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.
Here’s the most depressing map you’re likely to see this week, courtesy of Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases. The map, packaged in a recent paper co-written by Fauci, showcases the many other emerging diseases besides covid-19 that pose a threat to our health.
The paper, released over the weekend as a preprint in the journal Cell (meaning it may be revised before its final publication), is intended to lay out the environmental and human factors that led to covid-19 erupting on the world stage in late 2019. Fauci’s co-author is David Morens, senior scientific advisor at Office of the Director at NIAID. It’s an educational read, delving into how newly emerging diseases like covid-19 and familiar enemies like influenza can become so dangerous to humankind.
Viruses like the flu, for instance, quickly mutate into new strains that can easily swap genes with other flu viruses and pick up just the right assortment of genetic tricks that make them more lethal than the seasonal flu and help them spread widely from person to person. Coronaviruses aren’t quite so erratic, but their ability to infect a wide variety of host species makes them more likely to spill over into people—and that’s the leading theory behind how covid-19 entered the picture.
In fact, it’s more than possible, Fauci and Morens note, that the common cold coronaviruses we have today once caused major and deadly epidemics in the past. Though that could provide some comfort, seeing as these viruses are now relatively harmless, not all dangerous viruses become more tame over time, and those that do often take a long time to mellow out.
That brings us to the aforementioned map, an exhaustive but by no means complete illustration of the emerging and reemerging diseases that have recently caused us trouble or are still plaguing us (the danger of weaponized anthrax is highlighted as a “deliberately emerging” disease). Many of these aren’t particularly likely to become a pandemic, at least at the moment. Ebola, for instance, is highly fatal but remains relatively hard to transmit between people. Bacterial diseases like gonorrhea are worrisome because they’re becoming resistant to antibiotics, but they’re not especially lethal.
Far from being a vanishingly rare event, though, humankind has experienced a pandemic on average every 20 years in the last hundred years, with the last, the H1N1 flu, showing up 10 years ago.
None of this is to say that we’re powerless against the coming germ tide—there’s much we can do to prepare, and in fact, many people predicted something like covid-19 happening as recently as last October. But without learning from our mistakes this time around, there’s no telling just how bad the next pandemic will be.
“Science will surely bring us many life-saving drugs, vaccines, and diagnostics; however, there is no reason to think that these alone can overcome the threat of ever more frequent and deadly emergencies of infectious diseases,” Fauci and Morens wrote. “Covid-19 is among the most vivid wake-up calls in over a century. It should force us to begin to think in earnest and collectively about living in more thoughtful and creative harmony with nature, even as we plan for nature’s inevitable, and always unexpected, surprises.”
BRASÍLIA – No dia 29 de junho, quando o Brasil se aproximava de 60 mil mortos pela covid-19 e já ultrapassava 1,3 milhão de pessoas infectadas pelo coronavírus, o presidente da Fundação Nacional do Índio (Funai), Marcelo Xavier, mandou uma carta para os índios Waimiri Atroari, de Roraima, em que afirmou que compreendia a necessidade de isolamento imposta pela doença, mas que não dava mais para esperar o surto passar e que sua equipe tinha de entrar na terra indígena.
O presidente da Funai, ainda sem saber que, apenas nove dias depois, contrairia covid-19, argumentou aos índios Waimiri Atroari que suas lideranças tinham que permitir a entrada de funcionários nas aldeias para dar continuidade ao licenciamento ambiental da linha de energia que pretende ligar Manaus (AM) a Boa Vista (RR).
Seu objetivo era enviar tradutores do estudo de impacto ambiental para dentro da terra indígena, para que o material fosse traduzido para o “kinja iara” (língua de gente), a língua dos Waimiri. Roraima é hoje o único Estado do Brasil que não está conectado ao sistema interligado de transmissão de energia, e o presidente Jair Bolsonaro cobra a liberação desde que entrou no Palácio do Planalto.
Na carta de uma página à qual o Estadão teve acesso, o presidente da Funai admite que “a intenção inicial era de que se aguardasse o fim da pandemia para dar início aos trabalhos de tradução”. No entanto, prossegue, “deve-se levar em consideração que, diante da incerteza do prazo para o fim da pandemia, estamos buscando novas alternativas para podermos dar continuidade aos trabalhos”.
Marcelo Xavier argumentou que seus funcionários tomariam medidas de segurança para evitar o contágio, mas aproveitou para destacar que a ausência da linha, conforme apontado pelo governo em um relatório do Tribunal de Contas da União (TCU), custava R$ 133 milhões por mês ao consumidor de energia de todo o País, porque Roraima tinha de ser iluminada com usinas térmicas locais, movidas a óleo, que são mais caras.
“Desse modo, quando findada essa pandemia que assola todo o País, todo o material necessário para análise já estará traduzido”, afirmou Xavier, no documento.
Isolamento por mais 60 dias
A resposta dos Waimiri Atroari, povo que reúne cerca de 2,1 mil indígenas, chegou no dia 24 de julho, com um retumbante “não”. Na carta, também obtida pela reportagem, o presidente da Associação Comunidade Waimiri Atroari, Mario Parwe Atroari, deixa claro que seu povo não abrirá mão do isolamento social. “Não vemos novas alternativas eficientes que impeçam essa doença de chegar à terra indígena Waimiri Atroari, senão o isolamento social e respeito à quarentena”, afirma.
Ele responde ao presidente da Funai que as cidades que fazem limite com a terra indígena somavam mais de mil contaminações naquele momento, mas que o vírus ainda não tinham sido confirmado em nenhum indígena de suas aldeias, devido à adoção rígida do isolamento.
Os indígenas lembram ainda que o próprio presidente da Funai, que pede para funcionários entrarem em suas terras, havia sido contagiado pelo vírus. “Chegou até nós a notícia que o senhor e outros membros de sua equipe da Funai foram contagiados pela covid-19, mesmo com todos os cuidados que sabemos que o senhor toma. Como o senhor mesmo agora pode ver, essa doença é perigosa e, para gente, ela é muito mais ainda.”
Ao comentarem os prejuízos financeiros mencionados pelo presidente da Funai, os Waimiri afirmaram que Marcelo Xavier teve a preocupação de destacar a necessidade de “garantir o abastecimento do mercado de energia em Roraima, com segurança, eficiência e sustentabilidade”, mas deixou de mencionar “a preocupação com a saúde do nosso povo”. “É como se não existíssemos!”, afirmam os índios.
Na rejeição do pedido, os Waimiri relembram fases catastróficas vividas por seu povo na década de 1970, durante a abertura da BR-174, em Roraima, quando muitos morreram por causa de um surto de sarampo, e afirmam que a decisão de suspender a entrada de pessoal de fora nas áreas foi tomada em 16 de março, baseada em determinação médica. A decisão deverá prosseguir por, pelo menos, mais 60 dias.
Questionada pela reportagem, a Funai declarou, por meio de nota, que “pediu ao povo Waimiri Atroari para dar continuidade ao protocolo de consulta, respeitando todas as medidas de segurança para que não houvesse riscos à comunidade e o processo fosse continuado, tendo em vista o isolamento energético do estado de Roraima, que já perdura por muitos anos”.
A Funai afirmou que “está atendendo a todos os protocolos de consulta sem colocar os indígenas em situação de risco e buscando não interromper o diálogo com a etnia”.
“A fundação esclarece ainda que o empreendedor (Transnorte Energia) se dispôs a qualquer alternativa necessária para proporcionar a logística segura dos tradutores. A intenção é realizar a tradução do Componente Indígena do Plano Básico Ambiental (PBA-CI), para posterior distribuição do documento a todo o povo Waimiri Atroari.”
Por trás da motivação de Marcelo Xavier para retomar os estudos presenciais em plena pandemia está a pressão total do governo sobre esse projeto. Bolsonaro já cobrou a liberação das obras diversas vezes e o ministro de Minas Energia, Bento Albuquerque, declarou em inúmeras ocasiões que a obra iria começar, o que não teve autorização até hoje.
Leiloada em setembro de 2011, a linha de transmissão Manaus-Boa Vista tinha prazo de três anos para ficar pronta, com entrada em operação prevista para janeiro de 2015. O impasse sobre a questão indígena, no entanto, paralisou o empreendimento, que corta a terra demarcada dos Waimiri.
Do total de 721 km do traçado previsto para ser erguido ao lado da BR-174, rodovia que liga as duas capitais, 125 km passam dentro da terra indígena, onde vivem mais de 2,1 mil índios em 56 aldeias.
Os povos indígenas não são contra o projeto, mas exigem que sejam consultados e que tenham seus pedidos atendidos por causa dos impactos ambientais. Na fase atual, eles aguardam a tradução do estudo de impacto ambiental para dar prosseguimento à execução do projeto.
No estudo, a empresa afirmava que tinha identificado 37 impactos da obra nas terras indígenas. Havia ainda outros 27 impactos considerados irreversíveis, com reflexo constante à população indígena. Não houve avanço, porém, para a conclusão do processo. O parecer definitivo do presidente da Funai sobre o licenciamento só ocorrerá depois da consulta às comunidades indígenas.
Contaminações entre indígenas
Dados coletados pela Articulação dos Povos Indígenas do Brasil (Apib) mostram que, até esta quarta-feira, 5, já foram confirmadas 633 mortes de indígenas pela covid-19 em todo o País, além de 22.325 casos de contaminações, com 148 povos afetados. Na maioria dos casos, segundo a Apib, as contaminações ocorreram quando equipes da Secretaria Especial de Saúde Indígena (Sesai), do Ministério da Saúde, acessaram as terras.
“Estamos enfrentando o descaso do Estado, lutando pelo direito de viver enquanto socorremos os contaminados e celebramos o legado daqueles que não sobreviveram ao novo coronavírus”, afirma a instituição.
[RESUMO] Professor de filosofia analisa a sensação de medo da morte e de angústia intensificada nos últimos meses pelo coronavírus, o que nos leva a pensar na finitude da vida e em nossa liberdade no mundo, no significado do que fazemos e queremos, processo no qual a escrita tem papel essencial de dar forma ao que vivemos e anunciar o que está por vir.
“Para mim, em breve, será só escuridão.” Essas foram as palavras que Sérgio Sant’Anna escolheu para terminar seu conto publicado na Folha no dia 26 de abril. O texto recorda um treino de futebol do seu amado Fluminense nos anos 1950 e impressiona pelos detalhes. O golpe de mestre, entretanto, está no narrador: a trave. Quem nos conta o conto é a trave do gol.
Ela já está velha. Confessa que funcionários do clube foram vê-la e deram um veredicto: tem que trocar, pode até dar cupim. “Em breve meu tempo terá passado”, diz.
Sérgio fazia muitos posts no Facebook, o que dava uma sensação de proximidade. Em um deles, semanas antes de morrer, admitia achar aterrorizante essa peste que nos assola e afirmava que só sabia responder a isso escrevendo. Foi o que fez até o fim. Isso é um escritor.
Mesmo quem não é, porém, pode entender a pressa que parecia ter o Sérgio. A consciência de que vamos morrer, a consciência da nossa finitude, pode ter esse efeito. Uma pressa que é desejo de viver. É que, para ele, viver era escrever, e escrever talvez fosse mais até que viver.
O que está em jogo, contudo, é a mesma coisa: o tempo finito que temos, ou melhor, que nós somos. Com a pandemia, é provável que ela, de quem tentamos manter distância, chegue perto de nós: não a morte em si apenas, mas a mortalidade que nos constitui.
O enredo se passa na Idade Média. O filme narra o retorno do cavaleiro da Cruzada da Fé para a terra natal, onde está a peste, o que suscita uma consciência da morte. O cavaleiro engaja-se em um jogo de xadrez com ela, que aparece como um personagem, vestida de preto. Block descobre no fim, e Sydow anos depois, que ninguém vence a morte. Mas ganhou uns dias de vida enquanto jogava com ela.
Para boa parte de nós, a pandemia de Covid-19 infunde um medo da morte. Isso enseja medidas concretas que ajudam a evitá-la: distanciar-se das outras pessoas que podem portar o vírus, lavar as mãos e até os produtos, usar máscaras no rosto.
São medidas objetivas de proteção, que podem ajudar a preservar a vida. O medo nos oferece o que fazer, pois ele possui um objeto definido ao qual se dirige, mesmo que seja algo invisível, como o vírus.
No entanto, além do medo, a pandemia também pode despertar a angústia. Não me refiro só ao quadro clínico patológico da angústia, e sim à disposição que a filosofia, desde Kierkegaard no século 19, distingue do medo precisamente porque não se refere a um objeto específico no interior do mundo, mas à nossa própria presença finita nele.
O que angustia na angústia somos nós mesmos. Por isso, a angústia nos deixa meio perdidos, sem ter o que fazer. Com ela, não se trata mais de evitar a morte, mas de compreender a vida mortal que temos.
Nesse sentido, o medo pode ser vencido sem que mudemos nada em nós, enquanto a angústia, que não pode ser vencida, mas apenas experimentada, exige a reconsideração da liberdade de nossa presença no mundo. Em outras palavras, o medo nos dá o que fazer, e a angústia coloca em jogo o nosso ser.
Talvez, e só talvez, a parada obrigatória que a pandemia forçou para todos possa fazer pensar. Não digo pensar só nos destinos do mundo, do Estado, do capitalismo e da modernidade, como os filósofos têm feito, embora isso tenha o seu interesse.
Refiro-me a pensar, cada um em seu íntimo, o sentido do que fazemos e queremos a partir dessa interrupção do que vínhamos fazendo e querendo. Um amigo querido se perguntou outro dia o valor de tanta filosofia que aprendeu até aqui. Por angustiante que seja, é uma chance de reconsiderar a vida.
O esvaziamento de nossas ocupações diárias anteriores ou a sua exacerbação sem as folgas e respiros de antigamente podem trazer à tona a questão de seu sentido, do que elas valem para nós. Por falta ou excesso, por tédio ou fartura, podemos perder a naturalidade familiar com nós mesmos e nos estranhar, até mesmo ao ponto de pensar o que antes não se pensava.
Pode ser cedo ainda para formular bem que tipo de suspensão é esta, mas ela está aí. Pois a morte não é o oposto da vida, é seu avesso. Ela é que nos faz ver a finitude da existência. Por isso mesmo, também há a possibilidade de fugirmos da angústia, pois ela nos lança cara a cara conosco e com o mundo em que não temos muitos amparos.
Desconfio inclusive que o apelo dos motes de retorno ao trabalho e volta à normalidade —para além de necessidades reais e dos desejos pujantes, já que nos foi subtraído o próprio convívio amoroso com as outras pessoas— tem força não apenas por causa da economia, mas porque carrega a esperança de acabar com a angústia, de tapar o buraco que foi cavado por um reles vírus.
O problema é que não foi o vírus que cavou esse buraco. Ele já estava lá, e sempre está, como sabiam os filósofos existencialistas. As condições da pandemia podem fazer olharmos para ele. É um vazio, mas cuja abertura nos faz livres.
Ou seja, se tudo fosse preenchido, não haveria margem de liberdade. O nada, que mora no coração do ser, permite deixarmos de ser o que éramos e nos tornarmos outros (na sua poesia, Fernando Pessoa falava de um “outrar-se”). Esse nada impede que nos definamos de uma vez por todas: põe aventura na vida.
Evidentemente, essa especulação um tanto metafísica convive com pressões ordinárias e terríveis que são as pessoas morrendo, como o próprio Sérgio: deixando de ser. Mas o resto de nós, muitos reclusos em casa, é afetado também às vezes por essa “clara noite” da angústia.
É como se a abrupta e radical desarrumação do sentido do mundo deixasse um vazio ou um nada que, por não estar ocupado, permite que o sentir e o pensar se refaçam de outra forma, diferentemente de antes. Nada mais é tão certo. O futuro está perigosamente em aberto.
Como se ignora ainda a duração da pandemia no tempo e os estragos dela na sociedade, há um abismo, como diria o teórico Reinhart Koselleck, entre como concebemos nosso espaço de experiência e nosso horizonte de expectativa. Isso é o que causa angústia, essa espécie de soltura incerta do presente.
Quantos de nós têm segurança de que seus empregos, ou até suas profissões, ainda estarão aí em dois anos? Quantos estão convictos de que vão continuar querendo viver do mesmo jeito? Tudo isso pode significar uma fissura no ser.
Continuaremos a ter perdas. Não somente em relação aos que morrem, mas a um certo modo de viver. Teremos que incorporá-las, achar um lugar no qual a dor dispense a sua cura. Elizabeth Bishop, a poeta norte-americana que viveu no Brasil, tem conhecidos versos nos quais tenta, justamente, apresentar “uma arte”, ou seja, um ofício, um saber, sobre o perder. Na ótima tradução de Paulo Henriques Britto, o poema pode nos ensinar alguma coisa.
A arte de perder não é nenhum [mistério; Tantas coisas contêm em si o acidente De perdê-las, que perder [não é nada sério.
Perca um pouquinho a cada dia. [Aceite, austero, A chave perdida, a hora gasta [bestamente. A arte de perder não é [nenhum mistério.
Depois perca mais rápido, com mais [critério: Lugares, nomes, a escala subseqüente Da viagem não feita. [Nada disso é sério.
Perdi o relógio de mamãe. Ah! E nem [quero Lembrar a perda de três casas [excelentes. A arte de perder não é [nenhum mistério.
Perdi duas cidades lindas. E um [império Que era meu, dois rios, e mais um [continente. Tenho saudade deles. Mas [não é nada sério.
—Mesmo perder você (a voz, o riso etéreo que eu amo) não muda nada. [Pois é evidente que a arte de perder não chega a ser [mistério por muito que pareça [(Escreve!) muito sério.
Essa pedagogia pode nos fazer aprender exatamente que, em cada perda, da menor até a maior, insinua-se a morte. E que, portanto, a morte não é apenas aquele “depois da vida” sobre o qual tanto se especula, mas também o elemento interno que dá à vida seu tempo, que faz da vida algo no tempo. Esses versos talvez possam vir a constituir o epílogo do que está por vir. Escreve!
De novo, Sérgio Sant’Anna. Ele queria escrever enquanto houvesse tempo. E penso na quantidade enorme de textos, como este aqui, que desde o começo do ano são escritos sobre a pandemia. Por um lado, é claro, o tema se impõe e convoca compreensão para nos aproximarmos dele.
Por outro, acredito que há uma vontade de escrever sobre ele no sentido do poema da Bishop: um misto de testemunho e aviso, de lembrança e recomendação. Escrevendo, retemos aquilo que está se passando e advertimos sobre o que ainda pode estar por vir.
Desde os primórdios, a escrita teve essa dupla função: guardar e anunciar. Nos dois casos, ela era uma tentativa de vencer o esquecimento, do passado e no futuro. Para não esquecer o que se passou ontem, registramos. Uma salvaguarda. (Na Grécia, Platão condenou a escrita porque, com ela, nos desincumbiríamos de lembrar as coisas por nós mesmos: a memória deixaria de se localizar dentro de nós e ficaria guardada fora.) Já para não esquecermos o que devemos fazer amanhã, anotamos, como quando usamos um post-it.
Escrever deve ser ainda a forma de se tentar confirmar o que vivemos, já que parece inacreditável. Isso: escrever é uma forma de acreditar, de fazer crer. É de fato o que está acontecendo. Como se precisássemos dar forma a um conteúdo que ainda nos escapa, nos desafia, nos estarrece. É um modo de, a cada dia, saber que estamos de fato acordados, não dormindo ou sonhando. Pois essas duas coisas às vezes parecem se misturar confusamente na rotina insólita.
Vimos, no século 21, guerras, atentados e crises financeiras que dificultavam a vida acordada. Assistimos, no cinema, a sonhos com alienígenas, asteroides, zumbis, aquecimentos, congelamentos e até epidemias que acabam com o mundo.
Filmes de Hollywood nos deram diversas versões de causas não humanas para o fim dos humanos. Como afirmou Fredric Jameson, a julgar pela produção do cinema comercial, parece que ficou mais fácil conceber o fim do mundo do que o fim do capitalismo, já que revoluções sociais foram raramente encenadas.
Entre os filmes sobre o fim do mundo, um que se destaca é “Melancolia” (2011), de Lars von Trier. O diretor dinamarquês pôs em cena dois personagens com modos de vida opostos diante da iminente colisão de um planeta com a Terra: uma melancólica, interpretada por Kirsten Dunst, e um pragmático, interpretado por Kiefer Sutherland (o ator que encarnara o agente antiterrorista americano Jack Bauer na série “24 Horas”, um ícone do pragmatismo).
Ela lida melhor com o desastre. Já era versada na arte de perder; ele, somente na de ganhar. O sujeito se prepara, estoca mantimentos e tudo o mais —contudo, quando fica claro que não dá para vencer o jogo de xadrez, suicida-se. Já ela encontra um conforto simbólico: faz uma cabana imaginária na qual se abriga com a irmã e o sobrinho. O mundo acaba.
Trata-se de um raro filme sobre o fim do mundo no qual o mundo de fato acaba. Na maior parte das vezes, um herói ou super-herói salva a pátria, quer dizer, o planeta, ou então um grupo de pessoas consegue escapar e caberá a ele recomeçar a aventura humana na Terra. Filmes sobre o fim do mundo costumam ser filmes sobre o quase fim do mundo. Não o de Lars von Trier. Tudo acaba mesmo.
Como eu não tenho qualquer simpatia por ele e tampouco por essa ideia, embora goste muito do filme, devo dizer que outro dia, lendo um texto bastante triste de um amigo sobre a pandemia, só consegui me ater a uma frase, no meio daquela tristeza: a pandemia vai passar. Ele a tinha escrito como um mero detalhe. Para mim, a frase diz muito, mesmo que a pandemia não passe tão cedo.
Pois, embora a morte seja o nosso destino certo e irrevogável, nossa presença no mundo não ganha o seu sentido por causa disso. O medo da morte pode acordar certa lucidez, mas, como observou o filósofo José Gil, não deve nos dominar na pandemia, pois ele encolhe o espaço, suspende o tempo, paralisa o corpo.
É preciso ter um medo desse medo. Mesmo a angústia, que nos coloca em relação com a finitude, não o faz em nome da morte, e sim da vida e de sua liberdade no tempo breve em que existimos. Como escreveu Hannah Arendt, os seres humanos, “embora devam morrer, não nascem para morrer, mas para começar”.
Sérgio Sant’Anna parecia saber bem das duas coisas. No dia 5 de abril, publicou um post no Facebook em que dizia que Jorge Luis Borges tem um conto no qual o personagem, um escritor à beira da morte, consegue de Deus que o seu tempo final seja elástico o suficiente para terminar um romance. “Queria isso para a minha novelinha e todo o livro a que ela pertence”, disse Sérgio, “e confesso que rezo todo dia”.
É esse o valor da vida que a morte traz. Sérgio morreu começando. Só queria mais tempo para escrever. Foi-se, dando início. Aos 78 anos.
Estágio atual das pesquisas científicas sobre a covid-19 foi tema de exposição no primeiro painel da Mini Reunião Anual Virtual da SBPC
A mortalidade por covid-19 no Estado de São Paulo está concentrada na periferia, tendo como fatores principais as condições precárias de saneamento, habitação e transporte coletivo. Foi o que afirmou ontem o médico patologista Paulo Saldiva, durante o primeiro painel da Mini Reunião Anual Virtual da Sociedade Brasileira para o Progresso da Ciência (SBPC).
Com o tema “A Situação da Pandemia da Covid-19”, coordenado pela bioquímica Selma Bezerra Jeronimo, da Universidade Federal do Rio Grande do Norte (UFRN), o painel teve como expositores, além de Saldiva, o pneumologista Marcelo Amato, da Universidade de São Paulo (USP), a biocientista Daniela Barretto Barbosa Trivella, do Centro Nacional de Pesquisa em Energia e Materiais (CNPEM) e o infectologista Estevão Portela Nunes, da Fundação Oswaldo Cruz (Fiocruz).
Na linha de frente do enfrentamento à covid-19, estes profissionais apresentaram seus estudos e as últimas descobertas sobre a pandemia. Saldiva explicou que o perfil dos mais atingidos pela doença na cidade foi obtido em entrevistas com as famílias de 70 pessoas mortas, da qual foram feitas autópsias para pesquisa sobre o coronavírus.
As vítimas fatais, relatou, estavam cientes da necessidade de isolamento, mas não conseguiram “pagar o preço”, pois, ou não tinham condições de evitar o convívio com outras pessoas por habitarem casas pequenas, ou foram obrigados a frequentar o transporte público já que “têm que trabalhar de manhã para comprar o almoço”.
Ao fazer uma análise histórica, Saldiva frisou que a desigualdade e as condições de saneamento da população sempre estiveram na raiz da disseminação de epidemias no mundo. Ele explicou que os vírus sempre mutaram e se disseminaram devido ao adensamento populacional e aos fluxos migratórios. No entanto, alertou que o fenômeno está se acelerando. “De duas pandemias virais no século passado, passamos a duas por década, isso impõe desafios à ciência que são, primeiro, testagem e verificação de vírus em todos os países”, afirmou o médico.
Saldiva disse que, embora torça para que se encontre uma vacina, não será o suficiente, visto que algumas doenças para as quais já se havia encontrado vacina – como sarampo e poliomielite – voltaram a circular no mundo devido à falta de estrutura de saúde nos países onde elas são endêmicas e que tornaram a vacina ineficaz.
Apontou a influência dos aspectos culturais antivacina e anticiência – “o antavirus (sem ‘h’) da ignorância circula enormemente e é transmitido pelas redes sociais”, ironizou. Ele chamou a atenção para a necessidade de investimentos constantes no sistema de produção de vacinas que, no Brasil, foi em grande parte sucateado. Além da vacina que, para Saldiva, “não pode ser tratada como commodity, mas sim como um bem comum”, tem que haver maior cooperação internacional, financiamento e ocupação dos espaços de saúde que envolve as humanidades. “Não se controla as epidemias sem antropologia, história e urbanismo”, concluiu.
A pesquisadora no Laboratório Nacional de Biociências (LNBio), Daniela Barretto Barbosa Trivella, relatou a evolução dos estudos sobre o vírus que estão sendo desenvolvidos no Sirius, o maior acelerador de elétrons da América Latina, e as estratégias farmacológicas adotadas para combater os sintomas da covid-19. O acelerador, sediado no CNPEM em Campinas (SP) e vinculado ao Ministério da Ciência, Tecnologia e Inovações (MCTI), realizou semana passada os primeiros experimentos em uma nova estação de trabalho chamada Manacá, capaz de revelar detalhes da estrutura de moléculas biológicas, como proteínas virais.
“Uma das coisas importantes quando a gente se coloca frente a uma pandemia como essa é entender o máximo possível do agente causador da doença, como o ciclo de vida ocorre e como podemos, a partir dessa informação, racionalizar e interferir nesse ciclo de vida do vírus”, comentou Trivella.
Segundo ela, os estudos visam encontrar substâncias capazes de bloquear a maturação das proteínas que envolvem o material genético do vírus e que viabilizam sua interação com o corpo humano. “Isso nos dá a visão de raio x do vírus que traz nossa pesquisa para outro patamar”, comentou.
Enquanto as pesquisas tentam desvendar os mecanismos de ataque do coronavírus, a primeira estratégia da comunidade científica, segundo Trivella, tem sido o reposicionamento de fármacos, o que envolve medicamentos já aprovados para outras doenças, com eficácia comprovada em evitar a replicação dos vírus em células. Atualmente, de acordo com a pesquisadora, há dez substâncias em estudo no mundo, entre elas a cloroquina e a hidroxicloroquina. “A hidroxicloroquina foi retirado da iniciativa porque não vem mostrando bons resultados”, afirmou.
O médico pneumologista Marcelo Brito, do HC/USP, explicou como um dos equipamentos mais importantes no combate à covid-19 e às demais síndromes respiratórias agudas graves (SRAG), os ventiladores, podem causar lesões posteriores. “Os pacientes sobreviventes da covid, que precisaram do auxílio de ventiladores, têm fibrose pulmonar muito extensa, seis meses depois”, relatou.
Para Brito, a pandemia trouxe desafios enormes, tanto para quem está fora, quanto para quem está dentro do ventilador porque a força que o paciente faz para respirar não é visível e pode causar lesões.
No entanto, afirmou, não é possível generalizar as respostas, elas têm que ser individualizadas de acordo com as condições do paciente. “Percebemos que quando a gente vai mapear os doentes, existe uma variabilidade individual tremenda”. Ele defendeu que se apliquem terapias adequadas às condições de cada pessoa, porque cada um tem uma fisiologia própria que deve ser respeitada, “mais ainda na covid-19, que é uma doença inflamatória na qual o erro do ventilador se soma à doença.”
Ao analisar os testes existentes para detecção da doença, o infectologista Estevão Portela Nunes, da Fiocruz, disse que os mais utilizados, os PCR, têm mais eficácia nos primeiros dias da doença. “A partir do sétimo, oitavo dia, a gente tem dificuldade de ter o diagnóstico pelo PCR e vamos precisar de outras ferramentas para identificar os pacientes”.
Ele criticou a grande quantidade de testes sorológicos aprovados pela Anvisa hoje disponíveis no varejo e que, na visão dele, não trazem resultados confiáveis. “Fomos invadidos por diversos métodos, todos com sensibilidade não tão boa e que vai caindo com o tempo”, afirmou.
Museums are working overtime to collect artifacts and ephemera from the pandemic and the racial justice movement — and they need your help.
July 14, 2020, 5:00 a.m. ET
A few weeks ago, a nerdy joke went viral on Twitter: Future historians will be asked which quarter of 2020 they specialize in.
As museum curators and archivists stare down one of the most daunting challenges of their careers — telling the story of the pandemic; followed by severe economic collapse and a nationwide social justice movement — they are imploring individuals across the country to preserve personal materials for posterity, and for possible inclusion in museum archives. It’s an all-hands-on-deck effort, they say.
“Our cultural seismology is being revealed,” said Anthea M. Hartig, the director of the Smithsonian’s National Museum of American History of the events. Of these three earth-shaking events, she said, “The confluence is unlike mostanything we’ve seen.”
Museums, she said, are grappling “with the need to comprehend multiple pandemics at once.”
We Are All Field Collectors
Last August, Dr. Erik Blutinger joined the staff of Mt. Sinai Queens as an emergency medicine physician. He knew that his first year after residency would be intense, but nothing could have prepared him for the trial-by-fire that was Covid-19.
Aware that he was at the epicenter not only of a global pandemic, but of history, Dr. Blutinger, 34, began to take iPhone videos of the scenes in his hospital, which was one of New York City’s hardest hit during the early days of the crisis.
“Everyone is Covid positive in these hallways,” he told the camera in one April 9 recording which has since been posted on the Mount Sinai YouTube channel, showing the emergency room hallways filled with hissing oxygen tanks, and the surge tents set up outside the building. “All you hear is oxygen. I’m seeing young patients, old patients, people of all age ranges, who are just incredibly sick.”
He estimated that he has recorded over 50 video diaries in total.
In Louisville, Ky., during the protests and unrest that followed the killings of George Floyd and Breonna Taylor, a Louisville resident, filmmaker named Milas Norris rushed to the streets to shoot footage using a Sony camera and a drone.
“It was pretty chaotic,” said Mr. Norris, 24, describing police in riot gear, explosions, and gas and pepper bullets. He said thatat first he didn’t know what he would do with the footage; he has since edited and posted some of it on his Instagram and Facebook accounts. “I just knew that I had to document and see what exactly was happening on the front lines.”
About 2,000 miles west, in Los Angeles, NPR producer Nina Gregory, 45, had set up recording equipment on the front patio of her Hollywood home. In March and April, she recorded the absence of city noise. “The sound of birds was so loud it was pinging red on my levels,” she said.
Soon the sounds of nature were replaced by the sounds of helicopters from the Los Angeles Police Department hovering overhead, and the sounds of protesters and police convoys moving through her neighborhood. She recorded all this for her personal records.
“It’s another form of diary,” she said.
Museums have indicated that these kinds of private recordings have critical value as public historical materials. All of us, curators say, are field collectors now.
‘A National Reckoning’
In the spirit of preservation, Ms. Hartig from the National Museum of American History — along with museum collectors across the country — have begun avid campaigns to “collect the moment.”
“I do think it’s a national reckoning project,” she said. There are “a multitude of ways in which we need to document and understand — and make history a service. This is one of our highest callings.”
Some museums have assembled rapid response field collecting teams to identify and secure storytelling objects and materials. Perhaps the mostwidely-publicizedtask force, assembled by three Smithsonian museums working in a coalition, dispatched curators to Lafayette Square in Washington, D.C., to identify protest signs for eventual possible collection.
The collecting task force went into action after June 1, when President Trump ordered Lafayette Square cleared of protesters so he could pose for photos in front of St. John’s Episcopal Church, clutching a bible. Shield-bearing officers and mounted police assailed peaceful protesters there with smoke canisters, pepper bullets, flash grenades and chemical spray. The White House subsequently ordered the construction of an 8-foot-high chain link fence around the perimeter, which protesters covered in art and artifacts.
Taking immediate moves to preserve these materials — much of which was made of paper and was vulnerable to the elements — amounted to a curatorial emergency for the Smithsonian’s archivists.
Yet with many museums still closed, or in the earliest stages of reopening, curatorial teams largely cannot yet bring most objects into their facilities. It isfalling to individuals to become their own interim museums and archives.
The Ordinary is Extraordinary (Even Your Shopping Lists)
While some curators are loath to suggest a laundry list of items that we should be saving — they say that they don’t want to manipulate the documentation of history, but take their cues from the communities they document — many are imploring us to see historical value in the everyday objects of right now.
“Whatever we’re taking to be ordinary within this abnormal moment can, in fact, serve as an extraordinary artifact to our children’s children,” said Tyree Boyd-Pates, an associate curator at the Autry Museum of the American West, which is asking the public to consider submitting materials such as journal entries, selfies and even sign-of-the times social media posts (say, a tweet about someone’s quest for toilet paper — screengrab those, he said)
To this end, curators said, don’t be so quick to edit and delete your cellphone photos right now. “Snapshots are valuable,” said Kevin Young, the director of New York City’s Schomburg Center for Research in Black Culture. “We might look back at one and say, ‘This picture tells more than we thought at the time.’”
At the National Civil Rights Museum in Memphis, the curatorial team will be evaluating and collecting protest materials such as placards, photos, videos and personalized masks — and the personal stories behind them.
“One activist found a tear-gas canister, and he gave it to us,” said Noelle Trent, a director at the museum. “We’re going to have to figure out how to collect items from the opposing side: We have to have theracist posters, the ‘Make America Great’ stuff. We’re going to need that at some point. The danger is that if we don’t have somebody preserving it, they will say this situation was notas bad.”
And there is perhaps no article more representative of this year than the mask, which has “become a really powerful visual symbol,” said Margaret K. Hofer, the vice president and museum director of the New-York Historical Society, which has identified around 25 masks that the museum will collect, including an N95 mask worn by a nurse in the Samaritan’s Purse emergency field hospital set up in New York’s Central Park in the spring. (The museum also collected a set of field hospital scrubs, and a cowbell that the medical team rang whenever they discharged a patient.)
“The meaning of masks has shifted over the course of these past several months,” Ms. Hofer said. “Early on, the ones we were collecting were being sewn by people who were trying to aid medical workers, when there were all those fears about shortage of P.P.E. — last resort masks.And they’ve more recentlybecome a political statement.”
Document the Back Stories Too
Curators say that recording the personal stories behind photos, videos and objects are just as crucial as the objects themselves — and the more personal, the better. Museums rely on objects to elicit an emotional reaction from visitors, and that sort of personal connection requires knowing the object’s back story.
“For us, really the artifact is just a metaphor, and behind that artifact are these voices, and this humanity,” said Aaron Bryant, who curates photography and visual culture at the Smithsonian’s National Museum of African American History and Culture, and who isleading the Smithsonian’s ongoing collection response in Lafayette Square.
Curatorial teams from many museums are offering to interview donors about their materials and experiences,and encourage donors to include detailed descriptions and back stories when submitting objects and records for consideration. Many are also collecting oral histories of the moment.
How to Donate to a Museum
Many museums have put out calls for submissions on social media and are directing would-be donors to submission forms to their websites. The National Museum of African American History and Culture site has a thorough form that covers items’ significance, dimensions, condition and materials. The Civil Rights Museum is looking for “archival materials, books, photographs, clothing/textiles, audio visual materials, fine art and historic objects” that share civil rights history. The New-York Historical Society is seeking Black Lives Matter protest materials.
“We review material, we talk about it, and we respond to everyone,” said William S. Pretzer, a senior curator of history at the National Museum of African American History and Culture. “We can’t collect everything, but we’re not limiting ourselves to anything.”
Gathering materials from some communities is proving challenging, and curators are strategizing collection from individuals who may be unlikely to offer materials to historical institutions.
“A lot of our critical collecting and gathering of diverse stories we’ve been able to do because of directed outreach,” said Ms. Hofer of the New-York Historical Society. “We’re trying to capture the experience of all aspects of all populations in the city, including people experiencing homelessness and the incarcerated.”
“We want to make the barrier to entry on this very low,” said Nancy Yao Maasbach, the president of New York’s Museum of Chinese in America, which began collecting materials relating to pandemic-related racist attacks on Asians and Asian-Americans in late winter, and personal testimonies about experiences during the pandemic and protests. Because museums may not necessarily be obvious repositories for many immigrant communities, Ms. Maasbach said, the museum is making translators available to those who want to tell their stories.
“We’re trying to make sure we’re being accessible in creating this record,” Ms. Maasbach said.
Curators recognize that their story-of-2020 collecting will continue for years; we are in the midst of ongoing events. They are asking us to continue to document the subsequent chapters — and to be as posterity-minded as one can be when it comes to ephemera.
“We don’t know what the puzzle looks like yet,” said Ms. Hartig of the National Museum of American History. “Yet we know that each of these pieces might be an important one.”
Some museums are exhibiting submitted and accepted items right away on websites or on social media; others are planning virtual and physical exhibits for as early as this autumn. The Eiteljorg Museum of American Indians and Western Art, for example, is collecting masks and oral history testimonies from Native American communities and is considering the creation of a “rapid response gallery,” said the museum’s vice president and chief curator Elisa G. Phelps.
“If art is being sparked by something very timely, we want to have a place where we can showcase works and photos,” she said, adding that this process differed from “the elaborate, formal exhibit development process.”
Some donors, however, may not be among those to view their materials once they become part of institutionalized history — at least not right away. Even though Dr. Blutinger said that he sees the historical value of his emergency room video diaries,he has yet to revisit the peak-crisis videos himself.
“I’m almost scared to look back at them,” he said. “I’m worried that they’ll reignite a set of emotions that I’ve managed to tuck away. I’m sure one day I’ll look back and perhaps open up one or two clips, but I have never watched any of them all the way through.”
On May 20, disease modelers at Columbia University posted a preprint that concluded the US could have prevented 36,000 of the 65,300 deaths that the country had suffered as a result of COVID-19 by May 3 if states had instituted social distancing measures a week earlier. In early June, Imperial College London epidemiologist Neil Ferguson, one of the UK government’s key advisers in the early stages of the pandemic, came to a similar conclusion about the UK. In evidence he presented to a parliamentary committee inquiry, Ferguson said that if the country had introduced restrictions on movement and socializing a week sooner than it did, Britain’s official death toll of 40,000 could have been halved.
On a more positive note, Ferguson and other researchers at Imperial College London published a model in Nature around the same time estimating that more than 3 million deaths had been avoided in the UK as a result of the policies that were put in place.
These and other studies from recent months aim to understand how well various social-distancing measures have curbed infections, and by extension saved lives. It’s a big challenge to unravel and reliably understand all the factors at play, but experts say the research could help inform future policies.
The most effective measure, one study found, was getting people not to travel to work, while school closures had relatively little effect.
“It’s not just about looking retrospectively,” Jeffrey Shaman, a data scientist at Columbia University and coauthor of the preprint on US deaths, tells The Scientist. “All the places that have managed to get it under control to a certain extent are still at risk of having a rebound and a flare up. And if they don’t respond to it because they can’t motivate the political and public will to actually reinstitute control measures, then we’re going to repeat the same mistakes.”
Diving into the data
Shaman and his team used a computer model and data on how people moved around to work out how reduced contact between people could explain disease trends after the US introduced social distancing measures in mid-March. Then, the researchers looked at what would have happened if the same measures had been introduced a week earlier, and found that more than half of total infections and deaths up to May 3 would have been prevented. Starting the measures on March 1 would have prevented 83 percent of the nation’s deaths during that period, according to the model. Shaman says he is waiting to submit for publication in a peer-reviewed journal until he and his colleagues update the study with more-recent data.
“I thought they had reasonably credible data in terms of trying to argue that the lockdowns had prevented infections,” says Daniel Sutter, an economist at Troy University. “They were training or calibrating that model using some cell phone data and foot traffic data and correlating that with lockdowns.”
Sébastien Annan-Phan, an economist at the University of California, Berkeley, undertook a similar analysis, looking at the growth rate of case numbers before and after various lockdown measures were introduced in China, South Korea, Italy, Iran, France, and the US. Because these countries instituted different combinations of social distancing measures, the team was able to estimate how well each action slowed disease spread. The most effective measure, they found, was getting people not to travel to work, while school closures had relatively little effect. “Every country is different and they implement different policies, but we can still tease out a couple of things,” says Annan-Phan.
In total, his group estimated that combined interventions prevented or delayed about 62 million confirmed cases in the six countries studied, or about 530 million total infections. The results were published in Naturein June alongside a study from a group at Imperial College London, which had compared COVID-19 cases reported in several European countries under lockdown with the worst-case scenario predicted for each of those countries by a computer model in which no such measures were taken. According to that analysis, which assumed that the effects of social distancing measures were the same from country to country, some 3.1 million deaths had been avoided.
It’s hard to argue against the broad conclusion that changing people’s behavior was beneficial, says Andrew Gelman, a statistician at Columbia University. “If people hadn’t changed their behavior, then it would have been disastrous.”
Lockdown policies versus personal decisions to isolate
Like all hypothetical scenarios, it’s impossible to know how events would have played out if different decisions were made. And attributing changes in people’s behavior to official lockdown policies during the pandemic is especially difficult, says Gelman. “Ultimately, we can’t say what would have happened without it, because the timing of lockdown measures correlates with when people would have gone into self-isolation anyway.” Indeed, according to a recent study of mobile phone data in the US, many people started to venture out less a good one to four weeks before they were officially asked to.
A report on data from Sweden, a country that did not introduce the same strict restrictions as others in Europe, seems to support that idea. It found that, compared with data from other countries, Sweden’s outcomes were no worse. “A lockdown would not have helped in terms of limiting COVID-19 infections or deaths in Sweden,” the study originally concluded. But Gernot Müller, an economist at the University of Tubingen who worked on that report, now says updated data show that original conclusion was flawed. Many Swedes took voluntary actions in the first few weeks, he says, and this masked the benefits that a lockdown would have had. But after the first month, the death rate started to rise. “It turns out that we do now see a lockdown effect,” Müller says of his group’s new, still unpublished analyses. “So lockdowns do work and we can attach a number to that: some 40 percent or 50 percent fewer deaths.”
Some critics question the assumption that such deaths have been prevented, rather than simply delayed. While it can appear to be a semantic point, the distinction between preventing and delaying infection is an important one when policymakers assess the costs and benefits of lockdown measures, Sutter says. “I think it’s a little misleading to keep saying these lockdowns have prevented death. They’ve just prevented cases from occurring so far,” he says. “There’s still the underlying vulnerability out there. People are still susceptible to get the virus and get sick at a later date.”
Shaman notes, however, that it’s really a race against the clock. It’s about “buying yourself and your population critical time to not be infected while we try to get our act together to produce an effective vaccine or therapeutic.”
Data from those tested at a storefront medical office in Queens is leading to a deeper understanding of the outbreak’s scope in New York.
July 9, 2020; Updated 7:37 a.m. ET
At a clinic in Corona, a working-class neighborhood in Queens, more than 68 percent of people tested positive for antibodies to the new coronavirus. At another clinic in Jackson Heights, Queens, that number was 56 percent. But at a clinic in Cobble Hill, a mostly white and wealthy neighborhood in Brooklyn, only 13 percent of people tested positive for antibodies.
As it has swept through New York, the coronavirus has exposed stark inequalities in nearly every aspect of city life, from who has been most affected to how the health care system cared for those patients. Many lower-income neighborhoods, where Black and Latino residents make up a large part of the population, were hard hit, while many wealthy neighborhoods suffered much less.
But now, as the city braces for a possible second wave of the virus, some of those vulnerabilities may flip, with the affluent neighborhoods becoming most at risk of a surge. According to antibody test results from CityMD that were shared with The New York Times, some neighborhoods were so exposed to the virus during the peak of the epidemic in March and April that they might have some protection during a second wave.
“Some communities might have herd immunity,” said Dr. Daniel Frogel, a senior vice president for operations at CityMD, which plays a key role in the city’s testing program.
The CityMD statistics — which Dr. Frogel provided during an interview and which reflect tests done between late April and late June — appear to present the starkest picture yet of how infection rates have diverged across neighborhoods in the city.
As of June 26, CityMD had administered about 314,000 antibody tests in New York City. Citywide, 26 percent of the tests came back positive.
But Dr. Frogel said the testing results in Jackson Heights and Corona seemed to “jump off the map.”
While stopping short of predicting that those neighborhoods would be protected against a major new outbreak of the virus — a phenomenon known as herd immunity — several epidemiologists said that the different levels of antibody prevalence across the city are likely to play a role in what happens next, assuming that antibodies do in fact offer significant protection against future infection.
“In the future, the infection rate should really be lower in minority communities,” said Kitaw Demissie, an epidemiologist and the dean of the School of Public Health at SUNY Downstate Medical Center in Brooklyn.
Dr. Ted Long, the executive director of the city’s contact-tracing program, said that while much remained unknown about the strength and duration of the protection that antibodies offer, he was hopeful that hard-hit communities like Corona would have some degree of protection because of their high rate of positive tests. “We hope that that will confer greater herd immunity,” he said.
Neighborhoods that had relatively low infection rates — and where few residents have antibodies — are especially vulnerable going forward. There could be some degree of “catch up” among neighborhoods, said Prof. Denis Nash, an epidemiology professor at the CUNY School of Public Health.
But he added that even if infection rate were to climb in wealthier neighborhoods, “there are advantages to being in the neighborhoods that are hit later.” For one, doctors have become somewhat more adept at treating severe cases.
Some epidemiologists and virologists cautioned that not enough data exists to conclude that any areas have herd immunity. For starters, the fact that 68.4 percent of tests taken at an urgent care center in Corona came back positive does not mean that 68.4 percent of residents had been infected.
“For sure, the persons who are seeking antibody testing probably have a higher likelihood of being positive than the general population,” said Professor Nash. “If you went out in Corona and tested a representative sample, it wouldn’t be 68 percent.”
So far, the federal government has released relatively little data from antibody testing — making the CityMD data all the more striking. The Centers for Disease Control and Prevention, for instance, has published limited data that suggested that 6.93 percent of residents in New York City and part of Long Island had antibodies. But that survey was based on samples collected mainly in March, before many infected New Yorkers might have developed antibodies.
New York State conducted a more comprehensive survey on antibody rates, which involved testing some 28,419 people across the state. That survey suggested that roughly 21.6 percent of New York City residents had antibodies. But it also revealed a much higher rate in some neighborhoods. While the state has released little data from Queens, its numbers showed that in Flatbush, Brooklyn, for example, about 45 percent of those tested had antibodies.
The CityMD data provides similar conclusions. At a location in Bushwick, a Brooklyn neighborhood which has a large Hispanic population and where the median household income is below the citywide average, some 35 percent of antibody tests were positive, according to Dr. Frogel.
Dr. Frogel said that across the Bronx, which has had the city’s highest death rate from Covid-19, about 37 percent of antibody tests were turning up positive.
The CityMD in Corona, on Junction Boulevard, serves a predominantly Hispanic neighborhood whose residents include many construction workers and restaurant employees. Many had to work throughout the pandemic, raising their risk of infection.
Angela Rasmussen, a virologist at Columbia University, called the high positive rate in Corona “a stunning finding.” Epidemiologists said the rate showed the limits of New York’s strategy in curtailing the virus: While public health measures may have slowed the spread in some neighborhoods, they did far less for others.
For residents of Corona, the main sources of employment are jobs in hospitality, including restaurants, as well as construction and manufacturing, according to a 2019 report by the Citizens’ Committee for Children of New York. Many construction workers and restaurant employees showed up to work throughout the pandemic, elevating their risk of infection.
“Our plan did not really accommodate essential workers as it did people privileged enough — for lack of a better word — to socially distance themselves,” Professor Nash said. He said that one lesson of the past few months was that the city needed to better protect essential workers — everyone from grocery store employees to pharmacy cashiers — and make sure they had sufficient protective equipment.
Epidemiologists have estimated that at least 60 percent of a population — and perhaps as much as 80 percent — would need immunity before “herd immunity” is reached, and the virus can no longer spread widely in that community.
But scientists say it would be a mistake to base public health decisions off antibody rates across a population.
“Just looking at seroprevalence alone can’t really be used to make actionable public health decisions,” Dr. Rasmussen, the virologist at Columbia, said.
One reason is that the accuracy of the antibody tests is not fully known, nor is the extent of immunity conferred by antibodies or how long that immunity lasts. Dr. Rasmussen noted that the “magical number of 60 percent for herd immunity” assumes that everyone infected has complete protection from a second infection. “But what about people with partial protection?” she asked. “They may not get sick, but they can get infected and pass it along.”
“It is premature to discuss herd immunity, since we are still learning what the presence of Covid-19 antibodies means to an individual and whether, or for how long, that conveys immunity; and we don’t know how the level of immunity in a single community translates into herd immunity,” said Jonah Bruno, a spokesman for the state Department of Health.
He said he was unsurprised by the high rate in Corona, and senior officials with the city’s contact-tracing program and public hospital system agree. “We know this area was disproportionately affected,” said Dr. Andrew Wallach, a senior official in the city’s public hospital system, “so this just confirms what we’ve seen clinically.”
Joseph Goldstein covers health care in New York, following years of criminal justice and police reporting for the Metro desk. He also spent a year in The Times’ Kabul bureau, reporting on Afghanistan. @JoeKGoldstein
Though severe deprivation is rising, not everyone is worse off.
Jul 6th 2020
NO ONE WELCOMES a recession, but downturns are especially difficult when you are poor. Rising unemployment means rising poverty: the recession of 2007-09 prompted the share of Americans classified as poor, on a widely used measure, to jump from 12% to 17%, as jobs vanished by the million and businesses went bust. That economic shock, as bad as it was, pales in comparison with what America is seeing today under the coronavirus pandemic. The jobs report for June, published on July 2nd, showed that unemployment remained well above the peak of a decade ago.
Severe deprivation is certainly on the rise. According to a new survey from the Census Bureau, since the pandemic began the share of Americans who “sometimes” or “often” do not have enough to eat has grown by two percentage points, representing some 4m households. An astonishing 20% of African-American households with children are now in this position. Meanwhile, the proportion of Americans saying that they are able to make the rent is falling. More people are typing “bankrupt” into Google.
Yet these trends, as shocking as they are, do not appear to be part of a generalised rise in poverty. The official data will not be available for some time. A new paper from economists at the University of Chicago and the University of Notre Dame, however, suggests that poverty, as measured on an annual basis, may have actually fallen a bit in April and May, continuing a trend seen in the months before the pandemic hit (see chart 1).
Why? The main reason is that fiscal policy is helping to push poverty down. The stimulus plan passed by Congress is twice the size of the one passed to fight the recession of a decade ago. Much of it, including cheques worth up to $1,200 for a single person and a $600-a-week increase in unemployment insurance (UI) for those out of work, is focused on helping households through the lockdowns. At the same time, unemployment now looks unlikely to rise to 25% or higher, as some economists had predicted in the early days of the pandemic, thereby exerting less upward pressure on poverty than had been feared.
The upshot is that the current downturn looks different from previous ones. Household income usually falls during a recession—as it did the last time, pushing up poverty. But a paper in mid-June from Goldman Sachs, a bank, suggests that this year nominal household disposable income will actually increase by about 4%, pretty much in line with its growth rate before the pandemic hit (see chart 2). The extra $600 in UI ensures, in theory, that three-quarters of job losers will earn more on benefits than they had done in work.
By international standards, America’s unexpected success at reducing poverty nonetheless remains modest. Practically every other rich country has a lower poverty rate. It is also a fragile accomplishment. The extra $600-a-week payments are supposed to expire at the end of July. The authors of a recent paper from Columbia University argue that poverty could rise sharply in the second half of the year, a valid concern if unemployment has not decisively fallen by then. Goldman’s paper assumes that Congress will extend the extra unemployment insurance, but for the value of the payment to drop to $300. Even then, household disposable income would probably fall next year.
Whether extra stimulus would help those at the very bottom of America’s socio-economic ladder—including people not able to buy sufficient food—is another question. Six per cent of adults do not have a current (checking), savings or money-market account, making it difficult for them to receive money from Uncle Sam. Some may have been caught up in the delays which have plagued the UI system, and a small number may be undocumented immigrants not entitled to fiscal help at all. Others report not being able to gain access to shops, presumably closed under lockdowns. A surefire way to improve the lot of people in such unfortunate positions is to get the virus under control and the economy firing on all cylinders once again. But, for now, that looks some way off.
Depoimento concedido a Christina Queiroz. 5 de julho de 2020
“A chegada da Covid-19 causou um impacto muito forte em todos os meus colegas na Universidade Federal do Amazonas [Ufam]. Com minha esposa, estou fazendo um isolamento rigoroso em Manaus, porque tenho quase 60 anos, tomo remédios para controlar pressão e diabetes. Vivemos semanas muito tristes, marcadas por muita dor e sofrimento. Como indígena, sigo perdendo amigos, familiares e lideranças de longa data. Fomos pegos de surpresa. Não acreditávamos na possibilidade de uma tragédia humanitária como essa. Faço parte de uma geração de indígenas que tem fé no poder da ciência, da tecnologia e acredita nos avanços proporcionados pela modernidade. No nosso pensamento, o vírus representa um elemento a mais da natureza. E, por causa da nossa fé no poder da ciência e da medicina científica, não esperávamos uma submissão tão grande da humanidade a um elemento tão pequeno e invisível. Assim, a primeira consequência da chegada da pandemia foi pedagógica e causou reflexões sobre nossa compreensão do mundo e de nós mesmos.
Como pesquisadores acadêmicos, também precisamos ter a humildade de assumir que nos deparamos com os limites da técnica e da ciência. Ter humildade não significa se apequenar, mas, sim, buscar complementar os conhecimentos acadêmicos com outros saberes, para além da ciência eurocêntrica, e isso inclui as ciências indígenas. Ficou evidente o quanto é perigosa a trajetória que a humanidade está tomando, um caminho à deriva, sem lideranças, sem horizonte claro à possibilidade da própria existência humana. Somos uma sociedade que caminha para sua autodestruição. A natureza mostrou sua força, evidenciou que a palavra final é dela, e não dos humanos.
Com o passar das semanas, essa ideia foi sendo incorporada em nossa maneira de compreender, explicar, aceitar e conviver com a nova realidade. Os povos indígenas apresentam cosmovisões milenares, mas que são atualizadas de tempos em tempos, como tem acontecido na situação atual. Passamos a olhar para a nova situação como uma oportunidade para empreender uma revisão cosmológica, filosófica, ontológica e epistemológica da nossa existência e buscar formas pedagógicas para sofrer menos. Nós, indígenas, somos profundamente emotivos. Amamos a vida e nossa existência não é pautada pela materialidade. O momento atual representa uma situação única de formação, pois afeta nossas emoções e valores. Ficamos surpresos com o pouco amor à vida das elites econômicas e de parte dos governantes, mas também de uma parcela significativa da população. A pandemia revelou essas deficiências.
Por outro lado, um dos elementos que emergiu desse processo é uma profunda solidariedade, que tem permitido aos povos indígenas sobreviver no contexto atual. Identificamos fragilidades e limites. Também potencializamos nossas fortalezas. Uma delas, a valorização do conhecimento tradicional, considerado elemento do passado. Redescobrimos o valor do Sistema Único de Saúde [SUS], com toda a fragilidade que foi imposta a ele por diferentes governos. O SUS tem sido um gigante em um momento muito difícil para toda a sociedade.
Coordeno o curso de formação de professores indígenas da Faculdade de Educação da Ufam e me envolvo diariamente em discussões como essas com os alunos. São mais de 300 estudantes que fazem parte desse programa, divididos em cinco turmas. Recentemente, um deles morreu por conta de complicações causadas pelo novo coronavírus. No Amazonas, há mais de 2 mil professores indígenas atuando nas escolas das aldeias. Tenho muito trabalho com atividades burocráticas, para atualizar o registro acadêmico dos alunos e analisar suas pendências. Estamos planejando como fazer a retomada das atividades presenciais de ensino, mas essa retomada só deve acontecer em 2021. Enquanto isso, seminários on-line permitem dar continuidade ao processo de ensino-aprendizagem e ajudam a fomentar a volta de um espírito de solidariedade entre os estudantes indígenas, a valorização da natureza e a recuperação de saberes tradicionais sobre plantas e ervas medicinais. Em condições normais, a possibilidade de participar de tantos seminários e discussões não seria possível. Essas reflexões realizadas durante os encontros virtuais vão se transformar em material didático e textos publicados. Escrever esses textos me ajuda na compreensão da realidade e permite que esse saber seja compartilhado.
Estamos realizando uma pesquisa para identificar quantos alunos do programa dispõem de equipamentos e acesso à internet. Muitos estão isolados em suas aldeias, alguns deles se refugiaram em lugares ainda mais remotos e só acessam a internet em situações raras e pontuais, quando precisam ir até as cidades. Em Manaus, constatamos que apenas 30% dos estudantes da Faculdade de Educação da Ufam dispõem de equipamento pessoal para utilizar a internet. No interior, entre os alunos dos territórios, esse percentual deve ser de menos de 10%. Devemos ter os resultados desse levantamento nas próximas semanas. Sou professor há 30 anos e trabalho com organizações e lideranças indígenas e vejo como esse fator dificulta o planejamento de qualquer atividade remota. Quando tivermos os resultados dessa pesquisa, a ideia é ter uma base de dados para que o movimento indígena se organize para solucionar o problema. Essa situação de ensino remoto pode se prolongar e precisamos estar preparados para não prejudicar os direitos dos alunos e vencer a batalha da inclusão digital.
Há 50 dias, vivíamos o pico da pandemia em Manaus. Estávamos apavorados, com 140 mortes diárias e as pessoas sendo enterradas em valas coletivas. Essa semana foi a primeira que sentimos um alívio. Hoje, 25 de junho, foi o primeiro dia em que nenhuma morte por coronavírus foi registrada na cidade. O medo agora é que pessoas desinformadas, ou menos sensíveis à vida, com o relaxamento das regras de isolamento, provoquem uma segunda onda de contaminação. Percebemos que as pessoas abandonaram as práticas de isolamento e muitas nem sequer utilizam máscaras. Mas começamos a sair do fundo do poço, inclusive o existencial. As estruturas montadas para o caos, como os hospitais de campanha, estão sendo desmontadas.
Tivemos perdas de lideranças e pajés indígenas irreparáveis e insubstituíveis. Com a morte desses sábios, universos de sabedoria milenar desapareceram. Os pajés são responsáveis por produzir e manter o conhecimento tradicional, que só é repassado para alguns poucos herdeiros escolhidos, que precisam ser formados em um processo ritualístico longo e repleto de sacrifícios. As gerações mais jovens apresentam dificuldades para seguir esses protocolos e, por causa disso, o conhecimento tradicional tem enfrentado dificuldades em ser repassado. Eu e meus colegas da Ufam e dos movimentos indígenas estamos incentivando a nova geração a criar estratégias para absorver essa sabedoria, porque muitos sábios seguirão vivos. Escolas e universidades também podem colaborar com o processo, reconhecendo a importância desses saberes. Com os jovens, estamos insistindo que chegou a hora de garantir a continuidade dos saberes tradicionais.
Com a melhoria da situação em Manaus, minha preocupação agora se voltou para o interior, onde foram notificadas 24 mortes nas últimas 24 horas. A população do interior representa menos de 50% da do Amazonas, estado onde as principais vítimas têm sido indígenas, do mesmo modo que acontece em Roraima. Toda minha família vive em São Gabriel da Cachoeira, incluindo minha mãe de 87 anos. A cidade já registrou mais de 3 mil casos e 45 mortes e ainda não atingiu o pico da pandemia. Há cerca de 800 comunidades no entorno do município e sabemos que o vírus já se espalhou por quase todas elas.
Porém há algo que nos alivia. Inicialmente ficamos apavorados, pensando que o vírus causaria um genocídio na população da cidade e seus entornos. O único hospital de São Gabriel não possui leitos de UTI [Unidade de Terapia Intensiva]. Passados 45 dias da notificação do primeiro caso na cidade, apesar das perdas significativas, vemos que as pessoas têm conseguido sobreviver à doença se cuidando em suas próprias casas, com medicina tradicional e fortalecendo laços de solidariedade. Minha mãe ficou doente, apresentou os sintomas da Covid-19. Também meus irmãos e uma sobrinha de minha mãe de 67 anos. Eles não foram testados. Decidiram permanecer em suas casas e cuidar uns dos outros, se valendo de ervas e cascas de árvores da medicina tradicional. Sobreviveram. Sabiam que ir para o hospital lotado naquele momento significaria morrer, pois a estrutura é precária e eles ficariam sozinhos. Ao optar por permanecer em casa, possivelmente transmitiram a doença um ao outro, mas a solidariedade fez a diferença. Um cuidou do outro. Culturalmente, a ideia de isolar o doente é algo impossível para os indígenas, pois seria interpretado como abandono, falta de solidariedade e desumanidade, o que é reprovável. Os laços de solidariedade vão além do medo de se contaminar.”
Todos os anos, os povos do chamado Alto do Xingu, no Parque Nacional do Xingu, passam seis meses se preparando para a festa mais importante do ano, o Kuarup. A celebração que normalmente se estende de julho a setembro é o ritual sagrado no qual todos os mortos do último ano são homenageados. É a maneira que os índios das 11 etnias do Alto Xingu têm de celebrá-los. Com o Kuarup, as famílias que passaram os últimos 12 meses em luto, podem voltar à rotina normal.
Numa decisão histórica ocorrida no início desta semana, em conversas via rádio amador, os caciques das etnias participantes do Kuarup decidiram cancelar o ritual pela primeira vez. Aquilo que já era temido se confirmou: o coronavírus chegou ao Parque do Xingu, reserva indígena no norte do Mato Grosso, com mais de 7.000 habitantes de 16 etnias.
No último fim de semana, o cacique Vanité Kalapalo e seu Yarurú, da aldeia Sapezal, foram internados no Hospital Regional de Água Boa (MT), a 736 Km de Cuiabá, com sintomas agudos da Covid-19.
Outras pessoas da aldeia Sapezal, uma das mais próximas da cidade de Querência (MT), também fizeram testes com suspeita da doença.
O povo Kalapalo foi isolado, mas segundo especialistas e lideranças de outros povos, a previsão é que o coronavírus se espalhe pela primeira grande terra indígena demarcada pelo governo federal, em 1961, e considerada patrimônio nacional.
“O cenário é de possível genocídio”, afirma o médico sanitarista Douglas Rodrigues, da Unifesp (Universidade Federal de São Paulo), que há 40 anos trabalha no Xingu. “Se a taxa de transmissão do vírus seguir em alta como aconteceu nas aldeias da Amazônia, num pior cenário teremos 2.000 infectados e poderemos chegar a cem óbitos.”
Segundo o sanitarista, o potencial de propagação do coronavírus no Xingu dependerá da organização dos próprios índios, da Sesai (Secretaria Especial de Saúde Indígena), do DSEI (Distrito Sanitário Especial Indígena), e da Funai (Fundação Nacional do Índio).
“Mesmo com orientação e avisos sobre a pandemia, pedindo para que a circulação fosse evitada, não foi possível fazer com que alguns índios, principalmente os mais jovens, não deixassem suas aldeias. Parte das pessoas não acreditou no potencial da pandemia, há também desinformação e fake news circulando”, diz Rodrigues. “Também nesta época do ano são comuns surtos de gripe e de infecções respiratórias no parque. Há quase dois meses, quando muitos começaram a ficar doentes em uma das aldeias Kalapalo, pedimos à Sesai testes para Covid-19, mas isso não foi feito. Então não sabemos se a doença chegou ali há mais tempo.”
O professor de antropologia da Unicamp (Universidade Estadual de Campinas), Antonio Guerreiro, que pesquisa os Kalapalo desde 2006, também vê com muita preocupação a chegada do coronavírus ao Xingu e o risco de um possível genocídio.
“Os riscos do coronavírus se espalhar são enormes se compararmos a situação atual com a última grande epidemia que atingiu o Xingu, a de sarampo, em 1954, que dizimou ao menos 20% da população. Com a criação do Parque do Xingu em 1961, as aldeias ficaram mais próximas e hoje há uma intensa circulação entre seus habitantes e com a cidade, onde comprar alimentos, combustível, material para pesca. E o coronavírus tem uma propagação rápida”, diz Guerreiro, atualmente pesquisador na Universidade de Oxford, na Inglaterra.
Os dois Kalapalo com Covid-19 receberam alta no fim da tarde desta terça (9) e foram encaminhados para a Casai (Casa de Saúde e Apoio ao Índio) em Canarana (MT). A recomendação era que ficassem por lá para cumprir a quarentena, já que os primeiros sintomas surgiram no dia 3 de junho. O isolamento recomendado pelas principais organizações de saúde, no entanto, esbarra em resistência cultural.
Os índios não aceitaram fazer a quarentena por lá e voltaram para a aldeia com a promessa de ficarem numa casa isolada e usando máscaras. “Índio é muito complicado. Eles disseram que estavam bem e precisavam voltar para casa”, diz o também indígena e técnico de enfermagem Tafuraki Nahukuá, que trabalha na Casai.
Para Guerreiro, não dá para fazer uma simplificação dessa escolha em voltar para a aldeia apenas como sendo uma vontade ou capricho. Há questões culturais complexas que podem explicar o fato dos dois índios terem optado por voltar para casa.
“Estou especulando, porque não consegui contato com eles ainda. Mas, pelo que já pesquisei e ouvi dos Kalapalo, eles não gostam de ficar na Casai, porque além de ter uma infraestrutura péssima, eles ficam afastados da família e dos cuidados e supervisão que os parentes têm de perto com os doentes. E também porque temem feitiçaria por parte de algum índio de outra etnia que pode estar eventualmente internado ali”, diz.
Rodrigues explica como é complicado o cenário de isolamento social dentro do Xingu. Os indígenas da região moram em ocas coletivas, com 30, 40 pessoas dentro e compartilham objetos e comida. Muitos não têm acesso à água e sabão para lavar as mãos.
“Faltam EPI [equipamento de proteção individual], treinamento, comunicação, faltam testes e cilindros maiores de oxigênio para os atendimentos que precisarem de mais cuidados e para possíveis remoções até a cidade mais próxima, entre outras coisas.”
A Unifesp, o ISA (Instituto SocioAmbiental), a SPDM (Associação Paulista para o Desenvolvimento da Medicina), o DSEI Xingu, a Coordenação Nacional do Xingu, da Funai, e Atix (Associação da Terra Indígena Xingu) montaram um comitê de crise e com realocação de recursos próprios estão enviando testes para Covid-19, concentradores de oxigênio, oxímetros, EPIs, equipamentos de pesca, máscaras e alimentos.
A universidade, por meio de seu Projeto Xingu, da Escola Paulista de Medicina, está dando treinamento a distância para agentes de saúde e também enviará 500 testes para Covid-19. O ISA mandará outros 380 testes.
“Faltariam no mínimo mais mil”, diz Paulo Junqueira, coordenador do projeto Xingu no ISA, que há 20 anos trabalha na região.
Para Junqueira, a questão agora é ganhar tempo até que as aldeias consigam se organizar melhor e receber equipamentos necessários para conter a doença. Existem dez casas de apoio para isolamento sendo construídas no parque.
O povo Kuikuro está construindo numa aldeia uma oca específica para colocar possíveis infectados em isolamento. Também preparou uma cartilha com informações sobre o coronavírus, em português e na língua Kuikuro.
A AIKAX (Associação Indígena Kuikuro do Alto Xingu) recebeu 28 mil libras (cerca de R$ 176 mil) de ajuda por meio de uma iniciativa comandada pela People’s Palace Project (PPP), organização vinculada à Universidade Queen Mary, de Londres, que trabalha há seis anos com os Kuikuro. “Estamos organizando o envio de suprimentos para evitar ao máximo a exposição das pessoas dali ao vírus”, diz Thiago Jesus, da PPP.
O cacique Yanama Kuikuro, da aldeia Ipatse, diz que a preocupação é grande e que estão correndo contra o tempo para conseguir equipamentos e construir a casa de quarentena rapidamente. Ele conta que com a ajuda do doutor Rodrigues, da Unifesp, está fazendo a compra dos suprimentos necessários e orientando o seu povo. “É uma tristeza enorme termos que cancelar o Kuarup, isso nunca aconteceu. Mas todas lideranças conversaram e vimos que é muito perigoso fazer aglomeração”, fala Yanama.
O povo Yawalapiti também está devastado com o cancelamento do Kuarup. “É o ritual mais sagrado do povo do Alto Xingu. Mas não teve outro jeito”, diz Tapi Yawalapiti, filho do cacique Aritana e uma das lideranças locais.
Ele conta que há dois meses vinham pedindo para as pessoas da aldeia evitarem ir à cidade por causa do vírus, mas que os mais jovens não acreditavam que a doença era grave e poderia atingir os índios. “Eles pegavam as motos e iam escondido. Agora está proibido, precisa de autorização.”
Tapi também conta que na segunda eles fecharam de vez a estrada próxima à aldeia que vai até a cidade. “Ontem já não deixamos nem o carro da Funai passar.”
Segundo ele, nas aldeias Yawalapiti não há máscaras, álcool em gel, remédios ou equipamentos básicos.
O técnico indígena de enfermagem Leonardo Kamaiurá também relata falta de suprimentos e equipamentos de prevenção nas Unidades Básicas de Saúde. “Temos poucas máscaras, o álcool em gel temos que dividir metade do pote para mandar para outros postos. Falta o básico.”
O profissional conta que ouve de muitos índios que o coronavírus seria uma doença apenas de não-indígenas, que seriam mais fracos. “Há uma resistência grande por aqui também para acreditar na pandemia, como acontece no resto do Brasil.”
Todas lideranças indígenas e profissionais de saúde ouvidos pelas Folha dizem que o governo não tem ajudado e que falta informação correta.
A disseminação de notícias falsas ou incorretas, segundo alguns indígenas, está levando medo à população. Em um áudio ao qual a Folha teve acesso, o presidente da Atix, Ianukulá Kaiabi Suiá, diz que há pessoas falando em não reportar sintomas aos agentes de saúde, porque, se isso acontecer, “eles serão levados aos hospitais, serão entubados e vão morrer”.
A médica Daphne Andrade, do DSEI Xingu, diz que não ouviu isso nas aldeias do Alto Xingu nas quais ela trabalha. “Rodei muitas aldeias levando informação sobre corona, fazendo alguns testes e não ouvi isso. Eles falam sim que têm medo de intubar, porque isso todos nós temos, né? Mas não ouvi isso de não reportar sintomas.”
A reportagem tentou contato com alguma liderança dos Kalapalo, mas por problemas de comunicação no local, não conseguiu.
Em nota, o Ministério da Saúde, por meio da Sesai (Secretaria Especial de Saúde Indígena), diz trabalhar em articulação com o estado, tanto que está prevista a instalação de ala indígena em hospital do Mato Grosso. E que o Distrito Sanitário Especial Indígena do Xingu já recebeu 720 testes para Covid-19 e que estão sendo enviados mais mil. E que enviará mais 36 cilindros de 50 litros de oxigênio.
Quando o irmão da psicóloga Marília Gabriela morreu, três meses atrás, a pandemia no Brasil ainda era chamada de gripezinha. Saudável, ativo e aos 39 anos, Alexandre prestou sua peregrinação pelo sistema de saúde por alguns dias, até que não considerassem mais sua condição tão benigna. Quando finalmente foi internado, apenas o irmão que o conduziu ao hospital o viu entrar. Nunca mais ninguém da família pôde falar com ele. Um dia depois, ligaram pedindo os seus documentos, e os parentes já entenderam.
Acabou assim, no ar. “A gente foi até o local da cremação, mas você só vai para assinar papel. E tem a coisa de não poder tocar no outro. Na hora, minha mãe acabou abraçando algumas pessoas. Tentei impedir, mas me disseram que deixasse”, conta Marília.
Não foi suficiente para aplacar o rompimento inesperado do vínculo que o jovem filho, irmão, amigo tinha com os seus. A mãe de Alexandre não sabia, mas decidiu fazer exatamente o que aconselham os especialistas: criar um ritual possível. “Ela ligou para um amigo muito querido dele e falou, me ajuda a pensar, não sei o que faço com as cinzas”. A atitude desencadeou um movimento em rede entre pessoas que amavam Alexandre e que começaram a falar sobre ele e rememorar – a viver seu luto. Os amigos sugeriram espalhar as cinzas na praça ao lado da casa onde cresceram e passaram muitos momentos. Uma amiga da mãe pensou em plantar uma árvore e fazer uma oração.
Criaram então, juntos, seu próprio ritual. Escolheram uma árvore – flamboyant – e chamaram poucas pessoas para uma celebração. Na véspera, Marília teve medo de remexer nos sentimentos. Mas foi em frente. “Procurei o jardineiro da praça, ele preparou o buraco com todo cuidado para a muda”. No dia seguinte, cerca de 10 pessoas, afastadas e de máscara, mas juntas, estavam lá. “Nosso irmão mais novo disse algumas palavras, falou o quanto Alexandre amava essas pessoas e fizemos uma oração”. Um ritual simples, mas fundamental. Agora, a mãe de Alexandre sempre visita a mudinha quando passeia com a cachorra que era do filho. Anda achando que a planta está mirrada, quer ver a árvore mais vigorosa. De vez em quando, vai lá cuidar do canteiro.
“Sentimos acho que uma calma, uma coisa que se fecha. A dor existe, mas está bem diferente”, diz Marília. “Não é algo banal”.
Meio milhão sem adeus
Todas as culturas têm um ritual próprio para despedir-se de seus mortos. Todos, até onde sabemos, desde sempre, desde o momento mais primitivo da história humana. A unanimidade dessa necessidade é incomum, e um bom indicativo do quanto ela é, literalmente, uma necessidade. Nem mesmo os rituais de nascimento têm essa incidência absoluta. “Porque a morte desorganiza”, explica a doutora em psicologia Maria Helena Franco, coordenadora do Laboratório de Estudos e Intervenções sobre o Luto da PUC-SP. “O nascimento, nem tanto. A morte desorganiza um grupo, uma sociedade, e em extensão, uma cultura. E o ritual tem essa função de reorganizar”.
Desde o início da pandemia, no entanto, os ritos tradicionais foram suspensos pela imposição de uma realidade em que a despedida tornou-se um risco. Os rituais existem em diversidade inumerável, mas quase sempre envolvem o toque, a presença ou a manipulação do corpo. Essa proximidade não é mais possível, já que, por questões de segurança sanitária, as vítimas de covid-19 chegam às suas famílias envoltas em três camadas protetoras, dentro de urnas lacradas, com a orientação de velórios muito curtos e funerais sem aglomeração.
Uma série de estudos sobre luto antes da pandemia, e outros realizados também com o viés do coronavírus, estima que, em média, cada vida deixa até dez enlutados. Dez pessoas com vínculo significativo com a pessoa que se foi, e que passarão pelo processo do luto. É o número com que trabalham especialistas como Maria Helena, embora ela o considere “conservador” para a realidade brasileira. Isso significa que, dentro dessa estimativa conservadora, os (também conservadores) mais de 50 mil mortos oficiais por Covid, somados aos mortos suspeitos que também são submetidos aos mesmos cuidados, deixaram para trás uma multidão de mais de meio milhão de brasileiros que não puderam se despedir de seus entes queridos. E essa multidão segue crescendo.
“Estamos vivendo um desastre. Mas é um desastre diferente, porque é lento. Em um tsunami, numa barragem que estoura, a onda vem, passa, e fica a destruição. O coronavírus é uma onda em câmera lenta. Você olha para fora e não tem destruição”, diz Elaine Gomes Alves, doutora e pesquisadora da área de Psicologia de Emergências e Desastres do Laboratório de Estudos sobre a Morte da USP.
A gente tem que desconstruir uma coisa que já existe há gerações para colocar no lugar uma realidade que tá aqui, agora, imposta. Não foi nem construída, foi imposta. E é natural que a gente proteste e tenha dificuldade de aceitar isso
Maria Helena Franco, coordenadora do Laboratório de Estudos e Intervenções sobre o Luto da PUC-SP
Diferentemente da maior parte dos desastres, a pandemia não tem a vivência do luto coletivo, que é um recurso muito útil de acolhimento. “As pessoas se aglomeram, ofertam apoio, vivenciam junto. Em Brumadinho, por exemplo, você pode chegar na cidade e falar dos mortos com qualquer um. Na situação atual, a pessoa morre, é enterrada e vai cada um para sua casa, fica sozinho, isolado”, aponta Elaine.
“Não é a pessoa, é o corpo da pessoa. Mas nós, humanos, trabalhamos com símbolos, e para os enlutados falta como simbolizar”, concorda Maria Helena.
Além de ser uma nuance comovente dentro da situação que vivemos, esse obstáculo ao luto é, por si, um potencial problema para cada um que passa por isso e, na proporção que está sendo construído, para a sociedade. Quando o processo do luto não é bem vivido, ele pode tornar-se o que os especialistas chamam de “luto complicado”, que é um luto com possibilidade de adoecimento. As duas especialistas ouvidas pela reportagem, assim como a OMS, esperam uma enormidade de aumento na demanda de saúde mental no porvir da pandemia. Aliás, da saúde como um todo, já que nenhuma das duas dissocia totalmente as saúdes física e mental.
“O luto é um processo de dor intensa. Não existe na existência humana nenhum processo que seja pior do que o luto. Você precisa de um tempo primeiro para entender que a pessoa morreu, para chorar com ela, entrar em contato com a falta, buscar ferramentas internas parta sair do sofrimento. Cada um vai ter um tempo de luto para terminar seu processo”, explica Elaine. O problema é que, sem os rituais, os enlutados muitas vezes sequer conseguem começar adequadamente. “Você pode empacar em algumas coisas. Por exemplo, na negação – como não viu o corpo, pode dizer que ele não morreu. Algumas pessoas que passam por isso dizem coisas como ‘Sabe o que eu penso? Que ele está viajando’. E isso é um problema. É importante fechar o ciclo. Não importa quanto tempo leve.”
Em busca de um símbolo
A construção de uma despedida possível feita pela família de Marília Gabriela não é banal, como ela apontou. Fazer um ritual, ainda que não seja seguindo a tradição, é a recomendação unânime dos psicólogos. Mas não é fácil encontrar os recursos internos para isso, muito menos em um momento de dor. “A racionalidade não tem tido muito efeito. Porque o ritual é tão antigo, é tão arraigado, que a gente saber por quê não pode – por quê não pode aglomeração, por quê tem que enterrar rapidamente – não surte muito efeito”, diz Maria Helena.
No caso de Alexandre, colaborou o fato de que ele não seguia nenhuma religião específica – os ritos a seguir, portanto, eram menos rígidos, mais fáceis de serem adaptados. Mas esse é o caso de apenas 10% dos brasileiros, segundo o IBGE. Nem todos os detalhes religiosos e culturais precisam ser impossíveis na pandemia, mas, para que isso seja avaliado, seria preciso uma cartilha de manejo com mais nuances do que as publicadas até agora.
Na região metropolitana de São Paulo como no Alto Xingu, tem sido difícil. Pela primeira vez em sua milenar história, este ano foi cancelado o Kuarup. Talvez a mais conhecida entre as manifestações indígenas brasileiras, o Kuarup é um grande ritual sagrado que celebra os mortos de todo um ano, e envolve onze etnias do Alto Xingu. É no Kuarup que os parentes encerram o período de luto pelos que morreram. O coronavírus chegou ao Alto Xingu, e este ano não tem Kuarup.
Quando se encerrarão esses milhares de lutos?
O líder indígena Dário Kopenawa, vice-presidente da Hutukara Associação Yanomami, em Roraima, tem sido uma das vozes ativas sobre tudo que envolve a questão do coronavírus entre os povos das florestas. Em sua etnia, uma das tradições fundamentais é de que o corpo, cremado, permaneça na aldeia. Mas os yanomamis mortos estão sendo enterrados em cemitérios de Boa Vista, sem a participação ou autorização de seus entes queridos. “Estamos seguindo os protocolos do mundo não-indígena, como os da Organização Mundial da Saúde, das prefeituras, do governo. E isso atrapalha muito em nossa cerimônia [fúnebre]. Sabemos que, neste momento, não é bom pegar o corpo de nosso parente e transmitir a doença. Mas não nos despedimos das vítimas que foram enterradas. É uma falta de respeito, um preconceito contra a nossa cultura”, diz.
O deslocamento dos corpos é uma ruptura grande demais no rito para que a comunidade consiga criar alternativas. “É muito longe, a comunicação é difícil, mas os familiares estão muito tristes de não enterrar os corpos onde ele nasceu, cresceu e viveu. É muito importante o corpo retornar para a aldeia. É muito ruim para nossa cultura e para o familiar fora da comunidade ter o corpo em um cemitério. As lideranças acionaram o Ministério Público Federal questionando que não pode colocar nossos parentes longe da família. Precisamos mais ainda dos médicos, dos epidemiologistas, para nos dizer: quantos dias a doença fica no corpo morto? Isso não é claro ainda. Nós não somos médicos, e acionamos o órgãos públicos para desenterrar o corpo e levá-los para as aldeias, ou cremá-los na cidade e levar as cinzas para as aldeias”.
Quando os yanomamis morrem sem doenças e problemas, conversam com a família e guardam as cinzas em uma vasilha. Reúnem muita comida, muitos alimentos para fazer festa, despedir novamente. Normalmente, parentes de outras aldeias vão ao cerimonial. Riem, choram. “Depois pega as cinzas em uma vasilha e devolvemos à mãe terra com respeito. É tradicional.”
Também liderança, Milena Kokama chorava os então 55 mortos de seu povo sepultados em cova coletiva em Manaus. “Na nossa cultura, a gente não sepulta. A gente crema”, diz, sobre seu luto, agravado pelos entraves das autoridades. “E ainda sai assim no atestado de óbito: pardo. Eu não sei o que é pardo, eu sou Kokama.”
É uma questão muito difícil. Eu não sei o que você entende como parente, mas meu povo é meu parente independentemente de laços sanguíneos
Milena Kokama, liderança indígena
Promessa do encontro
O babalorixá e antropólogo Pai Rodney de Oxóssi sabe o que os enlutados estão sentindo. “Nós, do candomblé, já tínhamos que pensar em alternativas desde antes da doença, sempre tivemos nossos ritos impedidos por intolerância e o racismo religioso”. As restrições a religiões de matrizes africanas acontecem desde famílias que não seguem a denominação e impedem que um familiar iniciado seja tratado segundo sua crença, até hospitais que não permitem a entrada dos sacerdotes – ainda que os de outras religiões circulem sem problemas. “Já tomei chá de cadeira para visitar minha própria mãe, já tive gente de hospital me ligando no dia seguinte a uma visita dizendo que fosse mais discreto e não usasse ‘aquelas roupas'”.
A assistência religiosa é uma garantia legal dos cidadãos brasileiros, mas o babalorixá diz que começou a sentir melhora a partir da lei estadual, sancionada no ano passado, que proíbe a discriminação religiosa. “A lei tem garantido a gente tomar o caminho da cidadania. E isso não permite que as pessoas te impeçam do que a lei te assegura”.
Mesmo com vivência desses complicadores, o candomblé não passou imune às restrições da covid. Com rituais fúnebres muito específicos que incluem o comunitário axexê e um preparo do corpo feito pelo babalorixá, seus enlutados estão, como todos, sem poder exercer seus símbolos tradicionais. “Essas despedidas fazem com que a gente consiga acomodar a morte. Sem elas, há essa sensação de vazio, porque a morte continua fora do lugar. O luto acomoda as dores para que você consiga se recuperar”, diz.
Como os terreiros se organizam como uma espécie de família expandida, todos eles têm hoje seu grupo de WhatsApp. Na ausência da homenagem tradicional, é nesses espaços que os enlutados têm encontrado seus símbolos. “É uma religião essencialmente comunitária, cada terreiro é uma família extensa, então a vivência comunitária para nós é essencial. Sempre que alguém morre há um momento de solidariedade, mandam muitas mensagens, fazem suas homenagens, postam suas fotos com os falecidos”, explica.
O axexê com toda a comunidade, suspenso, também está se tornando, em si, um símbolo, com a promessa de que será feito no momento oportuno em que seja possível a aglomeração, a reunião que o ritual demanda. Quando ele vier, será um grande momento de comemoração.
Claro que a humanidade sempre acha uma maneira de compensar isso. Sempre há, depois que tudo isso passa, um florescimento – das artes, da religiosidade, das coisas que fazem o imaginário humano fluir para que compense esse período de obscuridade. A religião e as culturas têm um papel . Os rituais são inventados na medida em que a gente tem necessidade de preencher uma lacuna que a ciência e racionalidade não preenchem
Pai Rodney de Oxóssi, babalorixá e antropólogo
É preciso sensibilidade
Os enlutados nem sempre vão conseguir criar esses novos símbolos sozinhos. As alternativas podem vir de seus líderes religiosos, dos hospitais, dos próprios serviços funerários. Mas as especialistas recomendam que não se espera que os outros façam: que venham de todos nós que tivermos contato com quem perdeu um ente querido.
“Vamos possibilitar que as pessoas façam seus rituais. Que a gente não fique naquele lugar de ‘ah, mas não é a mesma coisa’. É fato, não é a mesma coisa, e a gente não ganha muito ficando nesta tecla. Vamos ver que outra coisa a gente vai fazer”, diz Maria Helena. “Acho que aí a gente pode ser criativo, ajudar as pessoas a honrar a memória do seu amado, honrar uma tradição, de uma outra forma. Que não terá menos valor. Que será diferente. Acho importante a gente entender por aí, e não como algo que não pôde ser feito. Mas sim o que pôde ser feito, e o quão importante é o que pode ser feito.”
A psicóloga Elaine Alves tem dado várias sugestões práticas para as famílias que tem encontrado. “Que as famílias se unam, que possam fazer juntas um rito religioso que faça sentido para elas. Podem pegar uma caixa onde colocam coisas da pessoa que morreu que sejam significativas, fechar e colocar num lugar importante, por exemplo. Falar palavras de despedida. Escrever cartas – a escrita é muito importante, ajuda muito. Ver fotos. Usar a rede social da pessoa que morreu e ali postar coisas para se comunicar com os amigos da pessoa. Os amigos podem postar fotos que a família nunca viu, isso é um presente para os familiares”, diz. São infinitas opções, que funcionarão de acordo com o vínculo e os valores de cada um.
Mas é preciso sensibilidade. “Não deixem os enlutados sozinhos. E liguem logo, não tem que esperar um tempo, uma hora boa”, explica. E seja generoso. “Tem aquela coisa do ‘mas depois que morreu virou santo’? A verdade é que os enlutados não merecem ouvir coisas ruins de seus mortos”, diz. Se, por vício, perguntar se está tudo bem, acolha a resposta. “Entenda que o outro não está bem, e que é para o outro falar. E a parte mais fácil é de quem não está passando por aquilo e só precisa escutar. O enlutado conta várias vezes a mesma história, porque ele precisa entender o que aconteceu. Quando dizem que não aguentam mais escutar, respondo que essa é a parte mais fácil. Você não precisa passar pelo que outro está passando. Só precisa escutar. Escute”.
A fala encontra eco na de Maria Helena. “Eu queria muito pedir a quem tiver acesso a pessoas enlutadas que busque oferecer a elas possibilidades criativas de fazer seus rituais, que não terão menos valor. Terão valor, sim, porque serão feitos. Sem eles é que a gente vai ter problemas”, afirma. “Vamos respeitar algumas requisições religiosas que são necessárias, que fazem falta. Vamos buscar isso. Vamos proporcionar. Isso não precisa ser só a psicologia que faz, não. É a gente que faz com as pessoas que estão próximas a nós. Tendo essa sensibilidade, a gente consegue fazer. Vamos cuidar. E cuidar da gente também.”
Mathias Pape / Arte UOL. Edição de arte: René Cardillo; Edição de texto: Adriana Terra; Ilustração: Linoca Souza; Reportagem: Carina Martins.
Por Aluizio Marino², Danielle Klintowitz³, Gisele Brito², Raquel Rolnik¹, Paula Santoro¹, Pedro Mendonça²
Foto: Roberto Moreyra (Agência O Globo)
Desde o início da pandemia no Brasil muito tem se debatido acerca dos impactos nos diferentes territórios e segmentos sociais. Algo fundamental tanto para encontrar os melhores meios de prevenir a difusão da doença como de proteger aqueles que estão mais vulneráveis. Entretanto, a forma como as informações e os dados têm sido divulgados não auxilia na análise dos impactos territoriais e da difusão espacial da pandemia, dificultando também o seu devido enfrentamento.
Em artigo anterior, apresentamos o resultado de pesquisa em outra escala, a da rua. Para tanto, mapeamos as hospitalizações e óbitos pós internação por Covid-19 a partir do CEP – informação fornecida nas fichas dos pacientes hospitalizados com Síndrome Respiratória Aguda e Grave (SRAG) incluindo Covid-19 e disponibilizadas pelo DATASUS até aquele momento (18 de maio de 2020). Esse procedimento permitiu olhar mais detalhadamente para a distribuição territorial da pandemia, e assim evidenciar a complexidade de questões que explicam a sua difusão espacial, não apenas a precariedade habitacional e a presença de favelas.
A partir desta constatação passamos a investigar outros possíveis elementos explicativos, entre eles, a mobilidade urbana durante o período da pandemia, especificamente compreendendo o fluxo de circulação das pessoas na cidade e como isso influencia na difusão espacial da Covid-19. Com base nos dados disponibilizados pela SPTrans sobre dados de GPS dos ônibus, e a partir do roteamento de viagens selecionadas da Pesquisa Origem Destino de 2017, buscamos identificar de onde saíram e para onde foram as pessoas que circularam de transporte coletivo no dia 5 de junho, dia em que, segundo a SPTrans, cerca de 3 milhões de viagens foram realizadas usando os ônibus municipais. Ao mesmo tempo, fizemos uma leitura territorial sobre a origem das viagens durante o período de pandemia. Para esta análise identificou-se na Pesquisa Origem Destino (2017) as pessoas que usam transporte público como modo principal para chegar ao seu destino, motivadas pela ida ao local de trabalho. Consideramos apenas as viagens realizadas por pessoas sem ensino superior e em cargos não executivos. Esse perfil foi selecionado considerando que pessoas com ensino superior, em cargos executivos e profissionais liberais tenham aderido ao teletrabalho e que viagens com outras motivações, como educação e compras, pararam de ocorrer. Esses dados de mobilidade foram correlacionados com os dados de hospitalizações por SRAG não identificada, e Covid-19, até o dia 18 de maio, última data para qual o dado do CEP no DATASUS estava disponibilizado pelo Ministério da Saúde.
Desta forma produzimos um mapa que ilustra a distribuição dos lugares de origem das viagens diárias, a partir de uma distribuição que considera número de viagens nas zonas origem-destino e distribuição populacional dentro dessas zonas. O resultado mostra uma forte associação entre os locais que mais concentraram as origens das viagens com as manchas de concentração do local de residência de pessoas hospitalizadas com Covid-19 e Síndrome Respiratória Grave (SRAG) sem identificação, possivelmente casos de Covid-19, mas que não foram testados ou não tiveram resultado confirmado.
Mapa: Pedro Mendonça/ LabCidade
Com base neste estudo, pode-se dizer que, em síntese, quem está sendo mais atingido pela Covid-19 são as pessoas que tiveram que sair para trabalhar. Embora tenhamos mapeado os locais que concentram os maiores números de origens ou destinos dos fluxos de circulação por transporte coletivo, não é possível ainda afirmar se o contágio ocorreu no percurso do transporte, no local de trabalho ou no local de moradia, o que vai exigir análises futuras, que serão realizadas no âmbito desta pesquisa. Mas o que está evidente é que quem saiu para trabalhar e realizou percursos longos de transporte coletivo é que quem foi mais impactado pelos óbitos ocorridos. Enquanto esse fator mostrou associação forte com os casos de hospitalizações por SRAG não identificada e Covid-19, a densidade demográfica — frequentemente associada a áreas favelizadas e bairros populares — apresentou associação fraca.
Ainda que preliminares, esses dados apontam para a incoerência e inconsequência da abertura planejada pelas prefeituras e governo do estado. A reabertura de comércios e restaurantes implica em aumentar significativamente o número de áreas de origens com mais densidades de viagens e maior circulação de pessoas no transporte público. Se o maior número de óbitos está nos territórios que tiveram mais pessoas saindo para trabalhar durante o período de isolamento, temos que pensar tanto em políticas que as protejam em seus percursos como ampliar o direito ao isolamento paras as pessoas que não estão envolvidas com serviços essenciais mais precisam trabalhar para garantir seu sustento, o que reforça a importância de políticas de garantia de renda e segurança alimentar, subsídios de aluguel e outras despesas, e ações articuladas a coletivos e organizações locais para a proteção dos que mais estão ameaçados durante a pandemia.
Embora esses dados sejam públicos, nos parece que estão sendo ignorados para a definição de estratégias de enfrentamento a pandemia. É urgente repensar a forma como a política de mobilidade na cidade tem sido pensada, já que foram cometidos equívocos tal como o mega rodízio para veículos individuais, que durou apenas alguns dias e provocou uma superlotação nos transportes públicos ampliando os riscos das pessoas que precisavam sair para trabalhar. Ainda não foram implementadas medidas que garantam condições seguras para que as pessoas dos serviços essenciais pudessem fazer as viagens necessárias para exercer seus trabalhos sem ampliar a difusão da infecção do coronavírus. Bem como não existe uma leitura sobre a mobilidade metropolitana — inclusive não existem dados abertos sobre isso — ignorando as dinâmicas pendulares de pessoas que moram e trabalham em municípios diferentes da região metropolitana.
¹ Coordenadoras do LabCidade e professoras da Faculdade de Arquitetura e Urbanismo (FAU) da USP ² Pesquisadores do LabCidade ³ Pesquisadora do Instituto Pólis
Contrary to hopes for a tidy conclusion to the COVID-19 pandemic, history shows that outbreaks of infectious disease often have much murkier outcomes—including simply being forgotten about, or dismissed as someone else’s problem.
Recent history tells us a lot about how epidemics unfold, how outbreaks spread, and how they are controlled. We also know a good deal about beginnings—those first cases of pneumonia in Guangdong marking the SARS outbreak of 2002–3, the earliest instances of influenza in Veracruz leading to the H1N1 influenza pandemic of 2009–10, the outbreak of hemorrhagic fever in Guinea sparking the Ebola pandemic of 2014–16. But these stories of rising action and a dramatic denouement only get us so far in coming to terms with the global crisis of COVID-19. The coronavirus pandemic has blown past many efforts at containment, snapped the reins of case detection and surveillance across the world, and saturated all inhabited continents. To understand possible endings for this epidemic, we must look elsewhere than the neat pattern of beginning and end—and reconsider what we mean by the talk of “ending” epidemics to begin with.
The social lives of epidemics show them to be not just natural phenomena but also narrative ones: deeply shaped by the stories we tell about their beginnings, their middles, their ends.
Historians have long been fascinated by epidemics in part because, even where they differ in details, they exhibit a typical pattern of social choreography recognizable across vast reaches of time and space. Even though the biological agents of the sixth-century Plague of Justinian, the fourteenth-century Black Death, and the early twentieth-century Manchurian Plague were almost certainly not identical, the epidemics themselves share common features that link historical actors to present experience. “As a social phenomenon,” the historian Charles Rosenberg has argued, “an epidemic has a dramaturgic form. Epidemics start at a moment in time, proceed on a stage limited in space and duration, following a plot line of increasing and revelatory tension, move to a crisis of individual and collective character, then drift towards closure.” And yet not all diseases fit so neatly into this typological structure. Rosenberg wrote these words in 1992, nearly a decade into the North American HIV/AIDS epidemic. His words rang true about the origins of that disease—thanks in part to the relentless, overzealous pursuit of its “Patient Zero”—but not so much about its end, which was, as for COVID-19, nowhere in sight.
In the case of the new coronavirus, we have now seen an initial fixation on origins give way to the question of endings. In March The Atlantic offered four possible “timelines for life returning to normal,” all of which depended the biological basis of a sufficient amount of the population developing immunity (perhaps 60 to 80 percent) to curb further spread. This confident assertion derived from models of infectious outbreaks formalized by epidemiologists such as W. H. Frost a century earlier. If the world can be defined into those susceptible (S), infected (I) and resistant (R) to a disease, and a pathogen has a reproductive number R0 (pronounced R-naught) describing how many susceptible people can be infected by a single infected person, the end of the epidemic begins when the proportion of susceptible people drops below the reciprocal, 1/R0. When that happens, one person would infect, on average, less than one other person with the disease.
These formulas reassure us, perhaps deceptively. They conjure up a set of natural laws that give order to the cadence of calamities. The curves produced by models, which in better times belonged to the arcana of epidemiologists, are now common figures in the lives of billions of people learning to live with contractions of civil society promoted in the name of “bending,” “flattening,” or “squashing” them. At the same time, as David Jones and Stefan Helmreich recently wrote in these pages, the smooth lines of these curves are far removed from jagged realities of the day-to-day experience of an epidemic—including the sharp spikes in those “reopening” states where modelers had predicted continued decline.
In other words, epidemics are not merely biological phenomena. They are inevitably framed and shaped by our social responses to them, from beginning to end (whatever that may mean in any particular case). The questions now being asked of scientists, clinicians, mayors, governors, prime ministers, and presidents around the world is not merely “When will the biological phenomenon of this epidemic resolve?” but rather “When, if ever, will the disruption to our social life caused in the name of coronavirus come to an end?” As peak incidence nears, and in many places appears to have passed, elected officials and think tanks from opposite ends of the political spectrum provide “roadmaps” and “frameworks” for how an epidemic that has shut down economic, civic, and social life in a manner not seen globally in at least a century might eventually recede and allow resumption of a “new normal.”
To understand possible endings for this epidemic, we must look elsewhere than the neat pattern of beginning and end—and reconsider what we mean by the talk of “ending” epidemics to begin with.
These two faces of an epidemic, the biological and the social, are closely intertwined, but they are not the same. The biological epidemic can shut down daily life by sickening and killing people, but the social epidemic also shuts down daily life by overturning basic premises of sociality, economics, governance, discourse, interaction—and killing people in the process as well. There is a risk, as we know from both the Spanish influenza of 1918–19 and the more recent swine flu of 2008–9, of relaxing social responses before the biological threat has passed. But there is also a risk in misjudging a biological threat based on faulty models or bad data and in disrupting social life in such a way that the restrictions can never properly be taken back. We have seen in the case of coronavirus the two faces of the epidemic escalating on local, national, and global levels in tandem, but the biological epidemic and the social epidemic don’t necessarily recede on the same timeline.
For these sorts of reasons we must step back and reflect in detail on what we mean by ending in the first place. The history of epidemic endings has taken many forms, and only a handful of them have resulted in the elimination of a disease.
History reminds us that the interconnections between the timing of the biological and social epidemics are far from obvious. In some cases, like the yellow fever epidemics of the eighteenth century and the cholera epidemics of the nineteenth century, the dramatic symptomatology of the disease itself can make its timing easy to track. Like a bag of popcorn popping in the microwave, the tempo of visible case-events begins slowly, escalates to a frenetic peak, and then recedes, leaving a diminishing frequency of new cases that eventually are spaced far enough apart to be contained and then eliminated. In other examples, however, like the polio epidemics of the twentieth century, the disease process itself is hidden, often mild in presentation, threatens to come back, and ends not on a single day but over different timescales and in different ways for different people.
Campaigns against infectious diseases are often discussed in military terms, and one result of that metaphor is to suggest that epidemics too must have a singular endpoint. We approach the infection peak as if it were a decisive battle like Waterloo, or a diplomatic arrangement like the Armistice at Compiègne in November 1918. Yet the chronology of a single, decisive ending is not always true even for military history, of course. Just as the clear ending of a military war does not necessarily bring a close to the experience of war in everyday life, so too the resolution of the biological epidemic does not immediately undo the effects of the social epidemic. The social and economic effects of the 1918–1919 pandemic, for example, were felt long after the end of the third and putatively final wave of the virus. While the immediate economic effect on many local businesses caused by shutdowns appears to have resolved in a matter of months, the broader economic effects of the epidemic on labor-wage relations were still visible in economic surveys in 1920, again in 1921, and in several areas as far as 1930.
The history of epidemic endings has taken many forms, and only a handful of them have resulted in the elimination of a disease.
And yet, like World War One with which its history was so closely intertwined, the influenza pandemic of 1918–19 appeared at first to have a singular ending. In individual cities the epidemic often produced dramatic spikes and falls in equally rapid tempo. In Philadelphia, as John Barry notes in The Great Influenza (2004), after an explosive and deadly rise in October 1919 that peaked at 4,597 deaths in a single week, cases suddenly dropped so precipitously that the public gathering ban could be lifted before the month was over, with almost no new cases in following weeks. A phenomenon whose destructive potential was limited by material laws, “the virus burned through available fuel, then it quickly faded away.”
As Barry reminds us, however, scholars have since learned to differentiate at least three different sequences of epidemics within the broader pandemic. The first wave blazed through military installations in the spring of 1918, the second wave caused the devastating mortality spikes in the summer and fall of 1918, and the third wave began in December 1918 and lingered long through the summer of 1919. Some cities, like San Francisco, passed through the first and second waves relatively unscathed only to be devastated by the third wave. Nor was it clear to those still alive in 1919 that the pandemic was over after the third wave receded. Even as late as 1922, a bad flu season in Washington State merited a response from public health officials to enforce absolute quarantine as they had during 1918–19. It is difficult, looking back, to say exactly when this prototypical pandemic of the twentieth century was really over.
Who can tell when a pandemic has ended? Today, strictly speaking, only the World Health Organization (WHO). The Emergency Committee of the WHO is responsible for the global governance of health and international coordination of epidemic response. After the SARS coronavirus pandemic of 2002–3, this body was granted sole power to declare the beginnings and endings of Public Health Emergencies of International Concern (PHEIC). While SARS morbidity and mortality—roughly 8,000 cases and 800 deaths in 26 countries—has been dwarfed by the sheer scale of COVID-19, the pandemic’s effect on national and global economies prompted revisions to the International Health Regulations in 2005, a body of international law that had remained unchanged since 1969. This revision broadened the scope of coordinated global response from a handful of diseases to any public health event that the WHO deemed to be of international concern and shifted from a reactive response framework to a pro-active one based on real-time surveillance and detection and containment at the source rather than merely action at international borders.
This social infrastructure has important consequences, not all of them necessarily positive. Any time the WHO declares a public health event of international concern—and frequently when it chooses not to declare one—the event becomes a matter of front-page news. Since the 2005 revision, the group has been criticized both for declaring a PHEIC too hastily (as in the case of H1N1) or too late (in the case of Ebola). The WHO’s decision to declare the end of a PHEIC, by contrast, is rarely subject to the same public scrutiny. When an outbreak is no longer classified as an “extraordinary event” and no longer is seen to pose a risk at international spread, the PHEIC is considered not to be justified, leading to a withdrawal of international coordination. Once countries can grapple with the disease within their own borders, under their own national frameworks, the PHEIC is quietly de-escalated.
At their worst, epidemic endings are a form of collective amnesia, transmuting the disease that remains into merely someone else’s problem.
As the response to the 2014–16 Ebola outbreak in West Africa demonstrates, however, the act of declaring the end of a pandemic can be just as powerful as the act of declaring its beginning—in part because emergency situations can continue even after a return to “normal” has been declared. When WHO Director General Margaret Chan announced in March 2016 that the Ebola outbreak was no longer a public health event of international concern, international donors withdrew funds and care to the West African countries devastated by the outbreak, even as these struggling health systems continued to be stretched beyond their means by the needs of Ebola survivors. NGOs and virologists expressed concern that efforts to fund Ebola vaccine development would likewise fade without a sense of global urgency pushing research forward.
Part of the reason that the role of the WHO in proclaiming and terminating the state of pandemic is subject to so much scrutiny is that it can be. The WHO is the only global health body that is accountable to all governments of the world; its parliamentary World Health Assembly contains health ministers from every nation. Its authority rests not so much on its battered budget as its access to epidemic intelligence and pool of select individuals, technical experts with vast experience in epidemic response. But even though internationally sourced scientific and public health authority is key to its role in pandemic crises, WHO guidance is ultimately carried out in very different ways and on very different time scales in different countries, provinces, states, counties, and cities. One state might begin to ease up restrictions to movement and industry just as another implements more and more stringent measures. If each country’s experience of “lockdown” has already been heterogeneous, the reconnection between them after the PHEIC is ended will likely show even more variance.
So many of our hopes for the termination of the present PHEIC now lie in the promise of a COVID-19 vaccine. Yet a closer look at one of the central vaccine success stories of the twentieth century shows that technological solutions rarely offer resolution to pandemics on their own. Contrary to our expectations, vaccines are not universal technologies. They are always deployed locally, with variable resources and commitments to scientific expertise. International variations in research, development, and dissemination of effective vaccines are especially relevant in the global fight against epidemic polio.
The development of the polio vaccine is relatively well known, usually told as a story of an American tragedy and triumph. Yet while polio epidemics that swept the globe in the postwar decades did not respect national borders or the Iron Curtain, the Cold War provided context for both collaboration and antagonism. Only a few years after the licensing of Jonas Salk’s inactivated vaccine in the United States, his technique became widely used across the world, although its efficacy outside of the United States was questioned. The second, live oral vaccine developed by Albert Sabin, however, involved extensive collaboration in with Eastern European and Soviet colleagues. As the success of the Soviet polio vaccine trials marked a rare landmark of Cold War cooperation, Basil O’Connor, president of the March of Dimes movement, speaking at the Fifth International Poliomyelitis Conference in 1960, proclaimed that “in search for the truth that frees man from disease, there is no cold war.”
Two faces of an epidemic, the biological and the social, are closely intertwined, but they are not the same.
Yet the differential uptake of this vaccine retraced the divisions of Cold War geography. The Soviet Union, Hungary, and Czechoslovakia were the first countries in the world to begin nationwide immunization with the Sabin vaccine, soon followed by Cuba, the first country in the Western Hemisphere to eliminate the disease. By the time the Sabin vaccine was licensed in the United States in 1963, much of Eastern Europe had done away with epidemics and was largely polio-free. The successful ending of this epidemic within the communist world was immediately held up as proof of the superiority of their political system.
Western experts who trusted the Soviet vaccine trials, including the Yale virologist and WHO envoy Dorothy Horstmann, nonetheless emphasized that their results were possible because of the military-like organization of the Soviet health care system. Yet these enduring concerns that authoritarianism itself was the key tool for ending epidemics—a concern reflected in current debates over China’s heavy-handed interventions in Wuhan this year—can also be overstated. The Cold War East was united not only by authoritarianism and heavy hierarchies in state organization and society, but also by a powerful shared belief in the integration of paternal state, biomedical research, and socialized medicine. Epidemic management in these countries combined an emphasis on prevention, easily mobilized health workers, top-down organization of vaccinations, and a rhetoric of solidarity, all resting on a health care system that aimed at access to all citizens.
Still, authoritarianism as a catalyst for controlling epidemics can be singled out and pursued with long-lasting consequences. Epidemics can be harbingers of significant political changes that go well beyond their ending, significantly reshaping a new “normal” after the threat passes. Many Hungarians, for example, have watched with alarm the complete sidelining of parliament and the introduction of government by decree at the end of March this year. The end of any epidemic crisis, and thus the end of the need for the significantly increased power of Viktor Orbán, would be determined by Orbán himself. Likewise, many other states, urging the mobilization of new technologies as a solution to end epidemics, are opening the door to heightened state surveillance of their citizens. The apps and trackers now being designed to follow the movement and exposure of people in order to enable the end of epidemic lockdowns can collect data and establish mechanisms that reach well beyond the original intent. The digital afterlives of these practices raise new and unprecedented questions about when and how epidemics end.
Like infectious agents on an agar plate, epidemics colonize our social lives and force us to learn to live with them, in some way or another, for the foreseeable future.
Although we want to believe that a single technological breakthrough will end the present crisis, the application of any global health technology is always locally determined. After its dramatic successes in managing polio epidemics in the late 1950s and early 1960s, the oral poliovirus vaccine became the tool of choice for the Global Polio Eradication Initiative in the late 1980s, as it promised an end to “summer fears” globally. But since vaccines are in part technologies of trust, ending polio outbreaks depends on maintaining confidence in national and international structures through which vaccines are delivered. Wherever that often fragile trust is fractured or undermined, vaccination rates can drop to a critical level, giving way to vaccine-derived polio, which thrives in partially vaccinated populations.
In Kano, Nigeria, for example, a ban on polio vaccination between 2000 and 2004 resulted in a new national polio epidemic that soon spread to neighboring countries. As late as December 2019 polio outbreaks were still reported in fifteen African countries, including Angola and the Democratic Republic of the Congo. Nor is it clear that polio can fully be regarded as an epidemic at this point: while polio epidemics are now a thing of the past for Hungary—and the rest of Europe, the Americas, Australia, and East Asia as well—the disease is still endemic to parts of Africa and South Asia. A disease once universally epidemic is now locally endemic: this, too, is another way that epidemics end.
Indeed, many epidemics have only “ended” through widespread acceptance of a newly endemic state. Consider the global threat of HIV/AIDS. From a strictly biological perspective, the AIDS epidemic has never ended; the virus continues to spread devastation through the world, infecting 1.7 million people and claiming an estimated 770,000 lives in the year 2018 alone. But HIV is not generally described these days with the same urgency and fear that accompanied the newly defined AIDS epidemic in the early 1980s. Like coronavirus today, AIDS at that time was a rapidly spreading and unknown emerging threat, splayed across newspaper headlines and magazine covers, claiming the lives of celebrities and ordinary citizens alike. Nearly forty years later it has largely become a chronic disease endemic, at least in the Global North. Like diabetes, which claimed an estimated 4.9 million lives in 2019, HIV/AIDS became a manageable condition—if one had access to the right medications.
Those who are no longer directly threatened by the impact of the disease have a hard time continuing to attend to the urgency of an epidemic that has been rolling on for nearly four decades. Even in the first decade of the AIDS epidemic, activists in the United States fought tooth and nail to make their suffering visible in the face of both the Reagan administration’s dogged refusal to talk publicly about the AIDS crisis and the indifference of the press after the initial sensation of the newly discovered virus had become common knowledge. In this respect, the social epidemic does not necessarily end when biological transmission has ended, or even peaked, but rather when, in the attention of the general public and in the judgment of certain media and political elites who shape that attention, the disease ceases to be newsworthy.
Though we like to think of science as universal and objective, crossing borders and transcending differences, it is in fact deeply contingent upon local practices.
Polio, for its part, has not been newsworthy for a while, even as thousands around the world still live with polio with ever-decreasing access to care and support. Soon after the immediate threat of outbreaks passed, so did support for those whose lives were still bound up with the disease. For others, it became simply a background fact of life—something that happens elsewhere. The polio problem was “solved,” specialized hospitals were closed, fundraising organizations found new causes, and poster children found themselves in an increasingly challenging world. Few medical professionals are trained today in the treatment of the disease. As intimate knowledge of polio and its treatment withered away with time, people living with polio became embodied repositories of lost knowledge.
History tells us public attention is much more easily drawn to new diseases as they emerge rather than sustained over the long haul. Well before AIDS shocked the world into recognizing the devastating potential of novel epidemic diseases, a series of earlier outbreaks had already signaled the presence of emerging infectious agents. When hundreds of members of the American Legion fell ill after their annual meeting in Philadelphia in 1976, the efforts of epidemiologists from the Centers for Disease Control to explain the spread of this mysterious disease and its newly discovered bacterial agent, Legionella, occupied front-page headlines. In the years since, however, as the 1976 incident faded from memory, Legionella infections have become everyday objects of medical care, even though incidence in the U.S. has grown ninefold since 2000, tracing a line of exponential growth that looks a lot like COVID-19’s on a longer time scale. Yet few among us pause in our daily lives to consider whether we are living through the slowly ascending limb of a Legionella epidemic.
Nor do most people living in the United States stop to consider the ravages of tuberculosis as a pandemic, even though an estimated 10 million new cases of tuberculosis were reported around the globe in 2018, and an estimated 1.5 million people died from the disease. The disease seems to only receive attention in relation to newer scourges: in the late twentieth century TB coinfection became a leading cause of death in emerging HIV/AIDS pandemic, while in the past few months TB coinfection has been invoked as a rising cause of mortality in COVID-19 pandemic. Amidst these stories it is easy to miss that on its own, tuberculosis has been and continues to be the leading cause of death worldwide from a single infectious agent. And even though tuberculosis is not an active concern of middle-class Americans, it is still not a thing of the past even in this country. More than 9,000 cases of tuberculosis were reported in the United States in 2018—overwhelmingly affecting racial and ethnic minority populations—but they rarely made the news.
There will be no simple return to the way things were: whatever normal we build will be a new one—whether many of us realize it or not.
While tuberculosis is the target of concerted international disease control efforts, and occasionally eradication efforts, the time course of this affliction has been spread out so long—and so clearly demarcated in space as a problem of “other places”—that it is no longer part of the epidemic imagination of the Global North. And yet history tells a very different story. DNA lineage studies of tuberculosis now show that the spread of tuberculosis in sub-Saharan Africa and Latin America was initiated by European contact and conquest from the fifteenth century through the nineteenth. In the early decades of the twentieth century, tuberculosis epidemics accelerated throughout sub-Saharan Africa, South Asia, and Southeast Asia due to the rapid urbanization and industrialization of European colonies. Although the wave of decolonizations that swept these regions between the 1940s and the 1980s established autonomy and sovereignty for newly post-colonial nations, this movement did not send tuberculosis back to Europe.
These features of the social lives of epidemics—how they live on even when they seem, to some, to have disappeared—show them to be not just natural phenomena but also narrative ones: deeply shaped by the stories we tell about their beginnings, their middles, their ends. At their best, epidemic endings are a form of relief for the mainstream “we” that can pick up the pieces and reconstitute a normal life. At their worst, epidemic endings are a form of collective amnesia, transmuting the disease that remains into merely someone else’s problem.
What are we to conclude from these complex interactions between the social and the biological faces of epidemics, past and present? Like infectious agents on an agar plate, epidemics colonize our social lives and force us to learn to live with them, in some way or another, for the foreseeable future. Just as the postcolonial period continued to be shaped by structures established under colonial rule, so too are our post-pandemic futures indelibly shaped by what we do now. There will be no simple return to the way things were: whatever normal we build will be a new one—whether many of us realize it or not. Like the world of scientific facts after the end of a critical experiment, the world that we find after an the end of an epidemic crisis—whatever we take that to be—looks in many ways like the world that came before, but with new social truths established. How exactly these norms come into being depends a great deal on particular circumstances: current interactions among people, the instruments of social policy as well as medical and public health intervention with which we apply our efforts, and the underlying response of the material which we applied that apparatus against (in this case, the coronavirus strain SARS-CoV-2). While we cannot know now how the present epidemic will end, we can be confident that it in its wake it will leave different conceptions of normal in realms biological and social, national and international, economic and political.
Though we like to think of science as universal and objective, crossing borders and transcending differences, it is in fact deeply contingent upon local practices—including norms that are easily thrown over in an emergency, and established conventions that do not always hold up in situations of urgency. Today we see civic leaders jumping the gun in speaking of access to treatments, antibody screens, and vaccines well in advance of any scientific evidence, while relatively straightforward attempts to estimate the true number of people affected by the disease spark firestorms over the credibility of medical knowledge. Arduous work is often required to achieve scientific consensus, and when the stakes are high—especially when huge numbers of lives are at risk—heterogeneous data give way to highly variable interpretations. As data moves too quickly in some domains and too slowly in others, and sped-up time pressures are placed on all investigations the projected curve of the epidemic is transformed into an elaborate guessing game, in which different states rely on different kinds of scientific claims to sketch out wildly different timetables for ending social restrictions.
The falling action of an epidemic is perhaps best thought of as asymptotic: never disappearing, but rather fading to the point where signal is lost in the noise of the new normal—and even allowed to be forgotten.
These varied endings of the epidemic across local and national settings will only be valid insofar as they are acknowledged as such by others—especially if any reopening of trade and travel is to be achieved. In this sense, the process of establishing a new normal in global commerce will continue to be bound up in practices of international consensus. What the new normal in global health governance will look like, however, is more uncertain than ever. Long accustomed to the role of international scapegoat, the WHO Secretariat seems doomed to be accused either of working beyond its mandate or not acting fast enough. Moreover, it can easily become a target of scapegoating, as the secessionist posturing of Donald Trump demonstrates. Yet the U.S. president’s recent withdrawal from this international body is neither unprecedented nor unsurmountable. Although Trump’s voting base might not wish to be grouped together with the only other global power to secede from the WHO, after the Soviet Union’s 1949 departure from the group it ultimately brought all Eastern Bloc back to task of international health leadership in 1956. Much as the return of the Soviets to the WHO resulted in the global eradication of smallpox—the only human disease so far to have been intentionally eradicated—it is possible that some future return of the United States to the project of global health governance might also result in a more hopeful post-pandemic future.
As the historians at the University of Oslo have recently noted, in epidemic periods “the present moves faster, the past seems further removed, and the future seems completely unpredictable.” How, then, are we to know when epidemics end? How does the act of looking back aid us in determining a way forward? Historians make poor futurologists, but we spend a lot of time thinking about time. And epidemics produce their own kinds of time, in both biological and social domains, disrupting our individual senses of passing days as well as conventions for collective behavior. They carry within them their own tempos and rhythms: the slow initial growth, the explosive upward limb of the outbreak, the slowing of transmission that marks the peak, plateau, and the downward limb. This falling action is perhaps best thought of as asymptotic: rarely disappearing, but rather fading to the point where signal is lost in the noise of the new normal—and even allowed to be forgotten.
We are living in dangerous but also generative transformational times at the confluence of (at least) 3 emergencies:
1) covid 19 pandemic (not to mention other diseases of both humans and nonhumans rampaging through the living world), but also in the midst of powerful emergent practices of collective care and refusal of death-denial and transcendentalism
2) racial capitalism/neofascism run rampant, but also anti-racist & indigenous justice&care movements surging in the context of world wide economic & environmental crises
3) multispecies extermination/extinction/genocide in the web of climate injustice, extractionism, and catastrophe capitalism, but also widespread revulsion at human exceptionalism and growing affirmation of the earth & earthlings of powerful kinds
Science and technology matter in all of these. “Science for the People” has never been more relevant (especially if the “people” are both human and more than human). No more business as usual. These times are more dangerous than ever, but maybe, just maybe, there is a chance for something better. So, the old question for the left, what is to be done?
That’s what I want to talk about. What is it like to live in times of possibilities, when just a year ago many of us thought nothing was possible?