it would have been impractical to demand patent concessions and still deliver on the program’s primary goals of speed and volume, he said.
“I can guarantee you that the agreements with the companies would have been much more complex and taken a much longer time,” he said. The European Union, for example, haggled over price and liability provisions, which delayed the rollout.
In some ways, this was a trip down a trodden path. When the H1N1 “swine flu” pandemic broke out in 2009, the wealthiest countries cornered the global vaccine market and all but locked out the rest of the world.
Experts said at the time that this was a chance to rethink the approach. But the swine flu pandemic fizzled and governments ended up destroying the vaccines they had hoarded. They then forgot to prepare for the future.
The International View
For months, the United States and European Union have blocked a proposal at the World Trade Organization that would waive intellectual property rights for Covid-19 vaccines and treatments. The application, put forward by South Africa and India with support from most developing nations, has been bogged down in procedural hearings.
“Every minute we are deadlocked in the negotiating room, people are dying,” said Mustaqeem De Gama, a South African diplomat who is involved in the talks.
But in Brussels and Washington, leaders are still worried about undermining innovation.
During the presidential campaign, Mr. Biden’s team gathered top intellectual property lawyers to discuss ways to increase vaccine production.
“They were planning on taking the international view on things,” said Ana Santos Rutschman, a Saint Louis University law professor who participated in the sessions.
Most of the options were politically thorny. Among them was the use of a federal law allowing the government to seize a company’s patent and give it to another in order to increase supply. Former campaign advisers say the Biden camp was lukewarm to this proposal and others that called for a broader exercise of its powers.
The administration has instead promised to give $4 billion to Covax, the global vaccine alliance. The European Union has given nearly $1 billion so far. But Covax aims to vaccinate only 20 percent of people in the world’s poorest countries this year, and faces a $2 billion shortfall even to accomplish that.
Dr. Graham, the N.I.H. scientist whose team cracked the coronavirus vaccine code for Moderna, said that pandemic preparedness and vaccine development should be international collaborations, not competitions.
“A lot of this would not have happened unless there was a big infusion of government money,” he said.
But governments cannot afford to sabotage companies that need profit to survive.
Dr. Graham has largely moved on from studying the coronavirus. He is searching for a universal flu vaccine, a silver bullet that could prevent all strains of the disease without an annual tweak.
Though he was vaccinated through work, he spent the early part of the year trying to get his wife and grown children onto waiting lists — an ordeal that even one of the key inventors had to endure. “You can imagine how aggravating that is,” he said.
Matina Stevis-Gridneff and Monika Pronczuk contributed reporting.
Cal Newport explains how Slack and Gmail are making us miserable — and what to do about it.
Friday, March 5th, 2021
Well, I’m Ezra Klein. Welcome to “The Ezra Klein Show.”
Before we get into it, a bit of housekeeping. We are looking for an associate producer. That job is still open, but not for much longer. If you have two years of audio experience and want to work on the show, go check out the link to the job listing and show notes. But to the show today, I want to begin here with a concept that’s going to be important throughout the episode — the hyperactive hive mind. That’s the idea at the center of Cal Newport’s new book, “A World Without Email.” And it’s the idea he says at the center of how a lot of us are working and living these days. He defines the hyperactive hive mind as a workflow centered on ongoing conversation fueled by unstructured and unscheduled messages delivered through digital communication tools, like email and instant messenger. It’s a bit of a mouthful, but if you’re someone working in an office, maybe a remote one now, where there’s just a constant stream of digital work-like chatter, that you kind of always need to be keeping up with, but also you sense it’s distracting you from doing your work and also from seeing your family and just relaxing pretty often, that you’re in a hyperactive hive mind. And a lot of us — not all of us, but a lot of us — are in this now. I’ve been a fan of Newport’s work for years, going back to his book, “Deep Work.” Newport has been circling this idea that all of the digital wonder around us has come with a cost. We’re losing our ability to concentrate. These remarkable vistas of information that have been opened to us have also been polluted by endless distraction. And so, we’re not benefiting from any of this the way we thought we would. Instead of getting more done in less time, we feel like we have less time than ever and are never getting enough done. It’s really weird. Something is wrong here. And one reason I like Newport’s work is I think he is right on this. I think we have a lot of trouble seeing the cost of technology, at least when that technology comes with a lot of good, as the internet and digital communication, of course, does. But we have to be able to step back and look at it because the way we adopt a technology at the beginning is never going to be — never going to be — particularly when it is harnessed to firms trying to sell it all to us. It is never going to be the way we ultimately should use it. But the weakness, I would say, of Newport’s previous book — so a weakness he agrees with — is that they were about individuals. They were sometimes the equivalent of giving diet advice to somebody who lives in the chips and cookies aisle of the supermarket. There’s not a lot you can do around that much temptation, but even more so when your built environment is decided for you, when so many choices about how you have to work and what you have to be part of are already made for you. But this book is a step forward in that way. This book is about systems, and in particular, about workplaces. Newport is making a radical argument here, that companies that obsess about efficiency, that think of themselves as rational economic actors, they are utterly failing to question and experiment with their own workflows, like the fundamental nature of how they do their business. And in that, they are making their employees unhappy. They are making their products worse, and they are just contributing to an overall degradation of society. It’s a pretty stunning indictment. I’m not sure I agree with all of it. But I think there’s really something to it. As always, my email is email@example.com. Always interested to know who you’d like to see on the show next, so send me your guest suggestions. Here’s Cal Newport.
So this is a book about how the information technology revolution went wrong in the workplace. What went wrong?
Well, once we had the arrival of email in the workplace, it very quickly gave rise to a really new way of organizing large groups of people to work together. It’s what I call the hyperactive hive mind. But essentially, we said, OK, now that we have low friction, low cost digital communication, we can just figure things out on the fly. We’ll plug everyone into an inbox, or later, into a Slack channel, and ad hoc unstructured back and forth messages, just figure things out with people as you need them. And that swept basically the entire knowledge sector. And I think that ended up being a disaster.
Why? What is your evidence it’s a disaster?
Well, I have two main threads. So the first thread of evidence is that it makes it essentially impossible to work. And essentially, the culprit here is network switching. Human brains take a long time to switch. If you’re going to put your target of attention on one thing and then switch it to a new target, that takes a while, right? There’s biological things going on here. You have to suppress some networks. You have to amplify other networks. It takes some time. When you glance at an inbox or when you glance at a Slack channel, as is required that you do constantly, if back and forth messaging is how you organize most of your work, you begin to trigger all these network shifts, so all of these complex biological cascades initiate. And you see all these unresolved issues and things you can’t get back to. And then if you wrench your attention back to what you were trying to do, it creates this whole pile-up in your brain, which we experience as a loss of cognitive function. We also feel frustrated. We feel tired. We feel anxious. Because the human brain can’t do it. And so essentially, the hyperactive hive mind, on paper, had this really good attribute, which is it’s flexible and it’s easy and it’s cheap. You just kind of figure things out on the fly. But the biological reality is it made us really bad at doing our work. And then we have the second thread, which I think had been somewhat unexplored, which is this way of working makes us miserable. It just clashes with our fundamental human wiring to have this nonstop piling up of communication from our tribe members that we can’t keep up with. And that hits all of these deeply rooted social networks in our brain to take this type of thing seriously. No matter how much the frontal cortex tells us it’s OK, we don’t have to answer these emails right away. There’s a deeper part of our brain that’s worried. And so it makes us miserable, and it makes us terrible at work. But other than that, though, it’s been pretty good.
I want to pick up on this question of whether or not it’s making us miserable. Because one way of looking at this is that it is a triumph of workers who don’t want to work all that hard and want lots of opportunities for distraction over bosses who want them to work really hard. So Slack is just an amazingly deceptive piece of enterprise software, in my mind. I was at an organization that we didn’t have it. And then I helped bring it to that organization. And now, it’s completely clear to me that Slack makes organizations less effective. It’s very well built to help workers slack off, right? To help me slack off. I enjoy slacking off on Slack. I mean, it’s literally right there in the name. It’s called Slack. And they’ve made all these wonderful — you can put GIFs in so easily and little reaction emoji. It’s a great way to bullshit around the water cooler digitally. And so there’s one perspective on this, which is that we’re seeing a failure, and then another that we’re seeing a kind of success of people taking their time back and having more socializing at work. Why should that not be the attitude or conceptual frame I put around this?
Well, no, I think you’re getting at some truth there. I had a recent New Yorker piece that was titled, “Slack is the right tool for the wrong way to work,” where I was trying to really grapple with this notion that there’s a reason why Slack is popular, and there’s also a reason why we hate it. It’s serving two purposes, which kind of complicates the story. I think it’s absolutely true that one of the benefits of the hive mind is it gives you obfuscation. So say you don’t want to work as hard. Let’s say I don’t want to do as much, or I’m in a situation maybe where I can’t work as hard. There is an obfuscation you can get because it’s so ambiguous and ad hoc and on-demand that you can basically generate smokescreens by rapid responses and being on active on the Slack channels. And there’s also a social component to it. And I think those are both really interesting aspects of the hive mind. But I don’t think either justify the hive mind is the right way to work.
A point you make in the book is productivity growth across the economy is not way better today than it was before the widespread adoption of email or before the widespread adoption of Slack. One might have thought that speeding communication would make it so we could get a lot more done a lot quicker. That does not appear to be happening. What problem does interoffice communication solve, and at what point does it become too much?
Well, so what Slack was trying to do — or at least, this was my argument in that former piece — is, Slack said, OK, if we’re going to use the hyperactive hive mind as our primary workflow — that is, if we’re just going to work things out on the fly with back and forth messaging, email is not that great at it. We can do it better with Slack. So when I called Slack the right tool for the wrong way to work, I mean, it’s a tool that is optimized. If we’re going to do the hive mind, this is a better tool for implementing constant chatter than email was, which is why we both love and hate it. We love it because if our organization runs on constant chatter, it does a better job as a tool of that than an inbox does with email. We hate it because this way of working has fundamental issues. But if we go back in time, what problem was email solving? I mean, my ultimate argument is that the original rise, which I document, came from the reality that having fast, but asynchronous communication was sort of a productivity silver bullet. It was an issue that rose once the rise of large offices emerged in mid century, this notion that you might have 1,000 people working in a non-industrial manner for the same company. How do they communicate? And the telephone, the interoffice telephone introduced a synchronous option, but there’s a lot of overhead to getting someone on the phone at the same time. Memos and mail carts, this gave us an asynchronous option, but they were slow. There was people involved. You had to put things on carts. It could take all day. So email was solving a really real problem. I want to do asynchronous communication. I want to do it fast and with low overhead. But once it was there in a way that was unintentional, unplanned, no one thought this was a good way to work, it spiraled us into this hyperactive hive mind, where we basically threw out any other processes or structures for organizing our work and said, why don’t we just figure it out on the fly? And there’s a lot of reasons why that happened. But what I want to underscore here is that shift was unintentional and unplanned. We live in this hive mind not because some corporate consultant said this will make us more productive. It’s actually a lot more accidental.
From an economic perspective, what you’re positing here is not just a very big market failure, but a really big failure of firm organization and management. What you’re saying is that the people in charge of these firms, certainly the people in charge of the digital structure internally at these firms, have actually failed at a very profound level. They’ve brought in these tools. These tools have gotten out of control. They’re reducing worker productivity and firm productivity. They’re reducing worker happiness and firm overall happiness. All that seems basically true to me, but then what is your explanation for why so very, very few major firms have come up with some really, really aggressively alternative way to work? If this is all working so badly, why is it spreading so ubiquitously?
This was one of the big ideas I did some original reporting on for the book. We have a big explanation from this from the late management theorist, Peter Drucker, who coined the term “knowledge work” and really helped American industry in particular understand how this type of work was different than industrial work. He sort of set the trajectories in place. One of the big ideas he emphasized was autonomy. Knowledge workers, unlike industrial workers, need autonomy on how they get their work done. You cannot tell them how to work, how they organize themselves productivity. So he was really pushing autonomy. He introduced this very influential notion of management by objectives. Don’t tell me how to work, just give me clear objectives, and leave it up to me how to actually get things done. And there’s a lot of truth in that, right? I mean, he was right in the sense that you can’t tell an ad copywriter or a computer programmer, you know, how to write ad copy or how to program a computer in the way that you could go to an assembly line in a car plant, because he used to study GM, and say, OK, here’s the step-by-step process for building a steering wheel. So he was right about that. But I think it went too far. My argument is that we are so insistent on autonomy on how we execute work, we accidentally expanded that envelope to mean autonomy on how we also organize our work, how we assign our work, how we figure out who should be working on what. And so we fell into this autonomy trap where we feel as managers or entrepreneurs or people who run companies, like, look, it’s not our job to try to figure out the best way to organize work. We’ll just let individuals do that. And when you leave it entirely up to the individuals, you end up with the hyperactive hive mind because it’s the kind of the easiest, least common denominator thing, that if you have no other control, that’s where we’re going to end up. So I think we’re in a trap because we took truckers’ autonomy maybe a little bit too literally.
I want to try out an alternative explanation I knew that I’ve been thinking about. And this one comes more from the incentives of enterprise software companies like Slack or Microsoft in making Teams. Or I guess, Facebook has Blue Jeans as their Zoom competitor and so on and so forth. Which is that you might think the way productivity software, firm level productivity software, gets marketed is that you go to the people who run IT for a big firm and you show some studies about how your software will make the firm work better, and they compare that to the other people trying to sell them something and then go with you if your studies are best. But actually, particularly once you hit a critical mass of other firms using something, there’s actually pressure from employees. And the employee pressure comes from, I would enjoy this software, so I could be good. We would prefer — I remember pushing for Gmail at The Washington Post because we were using Lotus Notes at that point, or Lotus mail, whatever the Lotus level mail software was. And of course, Gmail made it easier to be on email all the time. And so, there’s a funny way in which what we think of as enterprise software is actually sold for the ones that are the real winners in the space through employee demands. But the incentives are misaligned. Then what you’re actually trying to do is win over employees, and you’re going to do that through software that’s more fun to use.
That actually just underscores this interesting autonomy trap we’re in. I mean, you want to imagine a car factory, right? How is it that might be the more fun way to build the cars, right? So in other sectors, people are more process engineering focused, right? What’s the evidence? What’s the best way to do this? And in the knowledge sector, you can imagine a similar thought about how should brains collaborate, what’s the right way for brains to work, how much work should be on everyone’s plate, where should we store things, what’s the right way to communicate. Should it be back and forth messages? Should it be more synchronous meetings? You would think that we could be doing tons of thinking and engineering like that. But we don’t because we’re in this autonomy trap. We’re like, look, that’s not up for us. We put up the OKRs. You guys figure out how to work. And if you tell us you think Slack is more fun, then maybe we’ll buy Slack. But if you step back, I think the metaphorical house is on fire here. We’re at a point now where it’s completely common in a lot of knowledge ware companies that not only do you spend a lot of time doing things like email and meetings, you now spend all of your time doing that, every working hour. And actual work has to get done in these hidden second shifts that happen in the morning or happen in the evening, which creates all of these unexpected inequities. I mean, the fact that that is happening now should be alarm bells ringing, but instead, we’re like, it’s busy. It’s modern times. We’re high tech. That’s just what life is like. We have acceded to it, which I find surprising.
So there’s a thread here that I think is interesting. So you go back to more of the period you’re talking about. Well, let’s call it the early 2000s. So now you’re seeing the very sharp rise of your Google’s. Apple’s already pretty big, but you begin to see Facebook, et cetera. And you remember all this. There was a real vogue for, can you believe all these Silicon Valley firms have ping pong tables? Just like, it’s ping pong tables everywhere. And, right, Google had all of these features done on their workplace culture. And there were slides in a bunch of the offices and on-site laundry and these beautiful lunches with fancy chefs and cafeterias. Initially, this was all presented as paradise for a worker. And then, slowly, this alternative narrative began to take hold, which is, no, this is actually a quite insidious kind of trap. This is a way of making workers spend all of their time at work. It’s a way of making it so people don’t go home easily at night. It’s a way of blurring the lines between what is fun and social and community, which we normally think of as not happening in your office, and what is your office. And it’s a way of getting people to put in 10, 12-hour days. And a lot of the software that emerges out of these companies and out of this period actually seems to me to take that physical insight, that by blurring the line of fun at work, you could allow work to colonize spaces that hadn’t colonized before, and it becomes a software insight. And so then, as you say, things that look like fun at the front end, right — we can chatter with our employees all day — now begin to overwhelm things that actually would have been more fun or more restful or more fulfilling. Like, you have Slack pings hitting your phone at night when you’re supposed to be with your family, or you’re sitting with your friends, and you’re looking at your phone because you’re just so used to being in that constant communication. That the blending of work and fun, which I do think of as a distinctive work culture thing of our era, has actually been really toxic for real fun — and maybe for work, too.
Well, it certainly doesn’t help. And I agree that it’s really a culture of 20 to 30 somethings living in the Bay Area during a certain period, who had emerged with this lifestyle that was entirely integrated with the digital, especially once you get post-smartphone, post-constant connectivity. And you do see that trend move into these tools. But there’s also countervailing trends. So I’ll give you a counter example. I was fascinated working on the book on this notion of extreme programming. So it’s like a workplace methodology and the guy who was telling me about it is a real zealot. His company had been bought by Google, and he had gotten disillusioned that Google wasn’t hardcore enough about his methodology. So he left to start his own lab. But if we think about extreme programming as like an extreme case study, what they do in these shops is all built around, OK, we have brains that can produce good code. If that’s really what we want to maximize, how do we do it? So there’s no email, there’s no Slack. You come in, you sit at a screen with another programmer. If you have two brains working on the same thing, you push each other, and you get more insights. But also, you take less breaks. You slack less, right? Their project leads handles all communication on their behalf. You have no inbox, you have no whatever, and they just code. And it’s so intense that they’re done by 3:00 or 4:00. And there would be no notion that you would stay there late. It would be impossible to. We work really hard, and then when we’re done, we’re done. They said when people are newly hired here, they end up having to go home and take naps for the first couple of weeks, just to adjust to the load. Now that is rightfully called extreme, but what boggles my mind is why aren’t there dozens and dozens of experiments of all these different ways of working? Clearly, you can change the way you work. When you start thinking about, OK, how do you get value out of human minds? How do you stop the human mind from burning out? How do we stop people from being miserable? There’s all of these options. And the fact that it’s so unexplored, that something like an extreme program is this weird outlier case study, to me, I think that’s very striking, right? I mean, to me, it’s a revolution waiting to happen. We’ve seen this in past intersections of technology and commerce, that there’s these long simmering revolutions, where we’re not doing things the way that would be smart. We’re doing what’s convenient. We’re doing what the momentum pushes us. We’re following inertia. And then, overnight, suddenly, we have electric motors and factories. Overnight, they don’t build cars craft method anymore. They do it the assembly line. So these tend to be non-contiguous, right, so these kind of discontinuities when we have these jumps. I just think something like this is coming for knowledge work. This constant back and forth chatter, it doesn’t make a lot of sense. And so something has to change.
Let me pick up on the cars example. I love the way you tell the very oft told story of Henry Ford and the Model T and the assembly line. Because I’ve read a version of that story I don’t know how many dozen times in productivity and management and innovation books. But it often feels like there was bespoke artisanal car manufacturing, and then all of a sudden, here comes Henry Ford and the Model T. And you focus on what is happening between those two moments, right? This period when Ford is experimenting, how difficult the experimentation must have been, how frustrating it must have been, and that there are a bunch of experiments that failed. Can you talk a little bit about that, the path from one to the other?
Yeah, I think it’s very, very illustrative. So, Ford, when he was first running his factory, when you have the early days, let’s say, of the Highland Park Factory, the craft method did dominate, right? So they took this bespoke method, where just some craftsmen would build a car. And the way they scaled it is they just had more teams working on more cars. They put them up on sawhorses, and you would surround it, you and five other guys. And you would build a car. And so he started experimenting. OK, this seems like it’s not that fast. And so he went through a whole series of experimentations, which I thought were really interesting once you uncovered them. They tried lots of things. Like, what if we have one guy who is the wheel guy, and he just goes from sawhorse to sawhorse and puts on the wheels? Well, what if we put the materials in the ceiling so that they can come down chutes? And then you could have it come right down to where you are without having to take on space on the floor. Well, what if we have a whole team that moves from car to car? So he was doing all of these experiments to try to figure out, is there a better way to actually take all this material, and then on the other end, have a car built? And the two things I like to emphasize is, one, the way they were building cars before was very easy and very convenient and very natural. And we actually see this story come up a lot in the history of industrial manufacturing, that when you had early factories, you built things the way that was convenient and natural because it seemed too foreboding to try to figure out something else, right? And this goes back to sort of the history of industrial manufacturing. And, two, it was a huge pain to get past that. It was all those experiments, but the assembly line was a huge pain. Once it got running, they had to hire a lot more people. They had to spend a lot more money. I’m sure no one liked the notion who was an investor in Ford. Like, you’re doing what? We’re going to double the amount of floor managers who don’t build things, but just watch things? And it would get stuck all the time. When you’re trying to figure out how to make this thing work, if the steering wheel guy is a little bit too slow, the whole assembly line would stop. So it was really inconvenient. It was a pain, and it cost more money at first. But it was 10 to 100x more productive once they figured it out, which, to me, is a good metaphor for we gravitate towards what’s easy and convenient. And it can be a pain to move to what works better at first. There is an upfront cost to figuring out, let’s say, better ways of producing things.
So you’ve been studying this over the course of your last two or three books. You’ve been circling this book, I would say. And for this book, you’ve spoken to a lot of firms that were trying to change the way they worked pretty radically. They’re the exceptions. And then I’m sure you’ve spoken to a lot of people in firms that weren’t. What is your explanation for why firms are more loath to experiment? Is it just the Peter Drucker thing at this point? Or do you see more happening in terms of the status quo bias, the lock in, the power dynamics of firms that make this kind of experimentation hard for managers to try?
So there’s sort of three hypotheses on the table I was looking at. So there’s the Peter Drucker autonomy trap. There is the — it just been hard, right? Let’s call this the Henry Ford lesson, right, that it’s actually a real pain to figure out what works better. This is convenient, this is cheap. When I was interviewing Gloria Mark, she told me about how, when she was in the computer supported collaborative work scene back in the early 1990s and computer networks were new, there was all this exciting research about look at all these tools we’re going to build that are going to sit on networks, and we can access them on networks. And it’s going to make our work so much more effective and productive. And she said the whole field basically went away once email spread because it was just cheaper to buy an email server. It’s like, look, we can just do this all with file attachments and CCs and it’s fine. We don’t need it. And then the third reason would be power dynamics, right? Which is something I heard hypothesized a lot that maybe that for a boss or something, this them more power. It could be either productivity power play, like I’ll get more out of my workers. Or it could be a sort of egotistic self-regard. I like people answer me, sort of powerplays. All three hypotheses play a role. As far as I can tell, though, it’s a combination of the first two that probably play the biggest role. So, the bosses, manager, C suites, at all these levels, I think there’s this growing awareness that this is terrible. It’s a terrible way to work. Our output as a company is lower, and employees turnover and leave the workforce because it makes them miserable. So the power dynamics didn’t show up to be as important as they once suspected. But I think it’s a combination of the autonomy bias and just the fact it’s hard. The companies I document that do replace the hyperactive hive mind with more bespoke processes that reduce all this constant back and forth, it wasn’t easy to do. It’s like figuring out how to make the assembly line work. There’s going to be false starts. There’s going to be experiments. It’s going to cost more overhead. Bad things are going to happen temporarily. And you have to be willing to go through that. And that’s a big hurdle.
So one of the obvious objections to your theory here is that if this is a market failure, if most firms are running this wrong, then it should be relatively easy to correct in the sense that firms will emerge that are working off of more Cal Newportian theory of the case. And they will come to overwhelm the market because their productivity will be higher, their output will be better. They will get better employees because it’ll be more fun to work there. When I read through the book, it obviously seems some of these firms are more fun, right? So you spend some time in firms that have shorter work weeks. You have firms that have way better work-life balances. I know some of those firms, and they don’t dominate their industry. Their practices are not spreading like wildfire. And that implies to me that something is wrong somewhere in the model because if this is such an economic drag, or at least, such a drag on worker happiness, then there should be a really huge competitive advantage to the firms who have figured out a better way or who are wandering around it. What’s your theory there?
I think it’s coming. There is a huge competitive advantage. It’s why I think we’re going to experience a punctuated equilibrium here. The shift is going to seem to be practically overnight when the shift does come. And a couple of reasons to believe it’s coming — one I like to emphasize that the timeline here is not unusual. I mean, how long did it take from the beginning of industrial car manufacturing to the change that was the assembly line? It was about 20 to 25 years. We’ve had email as a large presence for about 20 to 25 years. If you look at the electric dynamo, its integration into factory construction, it took about 50 years, even after we had generators who could generate electricity and we had electric motors. And clearly, the right thing to do was to put electric motors on the factory equipment, as opposed to having all these overhead cams and belts that were powered off of old steam engines. It still took 50 or 60 years until there was this moment where, OK, everything shifted over, and there was a lot of reasons about inertia and infrastructure that’s already been invested. So my argument is, you basically should hold this to me, right? So I’m making a falsifiable — this is my Karl Popper moment here. I’m saying, let’s look in five years. I think we’re going to see a big difference. Now partially what I’ve noticed is between when I started talking to people about this for my 2016 book, Deep Work, and now, there’s a notable shift in some of the CEOs I talked to. There’s a notable shift in some of the investors I talked to. This is on the radar, I should say, of these communities. Because they’re beginning to realize there might be hundreds of billions of dollars of GDP on the table, and that is a really rich pie. There’s been a lot of investment activity in the last couple of years on companies that are trying to better help extract this. In the conclusion of my book, I quote anonymously but a relatively well known CEO, who’s saying, like, this is going to be the moonshot of the next decade, is figuring out how to get past the hive mind and have much more sustainable productive ways of working. He calls it the moonshot because there is so much value there, but also it’s going to require so much energy to figure it out. So I would say five years from now, things will look different. And that’s a falsifiable hypothesis. I mean, if we’re in the same place five years from now, then maybe not. But we’re basically on track. This is a very normal timeline in technology and commerce. For a new technology comes, we do what’s easiest. We finally have this moment of punctuated equilibrium. We’re like, OK, enough is enough, and we shift to a different phase. [MUSIC PLAYING]
One of the things that I think about in the difficulty here because we’ve known each other a long time, and you know that I’m a believer in the Cal Newport oeuvre on these subjects. I care about deep work. Back when I was at Vox, we had a little deep work icon you could put on in Slack. And you’d be doing deep work, and nobody should bother you.
That’s a very ironic thing you just said, by the way, a deep work icon on Slack.
Listen, it’s all ironic. I’m aware of that. One of the things that I notice in myself as a worker — and others for that matter, too, but I’ll be the example here — is that as much as I know I get more done if I don’t flick over to Twitter, if I don’t flick over to Slack or my email, and I use freedom and I cut myself off from those things when I’m trying to get things done, there’s still a big part of me that wants to. And one of the tricky parts of this is, is that it’s not one of these things that is good for us and it feels good when we do it. It’s incredibly tiring to work in a sustained, focused way without getting those little dopamine hits of distraction. And the more often you get those little hits, the more you crave them. I mean, this is part of Deep Work, that you begin to train your brain to demand these little bits of feedback. And so it becomes very hard to change the way your firm works or to even just change the way you work, not because you don’t think you should, but because you are so trained to do the other thing, right? You’ve come to expect it. Then once you do it, you kind of fall back into old patterns. I’m curious how you think about that part of it, that retraining of our own expectations and rhythms.
Well, so one of the changes I’ve had in my thinking, let’s say between “Deep Work” and this book, is thinking about the individual. I think one of the issues people had — let’s say you read something like “Deep Work.” You’re like, OK, I get it. Like, concentration produces more than non-concentration. I try to spend more time in the deep work. And so then, as an individual, you should try to put more time on that. And you’re talking about how that’s very difficult. Well, that’s difficult in part because not a failure of will, you as an individual, but because it is a necessity of this underlying hyperactive hive mind workflow that this inbox is where everything’s happening. Like, there’s people who need you. Everything you’re involved in is taking place in that inbox. This back and forth messaging is how this is getting figured out and that is getting resolved and how this issue is also getting handled. And so this urge to, I need to go back and check this, I think we too often think of it as a failure of will, but it’s a failure of workflow. And it’s the reason why I think a lot of people had a hard time executing ideas of deep work. It’s the reason why I think moves to have email-free Fridays, or let’s have better norms about response times, the reason why this has failed to really calm any issues with inbox or email overload is because this is where the work happens, and when you’re away from it, it causes problems. Which is, this is my big revelation, is that we can’t solve these problems in the inbox. We have to solve these problems below the inbox. We actually have to go and take the implicit work processes that are generating all these back and forth messages and expectation of ad hoc unstructured communication, and we have to replace them with things to generate many fewer messages. We need to make the inbox a lot less interesting. I think that’s more important than trying to convince people to ignore the interesting nature of the inbox. And so, that’s something I’ve really been thinking about. Because it’s not helping to keep all of our focus on — and by our, I just mean the culture that deals with email overload — to keep all the focus on hacks and tips and how to better engage with your inbox. The problem, I think, is below.
And one of the difficulties here, too, is that there are some — advantages may not be exactly the right word, but benefits that come out of being personally engaged and sorting through the information flow. So I believe — you can tell me if I’m wrong. I believe I make an anonymous appearance in this book. And there’s this moment where you say I was talking to the editor-in-chief of a new media, a new journalism company.
This is you, yes, OK.
It is me, yeah. And I was saying to him, why didn’t you just have somebody checking Twitter on behalf of your staff and telling them if anything interesting is coming. And you say, well, this unnamed journalism EIC had never thought of this before and thought, well, what if — and that’s actually not how I remember that conversation. I’m going to give you some shit about this. And so I remember the issue there, what I said, it’s true I thought about that. That’s not a lie, but is that the difficulty with having somebody else check Twitter on my behalf, is that I am doing the information processing. And only I know what I find interesting. And only I see the things in it that I will see. And even worse for journalists — and this might be distinctive to my industry, but it is a problem in my industry — Twitter is an important place where you build your own brand. And so, I think collectively, it would make sense if we’re not all herding on there and thinking the same way and talking to each other. But for any individual to leave is a little bit irrational because you deprive yourself of mindshare and the people who could give you future jobs. And in the sort of ways your peers understand you as fitting into the firmament, which is very important for the future of your career. And so this is a situation where not every but a lot of journalists I know do not like how much time they spend on Twitter. There’s a lot of talk about this health site, all of that. And people drop off and they’ll come back because to not be there feels like it has worse consequences, even though to be there is very unpleasant. So I want to hear your response to my more nuanced explanation of why journalists are on Twitter.
Yeah, no, I remember you having that response, and I still don’t buy it. I think it’s — [LAUGHTER] I think Twitter is melting journalist brains. I mean —
I’m not arguing that.
Yeah, it’s making journalists miserable. I still hold by my original stance. Like, there’s got to be a way that the — I mean, you mentioned it was like breaking news was important. And hearing from sources was important, so that went over to email a little bit. And that’s where I figured —
No, I don’t think — I will say I don’t think the breaking news function is that important. I think a lot of journalists will tell you it is, but I don’t agree with them on that.
I think it’s actually more esoteric things one sees that can be important.
Right, but at the time, I think the breaking news was a thing that — and I think we’ve in general, as a culture, I think have evolved on that because we realize like, oh, wait, we’re not getting on the ground AP reports from Twitter. We’re getting a lot of randomness and a lot of false information, too. I would still argue there’s got to be a way — I mean, this is like digital minimalism 101. So let’s say there is something about direct encounter with the esoterica of Twitter that helps sort of you gain a better zeitgeist understanding of cultural trends, which will then inform your writing. OK, let’s say we buy that premise. Minimalism would say, great. What’s the right way to get that benefit while minimizing the cost? It would probably be like, I have my Twitter hour, where I go. The thing that I think was killer for a lot of journalists is this notion of, I always am on this thing, and I’m always checking this thing. And Twitter has its own emotional issues. It has its own issues like you’ve talked about. And I heard you talk about this with Zeynep Tufekci recently on your podcast. It has idea hurting issues, but it also has the issues I talk about, which it significantly reduces your cognitive capacity. You can’t think as clearly. You feel tired. You feel anxious. The work you produce as a journalist, all of that is worse as well. When I was doing the digital minimalism promotion a couple of years ago, there was one — I’ll leave this anonymous. And it’s not you, though — I will say that. There was one interview I did with a well-known journalist. And this journalist producer admitted to me, I didn’t really have you on for the audience, I wanted the host to hear these ideas because I think this person is going insane. I have to get them off of Twitter, so.
Did it work?
Oh, no. Oh, no. It got worse.
[LAUGHS] You say something, though, around this issue that I think is really wise, which is that one thing that a lot of these mediums do is that they make us all think we should be generalists. They make us all think that we should and can do everything. So something about the way Twitter does news is that it feels like you should be on top of everything. And I think actually something that I try very hard as a journalist to do is say, there are some things that I’m just not going to know that much about because I need to know a lot about the things I write on. And so, I need to let other things pass me by. But in general, you have a section of the book — this is more towards the end, but where you talk about specialization as an answer here and how one of the odd effects of hyperactive hive mind thinking is that it has cut against specialization. Could you talk a little bit about specialization, why you think we’ve lost it and what kinds of ways we could get it back?
One of the claims I try to back up in the book is that when you remove the friction required to communicate with people inside your organization, both the amount and diversity of things that’s on their plate that they have to deal with explodes. Right? So now you just have many more things you have to do. You have many more, some of it administrative and some of it non-administrative. But if you just look at the sheer variety of things that the knowledge worker has on their proverbial task list — and I say proverbial because they probably don’t actually have a real task list. It probably is just all mungled in their inbox, which is its own issue. It’s huge, right? So there’s a really interesting notion from the literature on this. And it’s this idea of diminishment of intellectual specialization. And it’s a term that was coined by an economist named Peter Sassone, and he was at Georgia Tech. And he wrote this paper back in the ‘90s that I cite all the time because I think it’s just really fascinating. But he studied earlier technologies arriving. He had five companies, 20 departments within these companies, more like the personal computer, right? So this would have been the late ‘80s. So not email, but we can extrapolate from this. And what he documented happened in these companies is that these computers had time-saving, quote unquote, software, word processors and early email and these type of things. And so these companies say this is great. We can fire support staff. We don’t need a typing pool. We don’t need secretaries. We can fire support staff because now everything is kind of easy enough. The friction’s low enough that the executives or the employees themselves can just do the work. The problem was, is, all this work now shifted onto the plate, so that the people that maybe were doing five main things for the company now had 15 things on their plate, so they could get less of the original value producing work done. So they had to hire more of these higher priced employees to actually keep up with the same amount of output. And Sassone crunched the numbers and said, actually, their salary costs ended up, after all this was done, 15 percent higher. So they cut the salaries of support staff, but then they had to add more of these higher priced salaries because people were less productive, and they ended up worse off than they were before. And he called this the diminishment of intellectual specialization. I think this is something that’s just really being amplified right now in our age of the hyperactive hive mind. Every unit in your company, every vendor, every client, every other team that might need your time and attention, can just easily grab you, grab that time and attention, put more and more things on your plate. It makes everyone’s life a little bit easier in the moment. But we get so much less done of the primary things that originally produce value, is that you’re not actually getting ahead. And in the end, you’re producing less. So I think this notion that we all do a lot more, we all can do a lot more, is not necessarily compatible with trying to get the most out of people. And I’m going to real argue that we need to return to much more specialization. I do very few things.
One of my criticisms of some of your past books — and we’ve talked about this — is that they felt to me very much about the individual creator, that it felt to me sometimes like you are really creating a structure that made sense for Cal Newport, university professor, or even maybe Ezra Klein, article writer. But that there were managers in this world that were collaborative workers in this world, and it wouldn’t work for them. You have more on that in this book in a way that I find persuasive. But something you talk about here is that management has to be about more than responsiveness, and that one of the things happening with a lot of these tools is they are changing the expectations of managers. They are changing how responsive their employees expect them to be. They are changing sort of the work that management is actually able to do. And so probably degrading or at least changing the way firms are managed. Can you talk a little bit about this from the manager’s perspective?
Yeah, and there’s research on this. I mean, I found this interesting study where they could look at inbox levels. Like, how much email is managers having to answer? And they could correlate this with what they call leadership activities. So the type of activities are important for getting the most out of your team, moving your team to where it needs to be, seeing issues that are coming from down the road and make sure that you’re around them, giving the support that individual team members need to thrive. All these leadership activities significantly decrease as you increase the amount of email that managers have to answer. And what these researchers documented is that as the email load increases, managers retreat into a task-oriented productivity mode. And they’re just like human network routers. Like, I’m just trying to take care of small things to come at me via email, answering questions, moving things around. And a lot of the managers I talked to when I was working on this book just have this vision of themselves as, I’m like an operator. And little questions and concerns come to me, and I try to answer them as quickly as possible. And one of the big points is, that’s not really good management. There’s some of that have to figure out how to do. Of course, questions need to be answered. But if all you’re doing is just trying to keep up with a hyperactive hive mind flow of all these ongoing conversations, the real important stuff doesn’t happen, that managers, too, need to be able to do one thing at a time, give things the attention they deserve. And that’s basically impossible if the hyperactive hive mind is the main way that your team coordinates and organizes. [MUSIC PLAYING]
So I want to ask a little bit about solutions here. And you go into sort of some granular detail on different ways different firms end up doing Trello boards and other things. But I want to talk about it in more high level. Let me start here. Let’s say you are somebody running an existing firm right now. You’re not starting something new. You have 100 employees or used to certain ways of doing things. You have all the accoutrements of modern enterprise software. You have Slack, you have Gmail. You’re an advertising firm, a media firm, whatever it might be. Where do they start implementing the ideas of this book?
Well, so the big idea is, whether you name it or not, you have processes that repeatedly happen that produce the stuff that has to happen in your company. Now if you don’t have names for them, if you haven’t thought about them, you’re probably implementing most of these processes with the hyperactive hive mind. Just, let’s figure it out on the fly. So the first step is just to identify what these things are. We have a deal with client question process. We have an article production process. We have a strategizing for future business moves process, right? You name them. You see what they are. What are the things that we actually do on a repeated basis? And what I recommend is what you really want to do is, process by process, say, OK, how do we actually want to implement how this happens? And the metric that I push, it’s not like how much time is it going to take or how hard is this particular method, but to what degree can we minimize unscheduled back and forth communication? So how can we implement this particular process, like responding to client questions, producing articles, whatever it is, in a way that does not require the sort of asynchronous back and forth messaging that, in turn, will require check after check after check after check to kind of keep that ping pong ball bouncing. Once you know that what you’re looking at is processes and what you’re trying to do is reduce unscheduled back and forth messaging, it opens up endless innovations. Like, oh, there’s all sorts of different ways we might do this, right? But if you don’t have the right metrics in mind, if you’re not looking at the right target, you’re just going to get stuck looking at these overcrowded email inboxes and sending around memos about, let’s have better norms on response times, or let’s write better subject lines or something like that. You’re putting your energy into the wrong process. So that’s that process oriented thinking. Optimize, optimize one by one. Back and forth messages, that’s the killer. That’s what we want to reduce. You just do that, and you’ll begin to see, I think, almost immediate results. It reduces the pressure on the inbox, as opposed to have better organizational tactics for dealing with the inbox.
And how about if you’re somebody starting a new firm or at a new firm? If you buy the Cal Newport theory that there are huge gains to be unlocked by building a radically different culture of communication and process, how do you unlock them? How do you keep focus on that, particularly when people are going to come in, expecting it to work or the way they’ve known other places to work?
It’s not easy. I mean, first, there’s a general culture that you want to try to instill, which is a culture that really thinks about tools like email are great for sending information. I’d rather send you a file with an email than a fax machine. They’re terrible for interaction. We should not be trying to collaborate or coordinate ourselves with back and forth messages. Two, you really have to separate execution from how we organize the work. Execution has to be really autonomous. You have to be very careful that you’re not stepping on the toes of creative skilled professionals about how they actually write their ad copy or how they actually write their code, that making that sacrosanct is what allows knowledge work to be much more satisfying and meaningful and allows us to avoid the drudgery that industrial work fell into. You’re putting your focus on the workflows that organize that work. What are the processes by which information moves? We make decisions. We agree on things. Where do files go? Where do we take them from? So make sure that execution is sacrosanct. It’s all of the organization around the execution that you’re trying to optimize. And then, two, lead by example. So even if it’s really convenient for you just to grab that purse and be like, OK, let me not do that. Let me try to think about these processes. And I document somewhat in the book what it’s like to try to get these things in place. They need buy-in. They have to be bottom up. Everyone involved in the process has to be involved in making it. And you have to have a culture of evolution. It’s not quite working, let’s tweak it. So put those things into place, it’s still not easy. But, again, it was a pain to build the assembly line. So at least there’s incentives to push you through that pain.
And one of the things that is a little bit counterintuitive about this book is, I think people building new things, meetings, in-person meetings, phone meetings, they have a really bad reputation. I often say to people, like, let’s try to just make this an email, which means I have a lot of emails bouncing back and forth. You have a little bit higher of an opinion about what it means to save more things for meetings than I think the dominant culture holds. So if you were to preach the value of actual meetings as opposed to having things be done through communication, how would you tell a CEO or tell a CEO to tell their employees that they should think about meetings with a little bit more affection, and email with a little bit less?
Well, any time you have to make a decision or have back and forth — there’s interaction that has to occur — real time is exponentially better than asynchronous, right? It’s better to be able to just talk with you on the phone or on Zoom or in person to go back and forth. The amount of bits of information that’s able to be established in a back and forth conversation is of a different order of magnitude than when you’re in a purely linguistic medium. Like, I put some text in an email, it goes to you. Later that day, you send an email back that has some more text. That type of asynchronous communication has huge overheads, and it’s not very effective. So I’m a huge believer in real time interaction as a highly effective and efficient way to get things done, to reach decisions that do interactions. The problem with meetings people have is that they’re not coupled with well thought through processes, right? So if you look at a software development firm, where they think a lot about this type of stuff, and if it’s a software development team that’s running an agile methodology like Scrum, they will have these daily stand-up meetings. They only last 20 minutes. They fit very clearly into an overall structure of how tasks are identified, assigned, and reviewed, right? So they have these 20-minute meetings that incredibly efficiently people figure out, here’s what I did. Here’s what I’m working on. Here’s what I need from you. I need it by now. Great, we’re on the same team. Go right, right? It’s a meeting done well. That’s way more effective than try and do that over email. What happens I think in a lot of hyperactive hive mind style knowledge firms is that we throw meetings as issues as a proxy for productivity. I don’t really want to think about this. If I put a meeting on my calendar, then at least I know that has to happen. So at least I won’t forget it. I think meetings are often used because people don’t have systems where they trust themselves to remember or make progress on things. Like, well, if it’s a recurring meeting, then I do look at my calendar. They’re not tied to other processes. They’re not tried to optimize ways to get things done. So, meetings not connected to processes can make work really unbearable. I think a lot of pandemic workers have discovered that doing Zoom all day long can’t possibly be the best way to organize. But a meeting tied to a really smart process can actually save you a lot of time.
I guess a good place to come to a close. So end of the show, I always ask for a couple of different book recommendations, and let me start here. What’s a book that’s done the most to inspire your work and your explorations?
Well, it probably depends on the topics that I’m reading, but when it came to these explorations of email, I was really taken by a lot of these books that were the 20th century techno determinists. So there was all this interesting philosophy of technology thinkers in the 20th century that were really trying to understand a way that if you introduce a new technology into an ecosystem, it can actually really unsettle this ecosystem in ways that are unpredictable and unintentional. And that opened up a lot for me because it got me out of this mindset of, well, if we’re all doing email, it must be because it’s helping somebody. There must be a reason why we’re doing this. It’s got to be maybe adversaries versus the good guys and what’s the battle going on. But the idea that technology itself can just have these ecological changes I think is really important. So probably Lewis Mumford’s “Technics and Civilization,” that’s an early 20th century book that really pushed those ideas. I think that’s really interesting. A lot of Neil Postman — Postman was a very famous techno determinist. I actually cite a speech from Postman at the end of the book that was influential to me. It wasn’t a book that he wrote. It was a summary of his thoughts on technology. And it’s really rich, and I put it in the citation in the book. But that’s where he made really clear this notion that technology is not additive, it’s ecological. He was like the Middle Ages plus the — once you got the printing press, it was not just the Middle Ages plus printing presses. It was an entirely different world. And that notion really shaped the way I thought about email. The arrival of email did not give us the 1990 office plus now we had email. It gave us an entirely different notion of what work meant. And so any of these writers who were writing in this vein of technological determinism were very influential. I think it comes through in a lot of my thinking.
You talk a lot about the difference between the kinds of products one creates and the hyperactive work worlds many of us exist in and the slower, more thoughtful, more deeply creative spaces of “Deep Work.” What’s a fiction book or piece of art that you think is what it looks like when “Deep Work” works, the kind of thing that you’re not going to be able to do checking Twitter every couple of minutes?
Well, I mean, basically, any award caliber literary fiction has to be created in that mindset. So whatever your favorite sort of award caliber literary fiction novel is, there’s really no way to produce real insight in writing at that level without actually just having the ability to be alone with your own thoughts and observing the world, and just letting that percolate and letting that move, and trying to craft and move and work with it. I’ll say it’s not a book, it’s a video. I actually wrote an essay about a blog post about not too long ago. It was a stone carver. A young woman, I think she’s based in the — near you, actually. I think she’s she’s based in the Bay Area. And it was just this video they had put up on Vimeo that just captured what it is to carve a statue out of stone. And something about that was really affecting to me. It’s just all you do all day long, and she’s looking at the stone and she has the bust. And then it’s manipulating the material and manipulating the real world. And it’s in this warehouse, and the doors open out into some trees or something like that. And I don’t know — there was something very affecting to me about that story. But it’s someone that’s just, they are 100 percent in the world of trying to take this block of stone, and from it, make manifest some sort of intention that exists just in their mind. I mean, that’s human depth personified, and the opposite, I would say, of Slack.
So my son just came home and is crying in the background. So this final one feels apropos. What’s your favorite children’s book?
When my first kid was born, my literary agent sent me a bunch of books. And there’s one that all of my kids have loved. It’s called “Andrew Henry’s Meadow.” And it’s an older book. It’s illustrated. And the premise is this young boy who builds things. It’s beautifully illustrated. And he’s not sort of — it feels like he’s not appreciated by his family, so he leaves. And all the kids follow him across the creek and through the woods and to Andrew Henry’s meadow. And they build these elaborate, beautifully illustrated houses. There’s like a castle, and there’s like a tree house. It’s all built from sort of found objects. And then the parents realize at some point that they’re gone, and they’re all panicking. And they go and they find them. And when they finally bring them back, they make a space for Andrew Henry in the basement to be able to build his contraptions. Kids love it because of the illustrations. It somehow just gets into the psyche of kids. But there’s kind of a nicer message lurking in there. I’ve always kind of liked that message of understanding what it is to drive your kids and then making room for it. So that’s my underground favorite because almost no one’s heard of it. And we’ve gone through a couple of copies now.
Cal Newport, thank you very much.
Thanks, Ezra. [MUSIC PLAYING]
That is the show. Thank you for listening. I always appreciate you being here. Give us a review on whatever podcast app you’re listening on if you’re enjoying it, or send it to a friend. “The Ezra Klein Show” is a production of New York Times Opinion. It is produced by Roge Karma and Jeff Geld, fact-checked by Michelle Harris, original music by Isaac Jones, and mixing by Jeff Geld.
We were promised, with the internet, a productivity revolution. We were told that we’d get more done, in less time, with less stress. Instead, we got always-on communication, the dissolution of the boundaries between work and home, the feeling of constantly being behind, lackluster productivity numbers, and, to be fair, reaction GIFs. What went wrong?
Cal Newport is a computer scientist at Georgetown and the author of books trying to figure that out. At the center of his work is the idea that the technologies billed as offering us more productive, happier, socially rich lives have left us more exhausted, empty and stressed out than ever. He’s doing something not enough people do: questioning whether this was all worth it.
My critique of Newport’s work has always been that it focuses too much on the individual: Telling someone whose workplace communicates exclusively via Slack and email to be a “digital minimalist” is like telling someone who lives in a candy store to diet. But his new book, “A World Without Email,” is all about systems — specifically, the systems that govern how we work. In it, Newport makes a radical argument: We are living through a massive, rolling failure of markets and firms to rethink work for the digital age. But that can change. We can change it.
To listen to the full conversation, subscribe to “The Ezra Klein Show” wherever you get your podcasts, or click the player below.
(A full transcript of the episode can be found here.)
On Monday, the U.S. reached a heartbreaking 500,000 deaths from COVID-19.
But widespread death from COVID-19 isn’t necessarily inevitable.
Data from Johns Hopkins University shows that some countries have had few cases and fewer deaths per capita. The U.S. has had 152 deaths per 100,000 people, for example, versus .03 in Burundi and .04 in Taiwan.
There are many reasons for these differences among countries, but a study in The LancetPlanetary Health published last month suggests that a key factor may be cultural.
The study looks at “loose” nations — those with relaxed social norms and fewer rules and restrictions — and “tight” nations, those with stricter rules and restrictions and harsher disciplinary measures. And it found that “loose” nations had five times more cases (7,132 cases per million people versus 1,428 per million) and over eight times more deaths from COVID-19 (183 deaths per million people versus 21 per million) than “tight” countries during the first ten months of the pandemic.
Gelfand says her past research suggested that tight cultures may be better equipped to respond to a global pandemic than loose cultures because their citizensmay be more willing to cooperate with rules, and that the pandemic “is the first time we have been able to examine how countries around the world respond to the same collective threat simultaneously.”
For the Lancet article, the researchers examined data from 57 countries in the fall of 2020 using the online database “Our World in Data,” which provides daily updates on COVID-19 cases and deaths. They paired this information with previous research classifying each of the countries on a scale of cultural tightness or looseness. Results revealed that nations categorized as looser — like the U.S., Brazil and Spain — experienced significantly more cases and deaths from COVID-19 by October 2020 than countries like South Korea, Taiwan and Singapore, which have much tighter cultures.
NPR talks to Gelfand about the findings and about how understanding the concepts of “looser” and “tighter” nations might lead to measures that help prevent COVID-19 cases and deaths as the pandemic continues.
This interview has been edited for length and clarity.
How did your past research bring you to your current findings about the pandemic?
One of the things I’ve been looking at for many years is how strictly cultures abide by social norms. All cultures have social norms that are kind of unwritten rules for social behavior. We don’t face backward in elevators. We don’t start singing loudly in movie theaters. And we behave this way because it helps us to coordinate with other human beings, to help our societies function. [Norms] are really the glue that keep us together.
One thing we learned during our earlier work is that some cultures abide by social norms quite strictly. And these differences are not random. Tight cultures tend to have had a lot of threat in their histories from Mother Nature, like disasters, famine and pathogen outbreaks, and non-natural threats such as invasions on their territory. And the idea is when you have a lot of collective threat you need strict rules. They help people coordinate and predict each other’s behavior. So, in a sense, you can think about it from an evolutionary perspective that following rules helps us to survive chaos and crisis.
Can you change a culture to make it tighter?
Yes, but you need leadership to tell you this is a really dangerous situation. And you need people from the bottom up being willing to sacrifice some of the freedom for rules to keep the whole country safe. And that’s what’s happening in New Zealand, where they had few cases and few deaths per million, and where they’re really very egalitarian. My interpretation is that people said look, “We all have to follow the rules to keep people safe.”
Can you give us some examples of how tight and loose cultures operate when there’s not a pandemic going on?
Tight cultures have a lot of order and discipline — they have a lot less crime and more monitoring of [citizens’] behavior and [more] security personnel and police per capita. Loose cultures struggle with order.
Loose cultures corner the market on openness toward people from different races and religion and are far more creative in terms of idea generation and ability to think outside the box. Tight cultures struggle with openness.
Do you think it’s possible to tighten up as needed?
Yeah, absolutely. I mean I would call that ambidexterity — the ability to tighten up when there’s an objective threat and to loosen up when the threat is diminished. People who don’t like the idea of tightening would need to understand that this is temporary and the quicker we tighten the quicker it will reduce the threat and the quicker we can get back to our freedom-loving behavior.
I imagine people are worried, though, about long-term consequences of tightening up.
We shouldn’t confuse authoritarianism with tightness.
Following rules in terms of wearing masks and social distancing will help get us back faster to opening up the economy and to saving our freedom. And we can also look to other cultures that have been able to open up with greater success, like Taiwan for example. Increased self-regulation and [abidance of] physical distancing, wearing masks and avoiding large crowds allowed the country to keep both the infection and mortality rates low without shutting down the economy entirely. We need to think of this as being situation-specific in terms of following certain types of rules.
It requires using cultural intelligence to understand when we deploy tightness and when we deploy looseness. And my optimistic view is that we’re going to learn how to communicate about threats better, how to nudge people to follow rules, so that people understand the danger but also feel empowered to deal with it.
[In the U.S., for example, we] need to have national unity to cope with collective threat so that we are prepared as a nation to come together like we have in the past during other collected threats, such as after September 11.
Fran Kritz is a health policy reporter based in Washington, D.C., who has contributed to The Washington Post and Kaiser Health News. Find her on Twitter: @fkritz
Many scientists are expecting another rise in infections. But this time the surge will be blunted by vaccines and, hopefully, widespread caution. By summer, Americans may be looking at a return to normal life.
Published Feb. 25, 2021Updated Feb. 26, 2021, 12:07 a.m. ET
Across the United States, and the world, the coronavirus seems to be loosening its stranglehold. The deadly curve of cases, hospitalizations and deaths has yo-yoed before, but never has it plunged so steeply and so fast.
Is this it, then? Is this the beginning of the end? After a year of being pummeled by grim statistics and scolded for wanting human contact, many Americans feel a long-promised deliverance is at hand.
Americans will win against the virus and regain many aspects of their pre-pandemic lives, most scientists now believe. Of the 21 interviewed for this article, all were optimistic that the worst of the pandemic is past. This summer, they said, life may begin to seem normal again.
But — of course, there’s always a but — researchers are also worried that Americans, so close to the finish line, may once again underestimate the virus.
So far, the two vaccines authorized in the United States are spectacularly effective, and after a slow start, the vaccination rollout is picking up momentum. A third vaccine is likely to be authorized shortly, adding to the nation’s supply.
But it will be many weeks before vaccinations make a dent in the pandemic. And now the virus is shape-shifting faster than expected, evolving into variants that may partly sidestep the immune system.
The latest variant was discovered in New York City only this week, and another worrisome version is spreading at a rapid pace through California. Scientists say a contagious variant first discovered in Britain will become the dominant form of the virus in the United States by the end of March.
The road back to normalcy is potholed with unknowns: how well vaccines prevent further spread of the virus; whether emerging variants remain susceptible enough to the vaccines; and how quickly the world is immunized, so as to halt further evolution of the virus.
But the greatest ambiguity is human behavior. Can Americans desperate for normalcy keep wearing masks and distancing themselves from family and friends? How much longer can communities keep businesses, offices and schools closed?
Covid-19 deaths will most likely never rise quite as precipitously as in the past, and the worst may be behind us. But if Americans let down their guard too soon — many states are already lifting restrictions — and if the variants spread in the United States as they have elsewhere, another spike in cases may well arrive in the coming weeks.
Scientists call it the fourth wave. The new variants mean “we’re essentially facing a pandemic within a pandemic,” said Adam Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine.
The declines are real, but they disguise worrying trends.
The United States has now recorded 500,000 deaths amid the pandemic, a terrible milestone. As of Wednesday morning, at least 28.3 million people have been infected.
Yet the numbers are still at the horrific highs of November, scientists noted. At least 3,210 people died of Covid-19 on Wednesday alone. And there is no guarantee that these rates will continue to decrease.
“Very, very high case numbers are not a good thing, even if the trend is downward,” said Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health in Boston. “Taking the first hint of a downward trend as a reason to reopen is how you get to even higher numbers.”
In late November, for example, Gov. Gina Raimondo of Rhode Island limited social gatherings and some commercial activities in the state. Eight days later, cases began to decline. The trend reversed eight days after the state’s pause lifted on Dec. 20.
The virus’s latest retreat in Rhode Island and most other states, experts said, results from a combination of factors: growing numbers of people with immunity to the virus, either from having been infected or from vaccination; changes in behavior in response to the surges of a few weeks ago; and a dash of seasonality — the effect of temperature and humidity on the survival of the virus.
The vaccines were first rolled out to residents of nursing homes and to the elderly, who are at highest risk of severe illness and death. That may explain some of the current decline in hospitalizations and deaths.
But young people drive the spread of the virus, and most of them have not yet been inoculated. And the bulk of the world’s vaccine supply has been bought up by wealthy nations, which have amassed one billion more doses than needed to immunize their populations.
Vaccination cannot explain why cases are dropping even in countries where not a single soul has been immunized, like Honduras, Kazakhstan or Libya. The biggest contributor to the sharp decline in infections is something more mundane, scientists say: behavioral change.
Leaders in the United States and elsewhere stepped up community restrictions after the holiday peaks. But individual choices have also been important, said Lindsay Wiley, an expert in public health law and ethics at American University in Washington.
“People voluntarily change their behavior as they see their local hospital get hit hard, as they hear about outbreaks in their area,” she said. “If that’s the reason that things are improving, then that’s something that can reverse pretty quickly, too.”
The downward curve of infections with the original coronavirus disguises an exponential rise in infections with B.1.1.7, the variant first identified in Britain, according to many researchers.
“We really are seeing two epidemic curves,” said Ashleigh Tuite, an infectious disease modeler at the University of Toronto.
The B.1.1.7 variant is thought to be more contagious and more deadly, and it is expected to become the predominant form of the virus in the United States by late March. The number of cases with the variant in the United States has risen from 76 in 12 states as of Jan. 13 to more than 1,800 in 45 states now. Actual infections may be much higher because of inadequate surveillance efforts in the United States.
Buoyed by the shrinking rates over all, however, governors are lifting restrictions across the United States and are under enormous pressure to reopen completely. Should that occur, B.1.1.7 and the other variants are likely to explode.
“Everybody is tired, and everybody wants things to open up again,” Dr. Tuite said. “Bending to political pressure right now, when things are really headed in the right direction, is going to end up costing us in the long term.”
Another wave may be coming, but it can be minimized.
Looking ahead to late March or April, the majority of scientists interviewed by The Times predicted a fourth wave of infections. But they stressed that it is not an inevitable surge, if government officials and individuals maintain precautions for a few more weeks.
A minority of experts were more sanguine, saying they expected powerful vaccines and an expanding rollout to stop the virus. And a few took the middle road.
“We’re at that crossroads, where it could go well or it could go badly,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
The vaccines have proved to be more effective than anyone could have hoped, so far preventing serious illness and death in nearly all recipients. At present, about 1.4 million Americans are vaccinated each day. More than 45 million Americans have received at least one dose.
A team of researchers at Fred Hutchinson Cancer Research Center in Seattle tried to calculate the number of vaccinations required per day to avoid a fourth wave. In a model completed before the variants surfaced, the scientists estimated that vaccinating just one million Americans a day would limit the magnitude of the fourth wave.
“But the new variants completely changed that,” said Dr. Joshua T. Schiffer, an infectious disease specialist who led the study. “It’s just very challenging scientifically — the ground is shifting very, very quickly.”
Natalie Dean, a biostatistician at the University of Florida, described herself as “a little more optimistic” than many other researchers. “We would be silly to undersell the vaccines,” she said, noting that they are effective against the fast-spreading B.1.1.7 variant.
But Dr. Dean worried about the forms of the virus detected in South Africa and Brazil that seem less vulnerable to the vaccines made by Pfizer and Moderna. (On Wednesday, Johnson & Johnson reported that its vaccine was relatively effective against the variant found in South Africa.)
About 50 infections with those two variants have been identified in the United States, but that could change. Because of the variants, scientists do not know how many people who were infected and had recovered are now vulnerable to reinfection.
South Africa and Brazil have reported reinfections with the new variants among people who had recovered from infections with the original version of the virus.
“That makes it a lot harder to say, ‘If we were to get to this level of vaccinations, we’d probably be OK,’” said Sarah Cobey, an evolutionary biologist at the University of Chicago.
Yet the biggest unknown is human behavior, experts said. The sharp drop in cases now may lead to complacency about masks and distancing, and to a wholesale lifting of restrictions on indoor dining, sporting events and more. Or … not.
“The single biggest lesson I’ve learned during the pandemic is that epidemiological modeling struggles with prediction, because so much of it depends on human behavioral factors,” said Carl Bergstrom, a biologist at the University of Washington in Seattle.
Taking into account the counterbalancing rises in both vaccinations and variants, along with the high likelihood that people will stop taking precautions, a fourth wave is highly likely this spring, the majority of experts told The Times.
Kristian Andersen, a virologist at the Scripps Research Institute in San Diego, said he was confident that the number of cases will continue to decline, then plateau in about a month. After mid-March, the curve in new cases will swing upward again.
In early to mid-April, “we’re going to start seeing hospitalizations go up,” he said. “It’s just a question of how much.”
Summer will feel like summer again, sort of.
Now the good news.
Despite the uncertainties, the experts predict that the last surge will subside in the United States sometime in the early summer. If the Biden administration can keep its promise to immunize every American adult by the end of the summer, the variants should be no match for the vaccines.
Combine vaccination with natural immunity and the human tendency to head outdoors as weather warms, and “it may not be exactly herd immunity, but maybe it’s sufficient to prevent any large outbreaks,” said Youyang Gu, an independent data scientist, who created some of the most prescient models of the pandemic.
Infections will continue to drop. More important, hospitalizations and deaths will fall to negligible levels — enough, hopefully, to reopen the country.
“Sometimes people lose vision of the fact that vaccines prevent hospitalization and death, which is really actually what most people care about,” said Stefan Baral, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.
Even as the virus begins its swoon, people may still need to wear masks in public places and maintain social distance, because a significant percent of the population — including children — will not be immunized.
“Assuming that we keep a close eye on things in the summer and don’t go crazy, I think that we could look forward to a summer that is looking more normal, but hopefully in a way that is more carefully monitored than last summer,” said Emma Hodcroft, a molecular epidemiologist at the University of Bern in Switzerland.
Imagine: Groups of vaccinated people will be able to get together for barbecues and play dates, without fear of infecting one another. Beaches, parks and playgrounds will be full of mask-free people. Indoor dining will return, along with movie theaters, bowling alleys and shopping malls — although they may still require masks.
The virus will still be circulating, but the extent will depend in part on how well vaccines prevent not just illness and death, but also transmission. The data on whether vaccines stop the spread of the disease are encouraging, but immunization is unlikely to block transmission entirely.
“It’s not zero and it’s not 100 — exactly where that number is will be important,” said Shweta Bansal, an infectious disease modeler at Georgetown University. “It needs to be pretty darn high for us to be able to get away with vaccinating anything below 100 percent of the population, so that’s definitely something we’re watching.”
Over the long term — say, a year from now, when all the adults and children in the United States who want a vaccine have received them — will this virus finally be behind us?
Every expert interviewed by The Times said no. Even after the vast majority of the American population has been immunized, the virus will continue to pop up in clusters, taking advantage of pockets of vulnerability. Years from now, the coronavirus may be an annoyance, circulating at low levels, causing modest colds.
Many scientists said their greatest worry post-pandemic was that new variants may turn out to be significantly less susceptible to the vaccines. Billions of people worldwide will remain unprotected, and each infection gives the virus new opportunities to mutate.
“We won’t have useless vaccines. We might have slightly less good vaccines than we have at the moment,” said Andrew Read, an evolutionary microbiologist at Penn State University. “That’s not the end of the world, because we have really good vaccines right now.”
For now, every one of us can help by continuing to be careful for just a few more months, until the curve permanently flattens.
“Just hang in there a little bit longer,” Dr. Tuite said. “There’s a lot of optimism and hope, but I think we need to be prepared for the fact that the next several months are likely to continue to be difficult.”
De acordo com a pesquisa, as emissões globais de gases do efeito estufa no último século favoreceram o crescimento de um habitat para morcegos, tornando o sul da China uma região propícia para o surgimento e a propagação do vírus Sars-CoV-2.
A análise foi feita com base em um mapa da vegetação do mundo no século 20, utilizando dados relacionados a temperatura, precipitação e cobertura de nuvens. Os pesquisadores analisaram a distribuição de morcegos no início dos anos 1900 e, comparando com a distribuição atual, concluíram que diferentes espécies mudaram de região por causa das mudanças no clima do planeta.
“Entender como a distribuição das espécies de morcego pelo mundo mudou em função das mudanças climáticas pode ser um passo importante para reconstruir a origem do surto de Covid-19”, afirmou, em nota, Robert Beyer, pesquisador do Departamento de Zoologia da Universidade de Cambridge, no Reino Unido, e autor principal do estudo.
Foram observadas grandes alterações na vegetação da província chinesa de Yunnan, de Mianmar e do Laos. Os aumentos na temperatura, na incidência da luz solar e nas concentrações de dióxido de carbono presente na atmosfera fizeram com que o habitat, que antes era composto por arbustos tropicais, se transformasse em savana tropical e florestas temperadas.
As novas características criaram um ambiente favorável para que 40 espécies de morcegos migrassem para a província de Yunnan no último século, reunindo assim mais de 100 tipos de coronavírus na área em que os dados apontam como a origem do surto do Sars-CoV-2. Essa região também é habitat dos pangolins, que são considerados prováveis agentes intermediários na pandemia.
“Conforme as mudanças climáticas alteraram os habitats, espécies deixaram algumas áreas e foram para outras — levando os vírus com elas. Isso não apenas alterou as regiões onde os vírus estão presentes, mas provavelmente permitiu novas interações entre animais e vírus, fazendo com que vírus mais perigosos fossem transmitidos ou desenvolvidos”, explicou Beyer.
O estudo ainda identificou que as mudanças climáticas resultaram no aumento do número de espécies de morcegos em outras regiões, como na África Central, na América do Sul e na América Central. “A pandemia de Covid-19 causou grande prejuízo social e econômico. Os governos devem aproveitar a oportunidade para reduzir os riscos que doenças infecciosas apresentam à saúde e agir para mitigar as mudanças climáticas”, alertou o professor Andrea Manica, do Departamento de Zoologia da Universidade de Cambridge.
Os pesquisadores também ressaltam que é preciso limitar a expansão de áreas urbanas, fazendas e áreas de caça em habitats naturais para que seja reduzido o contato entre humanos e animais transmissores doenças.
Esta matéria faz parte da iniciativa #UmSóPlaneta, união de 19 marcas da Editora Globo, Edições Globo Condé Nast e CBN. Saiba mais em umsoplaneta.globo.com
Intervenção artística com desenhos de Joseca Yanomami marca a entrega da petição #ForaGarimpoForaCovid a deputados federais e demais autoridades
Por Oswaldo Braga de Souza*
Poesia e política se somaram no encerramento da campanha #ForaGarimpoForaCovid, liderada pelo Fórum de Lideranças Yanomami e Ye’kwana. Para marcar o fim do capítulo mais recente da luta dos indígenas pela expulsão dos mais de 20 mil garimpeiros de suas terras, os coordenadores da Hutukara Associação Yanomami, Dário Kopenawa e Maurício Ye’kwana, entregaram a representantes do Parlamento brasileiro um abaixo-assinado com quase 440 mil assinaturas de apoiadores em todo o mundo.
À noite, em uma intervenção artística inédita, frases em defesa da floresta e desenhos dos xapiri, os espíritos Yanomami, foram projetados na fachada do Congresso por quase duas horas. As ilustrações são do artista Joseca Yanomami e o texto é do líder indigena Davi Kopenawa.
*Consulte a ficha ténica abaixo
Os xapiri são os espíritos que auxiliam os xamãs em seu árduo trabalho de manter o equilíbrio do mundo e o próprio céu em seu lugar. São figuras centrais na cosmologia Yanomami, e se materializam para os xamãs como os espíritos dos animais, das árvores, das águas, de tudo o que existe na Urihi a, a “terra-floresta”, conceito Yanomami que engloba a floresta e todos os seus habitantes físicos e metafísicos.
O objetivo da campanha é exigir a retirada de milhares de garimpeiros da Terra Indígena (TI) Yanomami (AM/RR) para impedir a disseminação da Covid-19, a contaminação do solo e dos rios e o degradação florestal. O garimpo está espalhando a doença na área, segundo relatório produzido pelo Fórum de Lideranças Yanomami e Ye’kwana e a Rede Pró-Yanomami e Ye’kwana, também encaminhado aos parlamentares.
Mais de um terço das 26,7 mil pessoas que moram na TI foi exposto ao novo coronavírus e o número de casos confirmados saltou de 335 para 1,2 mil, entre agosto e outubro, um aumento de mais de 250%, ainda conforme o levantamento. Apesar disso, menos de 5% da população foi testada.
A petição foi apresentada numa reunião virtual das frentes parlamentares de defesa dos direitos indígenas e ambientalista, com a presença de deputados federais e senadores. O evento foi organizado para discutir o aumento do garimpo e seus impactos nos territórios yanomami, kayapó e munduruku e contou com a participação de parlamentares, líderes indígenas, procuradores da República, pesquisadores e organizações da sociedade civil.
“Chega de sofrer. Já perdemos muitos parentes”
“Chega de sofrer. Já perdemos muitos parentes. Temos xawara [Covid-19]. Os Yanomami estão contaminados pelo garimpo, nossos rios estão poluídos, contaminados com mercúrio”, afirmou Dário Kopenawa. “Queremos que as autoridades tomem providências. Não queremos mais perder nossos velhos, nossos filhos, não queremos mais chorar. Queremos que as autoridades retirem os garimpeiros o mais rápido possível”, continuou.
“Ao longo desses meses, alertamos as autoridades sobre os impactos que sofremos com os garimpeiros que invadem nossa terra”, diz carta lida por Maurício Ye’kwana na reunião. “Mas nosso recado não foi escutado. Os garimpeiros continuam entrando em nossas casas”, seguiu a liderança.
“Um absurdo dizer que defender Terras Indígenas, defender indígena, se manifestar contra os garimpos em Terras Indígenas é uma questão ideológica, de esquerda ou de comunista. Isso é lei. Isso é direito. Está na nossa Constituição”, afirmou a deputada federal e coordenadora da Frente Parlamentar em Defesa dos Direitos dos Povos Indígenas, Joênia Wapichana (Rede-RR). “Essa petição é mais uma forma de reivindicar nada além do que está na Constituição, que é o direito à proteção à vida, o direito à terra, o direito de ter sua terra sem invasões”, afirmou.
Joênia lembrou que a TI Yanomami abriga grupos indígenas isolados, os Moxihatëtëa, que correm risco de desaparecer caso sejam contatados por não indígenas e contaminados por doenças para os quais não têm defesas imunológicas, como gripe e sarampo. A Covid-19 representa um risco ainda maior para essas comunidades em virtude da dificuldade para atendimento e transporte de doentes em regiões remotas e de difícil acesso, como é o caso da área.
Estímulo ao garimpo
O governo Bolsonaro não só não fez nada para retirar os invasores do território yanomami como estimula abertamente o garimpo em TIs, o que é ilegal. O Planalto enviou um Projeto de Lei ao Congresso, em fevereiro, para regulamentar a atividade nessas áreas, além da mineração industrial e a construção de hidrelétricas. O resultado é o aumento da presença garimpeira, dos conflitos envolvendo sua atividade e do desmatamento nos territórios indígenas em geral, nos últimos dois anos.
“A responsabilidade pelo aumento das invasões está diretamente relacionada à complacência deste governo com a criminalidade, a desestruturação dos órgãos de fiscalização e controle e com a omissão em cumprir decisões judiciais”, criticou, na reunião, a advogada do ISA Juliana de Paula Batista. Ela lembrou que a Justiça Federal determinou que a União apresente um plano de retirada dos garimpeiros da TI Yanomami e o STF ordenou a implantação de barreiras sanitárias na área. Nenhuma das duas decisões foi cumprida.
“É fundamental que as casas legislativas estejam comprometidas com a defesa e proteção dos povos indígenas e em assegurar seus direitos, previstos na Constituição”, concluiu.
Em agosto, o Supremo Tribunal Federal (STF) confirmou uma liminar do ministro Luís Roberto Barroso que obriga o governo a agir para conter a escalada da crise de saúde entre os povos indígenas. A única medida incluída no pedido original da ação e não atendida foi justamente a retirada imediata de invasores de sete TIs, entre elas a Yanomami. Barroso criou um grupo de trabalho para acompanhar as providências da administração federal. O ministro determinou que fossem refeitos os planos oficiais de enfrentamento geral da Covid-19 e de instalação de barreiras sanitárias nas TIs. O movimento indígena segue aguardando uma medida mais enérgica para forçar o governo a retirar os invasores das sete áreas.
“Querem legalizar o garimpo, como se isso fosse resolver o problema da população indígena. Isso só vai piorar a situação. O garimpo traz prostituição e drogas para o territorio”, criticou, na reunião do dia 03 de dezembro, Alessandra Korap Munduruku, líder indígena ameaçada de morte pelas denúncias contra os invasores da TI Sawré Muybu, no sudoeste do Pará. Em outubro, ela ganhou o prêmio Robert F. Kennedy de Direitos Humanos, dos EUA.
“A maioria dos indígenas tem de beber água suja do rio. Todas as nascentes estão sendo desmatadas para uso dos garimpos. Vemos máquinas, dragas cavando o fundo do rio, enquanto os indígenas têm de comer o peixe. Teremos de comprar peixes na cidade para levar para as aldeias? Teremos de comprar água na cidade para levar para as aldeias. O que será dos indígenas depois de legalizarem o garimpo?”, questionou Alessandra Munduruku.
Ainda na reunião, o WWF-Brasil apresentou parte dos resultados de um estudo realizado pela organização em conjunto com a Fundação Oswaldo Cruz (Fiocruz) sobre contaminação do mercúrio em três aldeias da TI Sawré Muybu.
Os dados revelam uma situação dramática. O mercúrio foi detectado em 100% da população e, em 60% dela, o nível da substância não foi considerado seguro. Em 100% das amostras de peixes, havia resquícios do elemento químico. Em algumas, havia 18 vezes mais mercúrio do que o máximo tolerado pelos critérios da agência ambiental dos EUA.
Em quatro de cada 10 crianças foram identificadas altas concentrações de mercúrio. Em 16% das crianças, foram detectados problemas de neurodesenvolvimento. “As crianças estão perdendo a saúde. Isso é um crime gravíssimo contra as crianças indígenas! Quando Alesssandra Munduruku fala em genocídio, ela não está exagerando”, afirmou Bruno Taitson, representante do WWF-Brasil.
* Com informações de Ester Cezar
O SOPRO DOS XAPIRI XAPIRI PË NË MARI 2020 animação em três canais projetada no Palácio do Congresso Nacional 01:39”
Desenhos: Joseca Yanomami
Frases: Davi Kopenawa Yanomami
Cantos: Ehuana Yaiara Yanomami, Levi Malamahi Alaopeteri Yanomami, Tafarel Yanomami – captados por Marcos Wesley de Oliveira na aldeia Watorikɨ. Outros registros sonoros captados por Gustavo Fioravante, em Watorikɨ.
Realização: Fórum de Lideranças Yanomami e Ye’kwana e Instituto Socioambiental
Apoio: Hutukara Associação Yanomami
Criação, direção e roteiro: Gisela Motta, Isabella Guimarães e Mariana Lacerda [Barreira Y.]
Animação e montagem: JR Muniz e Leandro Mendes – Vigas
Video mapping em Brasília, direção técnica: Alexis Anastasiou
Equipamentos: Visual Farm / Paralax
Captação em Brasília: Bruna Carolli, Cleber Machado, Daniel Basil, Ester Cezar, Guto Martins, Paulo Comar, Victor Ekstrom
Edição e áudio: Cauê Ito
Agradecimentos: aos povos Yanomami e Ye’kwana, Ana Teixeira, André Komatsu, Bruno Rangel, Carlo Zacquini, Claudia Andujar, Gui Conti, Irina Theophilo, Joana Amador, Juliana Calheiros, Kauê Lima, Laura Andreato, Lucas Bambozzi, Peter Pál Pelbart, Pio Figueiroa, Rede Pró-Yanomami e Ye’kwana, Rivane Neuenschwander, Tuíra Kopenawa Yanomami, Vitor Osório
SAO PAULO (Thomson Reuters Foundation) – As farms expand into the Amazon rainforest, felled trees and expanding pastures may open the way for new Brazilian exports beyond beef and soybeans, researchers say: pandemic diseases.
Changes in the Amazon are driving displaced species of animals, from bats to monkeys to mosquitoes, into new areas, while opening the region to arrivals of more savanna-adapted species, including rodents.
Those shifts, combined with greater human interaction with animals as people move deeper into the forest, is increasing the chances of a virulent virus, bacteria or fungus jumping species, said Adalberto Luís Val a researcher at INPA, the National Institute for Research in the Amazon, based in Manaus.
Climate change, which is driving temperature and rainfall changes, adds to the risks, the biologist said.
“There is a great concern because … there is a displacement of organisms. They try to adapt, face these new challenging scenarios by changing places,” Val told the Thomson Reuters Foundation in a telephone interview.
The Evandro Chagas Institute, a public health research organization in the city of Belém, has identified about 220 different types of viruses in the Amazon, 37 of which can cause diseases in humans and 15 of which have the potential to cause epidemics, the researcher said.
They include a range of different encephalitis varieties as well as West Nile fever and rocio, a Brazilian virus from the same family that produces yellow fever and West Nile, he noted in an article published in May by the Brazilian Academy of Sciences.
Val said he was especially concerned about arboviruses, which can be transmitted by insects such as the mosquitoes that carry dengue fever and Zika.
Cecília Andreazzi, a researcher at the Oswaldo Cruz Foundation (FIOCRUZ), a major public health institute in Brazil, said the current surge in deforestation and fires in the Amazon can lead to new meetings between species on the move – each a chance for an existing pathogen to transform or jump species.
The ecologist maps existing infectious agents among Brazil’s animals and constructs mathematical models about how the country’s changing landscape “is influencing the structure of these interactions”.
What she is looking for is likely “spillover” opportunities, when a pathogen in one species could start circulating in another, potentially creating a new disease – as appears to have happened in China with the virus that causes COVID-19, she said.
“Megadiverse countries with high social vulnerability and growing environmental degradation are prone to pathogen spillover from wildlife to humans, and they require policies aimed at avoiding the emergence of zoonoses,” she and other researchers wrote in a letter in The Lancet, a science journal, in September.
Brazil, they said, had already seen “clear warnings” of a growing problem, with the emergence of a Brazilian hemorrhagic fever, rodent-carried hantaviruses, and a mosquito-transmitted arbovirus called oropouche.
Brazil’s Amazon has registered some of the worst fires in a decade this year, as deforestation and invasions of indigenous land grow under right-wing President Jair Bolsonaro, who has urged that the Amazon be developed as a means of fighting poverty.
In a speech before the U.N. General Assembly last month, he angrily denied the existence of fires in the Amazon rainforest, calling them a “lie,” despite data produced by his own government showing thousands of blazes surging across the region.
‘BLAME THE BAT’
João Paulo Lima Barreto, a member of the Tukano indigenous people, said one way of combatting the emergence of new pandemic threats is reviving old knowledge about relationships among living things.
Barreto, who is doing doctoral research on shamanistic knowledge and healing at the Federal University of Amazonas, created Bahserikowi’i, an indigenous medicine center that brings the knowledge of the Upper Rio Negro shamans to Manaus, the Amazon’s largest city.
He has called for indigenous knowledge systems to be taken seriously.
“The model of our relationship with our surroundings is wrong,” he told the Thomson Reuters Foundation in a telephone interview.
“It is very easy for us to blame the bat, to blame the monkey, to blame the pig” when a new disease emerges, Barreto said. “But in fact, the human is causing this, in the relationship that we build with the owners of the space”.
Without adequate preservation of forests, rivers and animals, imbalance and disease are generated, he said, as humans fail to respect nature entities known to shamans as “wai-mahsã”.
Andreazzi said particularly strong disease risks come from converting Amazonian forest into more open, savanna-like pastures and fields, which attract marsupials and also rodents, carriers of hantaviruses.
“If you transform the Amazon into a field, you are creating this niche” and species may expand their ranges to fill it, she said, with “the abundance of these species greatly increasing”.
In the face of deforestation, animals are “relocating, moving. And the pathogen, the virus… is looking for hosts” – a situation that creates “very high adaptive capacity”, she said.
But Andreazzi worries about old diseases, as well as new ones.
As the Amazon changes, new outbreaks of threats such as malaria, leishmaniasis and Chagas disease – transmitted by a “kissing bug” and capable of causing heart damage – have been registered, she said.
“We don’t even need to talk about the new diseases. The old ones already carry great risks,” she added.
Reporting by Fabio Zuker ; editing by Laurie Goering : Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters. Visit news.trust.org/climate
É o que aponta levantamento feito entre 17 e 30 de agosto pela Rede de Pesquisa Solidária, que monitora as respostas à Covid pelo país. É a quarta rodada de uma enquete feita com 64 lideranças comunitárias nas regiões metropolitanas de Manaus, Recife, Belo Horizonte, Rio, São Paulo, Distrito Federal, Campinas (SP), Salvador, Joinville (SC) e Maringá (PR).
“Quando perguntamos sobre perspectiva para o futuro, houve essa percepção de que a pandemia gerou engajamento, foi uma surpresa para nós. Por um lado, é efeito de uma constatação negativa: as pessoas se sentiram abandonadas e aprenderam que tiveram que se reestruturar para reagir à pandemia”, diz Graziela Castello, diretora-administrativa e pesquisadora do Cebrap.
“Moradores que não tinham história de associativismo, relação com sindicato, com partido, começaram a se organizar. Dos entrevistados, 16%, acham que gerou algum tipo de consciência política na população e que a gestão da pandemia provocou a necessidade de avaliar o governo, pensar nas eleições. Dentro do cenário de abandono completo, talvez tenha impacto positivo de maior prática de cidadania política”, continua.
Uma outra questão despontou no último questionário feito: a preocupação com a educação. Um em cada cinco entrevistados citou a volta às aulas como um dos problemas mais críticos atualmente.
E aí os líderes se dividem: parte deles se preocupa que o retorno das crianças às escolas possa aumentar a contaminação dentro das comunidades; outra parte se preocupa com o pouco acesso das crianças e adolescentes a ferramentas de ensino remoto, prejudicando a aprendizagem.
“Os familiares são terrivelmente contra o retorno às aulas, mesmo porque se trata de um governo e de um prefeito que não investiu na saúde, não fez um investimento na preparação da volta às aulas, nas salas de aula. Segundo, o governo e o prefeito lá vão colocar um frasco de álcool em gel e um ventilador para fazer a ventilação, e [afirmam que] isso é o suficiente para espantar o vírus. A gente sabe que precisa de um investimento muito maior do que isso”, diz um entrevistado do Tucuruvi, zona norte de São Paulo.
“As famílias não têm internet, telefone, computador em casa. E as crianças estão sem estudar, sem escola. E devido a essa situação elas ficam em casa sem fazer nada. Tem mães analfabetas que não sabem explicar e ajudar nas atividades, ficou muito difícil nas comunidades”, diz outro na Brasilândia, também em São Paulo.
Para Castello, “a diversidade de opiniões mostra o drama que é gerenciar essa situação”, diz. “De um lado, tem o medo da volta às aulas, do impacto nos parentes mais velhos, a preocupação de que as escolas não estão preparadas para voltar. Do outro lado, as lideranças apontam deficiências cognitivas, depressão nas crianças, todo esse processo que o distanciamento tem gerado.”
“As duas coisas são muito perversas. Os pais lidam com o medo da volta e com a impossibilidade da manutenção em casa”, diz a pesquisadora.
A Rede de Pesquisa Solidária reúne dezenas de pesquisadores de instituições públicas e privadas, como a USP, o Cebrap (Centro Brasileiro de Análise e Planejamento) e a Fundação Getulio Vargas (FGV). Desde abril, eles têm produzido boletins semanais, que estão disponíveis no site da iniciativa.
But some things are improving, and it will not go on for ever
Sep 26th 2020
AS THE AUTUMNAL equinox passed, Europe was battening down the hatches for a gruelling winter. Intensive-care wards and hospital beds were filling up in Madrid and Marseille—a city which, a few months ago, thought it had more or less eliminated covid-19. Governments were implementing new restrictions, sometimes, as in England, going back on changes made just a few months ago. The al-fresco life of summer was returning indoors. Talk of a second wave was everywhere.
Across the Atlantic the United States saw its official covid-19 death toll—higher than that of all western Europe put together—break the 200,000 barrier. India, which has seen more than half a million new cases a week for four weeks running, will soon take America’s unenviable laurels as the country with the largest official case count.
The world looks set to see its millionth officially recorded death from covid-19 before the beginning of October. That is more than the World Health Organisation (WHO) recorded as having died from malaria (620,000), suicide (794,000) or HIV/AIDS (954,000) over the whole of 2017, the most recent year for which figures are available.
Those deaths represent just over 3% of the recorded covid-19 cases, which now number over 32m. That tally is itself an underestimate of the number who have actually been infected by SARS–CoV-2, the virus which causes covid 19. Many of the infected do not get sick. Many who do are never seen by any health system.
A better, if still imperfect, sense of how many infections have taken place since the outbreak began at the end of last year can be gleaned from “serosurveys” which scientists and public-health officials have undertaken around the world. These look for antibodies against SARS–CoV-2 in blood samples which may have been taken for other purposes. Their presence reveals past exposure to the virus.
Various things make these surveys inaccurate. They can pick up antibodies against other viruses, inflating their totals—an effect which can differ from place to place, as there are more similar-looking viruses circulating in some regions than in others. They can mislead in the other direction, too. Some tests miss low levels of antibody. Some people (often young ones) fight off the virus without ever producing antibodies and will thus not be recorded as having been infected. As a result, estimates based on serosurveys have to be taken with more than a grain of salt.
But in many countries it would take a small sea’s worth of the stuff to bring the serosurvey figures into line with the official number of cases. The fact that serosurvey data are spotty—there is very little, for example, openly available from China—means it is not possible to calculate the global infection rate directly from the data at hand. But by constructing an empirical relationship between death rates, case rates, average income—a reasonable proxy for intensity of testing—and seropositivity it is possible to impute rates for countries where data are not available and thus estimate a global total.
The graphic on this page shows such an estimate based on 279 serosurveys in 19 countries. It suggests that infections were already running at over 1m a day by the end of January—when the world at large was only just beginning to hear of the virus’s existence. In May the worldwide rate appears to have been more than 5m a day. The uncertainties in the estimate are large, and become greater as you draw close to the present, but all told it finds that somewhere between 500m and 730m people worldwide have been infected—from 6.4% to 9.3% of the world’s population. The WHO has not yet released serosurvey-based estimates of its own, though such work is under way; but it has set an upper bound at 10% of the global population.
As the upper part of the following data panel shows, serosurvey results which can be directly compared with the diagnosed totals are often a great deal bigger. In Germany, where cases have been low and testing thorough, the seropositivity rate was 4.5 times the diagnosed rate in August. In Minnesota a survey carried out in July found a multiplier of seven. A survey completed on August 23rd found a 6.02% seropositivity rate in England, implying a multiplier of 12. A national serosurvey of India conducted from the middle of May to early June found that 0.73% were infected, suggesting a national total of 10m. The number of registered cases at that time was 226,713, giving a multiplier of 44. Such results suggest that a global multiplier of 20 or so is quite possible.
If the disease is far more widespread than it appears, is it proportionately less deadly than official statistics, mainly gathered in rich countries, have made it look? Almost certainly. On the basis of British figures David Spiegelhalter, who studies the public understanding of risk at Cambridge University, has calculated that the risk of death from covid increases by about 13% for every year of age, which means a 65-year-old is 100 times more likely to die than a 25-year-old. And 65-year-olds are not evenly distributed around the world. Last year 20.5% of the EU’s population was over 65, as opposed to just 3% of sub-Saharan Africa’s.
But it is also likely that the number of deaths, like the number of cases, is being seriously undercounted, because many people will have died of the disease without having had a positive test for the virus. One way to get around this is by comparing the number of deaths this year with that which would be predicted on the basis of years past. This “excess mortality” method relies on the idea that, though official statistics may often be silent or misleading as to the cause of death, they are rarely wrong about a death actually having taken place.
The excessive force of destiny
The Economist has gathered all-cause mortality data from countries which report them weekly or monthly, a group which includes most of western Europe, some of Latin America, and a few other large countries, including the United States, Russia and South Africa (see lower part of data panel). Between March and August these countries recorded 580,000 covid-19 deaths but 900,000 excess deaths; the true toll of their share of the pandemic appears to have been 55% greater than the official one. This analysis suggests that America’s official figures underestimate the death toll by 30% or more (America’s Centres for Disease Control and Prevention have provided a similar estimate). This means that the real number of deaths to date is probably a lot closer to 300,000 than 200,000. That is about 10% of the 2.8m Americans who die each year—or, put another way, half the number who succumb to cancer. And there is plenty of 2020 still to go.
Add to all this excess mortality unreported deaths from countries where record keeping is not good enough to allow such assessments and the true death toll for the pandemic may be as high as 2m.
What can be done to slow its further rise? The response to the virus’s original vertiginous ascent was an avalanche of lockdowns; at its greatest extent, around April 10th, at least 3.5bn people were being ordered to stay at home either by national governments or regional ones. The idea was to stop the spread of the disease before health-care systems collapsed beneath its weight, and in this the lockdowns were largely successful. But in themselves they were never a solution. They severely slowed the spread of the disease while they were in place, but they could not stay in place for ever.
Stopping people interacting with each other at all, as lockdowns and limits on the size of gatherings do, is the first of three ways to lower a disease’s reproduction number, R—the number of new cases caused by each existing case. The second is reducing the likelihood that interactions lead to infection; it requires mandated levels of social distancing, hygiene measures and barriers to transmission such as face masks and visors. The third is reducing the time during which an infectious person can interact with people under any conditions. This is achieved by finding people who may recently have been infected and getting them to isolate themselves.
Ensuring that infectious people do not have time to do much infecting requires a fast and thorough test-and-trace system. Some countries, including Canada, China, Germany, Italy, Japan, Singapore and Taiwan, have successfully combined big testing programmes which provide rapid results with a well developed capacity for contact tracing and effective subsequent action. Others have foundered.
Networks and herds
Israel provides a ready example. An early and well-enforced lockdown had the expected effect of reducing new infections. But the time thus bought for developing a test-and-trace system was not well used, and the country’s emergence from lockdown was ill-thought-through. This was in part because the small circle around prime minister Binyamin Netanyahu into which power has been concentrated includes no one with relevant expertise; the health ministry is weak and politicised.
Things have been made worse by the fact that social distancing and barrier methods are being resisted by some parts of society. Synagogues and Torah seminaries in the ultra-Orthodox community and large tribal weddings in the Arab-Israeli community have been major centres of infection. While unhappy countries, like Tolstoy’s unhappy families, all differ, the elements of Israel’s dysfunction have clear parallels elsewhere.
Getting to grips with “superspreader” events is crucial to keeping R low. Close gatherings in confined spaces allow people to be infected dozens at a time. In March almost 100 were infected at a biotech conference in Boston. Many of them spread the virus on: genetic analysis subsequently concluded that 20,000 cases could be traced to that conference.
Nipping such blooms in the bud requires lots of contact tracing. Taiwan’s system logs 15-20 contacts for each person with a positive test. Contact tracers in England register four to five close contacts per positive test; those in France and Spain get just three. It also requires that people be willing to get tested in the first place. In England only 10-30% of people with covid-like symptoms ask for a test through the National Health Service. One of the reasons is that a positive test means self-isolation. Few want to undergo such restrictions, and few are good at abiding by them. In early May a survey in England found that only a fifth of those with covid symptoms had self-isolated as fully as required. The government is now seeking to penalise such breaches with fines of up to £10,000 ($12,800). That will reduce the incentive to get tested in the first place yet further.
As much of Europe comes to terms with the fact that its initial lockdowns have not put an end to its problems, there is increased interest in the Swedish experience. Unlike most of Europe, Sweden never instigated a lockdown, preferring to rely on social distancing. This resulted in a very high death rate compared with that seen in its Nordic neighbours; 58.1 per 100,000, where the rate in Denmark is 11.1, in Finland 6.19 and in Norway 4.93. It is not clear that this high death rate bought Sweden any immediate economic advantage. Its GDP dropped in the second quarter in much the same way as GDPs did elsewhere.
It is possible that by accepting so many deaths upfront Sweden may see fewer of them in the future, for two reasons. One is the phenomenon known, in a rather macabre piece of jargon, as “harvesting”. Those most likely to succumb do so early on, reducing the number of deaths seen later. The other possibility is that Sweden will benefit from a level of herd immunity: once the number of presumably immune survivors in the population grows high enough, the spread of the disease slows down because encounters between the infected and the susceptible become rare. Avoiding lockdown may conceivably have helped with this.
On the other hand, one of the advantages of lockdowns was that they provided time not just for the development of test-and-trace systems but also for doctors to get better at curing the sick. In places with good health systems, getting covid-19 is less risky today than it was six months ago. ISARIC, which researches infectious diseases, has analysed the outcomes for 68,000 patients hospitalised with covid-19; their survival rate increased from 66% in March to 84% in August. The greatest relative gains have been made among the most elderly patients. Survival rates among British people 60 and over who needed intensive care have risen from 39% to 58%.
This is largely a matter of improved case management. Putting patients on oxygen earlier helps. So does reticence about using mechanical ventilators and a greater awareness of the disease’s effects beyond the lungs, such as its tendency to provoke clotting disorders.
As for treatments, two already widely available steroids, dexamethasone and hydrocortisone, increase survival by reducing inflammation. Avigan, a Japanese flu drug, has been found to hasten recovery. Remdesivir, a drug designed to fight other viruses, and convalescent plasma, which provides patients with antibodies from people who have already recovered from the disease, seem to offer marginal benefits.
Many consider antibodies tailor-made for the job by biotech companies a better bet; over the past few years they have provided a breakthrough in the treatment of Ebola. The American government has paid $450m for supplies of a promising two-antibody treatment being developed by Regeneron. That will be enough for between 70,000 and 300,000 doses, depending on what stage of the disease the patients who receive it have reached. Regeneron is now working with Roche, another drug company, to crank up production worldwide. But antibodies will remain expensive, and the need to administer them intravenously limits their utility.
It is tempting to look to better treatment for the reason why, although diagnosed cases in Europe have been climbing steeply into what is being seen as a second wave, the number of deaths has not followed: indeed it has, as yet, barely moved. The main reason, though, is simpler. During the first wave little testing was being done, and so many infections were being missed. Now lots of testing is being done, and vastly more infections are being picked up. Correct for this distortion and you see that the first wave was far larger than what is being seen today, which makes today’s lower death rate much less surprising (see data panel).
The coming winter is nevertheless worrying. Exponential growth can bring change quickly when R gets significantly above one. There is abundant evidence of what Katrine Bach Habersaat of the WHO calls “pandemic fatigue” eating away at earlier behavioural change, as well as increasing resentment of other public-health measures. YouGov, a pollster, has been tracking opinion on such matters in countries around the world. It has seen support for quarantining people who have had contact with someone infected fall a bit in Asia and rather more in the West, where it is down from 78% to 63%. In America it has fallen to 55%.
It is true that infection rates are currently climbing mostly among the young. But the young do not live in bubbles. Recent figures from Bouches-du-Rhône, the French department which includes Marseille, show clearly how a spike of cases in the young becomes, in a few weeks, an increase in cases at all ages.
As the fear of such spikes increases, though, so does the hope that they will not be recurring all that much longer. Pfizer, which has promising vaccine candidate in efficacy trials, has previously said that it will seek regulatory review of preliminary results in October, though new standards at the Food and Drug Administration may not allow it to do so in America quite that soon. Three other candidates, from AstraZeneca, Moderna and J&J, are nipping at Pfizer’s heels. The J&J vaccine is a newcomer; it entered efficacy trials only on September 23rd. But whereas the other vaccines need a booster a month after the first jab, the J&J vaccine is administered just once, which will make the trial quicker; it could have preliminary results in November.
None of the companies will have all the trial data they are planning for until the first quarter of next year. But in emergencies regulators can authorise a vaccine’s use based on interim analysis if it meets a minimum standard (in this case, protection of half those who are vaccinated). Authorisation for use under such conditions would still make such a vaccine more credible than those already in use in China and Russia, neither of which was tested for efficacy at all. But there have been fears that American regulators may, in the run up to the presidential election, set the bar too low. Making an only-just-good-enough vaccine available might see social-distancing collapse and infections increase; alternatively, a perfectly decent vaccine approved in a politically toxic way might not be taken up as widely as it should be.
In either case, though, the practical availability of a vaccine will lag behind any sort of approval. In the long run, billions of doses could be needed. A global coalition of countries known as Covax wants to distribute 2bn by the end of 2021—which will only be enough for 1bn people if the vaccine in question, like Pfizer’s or AstraZeneca’s, needs to be administered twice. The world’s largest manufacturer of vaccines, the Serum Institute in India, recently warned that there will not be enough supplies for universal inoculation until 2024 at the earliest.
Even if everything goes swimmingly, it is hard to see distribution extending beyond a small number of front-line health and care workers this year. But the earlier vaccines are pushed out, the better. The data panel on this page looks at the results of vaccinating earlier versus later in a hypothetical population not that unlike Britain’s. Vaccination at a slower rate which starts earlier sees fewer eventual infections than a much more ambitious campaign started later. At the same time increases in R—which might come about if social distancing and similar measures fall away as vaccination becomes real—make all scenarios worse.
By next winter the covid situation in developed countries should be improved. What level of immunity the vaccines will provide, and for how long, remains to be seen. But few expect none of them to work at all.
Access to the safety thus promised will be unequal, both within countries and between them. Some will see loved ones who might have been vaccinated die because they were not. Minimising such losses will require getting more people vaccinated more quickly than has ever been attempted before. It is a prodigious organisational challenge—and one which, judging by this year’s experience, some governments will handle considerably better than others. ■
This article appeared in the Briefing section of the print edition under the headline “Grim tallies”
The coronavirus pandemic has triggered some interesting and unusual changes in our buying behavior
Date: September 10, 2020
Source: University of Technology Sydney
Summary: Understanding the psychology behind economic decision-making, and how and why a pandemic might trigger responses such as hoarding, is the focus of a new paper.
Rushing to stock up on toilet paper before it vanished from the supermarket isle, stashing cash under the mattress, purchasing a puppy or perhaps planting a vegetable patch — the COVID-19 pandemic has triggered some interesting and unusual changes in our behavior.
Understanding the psychology behind economic decision-making, and how and why a pandemic might trigger responses such as hoarding, is the focus of a new paper published in the Journal of Behavioral Economics for Policy.
‘Hoarding in the age of COVID-19’ by behavioral economist Professor Michelle Baddeley, Deputy Dean of Research at the University of Technology Sydney (UTS) Business School, examines a range of cross-disciplinary explanations for hoarding and other behavior changes observed during the pandemic.
“Understanding these economic, social and psychological responses to COVID-19 can help governments and policymakers adapt their policies to limit negative impacts, and nudge us towards better health and economic outcomes,” says Professor Baddeley.
Governments around the world have implemented behavioral insights units to help guide public policy, and influence public decision-making and compliance.
Hoarding behavior, where people collect or accumulate things such as money or food in excess of their immediate needs, can lead to shortages, or in the case of hoarding cash, have negative impacts on the economy.
“In economics, hoarding is often explored in the context of savings. When consumer confidence is down, spending drops and households increase their savings if they can, because they expect bad times ahead,” explains Professor Baddeley.
“Fear and anxiety also have an impact on financial markets. The VIX ‘fear’ index of financial market volatility saw a dramatic 564% increase between November 2019 and March 2020, as investors rushed to move their money into ‘safe haven’ investments such as bonds.”
While shifts in savings and investments in the face of a pandemic might make economic sense, the hoarding of toilet paper, which also occurred across the globe, is more difficult to explain in traditional economic terms, says Professor Baddeley.
Behavioural economics reveals that our decisions are not always rational or in our long term interest, and can be influenced by a wide range of psychological factors and unconscious biases, particularly in times of uncertainty.
“Evolved instincts dominate in stressful situations, as a response to panic and anxiety. During times of stress and deprivation, not only people but also many animals show a propensity to hoard.”
Another instinct that can come to the fore, particularly in times of stress, is the desire to follow the herd, says Professor Baddeley, whose book ‘Copycats and Contrarians’ explores the concept of herding in greater detail.
“Our propensity to follow others is complex. Some of our reasons for herding are well-reasoned. Herding can be a type of heuristic: a decision-making short-cut that saves us time and cognitive effort,” she says.
“When other people’s choices might be a useful source of information, we use a herding heuristic and follow them because we believe they have good reasons for their actions. We might choose to eat at a busy restaurant because we assume the other diners know it is a good place to eat.
“However numerous experiments from social psychology also show that we can be blindly susceptible to the influence of others. So when we see others rushing to the shops to buy toilet paper, we fear of missing out and follow the herd. It then becomes a self-fulfilling prophesy.”
Behavioral economics also highlights the importance of social conventions and norms in our decision-making processes, and this is where rules can serve an important purpose, says Professor Baddeley.
“Most people are generally law abiding but they might not wear a mask if they think it makes them look like a bit of a nerd, or overanxious. If there is a rule saying you have to wear a mask, this gives people guidance and clarity, and it stops them worrying about what others think.
“So the normative power of rules is very important. Behavioral insights and nudges can then support these rules and policies, to help governments and business prepare for second waves, future pandemics or other global crises.”
Science has taken center stage during the COVID-19 pandemic. Early on, as SARS-CoV-2 started spreading around the globe, many researchers pivoted to focus on studying the virus. At the same time, some scientists and science advisors—experts responsible for providing scientific information to policymakers—gained celebrity status as they calmly and cautiously updated the public on the rapidly evolving situation and lent their expertise to help governments make critical decisions, such as those relating to lockdowns and other transmission-slowing measures.
“Academia, in the case of COVID, has done an amazing job of trying to get as much information relevant to COVID gathered and distributed into the policymaking process as possible,” says Chris Tyler, the director of research and policy in University College London’s Department of Science, Technology, Engineering and Public Policy (STEaPP).
But the pace at which COVID-related science has been conducted and disseminated during the pandemic has also revealed the challenges associated with translating fast-accumulating evidence for an audience not well versed in the process of science. As research findings are speedily posted to preprint servers, preliminary results have made headlines in major news outlets, sometimes without the appropriate dose of scrutiny.
Some politicians, such as Brazil’s President Jair Bolsonaro, have been quick to jump on premature findings, publicly touting the benefits of treatments such as hydroxychloroquine with minimal or no supporting evidence. Others have pointed to the flip-flopping of the current state of knowledge as a sign of scientists’ untrustworthiness or incompetence—as was seen, for example, in the backlash against Anthony Fauci, one of the US government’s top science advisors.
Some comments from world leaders have been even more concerning. “For me, the most shocking thing I saw,” Tyler says, “was Donald Trump suggesting the injection of disinfectant as a way of treating COVID—that was an eye-popping, mind-boggling moment.”
Still, Tyler notes that there are many countries in which the relationship between the scientific community and policymakers during the course of the pandemic has been “pretty impressive.” As an example, he points to Germany, where the government has both enlisted and heeded the advice of scientists across a range of disciplines, including epidemiology, virology, economics, public health, and the humanities.
Researchers will likely be assessing the response to the pandemic for years to come. In the meantime, for scientists interested in getting involved in policymaking, there are lessons to be learned, as well some preliminary insights from the pandemic that may help to improve interactions between scientists and policymakers and thereby pave the way to better evidence-based policy.
Cultural divisions between scientists and policymakers
Even in the absence of a public-health emergency, there are several obstacles to the smooth implementation of scientific advice into policy. One is simply that scientists and policymakers are generally beholden to different incentive systems. “Classically, a scientist wants to understand something for the sake of understanding, because they have a passion toward that topic—so discovery is driven by the value of discovery,” says Kai Ruggeri, a professor of health policy and management at Columbia University. “Whereas the policymaker has a much more utilitarian approach. . . . They have to come up with interventions that produce the best outcomes for the most people.”
Scientists and policymakers are operating on considerably different timescales, too. “Normally, research programs take months and years, whereas policy decisions take weeks and months, sometimes days,” Tyler says. “This discrepancy makes it much more difficult to get scientifically generated knowledge into the policymaking process.” Tyler adds that the two groups deal with uncertainty in very different ways: academics are comfortable with it, as measuring uncertainty is part of the scientific process, whereas policymakers tend to view it as something that can cloud what a “right” answer might be.
This cultural mismatch has been particularly pronounced during the COVID-19 pandemic. Even as scientists work at breakneck speeds, many crucial questions about COVID-19—such as how long immunity to the virus lasts, and how much of a role children play in the spread of infection—remain unresolved, and policy decisions have had to be addressed with limited evidence, with advice changing as new research emerges.
“We have seen the messy side of science, [that] not all studies are equally well-done and that they build over time to contribute to the weight of knowledge,” says Karen Akerlof, a professor of environmental science and policy at George Mason University. “The short timeframes needed for COVID-19 decisions have run straight into the much longer timeframes needed for robust scientific conclusions.”
Academia has done an amazing job of trying to get as much information relevant to COVID gathered and distributed into the policymaking process as possible. —Chris Tyler, University College London
Widespread mask use, for example, was initially discouraged by many politicians and public health officials due to concerns about a shortage of supplies for healthcare workers and limited data on whether mask use by the general public would help reduce the spread of the virus. At the time, there were few mask-wearing laws outside of East Asia, where such practices were commonplace long before the COVID-19 pandemic began.
Gradually, however, as studies began to provide evidence to support the use of face coverings as a means of stemming transmission, scientists and public health officials started to recommend their use. This shift led local, state, and federal officials around the world to implement mandatory mask-wearing rules in certain public spaces. Some politicians, however, used this about-face in advice as a reason to criticize health experts.
“We’re dealing with evidence that is changing very rapidly,” says Meghan Azad, a professor of pediatrics at the University of Manitoba. “I think there’s a risk of people perceiving that rapid evolution as science [being] a bad process, which is worrisome.” On the other hand, the spotlight the pandemic has put on scientists provides opportunities to educate the general public and policymakers about the scientific process, Azad adds. It’s important to help them understand that “it’s good that things are changing, because it means we’re paying attention to the new evidence as it comes out.”
Bringing science and policy closer together
Despite these challenges, science and policy experts say that there are both short- and long-term ways to improve the relationship between the two communities and to help policymakers arrive at decisions that are more evidence-based.
Better tools, for one, could help close the gap. Earlier this year, Ruggeri brought together a group of people from a range of disciplines, including medicine, engineering, economics, and policy, to develop the Theoretical, Empirical, Applicable, Replicable, Impact (THEARI) rating system, a five-tiered framework for evaluating the robustness of scientific evidence in the context of policy decisions. The ratings range from “theoretical” (the lowest level, where a scientifically viable idea has been proposed but not tested) to “impact” (the highest level, in which a concept has been successfully tested, replicated, applied, and validated in the real world).
The team developed THEARI partly to establish a “common language” across scientific disciplines, which Ruggeri says would be particularly useful to policymakers evaluating evidence from a field they may know little about. Ruggeri hopes to see the THEARI framework—or something like it—adopted by policymakers and policy advisors, and even by journals and preprint servers. “I don’t necessarily think [THEARI] will be used right away,” he says. “It’d be great if it was, but we . . . [developed] it as kind of a starting point.”
Other approaches to improve the communication between scientists and policymakers may require more resources and time. According to Akerlof, one method could include providing better incentives for both parties to engage with each other—by offering increased funding for academics who take part in this kind of activity, for instance—and boosting opportunities for such interactions to happen.
Akerlof points to the American Association for the Advancement of Science’s Science & Technology Policy Fellowships, which place scientists and engineers in various branches of the US government for a year, as an example of a way in which important ties between the two communities could be forged. “Many of those scientists either stay in government or continue to work in science policy in other organizations,” Akerlof says. “By understanding the language and culture of both the scientific and policy communities, they are able to bridge between them.”
In Canada, such a program was established in 2018, when the Canadian Science Policy Center and Mona Nemer, Canada’s Chief Science Advisor, held the country’s first “Science Meets Parliament” event. The 28 scientists in attendance, including Azad, spent two days learning about effective communication and the policymaking process, and interacting with senators and members of parliament. “It was eye opening for me because I didn’t know how parliamentarians really live and work,” Azad says. “We hope it’ll grow and involve more scientists and continue on an annual basis . . . and also happen at the provincial level.”
The short timeframes needed for COVID-19 decisions have run straight into the much longer timeframes needed for robust scientific conclusions. —Karen Akerlof, George Mason University
There may also be insights from scientist-policymaker exchanges in other domains that experts can apply to the current pandemic. Maria Carmen Lemos, a social scientist focused on climate policy at the University of Michigan, says that one way to make those interactions more productive is by closing something she calls the “usability gap.”
“The usability gap highlights the fact that one of the reasons that research fails to connect is because [scientists] only pay attention to the [science],” Lemos explains. “We are putting everything out there in papers, in policy briefs, in reports, but rarely do we actually systematically and intentionally try to understand who is on the other side” receiving this information, and what they will do with it.
The way to deal with this usability gap, according to Lemos, is for more scientists to consult the people who actually make, influence, and implement policy changes early on in the scientific process. Lemos and her team, for example, have engaged in this way with city officials, farmers, forest managers, tribal leaders, and others whose decision making would directly benefit from their work. “We help with organization and funding, and we also work with them very closely to produce climate information that is tailored for them, for the problems that they are trying to solve,” she adds.
Azad applied this kind of approach in a study that involves assessing the effects of the pandemic on a cohort of children that her team has been following from infancy, starting in 2010. When she and her colleagues were putting together the proposal for the COVID-19 project this year, they reached out to public health decision makers across the Canadian provinces to find out what information would be most useful. “We have made sure to embed those decision makers in the project from the very beginning to ensure we’re asking the right questions, getting the most useful information, and getting it back to them in a very quick turnaround manner,” Azad says.
There will also likely be lessons to take away from the pandemic in the years to come, notes Noam Obermeister, a PhD student studying science policy at the University of Cambridge. These include insights from scientific advisors about how providing guidance to policymakers during COVID-19 compared to pre-pandemic times, and how scientists’ prominent role during the pandemic has affected how they are viewed by the public; efforts to collect this sort of information are already underway.
“I don’t think scientists anticipated that much power and visibility, or that [they] would be in [public] saying science is complicated and uncertain,” Obermeister says. “I think what that does to the authority of science in the public eye is still to be determined.”
Talking Science to PolicymakersFor academics who have never engaged with policymakers, the thought of making contact may be daunting. Researchers with experience of these interactions share their tips for success. 1. Do your homework. Policymakers usually have many different people vying for their time and attention. When you get a meeting, make sure you make the most of it. “Find out which issues related to your research are a priority for the policymaker and which decisions are on the horizon,” says Karen Akerlof, a professor of environmental science and policy at George Mason University. 2. Get to the point, but don’t oversimplify. “I find policymakers tend to know a lot about the topics they work on, and when they don’t, they know what to ask about,” says Kai Ruggeri, a professor of health policy and management at Columbia University. “Finding a good balance in the communication goes a long way.” 3. Keep in mind that policymakers’ expertise differs from that of scientists. “Park your ego at the door and treat policymakers and their staff with respect,” Akerlof says. “Recognize that the skills, knowledge, and culture that translate to success in policy may seem very different than those in academia.” 4. Be persistent. “Don’t be discouraged if you don’t get a response immediately, or if promising communications don’t pan out,” says Meghan Azad, a professor of pediatrics at the University of Manitoba. “Policymakers are busy and their attention shifts rapidly. Meetings get cancelled. It’s not personal. Keep trying.” 5. Remember that not all policymakers are politicians, and vice versa. Politicians are usually elected and are affiliated with a political party, and they may not always be directly involved in creating new policies. This is not the case for the vast majority of policymakers—most are career civil servants whose decisions impact the daily living of constituents, Ruggeri explains.
Humans are dismantling and disrupting natural ecosystems around the globe and changing Earth’s climate. Over the past 50 years, actions like farming, logging, hunting, development and global commerce have caused record losses of species on land and at sea. Animals, birds and reptiles are disappearing tens to hundreds of times faster than the natural rate of extinction over the past 10 million years.
Now the world is also contending with a global pandemic. In geographically remote regions such as the Brazilian Amazon, COVID-19 is devastating Indigenous populations, with tragic consequences for both Indigenous peoples and the lands they steward.
My research focuses on ecosystems and climate change from regional to global scales. In 2019, I worked with conservation biologist and strategist Eric Dinerstein and 17 colleagues to develop a road map for simultaneously averting a sixth mass extinction and reducing climate change by protecting half of Earth’s terrestrial, freshwater and marine realms by 2030. We called this plan “A Global Deal for Nature.”
Now we’ve released a follow-on called the “Global Safety Net” that identifies the exact regions on land that must be protected to achieve its goals. Our aim is for nations to pair it with the Paris Climate Agreement and use it as a dynamic tool to assess progress towards our comprehensive conservation targets.
What to protect next
The Global Deal for Nature provided a framework for the milestones, targets and policies across terrestrial, freshwater and marine realms required to conserve the vast majority of life on Earth. Yet it didn’t specify where exactly these safeguards were needed. That’s where the new Global Safety Net comes in.
We analyzed unprotected terrestrial areas that, if protected, could sequester carbon and conserve biodiversity as effectively as the 15% of terrestrial areas that are currently protected. Through this analysis, we identified an additional 35% of unprotected lands for conservation, bringing the total percentage of protected nature to 50%.
By setting aside half of Earth’s lands for nature, nations can save our planet’s rich biodiversity, prevent future pandemics and meet the Paris climate target of keeping warming in this century below less than 2.7 degrees F (1.5 degrees C). To meet these goals, 20 countries must contribute disproportionately. Much of the responsibility falls to Russia, the U.S., Brazil, Indonesia, Canada, Australia and China. Why? Because these countries contain massive tracts of land needed to reach the dual goals of reducing climate change and saving biodiversity.
Supporting Indigenous communities
Indigenous peoples make up less than 5% of the total human population, yet they manage or have tenure rights over a quarter of the world’s land surface, representing close to 80% of our planet’s biodiversity. One of our key findings is that 37% of the proposed lands for increased protection overlap with Indigenous lands.
As the world edges closer towards a sixth mass extinction, Indigenous communities stand to lose the most. Forest loss, ecotourism and devastation wrought by climate change have already displaced Indigenous peoples from their traditional territories at unprecedented rates. Now one of the deadliest pandemics in recent history poses an even graver additional threat to Indigenous lives and livelihoods.
To address and alleviate human rights questions, social justice issues and conservation challenges, the Global Safety Net calls for better protection for Indigenous communities. We believe our goals are achievable by upholding existing land tenure rights, addressing Indigenous land claims, and carrying out supportive ecological management programs with indigenous peoples.
Preventing future pandemics
Tropical deforestation increases forest edges – areas where forests meet human habitats. These areas greatly increase the potential for contact between humans and animal vectors that serve as viral hosts.
The Global Safety Net’s policy milestones and targets would reduce the illegal wildlife trade and associated wildlife markets – two known sources of zoonotic diseases. Reducing contact zones between animals and humans can decrease the chances of future zoonotic spillovers from occurring.
Our framework also envisions the creation of a Pandemic Prevention Program, which would increase protections for natural habitats at high risk for human-animal interactions. Protecting wildlife in these areas could also reduce the potential for more catastrophic outbreaks.
Achieving the Global Safety Net’s goals will require nature-based solutions – strategies that protect, manage and restore natural or modified ecosystems while providing co-benefits to both people and nature. They are low-cost and readily available today.
The nature-based solutions that we spotlight include: – Identifying biodiverse non-agricultural lands, particularly prevalent in tropical and sub-tropical regions, for increased conservation attention. – Prioritizing ecoregions that optimize carbon storage and drawdown, such as the Amazon and Congo basins. – Aiding species movement and adaptation across ecosystems by creating a comprehensive system of wildlife and climate corridors.
We estimate that an increase of just 2.3% more land in the right places could save our planet’s rarest plant and animal species within five years. Wildlife corridors connect fragmented wild spaces, providing wild animals the space they need to survive.
Leveraging technology for conservation
In the Global Safety Net study, we identified 50 ecoregions where additional conservation attention is most needed to meet the Global Deal for Nature’s targets, and 20 countries that must assume greater responsibility for protecting critical places. We mapped an additional 35% of terrestrial lands that play a critical role in reversing biodiversity loss, enhancing natural carbon removal and preventing further greenhouse gas emissions from land conversion.
But as climate change accelerates, it may scramble those priorities. Staying ahead of the game will require a satellite-driven monitoring system with the capability of tracking real-time land use changes on a global scale. These continuously updated maps would enable dynamic analyses to help sharpen conservation planning and help decision-making.
Earlier this summer, the Summit supercomputer at Oak Ridge National Lab in Tennessee set about crunching data on more than 40,000 genes from 17,000 genetic samples in an effort to better understand Covid-19. Summit is the second-fastest computer in the world, but the process — which involved analyzing 2.5 billion genetic combinations — still took more than a week.
When Summit was done, researchers analyzed the results. It was, in the words of Dr. Daniel Jacobson, lead researcher and chief scientist for computational systems biology at Oak Ridge, a “eureka moment.” The computer had revealed a new theory about how Covid-19 impacts the body: the bradykinin hypothesis. The hypothesis provides a model that explains many aspects of Covid-19, including some of its most bizarre symptoms. It also suggests 10-plus potential treatments, many of which are already FDA approved. Jacobson’s group published their results in a paper in the journal eLife in early July.
According to the team’s findings, a Covid-19 infection generally begins when the virus enters the body through ACE2 receptors in the nose, (The receptors, which the virus is known to target, are abundant there.) The virus then proceeds through the body, entering cells in other places where ACE2 is also present: the intestines, kidneys, and heart. This likely accounts for at least some of the disease’s cardiac and GI symptoms.
But once Covid-19 has established itself in the body, things start to get really interesting. According to Jacobson’s group, the data Summit analyzed shows that Covid-19 isn’t content to simply infect cells that already express lots of ACE2 receptors. Instead, it actively hijacks the body’s own systems, tricking it into upregulating ACE2 receptors in places where they’re usually expressed at low or medium levels, including the lungs.
In this sense, Covid-19 is like a burglar who slips in your unlocked second-floor window and starts to ransack your house. Once inside, though, they don’t just take your stuff — they also throw open all your doors and windows so their accomplices can rush in and help pillage more efficiently.
The renin–angiotensin system (RAS) controls many aspects of the circulatory system, including the body’s levels of a chemical called bradykinin, which normally helps to regulate blood pressure. According to the team’s analysis, when the virus tweaks the RAS, it causes the body’s mechanisms for regulating bradykinin to go haywire. Bradykinin receptors are resensitized, and the body also stops effectively breaking down bradykinin. (ACE normally degrades bradykinin, but when the virus downregulates it, it can’t do this as effectively.)
The end result, the researchers say, is to release a bradykinin storm — a massive, runaway buildup of bradykinin in the body. According to the bradykinin hypothesis, it’s this storm that is ultimately responsible for many of Covid-19’s deadly effects. Jacobson’s team says in their paper that “the pathology of Covid-19 is likely the result of Bradykinin Storms rather than cytokine storms,” which had been previously identified in Covid-19 patients, but that “the two may be intricately linked.” Other papers had previously identified bradykinin storms as a possible cause of Covid-19’s pathologies.
Covid-19 is like a burglar who slips in your unlocked second-floor window and starts to ransack your house.
As bradykinin builds up in the body, it dramatically increases vascular permeability. In short, it makes your blood vessels leaky. This aligns with recent clinical data, which increasingly views Covid-19 primarily as a vascular disease, rather than a respiratory one. But Covid-19 still has a massive effect on the lungs. As blood vessels start to leak due to a bradykinin storm, the researchers say, the lungs can fill with fluid. Immune cells also leak out into the lungs, Jacobson’s team found, causing inflammation.
And Covid-19 has another especially insidious trick. Through another pathway, the team’s data shows, it increases production of hyaluronic acid (HLA) in the lungs. HLA is often used in soaps and lotions for its ability to absorb more than 1,000 times its weight in fluid. When it combines with fluid leaking into the lungs, the results are disastrous: It forms a hydrogel, which can fill the lungs in some patients. According to Jacobson, once this happens, “it’s like trying to breathe through Jell-O.”
This may explain why ventilators have proven less effective in treating advanced Covid-19 than doctors originally expected, based on experiences with other viruses. “It reaches a point where regardless of how much oxygen you pump in, it doesn’t matter, because the alveoli in the lungs are filled with this hydrogel,” Jacobson says. “The lungs become like a water balloon.” Patients can suffocate even while receiving full breathing support.
The bradykinin hypothesis also extends to many of Covid-19’s effects on the heart. About one in five hospitalized Covid-19 patients have damage to their hearts, even if they never had cardiac issues before. Some of this is likely due to the virus infecting the heart directly through its ACE2 receptors. But the RAS also controls aspects of cardiac contractions and blood pressure. According to the researchers, bradykinin storms could create arrhythmias and low blood pressure, which are often seen in Covid-19 patients.
Bradykinin — especially at high doses — can also lead to a breakdown of the blood-brain barrier. Under normal circumstances, this barrier acts as a filter between your brain and the rest of your circulatory system. It lets in the nutrients and small molecules that the brain needs to function, while keeping out toxins and pathogens and keeping the brain’s internal environment tightly regulated.
If bradykinin storms cause the blood-brain barrier to break down, this could allow harmful cells and compounds into the brain, leading to inflammation, potential brain damage, and many of the neurological symptoms Covid-19 patients experience. Jacobson told me, “It is a reasonable hypothesis that many of the neurological symptoms in Covid-19 could be due to an excess of bradykinin. It has been reported that bradykinin would indeed be likely to increase the permeability of the blood-brain barrier. In addition, similar neurological symptoms have been observed in other diseases that result from an excess of bradykinin.”
Increased bradykinin levels could also account for other common Covid-19 symptoms. ACE inhibitors — a class of drugs used to treat high blood pressure — have a similar effect on the RAS system as Covid-19, increasing bradykinin levels. In fact, Jacobson and his team note in their paper that “the virus… acts pharmacologically as an ACE inhibitor” — almost directly mirroring the actions of these drugs.
By acting like a natural ACE inhibitor, Covid-19 may be causing the same effects that hypertensive patients sometimes get when they take blood pressure–lowering drugs. ACE inhibitors are known to cause a dry cough and fatigue, two textbook symptoms of Covid-19. And they can potentially increase blood potassium levels, which has also been observed in Covid-19 patients. The similarities between ACE inhibitor side effects and Covid-19 symptoms strengthen the bradykinin hypothesis, the researchers say.
ACE inhibitors are also known to cause a loss of taste and smell. Jacobson stresses, though, that this symptom is more likely due to the virus “affecting the cells surrounding olfactory nerve cells” than the direct effects of bradykinin.
Though still an emerging theory, the bradykinin hypothesis explains several other of Covid-19’s seemingly bizarre symptoms. Jacobson and his team speculate that leaky vasculature caused by bradykinin storms could be responsible for “Covid toes,” a condition involving swollen, bruised toes that some Covid-19 patients experience. Bradykinin can also mess with the thyroid gland, which could produce the thyroid symptoms recently observed in some patients.
The bradykinin hypothesis could also explain some of the broader demographic patterns of the disease’s spread. The researchers note that some aspects of the RAS system are sex-linked, with proteins for several receptors (such as one called TMSB4X) located on the X chromosome. This means that “women… would have twice the levels of this protein than men,” a result borne out by the researchers’ data. In their paper, Jacobson’s team concludes that this “could explain the lower incidence of Covid-19 induced mortality in women.” A genetic quirk of the RAS could be giving women extra protection against the disease.
The bradykinin hypothesis provides a model that “contributes to a better understanding of Covid-19” and “adds novelty to the existing literature,” according to scientists Frank van de Veerdonk, Jos WM van der Meer, and Roger Little, who peer-reviewed the team’s paper. It predicts nearly all the disease’s symptoms, even ones (like bruises on the toes) that at first appear random, and further suggests new treatments for the disease.
As Jacobson and team point out, several drugs target aspects of the RAS and are already FDA approved to treat other conditions. They could arguably be applied to treating Covid-19 as well. Several, like danazol, stanozolol, and ecallantide, reduce bradykinin production and could potentially stop a deadly bradykinin storm. Others, like icatibant, reduce bradykinin signaling and could blunt its effects once it’s already in the body.
Interestingly, Jacobson’s team also suggests vitamin D as a potentially useful Covid-19 drug. The vitamin is involved in the RAS system and could prove helpful by reducing levels of another compound, known as REN. Again, this could stop potentially deadly bradykinin storms from forming. The researchers note that vitamin D has already been shown to help those with Covid-19. The vitamin is readily available over the counter, and around 20% of the population is deficient. If indeed the vitamin proves effective at reducing the severity of bradykinin storms, it could be an easy, relatively safe way to reduce the severity of the virus.
Other compounds could treat symptoms associated with bradykinin storms. Hymecromone, for example, could reduce hyaluronic acid levels, potentially stopping deadly hydrogels from forming in the lungs. And timbetasin could mimic the mechanism that the researchers believe protects women from more severe Covid-19 infections. All of these potential treatments are speculative, of course, and would need to be studied in a rigorous, controlled environment before their effectiveness could be determined and they could be used more broadly.
Covid-19 stands out for both the scale of its global impact and the apparent randomness of its many symptoms. Physicians have struggled to understand the disease and come up with a unified theory for how it works. Though as of yet unproven, the bradykinin hypothesis provides such a theory. And like all good hypotheses, it also provides specific, testable predictions — in this case, actual drugs that could provide relief to real patients.
The researchers are quick to point out that “the testing of any of these pharmaceutical interventions should be done in well-designed clinical trials.” As to the next step in the process, Jacobson is clear: “We have to get this message out.” His team’s finding won’t cure Covid-19. But if the treatments it points to pan out in the clinic, interventions guided by the bradykinin hypothesis could greatly reduce patients’ suffering — and potentially save lives.
A simple mathematical mistake may explain why many people underestimate the dangers of coronavirus, shunning social distancing, masks and hand-washing.
Imagine you are offered a deal with your bank, where your money doubles every three days. If you invest just $1 today, roughly how long will it take for you to become a millionaire?
Would it be a year? Six months? 100 days?
The precise answer is 60 days from your initial investment, when your balance would be exactly $1,048,576. Within a further 30 days, you’d have earnt more than a billion. And by the end of the year, you’d have more than $1,000,000,000,000,000,000,000,000,000,000,000,000 – an “undecillion” dollars.
If your estimates were way out, you are not alone. Many people consistently underestimate how fast the value increases – a mistake known as the “exponential growth bias” – and while it may seem abstract, it may have had profound consequences for people’s behaviour this year.
A spate of studies has shown that people who are susceptible to the exponential growth bias are less concerned about Covid-19’s spread, and less likely to endorse measures like social distancing, hand washing or mask wearing. In other words, this simple mathematical error could be costing lives – meaning that the correction of the bias should be a priority as we attempt to flatten curves and avoid second waves of the pandemic around the world.
To understand the origins of this particular bias, we first need to consider different kinds of growth. The most familiar is “linear”. If your garden produces three apples every day, you have six after two days, nine after three days, and so on.
Exponential growth, by contrast, accelerates over time. Perhaps the simplest example is population growth; the more people you have reproducing, the faster the population grows. Or if you have a weed in your pond that triples each day, the number of plants may start out low – just three on day two, and nine on day three – but it soon escalates (see diagram, below).
Many people assume that coronavirus spreads in a linear fashion, but unchecked it’s exponential (Credit: Nigel Hawtin)
Our tendency to overlook exponential growth has been known for millennia. According to an Indian legend, the brahmin Sissa ibn Dahir was offered a prize for inventing an early version of chess. He asked for one grain of wheat to be placed on the first square on the board, two for the second square, four for the third square, doubling each time up to the 64th square. The king apparently laughed at the humility of ibn Dahir’s request – until his treasurers reported that it would outstrip all the food in the land (18,446,744,073,709,551,615 grains in total).
It was only in the late 2000s that scientists started to study the bias formally, with research showing that most people – like Sissa ibn Dahir’s king – intuitively assume that most growth is linear, leading them to vastly underestimate the speed of exponential increase.
These initial studies were primarily concerned with the consequences for our bank balance. Most savings accounts offer compound interest, for example, where you accrue additional interest on the interest you have already earned. This is a classic example of exponential growth, and it means that even low interest rates pay off handsomely over time. If you have a 5% interest rate, then £1,000 invested today will be worth £1,050 next year, and £1,102.50 the year after… which adds up to more than £7,000 in 40 years’ time. Yet most people don’t recognise how much more bang for their buck they will receive if they start investing early, so they leave themselves short for their retirement.
If the number of grains on a chess board doubled for each square, the 64th would ‘hold’ 18 quintillion (Credit: Getty Images)
Surprisingly, a higher level of education does not prevent people from making these errors. Even mathematically trained science students can be vulnerable, says Daniela Sele, who researchs economic decision making at the Swiss Federal Institute of Technology in Zurich. “It does help somewhat, but it doesn’t preclude the bias,” she says.
As I explored in my book The Intelligence Trap, intelligent and educated people often have a “bias blind spot”, believing themselves to be less susceptible to error than others – and the exponential growth bias appears to fall dead in its centre.
Most people will confidently report understanding exponential growth but then still fall for the bias
It was only this year – at the start of the Covid-19 pandemic – that researchers began to consider whether the bias might also influence our understanding of infectious diseases.
In March, Joris Lammers at the University of Bremen in Germany joined forces with Jan Crusius and Anne Gast at the University of Cologne to roll out online surveys questioning people about the potential spread of the disease. Their results showed that the exponential growth bias was prevalent in people’s understanding of the virus’s spread, with most people vastly underestimating the rate of increase. More importantly, the team found that those beliefs were directly linked to the participants’ views on the best ways to contain the spread. The worse their estimates, the less likely they were to understand the need for social distancing: the exponential growth bias had made them complacent about the official advice.
The charts that politicians show often fail to communicate exponential growth effectively (Credit: Reuters)
The researchers speculate that some of the graphical representations found in the media may have been counter-productive. It’s common for the number of infections to be presented on a “logarithmic scale”, in which the figures on the y-axis increase by a power of 10 (so the gap between 1 and 10 is the same as the gap between 10 and 100, or 100 and 1000).
While this makes it easier to plot different regions with low and high growth rates, it means that exponential growth looks more linear than it really is, which could reinforce the exponential growth bias. “To expect people to use the logarithmic scale to extrapolate the growth path of a disease is to demand a very high level of cognitive ability,” the authors told me in an email. In their view, simple numerical tables may actually be more powerful.
Even a small effort to correct this bias could bring huge benefits
The good news is that people’s views are malleable. When Lammers and colleagues reminded the participants of the exponential growth bias, and asked them to calculate the growth in regular steps over a two week period, people hugely improved their estimates of the disease’s spread – and this, in turn, changed their views on social distancing. Sele, meanwhile, has recently shown that small changes in framing can matter. Emphasising the short amount of time that it will take to reach a large number of cases, for instance – and the time that would be gained by social distancing measures – improves people’s understanding of accelerating growth, rather than simply stating the percentage increase each day.
Lammers believes that the exponential nature of the virus needs to be made more salient in coverage of the pandemic. “I think this study shows how media and government should report on a pandemic in such a situation. Not only report the numbers of today and growth over the past week, but also explain what will happen in the next days, week, month, if the same accelerating growth persists,” he says.
He is confident that even a small effort to correct this bias could bring huge benefits. In the US, where the pandemic has hit hardest, it took only a few months for the virus to infect more than five million people, he says. “If we could have overcome the exponential growth bias and had convinced all Americans of this risk back in March, I am sure 99% would have embraced all possible distancing measures.”
Is it safe to go to the grocery store? Can my kids have a play date? Will the other child wear a mask? Can I send them back to school? When my boss asks me to come back to the office, should I?
Shayla Bell lies awake at night racking her brain for answers and preparing for another day of unprecedented choices.
“There’s all these little, small decisions all the time,” said Bell, a suburban Chicago retail professional with two kids. “I find myself being my own devil’s advocate so often to try to reach the best conclusion. And I’m tired.”
“It’s a state of low willpower that results from having invested effort into making choices,” said Roy Baumeister, a psychology professor at Florida State University who coined the term in 2010. “It leads to putting less effort into making further choices, so either choices are avoided or they are made in a very superficial way.”
Like a mental gas tank, the human brain has a limited capacity of energy, and as you make decisions throughout the day, you deplete that resource. As you become fatigued, you may be inclined to avoid additional decisions, stick to the status quo or base a decision on a single criteria, Baumeister said.
When we’re able to maintain daily routines, the brain can automate decisions and rely on heuristics – or mental shortcuts – to avoid fatigue. But the pandemic has disrupted many of our routines, forcing us to allocate more mental energy to decision-making.
The effects of decision fatigue have serious implications for people in positions of authority. Jonathan Levav, who studies behavioral decision theory at Stanford University, found that judges serving on parole boards in Israel were more likely to give favorable rulings at the very beginning of the workday or after a food break than later in a sequence of cases, after the judges had made more decisions.
“If you make a lot of decisions repeatedly, that has an effect on subsequent decisions,” Levav said. “As people make more decisions, they’re more likely to simplify whatever subsequent decisions they’re dealing with.”
We’re not just making a greater number of daily decisions. We’re also making high-stakes, moral decisions, said Elizabeth Yuko, a writer and staff member at the Fordham University Center for Ethics Education.
“It’s fatigue with making decisions that have consequences we’ve never had to deal with before,” Yuko said. “These things come with such a moral weight on them, it comes with even more stress.”
For parents and guardians, in particular, the stakes are high. Erin Scarpa, a mother of two who works at a bank in New Jersey, said she temporarily relocated her family to North Carolina specifically to avoid making decisions about socializing with neighbors. Scarpa said she’s particularly concerned about reports of patients suffering lasting damage from COVID-19.
“You’re talking about decisions that could limit your child’s life forever,” Scarpa said. “That’s a whole other concept.”
Sneha Dave, a recent college graduate living with an inflammatory bowel disease and unidentified respiratory condition, said she struggled with crippling decision fatigue at the beginning of the pandemic.
“There’s been so many times where I go to the grocery store where I turn around because there are too many cars there. I spend a lot of time deciding what the right time to go to the grocery store is or whether I should go in,” she said.
Dave said she’s still grappling with a big decision – whether or not to pursue a round of treatment for her bowel disease, which would severely weaken her immune system – but she’s slowly learned how to cope with her decision fatigue.
“The chronic illness community has been able to adapt significantly better and make these decisions a little easier because these are decisions we’ve made our whole lives,” Dave said.
How statewide COVID-19 policies affect decision fatigue
Streamlined state and nationwide policies on COVID-19 have the potential to alleviate decision fatigue, some researchers said, but the notion of greater regulation carries contentious political implications.
“The more that requirements are in place, such as mask mandates, the less it’s a personal choice about what to do. And it makes it easier to make other, related decisions,” said Kathleen Vohs, a professor at the University of Minnesota who studies self-control. “You don’t have to agonize about whether it’s safe to go to the grocery store when you know that others will have masks on.”
Mandates may also cause people to feel depleted if they find it difficult to comply with a policy, researchers said. Others may be making such specific, preferential decisions that statewide policies wouldn’t be enough to alleviate decision fatigue.
Sheena Iyengar, a Columbia Business School professor and author studying the psychology and economics of choice, is gathering data on how Americans feel about statewide COVID-19 policies.
Contrary to classical economic theory, Iyengar’s work has found that, in some contexts, people may prefer to have their choices limited or entirely removed. For example, people are more likely to purchase jams or chocolates – or to undertake optional class essay assignments – when offered a limited rather than extensive array of choices. Study participants reported greater satisfaction with their selections when their options had been limited.
A similar trend may be playing out when it comes to COVID-19 policies, Iyengar said. Her preliminary findings suggest that people living in states with face mask policies reported being “happier” than those in states without mask mandates. The findings may simply be driven by political preferences, Iyengar said.
“There’s a naturally occurring experiment, although that experiment falls along political lines,” she said.
Tips for avoiding decision fatigue
There are some simple strategies for avoiding decision fatigue, researchers said. Many center on general health and well-being, such as maintaining a nutritious diet, getting a full night’s sleep and exercising regularly. Others focus on timing your decisions and developing routines to cut out unnecessary choices.
“Willpower diminishes and decision fatigue increases over the course of the day, so if you have important decisions to make, make them in the morning after a full night’s sleep and a good breakfast,” Baumeister said. “Be aware this is affecting you.”
Plan out tomorrow’s schedule the day before, said Dovid Spinka, a staff clinician at the Center for Anxiety in New York City. Prep or plan your meals for the week. Lay out your clothes in the evening, or – like Steve Jobs – develop a uniform.
If you begin to fade during the day, take a short break, go for a walk or practice mindfulness or breathing exercises, Spinka said. Prioritize your decisions, and try to focus on one at a time. If you’re facing a big decision but feel drained, take a nap or grab a snack. Write down your initial thoughts, but don’t make the decision yet. Come back to it when you’re feeling refreshed, or proactively delay the decision to a set date.
Especially in highly emotional times, people who tend to suppress their emotions may be more prone to experience decision fatigue, said Grant Pignatiello, a researcher at Case Western Reserve University. It’s important to be aware of how you’re feeling and talk to others about it.
“We are all going through a collective trauma of this pandemic, so it’s important that we cut ourselves a little slack. If we need to take a nap at the end of the day, watch Netflix or go for a walk, it’s OK,” Pignatiello said.
For Bell, that means granting herself some grace.
“I feel like we’re all – even the coolest cucumbers – we’re all at a higher stress level now,” she said. “So try to have some grace for yourself and others, and understand that we’re all doing the best we think we can.”
HUMANS ARE lucky to live a hundred years. Oak trees may live a thousand; mayflies, in their adult form, a single day. But they are all alive in the same way. They are made up of cells which embody flows of energy and stores of information. Their metabolisms make use of that energy, be it from sunlight or food, to build new molecules and break down old ones, using mechanisms described in the genes they inherited and may, or may not, pass on.
It is this endlessly repeated, never quite perfect reproduction which explains why oak trees, humans, and every other plant, fungus or single-celled organism you have ever seen or felt the presence of are all alive in the same way. It is the most fundamental of all family resemblances. Go far enough up any creature’s family tree and you will find an ancestor that sits in your family tree, too. Travel further and you will find what scientists call the last universal common ancestor, LUCA. It was not the first living thing. But it was the one which set the template for the life that exists today.
And then there are viruses. In viruses the link between metabolism and genes that binds together all life to which you are related, from bacteria to blue whales, is broken. Viral genes have no cells, no bodies, no metabolism of their own. The tiny particles, “virions”, in which those genes come packaged—the dot-studded disks of coronaviruses, the sinister, sinuous windings of Ebola, the bacteriophages with their science-fiction landing-legs that prey on microbes—are entirely inanimate. An individual animal, or plant, embodies and maintains the restless metabolism that made it. A virion is just an arrangement of matter.
The virus is not the virion. The virus is a process, not a thing. It is truly alive only in the cells of others, a virtual organism running on borrowed hardware to produce more copies of its genome. Some bide their time, letting the cell they share the life of live on. Others immediately set about producing enough virions to split their hosts from stem to stern.
The virus has no plan or desire. The simplest purposes of the simplest life—to maintain the difference between what is inside the cell and what is outside, to move towards one chemical or away from another—are entirely beyond it. It copies itself in whatever way it does simply because it has copied itself that way before, in other cells, in other hosts.
That is why, asked whether viruses are alive, Eckard Wimmer, a chemist and biologist who works at the State University of New York, Stony Brook, offers a yes-and-no. Viruses, he says, “alternate between nonliving and living phases”. He should know. In 2002 he became the first person in the world to take an array of nonliving chemicals and build a virion from scratch—a virion which was then able to get itself reproduced by infecting cells.
The fact that viruses have only a tenuous claim to being alive, though, hardly reduces their impact on things which are indubitably so. No other biological entities are as ubiquitous, and few as consequential. The number of copies of their genes to be found on Earth is beyond astronomical. There are hundreds of billions of stars in the Milky Way galaxy and a couple of trillion galaxies in the observable universe. The virions in the surface waters of any smallish sea handily outnumber all the stars in all the skies that science could ever speak of.
Back on Earth, viruses kill more living things than any other type of predator. They shape the balance of species in ecosystems ranging from those of the open ocean to that of the human bowel. They spur evolution, driving natural selection and allowing the swapping of genes.
They may have been responsible for some of the most important events in the history of life, from the appearance of complex multicellular organisms to the emergence of DNA as a preferred genetic material. The legacy they have left in the human genome helps produce placentas and may shape the development of the brain. For scientists seeking to understand life’s origin, they offer a route into the past separate from the one mapped by humans, oak trees and their kin. For scientists wanting to reprogram cells and mend metabolisms they offer inspiration—and powerful tools.
II A lifestyle for genes
THE IDEA of a last universal common ancestor provides a plausible and helpful, if incomplete, answer to where humans, oak trees and their ilk come from. There is no such answer for viruses. Being a virus is not something which provides you with a place in a vast, coherent family tree. It is more like a lifestyle—a way of being which different genes have discovered independently at different times. Some viral lineages seem to have begun quite recently. Others have roots that comfortably predate LUCA itself.
Disparate origins are matched by disparate architectures for information storage and retrieval. In eukaryotes—creatures, like humans, mushrooms and kelp, with complex cells—as in their simpler relatives, the bacteria and archaea, the genes that describe proteins are written in double-stranded DNA. When a particular protein is to be made, the DNA sequence of the relevant gene acts as a template for the creation of a complementary molecule made from another nucleic acid, RNA. This messenger RNA (mRNA) is what the cellular machinery tasked with translating genetic information into proteins uses in order to do so.
Because they, too, need to have proteins made to their specifications, viruses also need to produce mRNAs. But they are not restricted to using double-stranded DNA as a template. Viruses store their genes in a number of different ways, all of which require a different mechanism to produce mRNAs. In the early 1970s David Baltimore, one of the great figures of molecular biology, used these different approaches to divide the realm of viruses into seven separate classes (see diagram).
In four of these seven classes the viruses store their genes not in DNA but in RNA. Those of Baltimore group three use double strands of RNA. In Baltimore groups four and five the RNA is single-stranded; in group four the genome can be used directly as an mRNA; in group five it is the template from which mRNA must be made. In group six—the retroviruses, which include HIV—the viral RNA is copied into DNA, which then provides a template for mRNAs.
Because uninfected cells only ever make RNA on the basis of a DNA template, RNA-based viruses need distinctive molecular mechanisms those cells lack. Those mechanisms provide medicine with targets for antiviral attacks. Many drugs against HIV take aim at the system that makes DNA copies of RNA templates. Remdesivir (Veklury), a drug which stymies the mechanism that the simpler RNA viruses use to recreate their RNA genomes, was originally developed to treat hepatitis C (group four) and subsequently tried against the Ebola virus (group five). It is now being used against SARS–CoV-2 (group four), the covid-19 virus.
Studies of the gene for that RNA-copying mechanism, RdRp, reveal just how confusing virus genealogy can be. Some viruses in groups three, four and five seem, on the basis of their RdRp-gene sequence, more closely related to members of one of the other groups than they are to all the other members of their own group. This may mean that quite closely related viruses can differ in the way they store their genomes; it may mean that the viruses concerned have swapped their RdRp genes. When two viruses infect the same cell at the same time such swaps are more or less compulsory. They are, among other things, one of the mechanisms by which viruses native to one species become able to infect another.
How do genes take on the viral lifestyle in the first place? There are two plausible mechanisms. Previously free-living creatures could give up metabolising and become parasitic, using other creatures’ cells as their reproductive stage. Alternatively genes allowed a certain amount of independence within one creature could have evolved the means to get into other creatures.
Living creatures contain various apparently independent bits of nucleic acid with an interest in reproducing themselves. The smallest, found exclusively in plants, are tiny rings of RNA called viroids, just a few hundred genetic letters long. Viroids replicate by hijacking a host enzyme that normally makes mRNAs. Once attached to a viroid ring, the enzyme whizzes round and round it, unable to stop, turning out a new copy of the viroid with each lap.
Viroids describe no proteins and do no good. Plasmids—somewhat larger loops of nucleic acid found in bacteria—do contain genes, and the proteins they describe can be useful to their hosts. Plasmids are sometimes, therefore, regarded as detached parts of a bacteria’s genome. But that detachment provides a degree of autonomy. Plasmids can migrate between bacterial cells, not always of the same species. When they do so they can take genetic traits such as antibiotic resistance from their old host to their new one.
Recently, some plasmids have been implicated in what looks like a progression to true virus-hood. A genetic analysis by Mart Krupovic of the Pasteur Institute suggests that the Circular Rep-Encoding Single-Strand-DNA (CRESS–DNA) viruses, which infect bacteria, evolved from plasmids. He thinks that a DNA copy of the genes that another virus uses to create its virions, copied into a plasmid by chance, provided it with a way out of the cell. The analysis strongly suggests that CRESS–DNA viruses, previously seen as a pretty closely related group, have arisen from plasmids this way on three different occasions.
Such jailbreaks have probably been going on since very early on in the history of life. As soon as they began to metabolise, the first proto-organisms would have constituted a niche in which other parasitic creatures could have lived. And biology abhors a vacuum. No niche goes unfilled if it is fillable.
It is widely believed that much of the evolutionary period between the origin of life and the advent of LUCA was spent in an “RNA world”—one in which that versatile substance both stored information, as DNA now does, and catalysed chemical reactions, as proteins now do. Set alongside the fact that some viruses use RNA as a storage medium today, this strongly suggests that the first to adopt the viral lifestyle did so too. Patrick Forterre, an evolutionary biologist at the Pasteur Institute with a particular interest in viruses (and the man who first popularised the term LUCA) thinks that the “RNA world” was not just rife with viruses. He also thinks they may have brought about its end.
The difference between DNA and RNA is not large: just a small change to one of the “letters” used to store genetic information and a minor modification to the backbone to which these letters are stuck. And DNA is a more stable molecule in which to store lots of information. But that is in part because DNA is inert. An RNA-world organism which rewrote its genes into DNA would cripple its metabolism, because to do so would be to lose the catalytic properties its RNA provided.
An RNA-world virus, having no metabolism of its own to undermine, would have had no such constraints if shifting to DNA offered an advantage. Dr Forterre suggests that this advantage may have lain in DNA’s imperviousness to attack. Host organisms today have all sorts of mechanisms for cutting up viral nucleic acids they don’t like the look of—mechanisms which biotechnologists have been borrowing since the 1970s, most recently in the form of tools based on a bacterial defence called CRISPR. There is no reason to imagine that the RNA-world predecessors of today’s cells did not have similar shears at their disposal. And a virus that made the leap to DNA would have been impervious to their blades.
Genes and the mechanisms they describe pass between viruses and hosts, as between viruses and viruses, all the time. Once some viruses had evolved ways of writing and copying DNA, their hosts would have been able to purloin them in order to make back-up copies of their RNA molecules. And so what began as a way of protecting viral genomes would have become the way life stores all its genes—except for those of some recalcitrant, contrary viruses.
III The scythes of the seas
IT IS A general principle in biology that, although in terms of individual numbers herbivores outnumber carnivores, in terms of the number of species carnivores outnumber herbivores. Viruses, however, outnumber everything else in every way possible.
This makes sense. Though viruses can induce host behaviours that help them spread—such as coughing—an inert virion boasts no behaviour of its own that helps it stalk its prey. It infects only that which it comes into contact with. This is a clear invitation to flood the zone. In 1999 Roger Hendrix, a virologist, suggested that a good rule of thumb might be ten virions for every living individual creature (the overwhelming majority of which are single-celled bacteria and archaea). Estimates of the number of such creatures on the planet come out in the region of 1029-1030. If the whole Earth were broken up into pebbles, and each of those pebbles smashed into tens of thousands of specks of grit, you would still have fewer pieces of grit than the world has virions. Measurements, as opposed to estimates, produce numbers almost as arresting. A litre of seawater may contain more than 100bn virions; a kilogram of dried soil perhaps a trillion.
Metagenomics, a part of biology that looks at all the nucleic acid in a given sample to get a sense of the range of life forms within it, reveals that these tiny throngs are highly diverse. A metagenomic analysis of two surveys of ocean life, the Tara Oceans and Malaspina missions, by Ahmed Zayed of Ohio State University, found evidence of 200,000 different species of virus. These diverse species play an enormous role in the ecology of the oceans.
A litre of seawater may contain 100bn virions; a kilogram of dried soil perhaps a trillion
On land, most of the photosynthesis which provides the biomass and energy needed for life takes place in plants. In the oceans, it is overwhelmingly the business of various sorts of bacteria and algae collectively known as phytoplankton. These creatures reproduce at a terrific rate, and viruses kill them at a terrific rate, too. According to work by Curtis Suttle of the University of British Columbia, bacterial phytoplankton typically last less than a week before being killed by viruses.
This increases the overall productivity of the oceans by helping bacteria recycle organic matter (it is easier for one cell to use the contents of another if a virus helpfully lets them free). It also goes some way towards explaining what the great mid-20th-century ecologist G. Evelyn Hutchinson called “the paradox of the plankton”. Given the limited nature of the resources that single-celled plankton need, you would expect a few species particularly well adapted to their use to dominate the ecosystem. Instead, the plankton display great variety. This may well be because whenever a particular form of plankton becomes dominant, its viruses expand with it, gnawing away at its comparative success.
It is also possible that this endless dance of death between viruses and microbes sets the stage for one of evolution’s great leaps forward. Many forms of single-celled plankton have molecular mechanisms that allow them to kill themselves. They are presumably used when one cell’s sacrifice allows its sister cells—which are genetically identical—to survive. One circumstance in which such sacrifice seems to make sense is when a cell is attacked by a virus. If the infected cell can kill itself quickly (a process called apoptosis) it can limit the number of virions the virus is able to make. This lessens the chances that other related cells nearby will die. Some bacteria have been shown to use this strategy; many other microbes are suspected of it.
There is another situation where self-sacrifice is becoming conduct for a cell: when it is part of a multicellular organism. As such organisms grow, cells that were once useful to them become redundant; they have to be got rid of. Eugene Koonin of America’s National Institutes of Health and his colleagues have explored the idea that virus-thwarting self-sacrifice and complexity-permitting self-sacrifice may be related, with the latter descended from the former. Dr Koonin’s model also suggests that the closer the cells are clustered together, the more likely this act of self-sacrifice is to have beneficial consequences.
For such profound propinquity, move from the free-flowing oceans to the more structured world of soil, where potential self-sacrificers can nestle next to each other. Its structure makes soil harder to sift for genes than water is. But last year Mary Firestone of the University of California, Berkeley, and her colleagues used metagenomics to count 3,884 new viral species in a patch of Californian grassland. That is undoubtedly an underestimate of the total diversity; their technique could see only viruses with RNA genomes, thus missing, among other things, most bacteriophages.
Metagenomics can also be applied to biological samples, such as bat guano in which it picks up viruses from both the bats and their food. But for the most part the finding of animal viruses requires more specific sampling. Over the course of the 2010s PREDICT, an American-government project aimed at finding animal viruses, gathered over 160,000 animal and human tissue samples from 35 countries and discovered 949 novel viruses.
The people who put together PREDICT now have grander plans. They want a Global Virome Project to track down all the viruses native to the world’s 7,400 species of mammals and waterfowl—the reservoirs most likely to harbour viruses capable of making the leap into human beings. In accordance with the more-predator-species-than-prey rule they expect such an effort would find about 1.5m viruses, of which around 700,000 might be able to infect humans. A planning meeting in 2018 suggested that such an undertaking might take ten years and cost $4bn. It looked like a lot of money then. Today those arguing for a system that can provide advance warning of the next pandemic make it sound pretty cheap.
IV Leaving their mark
THE TOLL which viruses have exacted throughout history suggests that they have left their mark on the human genome: things that kill people off in large numbers are powerful agents of natural selection. In 2016 David Enard, then at Stanford University and now at the University of Arizona, made a stab at showing just how much of the genome had been thus affected.
He and his colleagues started by identifying almost 10,000 proteins that seemed to be produced in all the mammals that had had their genomes sequenced up to that point. They then made a painstaking search of the scientific literature looking for proteins that had been shown to interact with viruses in some way or other. About 1,300 of the 10,000 turned up. About one in five of these proteins was connected to the immune system, and thus could be seen as having a professional interest in viral interaction. The others appeared to be proteins which the virus made use of in its attack on the host. The two cell-surface proteins that SARS–CoV-2 uses to make contact with its target cells and inveigle its way into them would fit into this category.
The researchers then compared the human versions of the genes for their 10,000 proteins with those in other mammals, and applied a statistical technique that distinguishes changes that have no real impact from the sort of changes which natural selection finds helpful and thus tries to keep. Genes for virus-associated proteins turned out to be evolutionary hotspots: 30% of all the adaptive change was seen in the genes for the 13% of the proteins which interacted with viruses. As quickly as viruses learn to recognise and subvert such proteins, hosts must learn to modify them.
A couple of years later, working with Dmitri Petrov at Stanford, Dr Enard showed that modern humans have borrowed some of these evolutionary responses to viruses from their nearest relatives. Around 2-3% of the DNA in an average European genome has Neanderthal origins, a result of interbreeding 50,000 to 30,000 years ago. For these genes to have persisted they must be doing something useful—otherwise natural selection would have removed them. Dr Enard and Dr Petrov found that a disproportionate number described virus-interacting proteins; of the bequests humans received from their now vanished relatives, ways to stay ahead of viruses seem to have been among the most important.
Viruses do not just shape the human genome through natural selection, though. They also insert themselves into it. At least a twelfth of the DNA in the human genome is derived from viruses; by some measures the total could be as high as a quarter.
Retroviruses like HIV are called retro because they do things backwards. Where cellular organisms make their RNA from DNA templates, retroviruses do the reverse, making DNA copies of their RNA genomes. The host cell obligingly makes these copies into double-stranded DNA which can be stitched into its own genome. If this happens in a cell destined to give rise to eggs or sperm, the viral genes are passed from parent to offspring, and on down the generations. Such integrated viral sequences, known as endogenous retroviruses (ERVs), account for 8% of the human genome.
This is another example of the way the same viral trick can be discovered a number of times. Many bacteriophages are also able to stitch copies of their genome into their host’s DNA, staying dormant, or “temperate”, for generations. If the cell is doing well and reproducing regularly, this quiescence is a good way for the viral genes to make more copies of themselves. When a virus senses that its easy ride may be coming to an end, though—for example, if the cell it is in shows signs of stress—it will abandon ship. What was latent becomes “lytic” as the viral genes produce a sufficient number of virions to tear the host apart.
Though some of their genes are associated with cancers, in humans ERVs do not burst back into action in later generations. Instead they have proved useful resources of genetic novelty. In the most celebrated example, at least ten different mammalian lineages make use of a retroviral gene for one of their most distinctively mammalian activities: building a placenta.
The placenta is a unique organ because it requires cells from the mother and the fetus to work together in order to pass oxygen and sustenance in one direction and carbon dioxide and waste in the other. One way this intimacy is achieved safely is through the creation of a tissue in which the membranes between cells are broken down to form a continuous sheet of cellular material.
The protein that allows new cells to merge themselves with this layer, syncytin-1, was originally used by retroviruses to join the external membranes of their virions to the external membranes of cells, thus gaining entry for the viral proteins and nucleic acids. Not only have different sorts of mammals co-opted this membrane-merging trick—other creatures have made use of it, too. The mabuya, a long-tailed skink which unusually for a lizard nurtures its young within its body, employs a retroviral syncytin protein to produce a mammalian-looking placenta. The most recent shared ancestor of mabuyas and mammals died out 80m years before the first dinosaur saw the light of day, but both have found the same way to make use of the viral gene.
You put your line-1 in, you take your line-1 out
This is not the only way that animals make use of their ERVs. Evidence has begun to accumulate that genetic sequences derived from ERVs are quite frequently used to regulate the activity of genes of more conventional origin. In particular, RNA molecules transcribed from an ERV called HERV-K play a crucial role in providing the stem cells found in embryos with their “pluripotency”—the ability to create specialised daughter cells of various different types. Unfortunately, when expressed in adults HERV-K can also be responsible for cancers of the testes.
As well as containing lots of semi-decrepit retroviruses that can be stripped for parts, the human genome also holds a great many copies of a “retrotransposon” called LINE-1. This a piece of DNA with a surprisingly virus-like way of life; it is thought by some biologists to have, like ERVs, a viral origin. In its full form, LINE-1 is a 6,000-letter sequence of DNA which describes a “reverse transcriptase” of the sort that retroviruses use to make DNA from their RNA genomes. When LINE-1 is transcribed into an mRNA and that mRNA subsequently translated to make proteins, the reverse transcriptase thus created immediately sets to work on the mRNA used to create it, using it as the template for a new piece of DNA which is then inserted back into the genome. That new piece of DNA is in principle identical to the piece that acted as the mRNA’s original template. The LINE-1 element has made a copy of itself.
In the 100m years or so that this has been going on in humans and the species from which they are descended the LINE-1 element has managed to pepper the genome with a staggering 500,000 copies of itself. All told, 17% of the human genome is taken up by these copies—twice as much as by the ERVs.
Most of the copies are severely truncated and incapable of copying themselves further. But some still have the knack, and this capability may be being put to good use. Fred Gage and his colleagues at the Salk Institute for Biological Studies, in San Diego, argue that LINE-1 elements have an important role in the development of the brain. In 2005 Dr Gage discovered that in mouse embryos—specifically, in the brains of those embryos—about 3,000 LINE-1 elements are still able to operate as retrotransposons, putting new copies of themselves into the genome of a cell and thus of all its descendants.
Brains develop through proliferation followed by pruning. First, nerve cells multiply pell-mell; then the cell-suicide process that makes complex life possible prunes them back in a way that looks a lot like natural selection. Dr Gage suspects that the movement of LINE-1 transposons provides the variety in the cell population needed for this selection process. Choosing between cells with LINE-1 in different places, he thinks, could be a key part of the process from which the eventual neural architecture emerges. What is true in mice is, as he showed in 2009, true in humans, too. He is currently developing a technique for looking at the process in detail by comparing, post mortem, the genomes of different brain cells from single individuals to see if their LINE-1 patterns vary in the ways that his theory would predict.
V Promised lands
HUMAN EVOLUTION may have used viral genes to make big-brained live-born life possible; but viral evolution has used them to kill off those big brains on a scale that is easily forgotten. Compare the toll to that of war. In the 20th century, the bloodiest in human history, somewhere between 100m and 200m people died as a result of warfare. The number killed by measles was somewhere in the same range; the number who died of influenza probably towards the top of it; and the number killed by smallpox—300m-500m—well beyond it. That is why the eradication of smallpox from the wild, achieved in 1979 by a globally co-ordinated set of vaccination campaigns, stands as one of the all-time-great humanitarian triumphs.
Other eradications should eventually follow. Even in their absence, vaccination has led to a steep decline in viral deaths. But viruses against which there is no vaccine, either because they are very new, like SARS–CoV-2, or peculiarly sneaky, like HIV, can still kill millions.
Reducing those tolls is a vital aim both for research and for public-health policy. Understandably, a far lower priority is put on the benefits that viruses can bring. This is mostly because they are as yet much less dramatic. They are also much less well understood.
The viruses most prevalent in the human body are not those which infect human cells. They are those which infect the bacteria that live on the body’s surfaces, internal and external. The average human “microbiome” harbours perhaps 100trn of these bacteria. And where there are bacteria, there are bacteriophages shaping their population.
The microbiome is vital for good health; when it goes wrong it can mess up a lot else. Gut bacteria seem to have a role in maintaining, and possibly also causing, obesity in the well-fed and, conversely, in tipping the poorly fed into a form of malnutrition called kwashiorkor. Ill-regulated gut bacteria have also been linked, if not always conclusively, with diabetes, heart disease, cancers, depression and autism. In light of all this, the question “who guards the bacterial guardians?” is starting to be asked.
The viruses that prey on the bacteria are an obvious answer. Because the health of their host’s host—the possessor of the gut they find themselves in—matters to these phages, they have an interest in keeping the microbiome balanced. Unbalanced microbiomes allow pathogens to get a foothold. This may explain a curious detail of a therapy now being used as a treatment of last resort against Clostridium difficile, a bacterium that causes life-threatening dysentery. The therapy in question uses a transfusion of faecal matter, with its attendant microbes, from a healthy individual to reboot the patient’s microbiome. Such transplants, it appears, are more likely to succeed if their phage population is particularly diverse.
Medicine is a very long way from being able to use phages to fine-tune the microbiome. But if a way of doing so is found, it will not in itself be a revolution. Attempts to use phages to promote human health go back to their discovery in 1917, by Félix d’Hérelle, a French microbiologist, though those early attempts at therapy were not looking to restore balance and harmony. On the basis that the enemy of my enemy is my friend, doctors simply treated bacterial infections with phages thought likely to kill the bacteria.
The arrival of antibiotics saw phage therapy abandoned in most places, though it persisted in the Soviet Union and its satellites. Various biotechnology companies think they may now be able to revive the tradition—and make it more effective. One option is to remove the bits of the viral genome that let phages settle down to a temperate life in a bacterial genome, leaving them no option but to keep on killing. Another is to write their genes in ways that avoid the defences with which bacteria slice up foreign DNA.
The hope is that phage therapy will become a backup in difficult cases, such as infection with antibiotic-resistant bugs. There have been a couple of well-publicised one-off successes outside phage therapy’s post-Soviet homelands. In 2016 Tom Patterson, a researcher at the University of California, San Diego, was successfully treated for an antibiotic-resistant bacterial infection with specially selected (but un-engineered) phages. In 2018 Graham Hatfull of the University of Pittsburgh used a mixture of phages, some engineered so as to be incapable of temperance, to treat a 16-year-old British girl who had a bad bacterial infection after a lung transplant. Clinical trials are now getting under way for phage treatments aimed at urinary-tract infections caused by Escherichia coli, Staphylococcus aureus infections that can lead to sepsis and Pseudomonas aeruginosa infections that cause complications in people who have cystic fibrosis.
Viruses which attack bacteria are not the only ones genetic engineers have their eyes on. Engineered viruses are of increasing interest to vaccine-makers, to cancer researchers and to those who want to treat diseases by either adding new genes to the genome or disabling faulty ones. If you want to get a gene into a specific type of cell, a virion that recognises something about such cells may often prove a good tool.
The vaccine used to contain the Ebola outbreak in the Democratic Republic of Congo over the past two years was made by engineering Indiana vesiculovirus, which infects humans but cannot reproduce in them, so that it expresses a protein found on the surface of the Ebola virus; thus primed, the immune system responds to Ebola much more effectively. The World Health Organisation’s current list of 29 covid-19 vaccines in clinical trials features six versions of other viruses engineered to look a bit like SARS-CoV-2. One is based on a strain of measles that has long been used as a vaccine against that disease.
Viruses engineered to engender immunity against pathogens, to kill cancer cells or to encourage the immune system to attack them, or to deliver needed genes to faulty cells all seem likely to find their way into health care. Other engineered viruses are more worrying. One way to understand how viruses spread and kill is to try and make particularly virulent ones. In 2005, for example, Terrence Tumpey of America’s Centres for Disease Control and Prevention and his colleagues tried to understand the deadliness of the influenza virus responsible for the pandemic of 1918-20 by taking a more benign strain, adding what seemed to be distinctive about the deadlier one and trying out the result on mice. It was every bit as deadly as the original, wholly natural version had been.
The use of engineered pathogens as weapons of war is of dubious utility, completely illegal and repugnant to almost all
Because such “gain of function” research could, if ill-conceived or poorly implemented, do terrible damage, it requires careful monitoring. And although the use of engineered pathogens as weapons of war is of dubious utility—such weapons are hard to aim and hard to stand down, and it is not easy to know how much damage they have done—as well as being completely illegal and repugnant to almost all, such possibilities will and should remain a matter of global concern.
Information which, for billions of years, has only ever come into its own within infected cells can now be inspected on computer screens and rewritten at will. The power that brings is sobering. It marks a change in the history of both viruses and people—a change which is perhaps as important as any of those made by modern biology. It is constraining a small part of the viral world in a way which, so far, has been to people’s benefit. It is revealing that world’s further reaches in a way which cannot but engender awe. ■
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This article appeared in the Essay section of the print edition under the headline “The outsiders inside”
Invisível para muitos, a maior tragédia sanitária da história brasileira virou uma macabra estatística. A ilusão da volta ao normal, dizem antropólogos, sociólogos e psicólogos, esconde uma espécie de negação coletiva.
Há mais de três meses, em 19 de maio, o Brasil registrou pela primeira vez mais de mil mortos em 24 horas em decorrência da covid-19. Desde então, a situação epidemiológica do país, que já soma oficialmente mais de 113 mil óbitos pela pandemia, estabilizou-se em um trágico platô.
Se a situação sanitária parece longe de estar sob controle, por outro lado os discursos são de retomada de economia: há dois meses as atividades vêm sendo gradualmente reiniciadas em todo o território nacional, o isolamento social se afrouxa, e está sendo discutida a reabertura das escolas.
Para o antropólogo, cientista social e historiador Claudio Bertolli Filho, professor da Universidade Estadual Paulista (Unesp) e autor do livro História da Saúde Pública no Brasil, o país vive um cenário de “banalização da morte”.
Ele entende que isso é decorrente de uma dimensão política — a maneira como o governo federal conduziu e conduz a situação —, de uma aceitação social — o discurso de que “demos azar” ou de que quem tem comorbidades iria “acabar morrendo mesmo” —, e por fim, de aspectos culturais.
“O presidente Jair Bolsonaro é fruto da sociedade brasileira, que, historicamente, banalizou a morte, desde aquele papo que ‘bandido bom é bandido morto'”, diz Bertolli Filho à DW Brasil. “Há ainda uma tendência de nossa cultura, para sobrevivermos psicologicamente, a enfrentar o momento pandêmico negando as mortes, mostrando-nos imunes a elas.”
“É quando rejeito pensar que aquele que morreu é parecido comigo e eventualmente poderia ser eu próprio. Quem morreu é ‘o outro’, o ‘da periferia’, o que ‘tinha comorbidades’, o que ‘não seguiu as normas sanitárias'”, exemplifica o acadêmico.
Já para o historiador e sociólogo Mauro Iasi, professor da Universidade Federal do Rio de Janeiro (UFRJ) e autor de Política, Estado e Ideologia, a sequência diária de mortes, transformadas em estatística, acaba naturalizando-as à população.
“Quando nos vemos diante de um número elevado de mortes, como em um acidente, por exemplo, isso nos choca pela quebra desta aparente casualidade. No caso da pandemia, o ritmo diário das mortes, sua matematização pelas estatísticas, tende a devolver o fenômeno para o campo da casualidade, naturalizando-o”, argumenta ele.
Iasi exemplifica citando as mortes provocadas anualmente pela ação da Polícia Militar no Brasil — 5.804 em 2019. “A rotinização do fato faz com que se banalize o fenômeno, como parte da vida e, portanto, abrindo espaço para sua negação.”
Pesquisador do Núcleo de Estudos da Violência da Universidade de São Paulo (USP), o jornalista, economista e cientista político Bruno Paes Manso compara a sensação transmitida pelas mortes do coronavírus àquela em relação as vítimas de homicídio no país.
“Os grupos que morrem são vistos como aqueles que, de alguma forma, tinham justificativa para morrer. No caso dos homicídios, são as pessoas ‘que procuraram seu próprio destino’. [Para a opinião pública] a vítima é culpada da morte: são negros, pobres, moradores de periferia, suspeitos de serem traficantes”, comenta. “Existe uma certa ilusão de que as mortes se restringem a determinados grupos vistos pelas pessoas como aqueles que ‘podem morrer’. Isso gera não a banalização, mas uma tolerância a esse tipo de ocorrência.”
Ele acredita em uma lógica um tanto parecida nos óbitos decorrentes do coronavírus. Na racionalização, aponta o pesquisador, a opinião geral é de que a doença não atingiria os próximos, mas sim aqueles vistos como “o outro”: o idoso, aquele com comorbidades, os de alguma forma mais vulneráveis. Este raciocínio é balizado pelo que ocorre nas principais cidades — em geral, os distritos com maior número de mortos estão localizados nas periferias.
“O medo da morte iminente que vem junto com a pandemia mobiliza tanto conteúdos de medo e de desamparo, quanto uma espécie de negação coletiva, já que não existe nenhuma figura real de autoridade, nem na ciência, nem na política, que dê conta de ‘funcionar’ como figuras paternas ou maternas que possam cuidar ou proteger contra a morte”, analisa a psicóloga Nancy Ramacciotti de Oliveira-Monteiro, professora da Universidade Federal de São Paulo (Unifesp). “Até porque, em todo o mundo, por enquanto, ninguém sabe ainda como vencer essa ameaça comum a todos os seres humanos, com exceção da esperada chegada de vacinas.”
Ela lembra que o fato de essas mortes serem divulgadas diariamente por meio de estatísticas numéricas também dificulta a “identificação” por parte da população. Isso só não ocorre, pontua a professora, quando as mortes chegam a círculos próximos ou vitimizam alguma celebridade.
Para o psicólogo Ronaldo Pilati, professor da Universidade de Brasília (UnB), o fenômeno não pode ser chamado de “banalização”, mas sim de “minimização”. Ao recordar da comoção que houve no Brasil quando a Itália registrava cerca de mil mortes em um dia, por exemplo, ele ressalta que era um momento em que os brasileiros estavam “mais atentos e conectados à questão”, já que o mês de março foi quando diversas medidas de quarentena e isolamento social foram implementadas de fato.
“Com o passar do tempo e a maneira ineficiente com que o Brasil enfrentou a pandemia, houve uma mudança de comportamento”, observa. “Não houve enfrentamento coordenado [da questão] e isso confirmou a expectativa de desamparo que o brasileiro tem quando depende do Estado para a resolução de problemas.”
No livro Death Without Weeping: The Violence of Everyday Life in Brazil, a antropóloga americana Nancy Scheper-Hughes relata como mães brasileiras de favelas com altos índices de mortalidade infantil acabam lidando com os óbitos de seus filhos. Para a pesquisadora, a impotência faz com que essas mulheres acabem se conformando com a partida daqueles “mais fracos”, exercendo uma espécie de triagem para favorecer os bebês mais saudáveis, com mais “talento para viver”.
Professor da Universidade Estadual de Campinas (Unicamp), o antropólogo e sociólogo Marko Monteiro concorda que essa sensação é decorrente da desigualdade social brasileira. “Convivemos com a morte historicamente, desde a formação do país, a maneira violenta como foi construída a nação. Nossas ações cotidianas são permeadas por violência”, resume. “A banalização é consequência disso: os números mostram que quem está morrendo mais são as pessoas de áreas periféricas, negras, sem acesso… São os fatores modificáveis.”
“Então temos mecanismos sociais e psicológicos para conviver com essas mortes, que muitos consideram inevitáveis. É a clássica atitude do ‘eu não sou coveiro’, do ‘e daí?’… Por que isso ressoa em muita gente? Porque há a ideia de as mortes eram inevitáveis, que essas pessoas morreriam de qualquer jeito”, afirma.