Arquivo da tag: Epidemia

The covid-19 pandemic is worse than official figures show (The Economist)

economist.com

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 SARSCoV-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 SARSCoV-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.

Nouvelle vague

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”

A Supercomputer Analyzed Covid-19 — and an Interesting New Theory Has Emerged (Medium/Elemental)

A closer look at the Bradykinin hypothesis

Thomas Smith, Sept 1, 2020

Original article

3d rendering of multiple coronavirus.
Photo: zhangshuang/Getty Images

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.

The bradykinin hypothesis also accounts for Covid-19’s neurological effects, which are some of the most surprising and concerning elements of the disease. These symptoms (which include dizziness, seizures, delirium, and stroke) are present in as many as half of hospitalized Covid-19 patients. According to Jacobson and his team, MRI studies in France revealed that many Covid-19 patients have evidence of leaky blood vessels in their brains.

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.

Map showing newly emerging and reemerging infectious diseases (Cell)

Look at This Horrible, Horrible Map (Gizmodo)

Ed Cara, August 20, 2020

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.

A map showing newly emerging and reemerging infectious diseases that have recently or could someday pose a serious threat to people’s health. The dots indicate where they were discovered or are most relevant currently.
Image: Anthony Fauci, David Morens/Cell

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.”

68% Have Antibodies in This Clinic. Can Neighborhood Beat a Next Wave? (The New York Times)

nytimes.com

By Joseph Goldstein

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.

Some neighborhoods, like Corona in Queens, were so hard hit during the peak of the coronavirus epidemic that they might now have herd immunity. 
Credit…Victor J. Blue for The New York Times

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.

Many residents of neighborhoods like Elmhurst, in Queens, had to continue working during the peak. 
Credit…Brittainy Newman/The New York Times

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.

More than 56 percent of patients at one clinic in Jackson Heights,  Queens, tested positive for coronavirus antibodies. 
Credit…Juan Arredondo for The New York Times

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.

There are reasons parts of Queens were hit so hard. Homes in Elmhurst and parts of Corona are especially crowded — the highest rate of household crowding in the city, according to census bureau data from 2014. Given that transmission among family members is a leading driver of the disease’s spread, it is unsurprising that crowded households have been associated with higher risk of infection.

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

“Como pesquisadores, precisamos ter a humildade de assumir que nos deparamos com os limites da técnica e da ciência” (Revista Pesquisa Fapesp)

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.”

Coronavírus chega à reserva indígena do Xingu, e Kuarup é cancelado pela 1ª vez (Folha de S.Paulo)

www1.folha.uol.com.br

Lígia Mesquita, 12 de junho de 2020

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.

Em abril, reportagem do caderno especial Sebastião Salgado na Amazônia – Xingu, da Folha, já alertava para a chegada da Covid-19 àquela terra indígena.

“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.

Paraisópolis controla melhor a pandemia do que a cidade de São Paulo (Galileu)

Graças às iniciativas dos moradores da favela, taxa de mortalidade por Covid-19 é menor do que no resto da capital paulista. Em outras regiões pobres, porém, o cenário é diferente

Redação Galileu

25 Jun 2020 – 14h44 Atualizado em 25 Jun 2020 – 14h51

Paraisópolis tem melhor controle da pandemia do que a cidade de São Paulo (Foto: Wikimedia Commons)
Paraisópolis tem melhor controle da pandemia do que a cidade de São Paulo (Foto: Wikimedia Commons)

A favela de Paraisópolis, em São Paulo, tem melhor controle da pandemia de Covid-19 do que outros bairros da capital paulista. Em 18 de maio de 2020, a taxa de mortalidade pelo novo coronavírus na região era de 21,7 pessoas por 100 mil habitantes, enquanto a média municipal era de 56,2. Os números são do Instituto Pólis, organização da sociedade civil que realiza pesquisas no Brasil e no exterior.

“Desde a confirmação dos primeiros casos em São Paulo, logo em março, a associação de moradores de Paraisópolis desenvolveu estratégias para suprir a falta de políticas públicas para a comunidade”, explicam os responsáveis pelo estudo em um relatório publicado em junho.

Logo no início da pandemia, os moradores da favela criaram o sistema de “presidentes de rua”, em que uma pessoa de cada rua ficou responsável por monitorar e ajudar as outras, orientando sobre os sintomas da doença, distribuindo cestas básicas e até combatendo a disseminação de fake news.

Além disso, a comunidade contratou ambulâncias para atender os sintomáticos e recrutou médicos e enfermeiros para suprir a favela 24 horas. Outros 240 moradores foram treinados como socorristas para apoiar as 60 bases de emergência criadas com a presença de bombeiros civis.

Com mais de 70 mil habitantes, a densidade demográfica de Paraisópolis chega a 61 mil hab/km². Tendo isso em vista, a associação de moradores pediu ao governo estadual para utilizar duas escolas públicas como centro de isolamento de pessoas infectadas. A medida possibilitou que os sintomáticos se isolassem de forma eficaz, sem colocar pessoas próximas e familiares em perigo.

Para os pesquisadores, as ações tomadas pelos moradores de Paraisópolis deixam claro que iniciativas de atenção básica à saúde e ações voltadas para garantir a segurança alimentar e outras despesas são essenciais em tempos de pandemia. “A favela, apesar das condições de precariedade e vulnerabilidade, tem sido eficiente em baixar a média de mortalidade do distrito como um todo”, afirma o relatório.

Outras regiões, outra realidade
Enquanto em Paraisópolis a situação parece estar menos preocupante, em outras regiões pobres da capital paulista o cenário não é o mesmo. Um documento divulgado também neste mês pelo Instituto Pólis indica que as áreas com maior situação de precariedade urbana são as mais castigadas pela Covid-19. As mais afetadas são Brasilândia, Sapopemba, Grajaú, Capão Redondo e Jardim Ângela.

Dentre as explicações para isso está a impossibilidade de distanciamento social, tanto pela alta densidade demográfica quanto pelo fato de que os trabalhos exercidos pelos moradores dessas regiões não pemitiram que ficassem em casa. a precariedade do saneamento básico, a baixa renda e a falta de acesso à saúde também contribuem para a realidade preocupante. 

Número de óbitos por Covid-19 a cada 100 mil habitantes nos bairros de São Paulo (Foto: Instituto Pólis)
Número de óbitos por Covid-19 a cada 100 mil habitantes nos bairros de São Paulo (Foto: Instituto Pólis)

Em relação às taxas de óbitos a cada 100 mil habitantes, o mapa de Covid-19 se concentra em outras regiões de São Paulo, nos bairros Pari, Brás, Belém, Campo Belo e Limão. “Por haver mais pessoas morando nas regiões periféricas, o maior número de mortes absoluto pode fazer com que se pense que apenas a periferia está vulnerável”, disse Danielle Klintowitz, do Instituto Pólis, em comunicado. “Mas há de se analisar o contágio em territórios precários mais centrais para que a situação não fuja do controle.”

Volta às aulas após quarentena: veja 10 medidas adotadas em 7 países para a retomada do ensino (G1)

g1.globo.com

G1, 29 de maio de 2020

Alunos do ensino médio voltam à sala de aula em Wuham, província de Hubei, na China, nesta quarta-feira (6). Fonte: AFP.

Após decretarem o afrouxamento do isolamento social para conter a transmissão do novo coronavírus, países que estão voltando às aulas adotam medidas de prevenção para evitar uma nova onda de contaminação.

O G1 analisou a experiência de países como China, Coreia do Sul, Dinamarca, Finlândia, França, Portugal e Israel para saber quais cuidados estão sendo tomados na volta às aulas. No Brasil, as aulas estão suspensas em todos os estados e as escolas seguem fechadas.

Entre as medidas, estão:

  1. desinfecção de escolas
  2. tendas de desinfecção dos alunos na entrada
  3. controle de temperatura
  4. uso de máscaras
  5. lavagem de mãos e instalação de torneiras
  6. grupos menores de alunos
  7. distanciamento
  8. horários diferentes de entrada e saída
  9. arejar a sala
  10. afastar professores do grupo de risco

A reabertura das escolas é um marco no fim do isolamento porque permite que os pais possam voltar ao mercado de trabalho. Apesar dos esforços, ao menos dois dos países analisados voltaram a registrar casos de transmissão de coronavírus: Coreia do Sul e França.

Na Coreia do Sul, mais de 200 escolas foram fechadas nesta sexta-feira (29) dias após reabrirem, devido ao surgimento de novos casos de contaminação. Com isso, Seul adotou novas medidas para evitar a transmissão de casos, como limitar o número de alunos por sala, enquanto os demais ficam em casa, aprendendo por atividades remotas.

Na França, 40 mil escolas foram reabertas no início de maio. Uma semana depois, 70 registraram casos de coronavírus e tiveram que ser fechadas.

As regras de confinamento impostas para conter o avanço da disseminação do novo coronavírus deixaram mais de 1,5 bilhão de crianças e adolescentes fora da escola em 188 países, segundo balanço da Unesco divulgado em abril.

Desinfecção de escolas

20 de maio – trabalhador desinfeta escola em Parque Ivory, na África do Sul. — Foto: Siphiwe Sibeko/Reuters

Medidas extras de limpeza são uma recomendação comum. Em diversas partes do mundo, a desinfecção das escolas ocorre antes dos alunos chegarem e durante a permanência deles.

Em Portugal, 17 mil litros de desinfetantes e outros equipamentos de proteção e higiene foram distribuídos para centros educacionais.

Na França, as orientações do Ministério da Educação contêm inclusive quais produtos a serem utilizados para desinfecção das escolas e a frequência da higienização: o chão deve ser limpo uma vez por dia enquanto maçanetas, sanitários e interruptores devem ser higienizados várias vezes.

Tenda de desinfecção dos alunos

China tem volta às aulas do ensino médio com medidas de segurança e medo do coronavírus. — Foto: GREG BAKER / AFP

Na China, escolas instalaram tendas de desinfecção por onde os estudantes precisam passar antes de entrarem na escola.

Controle de temperatura

Termômetro usado para medir a temperatura das pessoas e fazer controle da Covid-19.. — Foto: Steve Parsons / Pool / AFP

O controle da temperatura para detectar se o aluno está com febre, um dos mais comuns sintomas da Covid-19, é uma preocupação em vários países.

Em Pequim,pulseiras inteligentes, que fazem essa medição em tempo real, estão sendo testadas. Os pais monitoram a situação por meio de um aplicativo. Caso a temperatura passe de 37ºC, um alerta é enviado para os professores, que são orientados a alertar a polícia.

Uso de máscara

China retoma aulas do ensino médio em Pequim e Xangai nesta segunda-feira (27). — Foto: GREG BAKER / AFP

O uso de máscaras em geral também é recomendado, mas os critérios variam de país para país.

Na China, as crianças utilizam máscaras o tempo todo, inclusive dentro da sala de aula.

Coronavírus na educação: na França, professora leciona com máscara nesta segunda-feira (18). — Foto: Sebastien Bozon/AFP

Em Israel, as crianças da 4ª série em diante tem que usar essa proteção. Na França, as crianças menores também estão dispensadas. No entanto, a escola deve ter máscaras à disposição dos alunos caso eles apresentem sintomas durante as aulas e estejam aguardando para serem retirados.

Uma exceção é a Dinamarca, país onde não existe a recomendação para utilização de máscaras em ambientes públicos.

Lavagem de mãos e instalação de torneiras

Crianças lavam as mãos na escola Gudenåskolen, na Dinamarca — Foto: Lone Mathiesen/ Divulgação/ Embaixada da Dinamarca no Brasil

O incentivo à higiene e lavagem de mãos está sendo constante nas escolas que voltam às aulas.

Na Dinamarca, as escolas chegaram a instalar torneiras fora dos edifícios para que as crianças lavem as mãos quando chegam à escola.

Em Portugal, é obrigatório a lavagem das mãos ao entrar e sair da escola. Na Coreia do Sul, os estudantes receberam material desinfetante para higienizar as mãos.

Grupos menores de alunos

18 de maio de 2020 – Alunos usam máscara em sala de aula no colégio D. Pedro V, em Lisboa, no dia em que parte dos estudantes volta a ter aula em meio à pandemia do novo coronavírus (COVID-19) em Portugal — Foto: Rafael Marchante/Reuters

Alguns países adotaram a medida de dividir os estudantes em grupos menores para evitar contatos mais próximos entre eles, como na Finlândia.

Na Dinamarca, as turmas, que têm entre 20 e 28 alunos, foram divididas para que os alunos possam interagir apenas dentro desse espectro menor.

Em Seul, na Coreia do Sul, os jardins de infância e escolas do ensino básico, fundamental e médio poderão receber apenas um aluno a cada três e os demais terão que seguir com o ensino a distância.

Distanciamento

15 de maio – Estudantes conversam enquanto praticam o distanciamento social no pátio de uma escola secundária durante sua reabertura em Bruxelas, na Bélgica, durante o surto do coronavírus (COVID-19) — Foto: Yves Herman/Reuters

Em geral, as salas de aula foram reorganizadas de maneira que as mesas dos alunos fiquem a pelo menos um metro de distância entre elas. A recomendação é feita pelo governos da França, Dinamarca. Em Israel, essa distância é de dois metros.

Na Dinamarca, além da distância de um metro entre as mesas dos alunos, o professor deve ficar a dois metros do estudante que senta mais próximo dele.

Alguns países adotam inclusive paredes acrílicas para evitar que gotículas da fala sejam trocadas entre os estudantes e entre estudantes e professores, como é o caso da Coreia do Sul.

Alunos retomam aulas na Coreia do Sul; em algumas escolas, carteiras têm divisórias — Foto: Yonhap / AFP Photo

Para estudantes menores, mantê-los afastados é um desafio. Uma solução lúdica, feita com asas de papelão, foi adotada na província de Shanxi, na China, para lembrá-los a distância que precisam ficar uns dos outros.

Alunos do ensino fundamental usam asas para manter o distanciamento na sala de aula em Taiyuan, na província de Shanxi, no norte da China. Foto tirada em 20 de maio de 2020 — Foto: AFP

Horários diferentes de entrada e saída

Em Portugal, alunos estão sendo organizados em grupos que terão horários de aula, intervalos e períodos de alimentação diferentes entre si, para minimizar o contato.

A mesma medida foi adotada pelos governo da Finlândia e Israel, que determinaram o estabelecimento de horários diferentes para intervalos, entrada e saída para evitar aglomeração.

Na Dinamarca, além dos horários variados, novos portões estão sendo utilizados para que a entrada e saída dos grupos não coincidam. Os pais também são orientados a se despedir dos filhos fora da escola e devem pedir permissão, caso necessitem entrar no estabelecimento.

Arejar a sala

Na França, as escolas são orientadas a manter as janelas abertas antes das aulas, durante o intervalo e depois da partida dos alunos.

Afastamento de professores do grupo de risco

27 de abril – Médicos de um hospital coletam amostras de professores do ensino médio para testes em uma escola após o surto da doença por coronavírus em Yichang, província de Hubei, na China — Foto: China Daily via Reuters

Em Israel, professoras com mais de 65 anos não retomaram as atividades. A medida é para evitar que eles fiquem expostos à uma possível nova onda de circulação do coronavírus.

Brazil coronavirus deaths could surpass 125,000 by August, U.S. study says (Reuters)

May 26, 2020 / 1:21 PM

Gravediggers work during a mass burial of people who passed away due to the coronavirus disease (COVID-19), at the Parque Taruma cemetery in Manaus, Brazil, May 26, 2020. Picture taken with a drone. REUTERS/Bruno Kelly

BRASILIA (Reuters) – As Brazil’s daily COVID-19 death rate climbs to the highest in the world, a University of Washington study is warning its total death toll could climb five-fold to 125,000 by early August, adding to fears it has become a new hot spot in the pandemic.

The forecast from the University of Washington’s Institute for Health Metrics and Evaluation (IHME), released as Brazil’s daily death toll climbed past that of the United States on Monday, came with a call for lockdowns that Brazil’s president has resisted.

“Brazil must follow the lead of Wuhan, China, as well as Italy, Spain, and New York by enforcing mandates and measures to gain control of a fast-moving epidemic and reduce transmission of the coronavirus,” wrote IHME Director Dr. Christopher Murray.

Without such measures, the institute’s model shows Brazil’s daily death toll could keep climbing to until mid-July, driving shortages of critical hospital resources in Brazil, he said in a statement accompanying the findings.

On Monday, Brazil’s coronavirus deaths reported in the last 24 hours were higher than fatalities in the United States for the first time, according to the health ministry. Brazil registered 807 deaths and 620 died in the United States.

The U.S. government on Monday brought forward to Tuesday midnight enforcement of restrictions on travel to the United States from Brazil as the South American country reported the highest death toll in the world for that day.

Washington’s ban applies to foreigners traveling to the United States if they had been in Brazil in the last two weeks. Two days earlier, Brazil overtook Russia as the world’s No. 2 coronavirus hot spot in number of confirmed cases, after the United States.

Murray said the IHME forecast captures the effects of social distancing mandates, mobility trends and testing capacity, so projections could shift along with policy changes.

The model will be updated regularly as new data is released on cases, hospitalizations, deaths, testing and mobility.

Reporting by Anthony Boadle; Editing by Brad Haynes and Steve Orlofsky

The religious roots of Trump’s magical thinking on coronavirus (CNN)

Analysis by Daniel Burke, CNN Religion Editor

Updated 1424 GMT (2224 HKT) May 21, 2020

(CNN) As the novel coronavirus has spread across the globe, President Trump has repeated one phrase like a mantra: It will go away.

Since February Trump has said the virus will “go away” at least 15 times, most recently on May 15.

“It’s going to disappear one day,” he said on February 27. “It’s like a miracle.”

Invoking a miracle is an understandable response during a pandemic, but to some, the President’s insistence that the coronavirus will simply vanish sounds dangerously like magical thinking — the popular but baffling idea that we can mold the world to our liking, reality be damned.

The coronavirus, despite Trump’s predictions, has not disappeared. It has spread rapidly, killing more than 90,000 Americans.

In that light, Trump’s response to the pandemic, his fulsome self-praise and downplaying of mass death seems contrary to reality. But long ago, his biographers say, Trump learned how to craft his own version of reality, a lesson he learned in an unlikely place: a church.

It’s called the “power of positive thinking,” and Trump heard it from the master himself: the Rev. Norman Vincent Peale, a Manhattan pastor who became a self-help juggernaut, the Joel Osteen of the 1950s.

“He thought I was his greatest student of all time,” Trump has said.

Undoubtedly, the power of positive thinking has taken Trump a long way — through multiple business failures to the most powerful office in the world.

Trump has repeatedly credited Peale — who died in 1993 — and positive thinking with helping him through rough patches.

Norman Vincent Peale wrote the bestselling 1952 self-help book, "The Power of Positive Thinking." It sold millions of copies.

Norman Vincent Peale wrote the bestselling 1952 self-help book, “The Power of Positive Thinking.” It sold millions of copies.

“I refused to be sucked into negative thinking on any level, even when the indications weren’t great,” Trump said of the early 1990s, when his casinos were tanking and he owed creditors billions of dollars.

But during a global public health crisis there can be a negative side to positive thinking.

“Trump pretending that this pandemic will just go away is not just an unacceptable fantasy,” said Christopher Lane, author of “Surge of Piety: Norman Vincent Peale and the Remaking of American Religious Life.”

“It is in the realm of dangerous delusion.”

Trump says Peale has made him feel better about himself

Though they were professed Presbyterians, it’s more accurate to call Trump’s family Peale-ites.

On Sundays, Trump’s businessman father drove the family from Queens to Peale’s pulpit at Marble Collegiate Church in Manhattan.

The centuries-old edifice was, and remains, the closest thing Trump has to a family church. Funerals for both of his parents were held there, and Peale presided over Trump’s marriage to Ivana at Marble Collegiate in 1977. Two of his siblings were also married in the sanctuary.

The draw, Trump’s biographers say, was Peale, who elevated businessmen like the Trumps to saint-like status as crusaders of American capitalism.

Known as “God’s Salesman,” Peale wrote many self-help books, including “The Power of Positive Thinking,” that sold millions of copies.

From left to right, Donald Trump, Ivana Trump, Ruth Peale and Dr. Norman V. Peale at Peale's 90th birthday party in 1988.

From left to right, Donald Trump, Ivana Trump, Ruth Peale and Dr. Norman V. Peale at Peale’s 90th birthday party in 1988.

Peale drew throngs of followers, but also sharp criticism from Christians who accused him of cherry-picking Bible verses and peddling simplistic solutions.

But the young Donald Trump was hooked.

“He would instill a very positive feeling about God that also made me feel positive about myself,” Trump writes in “Great Again,” one of his books. “I would literally leave that church feeling like I could listen to another three sermons.”

Peale peppered his sermons with pop psychology. Sin and guilt were jettisoned in favor of “spirit-lifters,” “energy-producing thoughts” and “7 simple steps” to happy living.

“Attitudes are more important than facts,” Peale preached, a virtual prophecy of our post-truth age.”Formulate and stamp indelibly on your mind a mental picture of yourself as succeeding,” Peale writes in “The Power of Positive Thinking.”

“Hold this picture tenaciously. Never permit it to fade.”

Peale has also influenced Trump’s spiritual advisers

To this day, Trump surrounds himself with Peale-like figures, particularly prosperity gospel preachers.

One of his closest spiritual confidantes, Florida pastor Paula White, leads the White House’s faith-based office and is a spiritual descendent of Peale’s positive thinking — with a Pentecostal twist.

White, a televangelist, belongs to the Word of Faith movement, which teaches that God bestows health and wealth on true believers.

In a Rose Garden ceremony for the National Day of Prayer earlier this month, White quoted from the Bible’s Book of Job: “If you decree and declare a thing, it will be established.”

“I declare no more delays to the deliverance of Covid-19,” White continued. “No more delays to healing and a vaccination.”

Paula White, a televangelist and religious adviser to President Trump.

Paula White, a televangelist and religious adviser to President Trump.

The Book of Job, a parable of human suffering and powerlessness, may be a strange book for a preacher to cite while “declaring” an end to the pandemic. If it were so easy, Job’s story would involve fewer boils and tortures.

But in a way, White perfectly captures the problem with positive thinking: It tries to twist every situation into a “victory,” even when reality demonstrates otherwise.

“Positive thinking can help people focus on goals and affirm one’s merits,” said Lane, author of the book on Peale. “But it does need a reality check, and to be based in fact.

“Sometimes, the reality is that you’ve failed and need to change course. But to Peale, that wasn’t an option. Even self-doubt was a sin, he taught, an affront to God.

“He had a huge problem with failure,” Lane said. “He would berate people for even talking about it.”

Peale’s teachings can explain why Trump won’t accept criticism

You can hear echoes of Peale’s no-fail philosophy in Trump’s angry response to reporters’ questions about his handling of the coronavirus pandemic, said Trump biographer Michael D’Antonio.

“Nothing is an exchange of ideas or discussion of facts,” D’Antonio said. “Everything is a life or death struggle for the definition of reality. For him, being wrong feels like being obliterated.”

President Donald Trump answers questions with members of the White House Coronavirus Task Force on April 3, 2020 in Washington.

President Donald Trump answers questions with members of the White House Coronavirus Task Force on April 3, 2020 in Washington.

And that’s one reason why the President refuses to accept any criticism or admit to any failure. To do so would puncture his bubble of positivity, not to mention his self-image.

So, despite his administration’s early missteps in preparing for and responding to the coronavirus, Trump won’t acknowledge any errors.

Instead, he has misled the public, claiming in February that the situation was “under control” when it was not; promising a vaccine is coming “very soon,” which it is not; and falsely insisting that “anyone can get tested,” when they could not and many still cannot.

Still, when asked in mid-March to grade his administration’s response, Trump gave himself a perfect score.

“I’d rate it a 10,” he said. “I think we’ve done a great job.”

Trump’s self-appraisal might not match reality. But Peale would be proud.

Qual o tamanho da pandemia do novo coronavírus? (Estadão)

estadao.com.br

Com mais de 300 mil mortes confirmadas no mundo, espalhadas por todos os continentes, a covid-19 já é mais letal que desastres naturais, atentados terroristas e guerras

Renato Vasconcelos e Paulo Beraldo

15 de maio de 2020 | 05h00

Apandemia do novo coronavírus já tem envergadura de desastre. Com mais de 300 mil mortes confirmadas até esta quinta-feira, 14, a covid-19 já matou mais pessoas do que guerras, desastres naturais e atentados terroristas que marcaram a história. Apesar da letalidade da doença, uma grande quantidade de pessoas, incluindo líderes mundiais, continuam a minimizar ou negar a pandemia – que continua a fazer vítimas diárias em todos os continentes.

Para o professor de história da Universidade Federal de Santa Maria (UFSM), João Malaia, o quanto um evento trágico impressiona alguém depende de fatores como a duração, a proximidade de quem morre e a distância física do fenômeno em si. “Muitas mortes em um período curto também tendem a impressionar mais. No caso de uma pandemia, as mortes diárias vão diluindo o sentimento da tragédia, a não ser para aqueles que perdem pessoas próximas”, explica o pesquisador, que coordena um projeto de pesquisa sobre a gripe espanhola no Brasil, o ‘Mais História, por favor!’.

Segundo Malaia, a normalização da morte nos discursos de autoridades como o presidente da República acaba reforçando o sentimento de conformação de parte da população. Olhando para o passado, vê semelhanças na forma como o Brasil lidou com a gripe espanhola. “O governo brasileiro foi muito criticado na época por setores da imprensa por demorar a tomar medidas, principalmente no Rio de Janeiro, então capital federal, quando já se sabia dos casos”, diz.

Imagem aérea mostra o dano causado pelo tsunami na cidade turística de Phuket, na Tailândia, em 26 de dezembro de 2004Reuters

O número de mortes pelo mundo já ultrapassou qualquer desastre natural da história recente. O tsunami de 2004, que varreu países banhados pelo Oceano Índico e considerado o mais mortal da história, vitimou cerca de 230 mil pessoas. O cenário não é muito diferente se observados os contextos regionais e nacionais.


MAIS BAIXAS QUE OS CIVIS DO IRAQUE

Soldado americano observa a derrubada da estátua de Saddam Hussein no centro de Bagdá, em 9 de abril de 2003Goran Tomasevic/Reuters

Na Europa, continente com mais mortos até o momento, somados os quatro países mais afetados pela pandemia – Reino Unido, Itália, França e Espanha – o número de vítimas é maior do que o total de civis mortos nos últimos dez anos da Guerra do Iraque (2009-2019).


EUA

PIOR QUE O VIETNÃ

Corpos de soldados americanos mortos na Batalha do vale Ia Drang, primeira grande derrota do país no Vietnã, em 15 de novembro de 1965Neil Sheehan/The New York Times

Nos Estados Unidos, o número de vítimas do novo coronavírus entre fevereiro e maio – menos de 120 dias – já é maior do que o de militares americanos mortos na Guerra do Vietña (58 mil), que durou 20 anos.

QUASE 30 VEZES O 11 DE SETEMBRO

Equipe de resgate retira homem de uma das torres do World Trade Center, em Nova York, logo após o atentado de 11 de setembro de 2001Shannon Stapleton/Reuters

Seriam necessários mais de 28 atentados iguais aos de 11 de setembro de 2001, que destruiu as torres gêmeas do World Trade Center, para igualar o número de mortos pela covid-19 nos EUA. Já o Estado de Nova York, palco da catástrofe, precisaria presenciar mais de 9 atentados para igualar o número de mortos pela pandemia.


MAIS DE 100 GUERRAS

Parentes de soldados argentinos mortos na Guerra das Malvinas visitam cemitério na ilha pela primeira vez, em 19 de março de 1991Reuters

O Reino Unido, que tomou o posto da Itália de país mais afetado pela pandemia no continente, teria que lutar mais de 130 Guerras das Malvinas para ter o mesmo número de baixas provocadas pelo coronavírus. Se contarmos o número total de mortos na guerra (britânicos e argentinos), seriam necessários mais de 36 conflitos idênticos ao disputado no Atlântico sul.


CUSTO MAIOR QUE A INDEPENDÊNCIA

Quadro retrata a Batalha de San MartinoLuigi Norfini

A Segunda Guerra de Independência da Itália, iniciada em 1859, foi o último episódio no processo de unificação do país. Estima-se que mais de 12 mil vidas foram perdidas durante o conflito, o que equivale a menos da metade das vítimas da pandemia.


1500 ANOS DE TERRORISMO

Mascarados, guerrilheiros do ETA leem anúncio ao vivo na televisão espanhola em 18 de fevereiro de 2004Vincent West/Reuters

Na Espanha, as vítimas da covid-19 somam um número 30 vezes maior do que os mortos em atentados promovidos pela Pátria Basca e Liberdade (ETA). Em 50 anos de atividade, as ações do grupo terrorista vitimaram 584 pessoas. Caso ainda existisse e mantivesse a mesma média de letalidade, o ETA só conseguiria igualar o número de mortes provocadas pela pandemia em 1.586 anos de terrorismo.


ATENTADOS DO ISIS EM PARIS

Brigadistas prestam socorro a feridos perto da boate Bataclan, em 13 de novembro de 2015Christian Hartmann/Reuters

Comparativamente, os mortos pela covid-19 na França correspondem a, aproximadamente, 300 ataques terroristas iguais ao que ocorreu na boate Bataclan, em 25 de novembro de 2015, quando o grupo jihadista Estado Islâmico (ISIS) fez um de seus mais famosos atentados até então.


BRASIL E SÃO PAULO

No caso brasileiro, os mais de 13 mil mortos fazem desastres como o de Brumadinho ficarem pequenos. Teriam que ter ocorrido 52 acidentes iguais ao da cidade mineira para alcançar a mortalidade. O mesmo pode ser dito do massacre do Carandiru. Seriam precisas 122 chacinas para que o número de mortos se igualasse ao do país. Já São Paulo teria que lutar quatro Revoluções Constitucionalistas para igualar as baixas.

REVOLUÇÃO CONSTITUCIONALISTA DE 1932

Soldados paulistas combateram, com armamento precário, as poderosas colunas inimigas. Reprodução feita no dia 02 de junho de 2013, dos originais publicados pelo jornal ‘O Estado de S. Paulo’ durante a cobertura da Revolução Constitucionalista de 1932ARQUIVO/AE
Os corpos dos detentos mortos há dois dias são acondicionados de salas e corredores do IML (Instituto Médico Legal)EPITÁCIO PESSOA/ESTADÃO
Helicóptero do Corpo de Bombeiros  e agentes da defesa civil trabalham no resgate dos corpos das vítimas encontrados em um ônibus de funcionários da VALE na região onde ficavam os escritórios da empresa em BrumadinhoWILTON JUNIOR/ ESTADÃO

REVOLUÇÃO TEOCRÁTICA DO IRÃ

Apoiadores do aiatolá Khomeini mostra sua imagem em Teerã, no Irã, durante a revolução islâmica de 1979REUTERS

Na Ásia, onde a pandemia começou, a mortalidade também alcançou níveis históricos. O número de mortos no Irã é duas vezes superior ao número de mortos da Revolução Teocrática que mudou o regime do país em 1979.


EXÉRCITO DE TERRACOTA

Imagem de parte do Exército de Soldados de Terracota de Xian, na ChinaLudovic Marin/ AFP

Na China, o número de mortos sepultados no país já é o equivalente a metade das estátuas do Exército de Terracota, enterradas no túmulo do imperador Qin Shi Huang.


Expediente

Editor executivo multimídia Fabio Sales / Editora de infografia multimídia Regina Elisabeth Silva / Editores assistentes multimídia Adriano Araujo, Carlos Marin, Glauco Lara e William Marioto / Editor de Internacional Cristiano Dias / Reportagem Renato Vasconcelos, Rodrigo Turrer e Paulo Beraldo / Edição de fotografia Sérgio Neves / Foto da capa Juan Carlos Ulate/Reuters / SEO Brenda Zacharias / Designer multimídia Lucas Almeida

A pandemia incide no ano mais importante da história da humanidade. Serão as próximas zoonoses gestadas no Brasil? (UNICAMP)

05, mai – 2020 | 14:02 Ciência, saúde e sociedade: Covid-19

Luiz Marques

Edição de imagem: Renan Garcia

O ano de 2020 será lembrado como o ano em que a pandemia causada pelo vírus SARS-CoV-2 precipitou uma ruptura maior no funcionamento das sociedades contemporâneas. Será provavelmente lembrado também como o momento de uma ruptura da qual nossas sociedades não mais se recuperaram completamente. Isso porque a atual pandemia intervém num momento em que três crises estruturais na relação entre as sociedades hegemônicas contemporâneas e o sistema Terra se reforçam reciprocamente, convergindo em direção a uma regressão econômica global, ainda que com eventuais surtos conjunturais de recuperação. Essas três crises são, como reiterado pela ciência, a emergência climática, a aniquilação em curso da biodiversidade e o adoecimento coletivo dos organismos, intoxicados pela indústria química.i Os impactos cada vez mais avassaladores decorrentes da sinergia entre essas três crises sistêmicas deixarão doravante as sociedades, mesmo as mais ricas, ainda mais desiguais e mais vulneráveis, menos aptas, portanto, a recuperar seu desempenho anterior. São justamente tais perdas parciais, cada vez mais frequentes, de funcionalidade na relação das sociedades com o meio ambiente que caracterizam essencialmente o processo de colapso socioambiental em curso (Homer-Dixon et al. 2015; Steffen et al. 2018; Marques 2015/2018 e 2020).

  1. O ano da pandemia é o do mais crucial ponto de inflexão da história humana

Por sua extensão global e pelo rastro de mortes deixadas em sua passagem, superior a 250 mil vítimas (oficialmente notificadas) em pouco mais de quatro meses, a atual pandemia é um fato cuja gravidade seria difícil exagerar, tanto mais porque novos surtos podem ainda ocorrer nos próximos dois anos, segundo um relatório do Center for Infectious Disease Research and Policy (CIDRAP), da Universidade de Minnesota (Moore, Lipsitch, Barry & Osterholm 2020).

Mas ainda mais grave que o saldo imenso de mortes, é o momento da incidência da pandemia na história humana. Outras pandemias, algumas muito mais letais, ocorreram no século XX, sem afetar profundamente a capacidade de recuperação das sociedades. O que singulariza a atual pandemia é o fato de se somar a diversas crises sistêmicas que ameaçam a humanidade, e isso justamente no momento em que não é mais possível postergar decisões que afetarão crucialmente, e muito em breve, a habitabilidade do planeta. A ciência condiciona a possibilidade de estabilizar o aquecimento médio global dentro, ou não muito além, dos limites almejados pelo Acordo de Paris a um fato incontornável: as emissões de CO2 devem atingir seu pico em 2020 e começar a declinar fortemente em seguida. O IPCC traçou 196 cenários através dos quais podemos limitar o aquecimento médio global a cerca de 0,5oC acima do aquecimento médio atual em relação ao período pré-industrial (1,2oC em 2019). Nenhum deles, lembram Tom Rivett-Carnac e Christiana Figueres, admite que o pico de emissões de gases de efeito estufa (GEE) seja protelado para além de 2020 (Hooper 2020). Ninguém exprime o significado dessa data-limite de modo mais peremptório que Thomas Stocker, co-diretor do IPCC entre 2008 e 2015:ii

“Mitigação retardada ou insuficiente impossibilita limitar o aquecimento global permanentemente. O ano de 2020 é crucial para a definição das ambições globais sobre a redução das emissões. Se as emissões de CO2 continuarem a aumentar além dessa data, as metas mais ambiciosas de mitigação tornar-se-ão inatingíveis”.

Já em 2017, Jean Jouzel, ex-vice-presidente do IPCC, advertia que “para manter alguma chance de permanecer abaixo dos 2oC é necessário que o pico das emissões seja atingido no mais tardar em 2020” (Le Hir 2017). Em outubro do ano seguinte, comentando o lançamento do relatório especial do IPCC, intitulado Global Warming 1.5oC, Debra Roberts, co-diretora do Grupo de Trabalho 2 desse relatório, reforçava essa percepção: “Os próximos poucos anos serão provavelmente os mais importantes de nossa história”. E Amjad Abdulla, representante dos Pequenos Estados Insulares em Desenvolvimento (SIDS) nas negociações climáticas, acrescentava: “Não tenho dúvidas de que os historiadores olharão retrospectivamente para esses resultados [do relatório especial do IPCC de 2018] como um dos momentos definidores no curso da história humana” (Mathiesen & Sauer 2018). Em The Second Warning: A Documentary Film (2018), divulgação do manifesto The Scientist’s Warning to Humanity: A Second Notice, lançado por William Ripple e colegas em 2017 e endossado por cerca de 20 mil cientistas, a filósofa Kathleen Dean Moore faz suas as declarações acima mencionadas: “Estamos vivendo um ponto de inflexão. Os próximos poucos anos serão os mais importantes da história da humanidade”.

Em abril de 2017, um grupo de cientistas, coordenados por Stephan Rahmstorf, lançava The Climate Turning Point, em cujo Prefácio se reafirma a meta mais ambiciosa do Acordo de Paris (“manter o aumento da temperatura média global bem abaixo de 2oC em relação ao período pré-industrial”), esclarecendo que: “essa meta é considerada necessária para evitar riscos incalculáveis à humanidade, e é factível – mas, realisticamente, apenas se as emissões globais atingirem um pico até o ano de 2020, no mais tardar”. Esse documento norteou então a criação, por diversas lideranças científicas e diplomáticas, da Missão 2020 (https://mission2020.global/). Ela definia metas básicas em energia, transporte, uso da terra, indústria, infraestrutura e finanças, de modo a tornar declinante, a partir de 2020, a curva das emissões de gases de efeito estufa e colocar o planeta numa trajetória consistente com o Acordo de Paris. “Com radical colaboração e teimoso otimismo”, escreve Christiana Figueres e colegas da Missão 2020, “dobraremos a curva das emissões de gases de efeito estufa até 2020, possibilitando à humanidade florescer.” De seu lado, António Guterres, cumprindo sua missão de incentivar e coordenar os esforços de governança global, alertava em setembro de 2018: “Se não mudarmos nossa rota até 2020, corremos o risco de deixar passar o momento em que é ainda possível evitar uma mudança climática desenfreada (a runaway climate change), com consequências desastrosas para a humanidade e para os sistemas naturais que nos sustentam”.

Pois bem, 2020, enfim, chegou. Fazendo em 2019 um balanço dos progressos realizados em direção às metas da Missão 2020, o World Resources Institute (Ge et al., 2019) escreve que “na maioria dos casos, a ação foi insuficiente ou o progresso foi nulo” (in most cases action is insufficient or progress is off track). Nenhuma das metas, em suma, foi alcançada e, em dezembro passado, a COP25 em Madri varreu definitivamente, em grande parte por culpa dos governos dos EUA, Japão, Austrália e Brasil (Irfan 2019), as últimas esperanças de uma diminuição iminente das emissões globais de GEE.

  1. A pandemia entra em cena

Mas eis que a Covid-19 irrompe, deslocando, paralisando e adiando tudo, inclusive a COP26. E em pouco mais de três meses resolveu pelo caos e pelo sofrimento o que mais de três décadas de fatos, de ciência, de campanhas e de esforços diplomáticos para diminuir as emissões de GEE mostraram-se incapazes de realizar (já a Conferência de Toronto, de 1988, recomendava “ações específicas” nesse sentido). Ao invés de um decrescimento econômico racional, gradual e democraticamente planejado, o decrescimento econômico abrupto imposto pela pandemia afigura-se já, segundo Kenneth S. Rogoff, como “a mais profunda queda da economia global em 100 anos” (Goodman 2020). Em 15 de abril, o Carbon Brief estimou que a crise econômica deve provocar uma diminuição estimada em cerca de 5,5% nas emissões globais de CO2 em 2020. Em 30 de abril, a Global Energy Review 2020 – The impacts of the Covid-19 crisis on global energy demand and CO2 emissions, da Agência Internacional de Energia (AIE), vai mais longe e estima que “as emissões globais de CO2 devem cair ainda mais rapidamente ao longo dos nove meses restantes do ano, atingindo 30,6 Gt [bilhões de toneladas] em 2020, quase 8% mais baixas que em 2019. Este seria o nível mais baixo desde 2010. Tal redução seria a maior de todos os tempos, seis vezes maior que a redução precedente de 0,4 Gt em 2009, devido à crise financeira e duas vezes maior que todas as reduções anteriores desde o fim da Segunda Guerra Mundial”. (https://www.iea.org/reports/global-energy-review-2020/global-energy-and-co2-emissions-in-2020). A Figura 1 indica como essa redução das emissões globais de CO2 reflete a queda na demanda de consumo global de energia primária, comparada com as quedas anteriores.

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Figura 1 – Taxas de mudança (%) na demanda global de energia primária, 1900 – 2020

Fonte: AIE, Global Energy Review 2020 The impacts of the Covid-19 crisis on global energy demand and CO emissions, Abril 2020, p. 11

A redução das emissões globais de CO2 projetada pela AIE para 2020 equivale ou é até pouco maior que os 7,6% de redução anual até 2030 que o IPCC considera imprescindível para conter o aquecimento aquém de níveis catastróficos (Evans 2020). O relatório da AIE apressa-se, contudo, em advertir que, “tal como nas crises precedentes, (…) o repique das emissões pode ser maior que o declínio, a menos que a onda de investimentos para retomar a economia seja dirigido a uma infraestrutura energética mais limpa e resiliente”. Salvo raras exceções, os fatos até agora não autorizam a expectativa de uma ruptura com os paradigmas energéticos e socioeconômicos anteriores. Malgrado o colapso do preço do petróleo, ou justamente por isso, as petroleiras estão se movendo com vertiginosa velocidade para tirar partido desse momento, obtendo, por exemplo, investimentos de USD 1,1 bilhão para financiar a conclusão do famigerado oleoduto Keystone XL, que ligará o petróleo canadense ao Golfo do México (McKibben 2020). Os exemplos desse tipo de oportunismo são inúmeros, inclusive no Brasil, onde os ruralistas se aproveitam da situação para fazer aprovar da Medida Provisória 910, que anistia a grilagem e eleva ainda mais as ameaças aos indígenas. Como bem afirma Laurent Joffrin, em sua Lettre politique de 30 de abril para o jornal Libération (Le monde d’avant, en pire?), o mundo pós-pandemia “corre o risco de parecer furiosamente, a curto prazo ao menos, com o mundo de antes, mas em versão piorada”. E Joffrin emenda: “o ‘mundo de após’ não mudará sozinho. Como para o ‘mundo de antes’, seu futuro dependerá de um combate político, paciente e árduo”. Político e árduo, sem dúvida, mas definitivamente não há mais tempo para paciência.

De qualquer modo, uma redução de quase 8% nas emissões globais de CO2 num ano apenas não abriu sequer um dente na curva cumulativa das concentrações atmosféricas desse gás, medidas em Mauna Loa (Havaí). Elas bateram mais um recorde em abril de 2020, atingindo 416,76 partes por milhão (ppm), 3,13 ppm acima de 2019, um dos maiores saltos desde o início de suas mensurações em 1958. Não se trata apenas de um número a mais na selva de indicadores climáticos convergentes. É o número decisivo. Como lembra Petteri Taalas, Secretário-Geral da Organização Meteorológica Mundial: “A última vez que a Terra apresentou concentrações atmosféricas de CO2 comparáveis às atuais foi há 3 a 5 milhões de anos. Nessa época, a temperatura estava 2oC a 3oC [acima do período pré-industrial] e o nível do mar estava 10 a 20 metros mais alto que hoje” (McGrath 2019). Faltam agora menos de 35 ppm para atingir 450 ppm, um nível de concentração atmosférica de CO2 largamente associado a um aquecimento médio global de 2oC acima do período pré-industrial, nível que pode ser atingido, mantida a trajetória atual, em pouco mais de 10 anos. O que nos aguarda por volta de 2030, mantida a engrenagem do sistema econômico capitalista globalizado e existencialmente dependente de sua própria reprodução ampliada, é nada menos que um desastre para a humanidade como um todo, bem como para inúmeras outras espécies. A palavra desastre não é uma hipérbole. O já mencionado Relatório do IPCC de 2018 (Global Warming 1.5oC) projeta que o mundo a 2oC em média acima do período pré-industrial terá quase 6 bilhões de pessoas expostas a ondas de calor extremo e mais de 3,5 bilhões de pessoas sujeitas à escassez hídrica, entre outras muitas adversidades. Desastre é a palavra que melhor define o mundo para o qual rumamos no horizonte dos próximos 10 anos (ou 20, pouco importa), e é exatamente o vocábulo empregado por Sir Brian Hoskins, diretor do Grantham Institute for Climate Change, do Imperial College em Londres: “Não temos evidência de que um aquecimento de 1,9oC é algo com que se possa lidar facilmente, e 2,1oC é um desastre” (Simms 2017).

Em consequência dessas altíssimas concentrações atmosféricas de CO2, o ano passado já foi o mais quente dos registros históricos na Europa (1,2oC acima do período 1981 – 2010!) e, mesmo sem El Niño, há agora, segundo o NOAA, 74,67% de chances de que 2020 venha a ser o ano mais quente em um século e meio de registros históricos na média global,iii batendo o recorde precedente de 2016 (1,24oC acima do período pré-industrial, segundo a NASA). Não é no espaço deste artigo que se podem elencar os muitos indícios de que 2020 será o primeiro ou segundo (após 2016) ano mais quente entre os sete mais quentes (2014-2020) da história da civilização humana desde a última deglaciação, cerca de 11.700 anos antes do presente. Baste aqui ter em mente que, se março de 2020 for representativo do ano, já perdemos a meta mais ambiciosa do Acordo de Paris, pois a temperatura média desse mês cravou globalmente 1,51oC acima do período 1880-1920, conforme mostra a Figura 2.

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Figura 2 – Anomalias de temperatura em março de 2020 (1,51C na média global), em relação ao período 1880-1920. Fonte: GISS Surface Temperature Analysis (v4), NASA. <https://data.giss.nasa.gov/gistemp/maps/index_v4.html>.

O aquecimento global é uma arma apontada contra a saúde global. Como mostra Sara Goudarzi (2020), temperaturas mais elevadas favorecem a adaptação de micro-organismos a um mundo mais quente, diminuindo a eficácia de duas defesas básicas dos mamíferos contra os patógenos: (1) muitos micro-organismos não sobrevivem ainda a temperaturas superiores a 37oC, mas podem vir a se adaptar rapidamente a elas; (2) o sistema imune dos mamíferos, pois este perde eficiência em temperaturas mais elevadas. Além disso, o aquecimento global amplia o raio de ação de vetores de epidemias, como a dengue, zika e chikungunya, e altera a distribuição geográfica das plantas e animais, levando espécies animais terrestres a se deslocarem em direção a latitudes mais altas a uma taxa média de 17 km por década (Pecl et al. 2017). Aaron Bernstein, diretor do Harvard University’s Center of Climate, Health and the Global Environment, sintetiza bem a interação entre aquecimento global e desmatamento em suas múltiplas relações com novos surtos epidêmicos:iv

“À medida que o planeta se aquece (…) os animais deslocam-se para os polos fugindo do calor. Animais estão entrando em contato com animais com os quais eles normalmente não interagiriam, e isso cria uma oportunidade para patógenos encontrar outros hospedeiros. Muitas das causas primárias das mudanças climáticas também aumentam o risco de pandemias. O desmatamento, causado em geral pela agropecuária é a causa maior da perda de habitat no mundo todo. E essa perda força os animais a migrarem e potencialmente a entrar em contato com outros animais ou pessoas e compartilhar seus germes. Grandes fazendas de gado também servem como uma fonte para a passagem de infecções de animais para pessoas”.

Sem perder de vista as relações entre a emergência climática e essas novas ameaças sanitárias, foquemos em duas questões bem circunscritas e diretamente ligadas à pandemia atual.

  1. A pandemia foi prevista e será, doravante, mais frequente

A primeira questão refere-se ao caráter, por assim dizer, antropogênico da pandemia. Bem longe de ser adventícia, ela é uma consequência, reiteradamente prevista, de um sistema socioeconômico crescentemente disfuncional e destrutivo. Josef Settele, Sandra Díaz, Eduardo Brondizio e Peter Daszak escreveram um artigo, a convite do IPBES, de leitura obrigatória e que me permito citar longamente:

“Há uma única espécie responsável pela pandemia Covid-19: nós. Assim como com as crises climáticas e o declínio da biodiversidade, as pandemias recentes são uma consequência direta da atividade humana – particularmente de nosso sistema financeiro e econômico global baseado num paradigma limitado, que preza o crescimento econômico a qualquer custo. (…) Desmatamento crescente, expansão descontrolada da agropecuária, cultivo e criação intensivos, mineração e aumento da infraestrutura, assim como a exploração de espécies silvestres criaram uma ‘tempestade perfeita’ para o salto de doenças da vida selvagem para as pessoas. (…) E, contudo, isso pode ser apenas o começo. Embora se estime que doenças transmitidas de outros animais para humanos já causem 700 mil mortes por ano, é vasto o potencial para pandemias futuras. Acredita-se que 1,7 milhão de vírus não identificados, dentre os que sabidamente infectam pessoas, ainda existem em mamíferos e pássaros aquáticos. Qualquer um deles pode ser a ‘Doença X’ – potencialmente ainda mais perturbadora e letal que a Covid-19. É provável que pandemias futuras ocorram mais frequentemente, propaguem-se mais rapidamente, tenham maior impacto econômico e matem mais pessoas, se não formos extremamente cuidadosos acerca dos impactos das escolhas que fazemos hoje” (https://ipbes.net/covid19stimulus).

Cada frase dessa citação encerra uma lição de ciência e de lucidez política. A maior frequência recente de epidemias e pandemias tem por causas centrais o desmatamento e a agropecuária, algo bem estabelecido também por Christian Drosten, atual coordenador do combate à Covid-19 na Alemanha, além de diretor do Instituto de Virologia do Hospital Charité de Berlim e um dos cientistas que identificou a pandemia SARS em 2003 (Spinney 2020).

“Desde que tenha oportunidade, o coronavírus está pronto para mudar de hospedeiro e nós criamos essa oportunidade através de nosso uso não natural de animais – a pecuária (livestock). Essa expõe os animais de criação à vida silvestre, mantém esses animais em grandes grupos que podem amplificar o vírus, e os humanos têm intenso contato com eles – por exemplo, através do consumo de carne –, de modo que tais animais certamente representam uma possível trajetória de emergência para o coronavírus. Camelos são animais de criação no Oriente Médio e são os hospedeiros do vírus MERS, assim como do coronavírus 229E – que é uma causa da gripe comum em humanos –, já o gado bovino foi o hospedeiro original do coronavírus OC43, outra causa de gripe”.

Nada disso é novidade para a ciência. Sabemos que a maioria das pandemias emergentes são zoonoses, isto é, doenças infecciosas causadas por bactérias, vírus, parasitas ou príons, que saltaram de hospedeiros não humanos, usualmente vertebrados, para os humanos. Como afirma Ana Lúcia Tourinho, pesquisadora da Universidade Federal de Mato Grosso (UFMT), o desmatamento é uma causa central e uma bomba-relógio em termos de zoonoses: “quando um vírus que não fez parte da nossa história evolutiva sai do seu hospedeiro natural e entra no nosso corpo, é o caos” (Pontes 2020). Esse risco, repita-se, é crescente. Basta ter em mente que “mamíferos domesticados hospedam 50% dos vírus zoonóticos, mas representam apenas 12 espécies” (Johnson et al. 2020). Esse grupo inclui porcos, vacas e carneiros. Em resumo, o aquecimento global, o desmatamento, a destruição dos habitats selvagens, a domesticação e a criação de aves e mamíferos em escala industrial destroem o equilíbrio evolutivo entre as espécies, facilitando as condições para saltos desses vírus de uma espécie a outra, inclusive a nossa.

4. As próximas zoonoses serão gestadas no Brasil?

O segundo ponto, com o qual concluo este artigo, são as consequências especificamente sanitárias da destruição em curso da Amazônia e do Cerrado. Entre as mais funestas está a crescente probabilidade de que o país se torne o foco das próximas pandemias zoonóticas. Na última década, as megacidades da Ásia do leste, principalmente na China, têm sido o principal “hotspot” de infecções zoonóticas (Zhang et al. 2019). Não por acaso. Esses países estão entre os que mais perderam cobertura florestal no mundo em benefício do sistema alimentar carnívoro e globalizado. O caso da China é exemplar. De 2001 a 2018, o país perdeu 94,2 mil km2 de cobertura arbórea, equivalente a uma diminuição de 5,8% em sua cobertura arbórea no período. “Extração de madeira e agropecuária consomem até 5 mil km2 de florestas virgens todo ano. Na China setentrional e central a cobertura florestal foi reduzida pela metade nas últimas duas décadas”.v Em paralelo com a destruição dos habitats selvagens, o crescimento econômico chinês desencadeou uma demanda por proteínas animais, incluindo as provenientes de animais exóticos (Cheng et al. 2007). Entre 1980 e 2015, o consumo de carne na China cresceu sete vezes e 4,7 vezes per capita (de 15 kg para 70 kg per capita por ano ao longo deste período). Com cerca de 18% da população mundial, a China era em 2018 responsável por 28% do consumo de carne no planeta (Rossi 2018). Segundo um relatório de 2017 do Rabobank, intitulado China’s Animal Protein Outlook to 2020: Growth in Demand, Supply and Trade, a demanda adicional por carne a cada ano na China será de cerca de um milhão de toneladas. “A produção local de carne bovina não consegue acompanhar o crescimento da demanda. Na realidade, a China tem uma escassez estrutural de oferta de carne bovina, que necessita ser satisfeita por importações crescentes”.

A cobertura vegetal dos trópicos tem sido destruída para sustentar essa dieta crescentemente carnívora, não apenas na China, mas em vários países do mundo e particularmente entre nós. No Brasil, a remoção de mais de 1,8 milhão de km2 da cobertura vegetal da Amazônia e do Cerrado nos últimos cinquenta anos, para converter suas magníficas paisagens naturais em zonas fornecedoras de carne e ração animal, em escala nacional e global, representa o mais fulminante ecocídio jamais perpetrado pela espécie humana. Nunca, de fato, em nenhuma latitude e em nenhum momento da história humana, destruiu-se tanta vida animal e vegetal em tão pouco tempo, para a degradação de tantos e para o benefício econômico de tão poucos. E nunca, mesmo para os pouquíssimos que enriqueceram com a devastação, esse enriquecimento terá sido tão efêmero, pois a destruição da cobertura vegetal já começa a gerar erosão dos solos e secas recorrentes, solapando as bases de qualquer agricultura nessa região (na realidade, no Brasil, como um todo).

Em decorrência dessa guerra de extermínio contra a natureza deflagrada pela insanidade dos ditadores militares e continuada pelos civis, atualmente o rebanho bovino brasileiro é de aproximadamente 215 milhões de cabeças, sendo que 80% de seu consumo é absorvido pelo mercado interno, que cresceu 14% nos últimos dez anos (Macedo 2019). Além disso, o Brasil tornou-se líder das exportações mundiais de carne bovina (20% dessas exportações) e de soja (56%), basicamente destinada à alimentação animal. A maior parte do rebanho bovino brasileiro concentra-se hoje nas regiões Norte e Centro-Oeste, com crescente participação da Amazônia. Em 2010, 14% do rebanho brasileiro já se encontrava na região norte do país. Em 2016, essa participação saltou para 22%. Juntas, a região norte e centro-oeste abrigam 56% do rebanho bovino brasileiro (Zaia 2018). Em 2017, apenas 19,8% da cobertura vegetal remanescente do Cerrado permanecia ainda intocada. A continuar a devastação, a pecuária e a agricultura de soja levarão em breve à extinção quase 500 espécies de plantas endêmicas – três vezes mais que todas as extinções documentadas desde 1500 (Strassburg et al. 2017). A Amazônia, que perdeu cerca de 800 mil km2 de cobertura florestal em 50 anos e perderá outras muitas dezenas de milhares sob a sanha ecocida de Bolsonaro, tornou-se, em sua porção sul e leste, uma paisagem desolada de pastos em vias de degradação. O caos ecológico produzido pelo desmatamento por corte raso de cerca de 20% da área original da floresta, pela degradação do tecido florestal de pelo menos outros 20% e pela grande concentração de bovinos na região cria as condições para tornar o Brasil um “hotspot” das próximas zoonoses. Em primeiro lugar porque os morcegos são um grande reservatório de vírus e, entre os morcegos brasileiros, cujo habitat são sobretudo as florestas (ou o que resta delas), circulam pelo menos 3.204 tipos de coronavírus (Maxman 2017). Em segundo lugar porque, como mostraram Nardus Mollentze e Daniel Streicker (2020), o grupo taxonômico dos Artiodactyla (de casco fendido), ao qual pertencem os bois, hospedam, juntamente com os primatas, mais vírus, potencialmente zoonóticos, do que seria de se esperar entre os grupos de mamíferos, incluindo os morcegos. Na realidade, a Amazônia já é um “hotspot” de epidemias não virais, como a leishmaniose e a malária, doenças tropicais negligenciadas, mas com alto índice de letalidade. Como afirma a OMS, “a leishmaniose está associada a mudanças ambientais, tais como o desmatamento, o represamento de rios, a esquemas de irrigação e à urbanização”,vi todos eles fatores que concorrem para a destruição da Amazônia e para o aumento do risco de pandemias. A relação entre desmatamento amazônico e a malária foi bem estabelecida em 2015 por uma equipe do IPEA: para cada 1% de floresta derrubada por ano, os casos de malária aumentam 23% (Pontes 2020).

A curva novamente ascendente desde 2013 da destruição da Amazônia e do Cerrado resultou da execrável aliança de Dilma Rousseff com o que há de mais retrógrado na economia brasileira. Já para a necropolítica de Bolsonaro, a destruição da vida, do que resta do patrimônio natural brasileiro, tornou-se um programa de governo e uma verdadeira obsessão. Bolsonaro está levando o país a dar um salto sem retorno no caos ecológico, de onde a necessidade inadiável de neutralizá-lo por impeachment ou qualquer outro mecanismo constitucional. Não há mais tempo a perder. Entre agosto de 2018 e julho de 2019, o desmatamento amazônico atingiu 9.762 km2, quase 30% acima dos 12 meses anteriores e o pior resultado dos últimos dez anos, segundo o INPE. No primeiro trimestre de 2020, que apresenta tipicamente os níveis mais baixos de desmatamento em cada ano, o sistema Deter, do INPE, detectou um aumento de 51% em relação ao mesmo período de 2019, o nível mais alto para esse período desde o início da série, em 2016. Segundo Tasso Azevedo, coordenador-geral do Projeto de Mapeamento Anual da Cobertura e Uso do Solo no Brasil (MapBiomas), “o mais preocupante é que no acumulado de agosto de 2019 até março de 2020, o nível do desmatamento mais do que dobrou” (Menegassi 2020). Ao monopolizar todas as atenções, a pandemia oferece a Bolsonaro uma oportunidade inesperada para acelerar sua obra de destruição da floresta e de seus povos (Barifouse 2020).

Recapitulemos. O que importa aqui, sobretudo, é entender que a pandemia intervém no momento em que o aquecimento global e todos os demais processos de degradação ambiental estão em aceleração. A pandemia pode acelerá-los ainda mais, na ausência de uma reação política vigorosa da sociedade. Ela acrescenta, em todo o caso, mais uma dimensão a esse feixe convergente de crises socioambientais que impõe à humanidade uma situação radicalmente nova. Pode-se assim formular essa novidade: não é mais plausível esperar, passada a pandemia, um novo ciclo de crescimento econômico global e ainda menos nacional. Se algum crescimento voltar a ocorrer, ele será conjuntural e logo truncado pelo caos climático, ecológico e sanitário. O próximo decênio evoluirá sob o signo de regressões socioeconômicas, pois mesmo a se admitir que a economia globalizada tenha trazido benefícios sociais, eles foram parcos e vêm sendo de há muito superados por seus malefícios. A pandemia é apenas um entre esses malefícios, mas certamente não o pior. Não são mais atuais, portanto, em 2020, as variadas agendas desenvolvimentistas, típicas dos embates ideológicos do século XX. É claro que a exigência de justiça social, bandeira histórica da esquerda, permanece mais que nunca atual. Além de ser um valor perene e irrenunciável, a luta pela diminuição da desigualdade social significa, antes de mais nada, retirar das corporações o poder decisório sobre os investimentos estratégicos (energia, alimentação, mobilidade etc.), assumir o controle democrático e sustentável desses investimentos e, assim, atenuar os impactos do colapso socioambiental em curso. É do aprofundamento da democracia que depende crucialmente, hoje, a sobrevivência de qualquer sociedade organizada num mundo que está se tornando sempre mais quente, mais empobrecido biologicamente, mais poluído e, por todas essas razões, mais enfermo. Sobreviver, no contexto de um processo de colapso socioambiental, não é um programa mínimo. Sobreviver requer, hoje, lutar por algo muito mais ambicioso que os programas socialdemocratas ou revolucionários do século XX. Supõe redefinir o próprio sentido e finalidade da atividade econômica, vale dizer, em última instância, redefinir nossa posição como sociedade e como espécie no âmbito da biosfera.

Referências

BARIFOUSE, Rafael, “Pandemia vai permitir aceleração do desmatamento na Amazônia, prevê consultoria”. BBC Brasil, 26/IV/2020.

CHENG, Vincent C. C. et al., “Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection”. Clinical Microbiology Reviews, October, 2007, pp. 660-694.

EVANS, Simon, “Analysis: Coronavirus set to cause largest ever annual fall in CO2 emissions”, Carbon Brief, 9/IV/2020, atualizado em 15 de abril.

GE, Mengpin. et al. , “Tracking Progress of the 2020 Climate Turning Point.” World Resources Institute, Washington D.C. 2019.

GOODMAN, Peter, “Why the Global Recession Could Last a Long Time”. The New York Times, 1/IV/2020.

GOUDARZI, Sara, “How a Warming Climate Could Affect the Spread of Diseases Similar to COVID-19”. Scientific American, 29/IV/2020.

HOMER-DIXON, Thomas et al., “Synchronous failure: the emerging causal architecture of global crisis. Ecology and Society, 20, 3, 2015.

HOOPER, Rowan, “Ten years to save the world”. New Scientist, 14/III/2020, pp. 45-47.

IRFAN, Umair, “The US, Japan, and Australia let the whole world down at the UN climate talks”. Vox, 18/XII/2019.

JOHNSON, Christine K. et al., “Global shifts in mammalian population trends reveal key predictors of virus spillover risk”. Proceedings of the Royal Society B, 8/IV/2020.

LE HIR, Pierre, “Réchauffement climatique: la bataille des 2C est presque perdue”. Le Monde, 31/XII/2017.

MACEDO, Flávia, “Consumo de carne bovina no Brasil cresceu 14% em 10 anos, diz Cepea”. Canal Rural, 9/XII/2019.

MARQUES, Luiz, Capitalismo e Colapso Ambiental (2015). Campinas, Editora da Unicamp, 3ª ed. 2018.

MARQUES, Luiz, “O colapso socioambiental não é um evento, é o processo em curso”. Revista Rosa, 1, Março, 2020 <http://revistarosa.com/1/o-colapso-socioambiental-nao-e-um-evento>

MATHIESEN, Karl & SAUER, Natalie, “‘Most important years in history’: major UN report sounds last-minute climate alarm”. Climate Home News, 8/X/2018.

MAXMAN, Amy, “Bats Are Global Reservoir for Deadly Coronaviruses”. Scientific American, 12/VI/2017.

McGRATH, Matt, “Climate Change. Greenhouse gas concentrations again break records”. BBC, 25/XI/2019.

McKibben, Bill, “Big Oi lis using the coronavirus pandemic to push through the Keystone XL pipeline”. The Guardian, 5/IV/2020.

MENEGASSI, Duda, “Desmatamento na Amazônia atinge nível recorde no primeiro trimestre de 2020”. ((O)) eco, 13/IV/2020.

MOLLENTZE, Nardus & STREICKER, Daniel G., “Viral zoonotic risk is homogenous among taxonomic orders of mammalian and avian reservoir hosts”. PNAS, 13/IV/2020.

MOORE, Kristine A., LIPSITCH, Marc, BARRY, John & OSTERHOLM, Michael, COVID-19: The CIDRAP Viewpoint. University of Minnesota, 20/IV/2020.

MORIYAMA, Miyu & ICHINOHE, Takeshi, “High Ambient Temperature Dampens Adaptative Immune Responses to Influnza A Virus Infection”. PNAS, 116, 8, 19/II/2019, pp. 3118-3125.

PECL, Gretta et al., “Biodiversity redistribution under climate change: Impacts on ecosystems and human well-being”. Science, 355, 6332, 31/III/2017.

PONTES, Nádia, “O elo entre desmatamento e epidemias investigado pela ciência”. DW, 15/IV/2020.

ROSSI, Marcello, “The Chinese Are Eating More Meat Than Ever Before and the Planet Can’t Keep Up”. Mother Jones, 21/VII/2018.

SETTELE, J., DIAZ, S., BRONDIZIO, E. & DASZAK, Peter, “COVID-19 Stimulus Measures Must Save Lives, Protect Livelihoods, and Safeguard Nature to Reduce the Risk of Future Pandemics”. IPBES Expert Guest Article, 27/IV/2020.

SIMMS, Andrew, “A cat in hell’s chance – why we’re losing the battle to keep global warming below 2C”, The Guardian, 19/I/2017.

SPINNEY, Laura, “Germany’s Covid-19 expert: ‘For many, I’m the evil guy crippling the economy”. The Guardian, 26/IV/2020.

STEFFEN, Will et al., “Trajectories of the Earth System in the Anthropocene”. PNAS, 9/VIII/2018.

STRASSBURG, Bernardo B.N. et al., “Moment of truth for the Cerrado hotspot”. Nature Ecology & Evolution, 2017.

ZAIA, Marina, “Rebanho Brasileiro por Região”. Scot Consultoria, 16/IV/2018.

ZHANG, Juanjuan et al., “Patterns of human social contact and contact with animals in Shanghai, China”. Scientific Reports, 9, 2019.

i Segundo a Chemical Data Reporting (CDR) da EPA, nos EUA, em 2016 havia 8.707 substâncias ou compostos químicos largamente comercializados, aos quais somos cotidianamente expostos, ignorando na maior parte dos casos seus efeitos e os de suas interações sobre a saúde humana e demais espécies. <https://www.chemicalsafetyfacts.org/chemistry-context/debunking-myth-chemicals-testing-safety/>.

ii <https://mission2020.global/testimonial/stocker/>.

iii Cf. NOAA, Global Annual Temperature Rankings Outlook. Março, 2020 <https://www.ncdc.noaa.gov/sotc/global/202003/supplemental/page-2>.

iv Cf. “Coronavirus, climate change, and the environment”. Environmental Health News, 20/III/2020. <https://www.ehn.org/coronavirus-environment-2645553060.html>.

v Cf. “Deforestation and Desertification in China”. <http://factsanddetails.com/china/cat10/sub66/item389.html>.

vi Leishmaniosis, OMS, 2/III/2020 https://www.who.int/en/news-room/fact-sheets/detail/leishmaniasis.

*** Luiz Marques é professor livre-docente do Departamento de História do IFCH /Unicamp. Pela editora da Unicamp, publicou Giorgio Vasari, Vida de Michelangelo (1568), 2011 e Capitalismo e Colapso ambiental, 2015, 3a edição, 2018. Coordena a coleção Palavra da Arte, dedicada às fontes da historiografia artística, e participa com outros colegas do coletivo Crisálida, Crises SocioAmbientais Labor Interdisciplinar Debate & Atualização (crisalida.eco.br).

‘We did it to ourselves’: scientist says intrusion into nature led to pandemic (The Guardian)

Leading US biologist Thomas Lovejoy says to stop future outbreaks we need more respect for natural world

Caged civet cats in a wildlife market in Guangzhou, China.
Caged civet cats in a wildlife market in Guangzhou, China. Photograph: Liu Dawei/AP

Phoebe Weston – Published on Sat 25 Apr 2020 06.00 BST

The vast illegal wildlife trade and humanity’s excessive intrusion into nature is to blame for the coronavirus pandemic, according to a leading US scientist who says “this is not nature’s revenge, we did it to ourselves”.

Scientists are discovering two to four new viruses are created every year as a result of human infringement on the natural world, and any one of those could turn into a pandemic, according to Thomas Lovejoy, who coined the term “biological diversity” in 1980 and is often referred to as the godfather of biodiversity.

“This pandemic is the consequence of our persistent and excessive intrusion in nature and the vast illegal wildlife trade, and in particular, the wildlife markets, the wet markets, of south Asia and bush meat markets of Africa… It’s pretty obvious, it was just a matter of time before something like this was going to happen,” said Lovejoy, a senior fellow at the United Nations Foundation and professor of environment science at George Mason University.

His comments were made to mark the release of a report by the Center for American Progress arguing that the US should step up efforts to combat the wildlife trade to help confront pandemics.

Wet markets are traditional markets selling live animals (farmed and wild) as well as fresh fruit, vegetables and fish, often in unhygienic conditions. They are found all over Africa and Asia, providing sustenance for hundreds of millions of people. The wet market in Wuhan believed to be the source of Covid-19 contained a number of wild animals, including foxes, rats, squirrels, wolf pups and salamanders.

Lovejoy said separating wild animals from farmed animals in markets would significantly lower the risk of disease transmission. This is because there would be fewer new species for viruses to latch on to. “[Domesticated animals] can acquire these viruses, but if that’s all there was in the market, it would really lower the probability of a leak from a wild animal to a domesticated animal.”

He told the Guardian: “The name of the game is reducing certain amounts of activity so the probability of that kind of leap becomes small enough that it’s inconsequential. The big difficulty is that if you just shut them down – which in many ways would be the ideal thing – they will be topped up with black markets, and that’s even harder to deal with because it’s clandestine.”

The pandemic will cost the global economy $1tn this year, according to the World Economic Forum, with vulnerable communities impacted the most, and nearly half of all jobs in Africa could be lost. “This is not nature’s revenge, we did it to ourselves. The solution is to have a much more respectful approach to nature, which includes dealing with climate change and all the rest,” Lovejoy said.

His comments echo those of a study published in the journal Proceedings of the Royal Society B earlier this month that suggested the underlying cause of the present pandemic was likely to be increased human contact with wildlife.

Experts are divided about how to regulate the vast trade in animals, with many concerned the poorest are most at risk from a crackdown. Urgent action on the wildlife trade is clearly needed, said Dr Amy Dickman, a conservation biologist from the University of Oxford, but she was “alarmed” by calls for indiscriminate bans on the wildlife trade.

She is one of more than 250 signatories of an open letter to the World Health Organization and United Nations Environment Programme saying any transition must contribute to – and not detract from – the livelihoods of the world’s most vulnerable people, many of whom depend on wild resources for survival. Other signatories include representatives from the African Wildlife Foundation, the Frankfurt Zoological Society and IUCN (International Union for Conservation of Nature).

The letter reads: “Covid-19 is inflicting unprecedented social and economic costs on countries and communities, with the poor and vulnerable hardest hit. The virus’s suspected links with a Chinese ‘wet market’ has led to calls to ban wet markets and restrict or end the trade, medicinal use and consumption of wildlife. However, indiscriminate bans and restrictions risk being inequitable and ineffective.”

Scientists and NGOs are concerned that over-simplistic and indiscriminate restrictions will exacerbate poverty and inequality, resulting in an increase in criminality. This could accelerate the exploitation and extinction of species in the wild, authors of the letter warn.

“People often seem more willing to point the finger at markets far away, as bans there will not affect their everyday lives – although they will often affect the rights of extremely vulnerable people,” said Dickman.

There are also concerns about the impacts of an outright ban on a number of indigenous populations, such as tribes in Orinoquia and Amazonia, with representatives describing it as an “attack” on their livelihoods.

Mama Mouamfon, who is based in Cameroon and directs an NGO called Fondation Camerounaise de la Terre Vivante (FCTV), said banning the trade would damage livelihoods: “Bush meat is very important for people in the forest because it’s one of the best ways to get animal protein. With this issue of poverty and people living in remote areas, it’s not easy for them to look for good meat,” he said.

“Sometimes people take decisions because they are sitting in an office and are very far from reality. If they knew our reality they would not take that [same] decision.”

Claudio Maierovitch Pessanha Henriques: O mito do pico (Folha de S.Paulo)

www1.folha.uol.com.br

Claudio Maierovitch Pessanha Henriques – 6 de maio de 2020

Desde o início da epidemia de doença causada pelo novo coronavírus (Covid-19), a grande pergunta tem sido “quando acaba?” Frequentemente, são divulgadas na mídia e nas redes sociais projeções as mais variadas sobre a famosa curva da doença em vários países e no mundo, algumas recentes, mostrando a tendência de que os casos deixem de surgir no início do segundo semestre deste ano.

Tais modelos partem do pressuposto de que há uma história, uma curva natural da doença, que começa, sobe, atinge um pico e começa a cair. Vamos analisar o sentido de tal raciocínio. Muitas doenças transmissíveis agudas, quando atingem uma população nova, expandem-se rapidamente, numa velocidade que depende de seu chamado número reprodutivo básico, ou R0 (“R zero”, que estima para quantas pessoas o portador de um agente infeccioso o transmite).

Quando uma quantidade grande de pessoas tiver adoecido ou se infectado mesmo sem sintomas, os contatos entre portadores e pessoas que não tiveram a doença começam a se tornar raros. Num cenário em que pessoas sobreviventes da infecção fiquem imunes àquele agente, sua proporção cresce e a transmissão se torna cada vez mais rara. Assim, a curva, que vinha subindo, fica horizontal e começa a cair, podendo até mesmo chegar a zero, situação em que o agente deixa de circular.

Em populações grandes, é muito raro que uma doença seja completamente eliminada desta forma, por isso a incidência cresce novamente de tempos em tempos. Quando a quantidade de pessoas que não se infectaram, somada à dos bebês que nascem e pessoas sem imunidade que vieram de outros lugares é suficientemente grande, então a curva sobe novamente.

É assim, de forma simplificada, que a ciência entende a ocorrência periódica de epidemias de doenças infecciosas agudas. A história nos ilustra com numerosos exemplos, como varíola, sarampo, gripe, rubéola, poliomielite, caxumba, entre muitos outros. Dependendo das características da doença e da sociedade, são ciclos ilustrados por sofrimento, sequelas e mortes. Realmente, nesses casos, é possível estimar a duração das epidemias e, em alguns casos, até mesmo prever as próximas.

A saúde pública tem diversas ferramentas para interferir em muitos desses casos, indicados para diferentes mecanismos de transmissão, como saneamento, medidas de higiene, isolamento, combate a vetores, uso de preservativos, extinção de fontes de contaminação, vacinas e tratamentos capazes de eliminar os microrganismos. A vacinação, ação específica de saúde considerada mais efetiva, simula o que acontece naturalmente, ao aumentar a quantidade de pessoas imunes na população até que a doença deixe de circular, sem que para isso pessoas precisem adoecer.

No caso da Covid-19, há estimativas de que para a doença deixar de circular intensamente será preciso que cerca de 70% da população seja infectada. Isso se chama imunidade coletiva (também se adota a desagradável denominação “imunidade de rebanho”). Quanto à situação atual de disseminação do coronavírus Sars-CoV-2, a Organização Mundial da Saúde (OMS) calcula que até a metade de abril apenas de 2% a 3% da população mundial terá sido infectada. Estimativas para o Brasil são um pouco inferiores a essa média.

Trocando em miúdos, para que a doença atinja naturalmente seu pico no país e comece a cair, será preciso esperar que 140 milhões de pessoas se infectem. A mais conservadora (menor) taxa de letalidade encontrada nas publicações sobre a Covid-19 é de 0,36%, mais ou menos um vigésimo daquela que os números oficiais de casos e mortes revelam. Isso significa que até o Brasil atingir o pico, contaremos 500 mil mortes se o sistema de saúde não ultrapassar seus limites —e, caso isso aconteça, um número muito maior.

Atingir o pico é sinônimo de catástrofe, não é uma aposta admissível, sobretudo quando constatamos que já está esgotada a capacidade de atendimento hospitalar em várias cidades, como Manaus, Rio de Janeiro e Fortaleza —outras seguem o mesmo caminho.

A única perspectiva aceitável é evitar o pico, e a única forma de fazê-lo é com medidas rigorosas de afastamento físico. A cota de contatos entre as pessoas deve ficar reservada às atividades essenciais, entre elas saúde, segurança, cadeias de suprimento de combustíveis, alimentos, produtos de limpeza, materiais e equipamentos de uso em saúde, limpeza, manutenção e mais um ou outro setor. Alguma dose de criatividade pode permitir ampliar um pouco esse leque, desde que os meios de transporte e vias públicas permaneçam vazios o suficiente para que seja mantida a distância mínima entre as pessoas.

O monitoramento do número de casos e mortes, que revela a transmissão com duas a três semanas de defasagem, deverá ser aprimorado e utilizado em conjunto com estudos baseados em testes laboratoriais para indicar o rigor das medidas de isolamento.

Se conseguirmos evitar a tragédia maior, vamos conviver com um longo período de restrição de atividades, mais de um ano, e teremos que aprender a organizar a vida e a economia de outras formas, além de passar por alguns períodos de “lockdown” —cerca de duas semanas cada, se a curva apontar novamente para o pico.

Hoje, a situação é grave e tende a se tornar crítica. O Brasil é o país com a maior taxa de transmissão da doença; é hora de ficar em casa e, se for imprescindível sair, fazer da máscara uma parte inseparável da vestimenta e manter rigorosamente todos os cuidados indicados.​

Para escapar do coronavírus, Yanomami se refugiam no interior da floresta (Amazônia Real)

Artigo original

Por: Ana Amélia Hamdan | 28/04/2020 às 23:41

Os indígenas chamam a pandemia de xawara. Um jovem da etnia morreu de Covid-19, em Boa Vista, Roraima.

A imagem é da Expedição Yanomami Okrapomai (Christian Braga/Midia Ninja/2014)

São Gabriel da Cachoeira (AM) – “A floresta protege porque ela tem um cheiro muito saudável, isso é a proteção que a floresta dá para nós Yanomami. A floresta tem mais proteção porque o ar não é contaminado. Muitos já foram para se proteger na floresta porque evitam de pegar gripe e outras doenças aqui na comunidade. Estão por lá se alimentando com caça, pesca, agora é muito açaí e muita fruta que está tendo na floresta”.

É assim, como se vê na fala da liderança Yanomami, José Mário Pereira Góes, que os indígenas estão se protegendo contra o coronavírus. Ele é presidente da Associação Yanomami do Rio Cauaburis e Afluentes (Ayrca), no Amazonas. Tal como os mais velhos fizeram para fugir de epidemias já enfrentadas no passado, como sarampo, gripes e coqueluche, os indígenas dessa etnia estão se refugiando no interior da floresta amazônica para se afastar do risco de contrair a Covid-19, a doença que causa uma pandemia no mundo e é responsável pela morte de um jovem da etnia.

A Terra Indígena Yanomami tem 9.664.975 hectares, localizada entre os estados do Amazonas e Roraima. São 380 comunidades e uma população de 28.148 pessoas, segundo a Secretaria Especial de Saúde Indígena, do Ministério da Saúde. A nova invasão de garimpeiros, que é um risco eminente da disseminação do novo coronavírus no território, foi denunciada pelo líder Davi Kopenawa Yanomami, em 2019.

Na comunidade Maturacá, localizada em São Gabriel da Cachoeira, no noroeste do Amazonas, pelo menos 12 famílias partiram para o interior da floresta. Outros grupos familiares se preparam para seguir o mesmo caminho. “O nosso povo Yanomami está alerta. A hora que chega em São Gabriel essa doença, vamos nos deslocar e estamos fazendo farinhada para a gente se isolar os 40 dias no mato. E a hora que tiver três casos, quatro casos, não vai ficar ninguém na comunidade. Só vai ficar pelotão, missão. Só isso que vai estar aqui na comunidade”, diz José Góes.

Assembleia para discutir turismo no Pico da Neblina, em Maturacá
(Foto: João Claudio Moreira/Amazônia Real)

Em Boa Vista, capital de Roraima, o vice-presidente da Hutukara Associação Yanomami, Dario Vitório Kopenawa explica que esse movimento de isolamento no interior da floresta amazônica não é uma tarefa fácil para os Yanomami. Muitas das comunidades se fixaram perto de locais onde há posto de saúde. É por isso que há divisão entre quem se refugiou na floresta e quem permaneceu na comunidade. “Algumas minorias foram para o isolado. A maioria ainda está na comunidade, ficando isolado na maloca”, explica.

Dario acompanha a movimentação dos Yanomami para dentro da floresta, recebendo informações via radiofonia, da sede da Hutukara, e relata que a ida para o mato vem acontecendo no Marauiá (região do Rio Marauiá); Parawa-u e Demini, todos no Amazonas. Em Roraima, é o subgrupo Ninam que segue a mesma estratégia. A família de Dario – inclusive seu pai, a liderança e xamã Yanomami Davi Kopenawa -, está na região Demini, buscando proteção na floresta.

Também via rádio, o vice-presidente da Hutukara tem notícias de que os xamãs vêm trabalhando na tentativa de conhecer a doença. “Pandemia coronavírus para nós é xawara. Os Yanomami pajés e médicos da floresta estão trabalhando reconhecendo essa doença. Assim os xamãs me falaram”, diz Dario Kopenawa. 

O isolamento em São Gabriel

Fiscais orientam população em São Gabriel da Cachoeira na terça-feira, 28 de abri
(Foto: Paulo Desana/Dabakuri/Amazônia Real)

A viagem da sede de São Gabriel da Cachoeira para Maturacá leva cerca de 10 horas, dependendo das condições da estrada e de navegação pelo Rio Negro e seus afluentes. No domingo (26), a prefeitura do município confirmou os dois primeiros casos de coronavírus e, no dia seguinte, houve a confirmação outros dois. É grande a possibilidade de já estar havendo a transmissão comunitária. Desses quatro pacientes, três são indígenas e um é militar do Exército.

José Mário Góes, presidente da Associação Yanomami do Rio Cauaburis e Afluentes (Ayrca), está em Maturacá e respondeu à reportagem da Amazônia Real por meio da mensagem de áudio de WhatsApp. O acesso à internet é possível porque durante parte do dia eles conseguem captar o sinal pela proximidade com o 5º Pelotão Especial de Fronteira do Exército.

“Quando uma família vai, outras famílias vão, a vizinhada vai. Porque na comunidade somos todos parentes, então eles levaram toda a família”, disse a liderança indígena. Cada grupo está construindo pequenos abrigos para morar por cerca de 40 dias. Além de se manterem com frutas, caça e pesca, levam alimentos. Se for necessário, voltam à comunidade para reforçar os mantimentos. “Levaram alimentos principais como farinha, banana, tapioca, beiju, e também café, açúcar, arroz, feijão e materiais de caça e pesca. E quando acaba os alimentos eles vêm buscar banana, pegar estoque de farinha”, relata Góes.

“Deixar as casas e ficar por um tempo na floresta é uma estratégia que algumas famílias já estão fazendo. Diferente de nós que estamos enfrentando pela primeira vez uma epidemia, os Yanomami têm experiências recentes que dizimaram comunidades inteiras e os sobreviventes foram os que se isolaram no mato”, explica o assessor do Programa Rio Negro do Instituto Socioambiental (ISA), Marcos Wesley de Oliveira.

Essa estratégia pode ser comparada ao isolamento social recomendado pela Organização Mundial da Saúde (OMS) e pelo Ministério da Saúde, aponta Marcos Wesley. “Os Yanomami sabem que até o momento não há remédio ou vacina eficazes contra a Covid-19”, reforça.

O município de São Gabriel da Cachoeira tem uma população de mais de 45 mil habitantes, a maioria indígenas de 23 etnias, segundo a taxa atualizada do Censo do IBGE. Desse total, 25 mil moram nas aldeias e comunidades, em territórios demarcados, segundo a Federação das Organizações Indígenas do Rio Negro (Foirn). 

Para evitar que os indígenas de Maturacá, cuja população total é de cerca de 2.000 pessoas, façam a viagem até São Gabriel para fazer compras, o ISA e a Foirn enviam cestas básicas e kits de higiene para a comunidade. Esse material será levado por avião do Exército, segundo protocolo de higienização e distribuição para evitar a contaminação da Covid-19. 

Em artigo publicada na Amazônia Real, o antropólogo francês Bruce Albert citou um trecho do livro A queda do Céu, escrito em conjunto por ele e pelo xamã e líder Davi Kopenawa Yanomami, para falar sobre a morte do jovem, em Boa Vista. O adolescente foi sepultado sem o conhecimento dos pais e sem o respeito aos rituais de seu povo. Ao tratar do tema funeral, o antropólogo sugeriu ao leitor “reler A queda do Céu, pp. 267-68, onde Davi Kopenawa conta como sua mãe morreu numa epidemia de sarampo trazida pelos missionários da Novas Tribos do Brasil (aliás, Ethnos360) e como estes sepultaram o cadáver à revelia num lugar até hoje desconhecido: Por causa deles, nunca pude chorar a minha mãe como faziam nossos antigos. Isso é uma coisa muito ruim. Causou-me um sofrimento muito profundo, e a raiva desta morte fica em mim desde então. Foi endurecendo com o tempo, e só terá fim quando eu mesmo acabar. ”

Bruce Albert, que trabalha com os Yanomami desde 1975, também escreveu em sua rede social sobre a saúde do adolescente Yanomami, de 15 anos, da aldeia Helepe, no Rio Uraricoera (RR), antes dele morrer vítima da Covid-19.

O alerta das epidemias do passado

Movimento nas ruas de São Gabriel da Cachoeira na manhã de segunda-feira (27/04/2020) (Foto: Paulo Desana/Dabakuri/Amazônia Real)

A morte do adolescente Yanomami despertou o temor desse povo, inclusive em Maturacá. “Essa morte traz alerta para que isso não acabe com povo Yanomami. Como aconteceu na região do Irokae, morrendo adultos, jovens e crianças, os idosos, como aconteceu isso não queremos que aconteça mais. Por isso estamos alerta por aqui”, afirma José Mário Góes.

Irokae é o primeiro acampamento para o Pico da Neblina, denominado pelos Yanomami de Yaripo, a Montanha de Vento. Essa trilha seria reaberta para o turismo em abril, mas foi adiada devido à pandemia. Anos atrás, na tentativa de fugir da coqueluche, os grupos seguiram por esse caminho, mas alguns acabaram morrendo.

“Essa doença de agora, o coronavírus, aqui em Maturacá, representa epidemia de coqueluche como aconteceu na região de Irokae. O que está acontecendo com os napë (forasteiro, homem branco), isso já aconteceu aqui para nós Yanomami na região do Irokae, onde fica a trilha do Yaripo”, relata José Mário. “Nossos avós já tiveram outra doença, como epidemia de coqueluche, que matou muitas crianças e os mais velhos. Eles não querem que repita essa história. Morreu até um pajé nessa epidemia. Então como fizeram agora, eles foram para a floresta, na região do frio, chegaram até lá no pico. É lá que ficam os restos mortais dos nossos parentes e por isso que nós falamos que temos histórias no caminho do Yaripo”, relata José Góes.

Outro problema enfrentado no passado foi o sarampo. “Aqui na comunidade, em Maturacá, onde está situado o polo base de saúde. Então era um xapono (casa coletiva) onde tivemos epidemia de sarampo. Também nós fizemos o movimento como estamos fazendo hoje aqui, mas não teve jeito. Pessoas fugiram, mas teve óbito nas crianças. Morreu muita criança e adulto. É a mesma história que eles não querem que repita. ”

Para os Yanomami, o vírus é um tipo de envenenamento. “Nós observamos que o próprio napë faz envenenamento no ser humano para dizer que é vírus. Isso é epidemia, é um vírus que afeta qualquer ser humano e acaba com a vida do ser humano. Isso tem na nossa realidade como aconteceu com nossos antepassados o que está acontecendo hoje no mundo inteiro. Até no Brasil e no exterior”, diz José Góes.

Em busca de proteção, os Yanomami recorrem a ensinamentos de seus antepassados. Após a confirmação dos casos em São Gabriel, as lideranças tradicionais iniciaram a chamada “recura’ para que a doença saia do lugar e seja levada pelo vento para onde não tem ser humano.

Expedição Yanomami Okrapomai (Christian Braga/ Midia Ninja/2014)

*Este texto foi atualizado em 29/04/2020 às 11h27 para corrigir o número da população Yonomami.

Crises are no excuse for lowering scientific standards, say ethicists (Science News)

Date: April 23, 2020

Source: Carnegie Mellon University

Summary: Ethicists are calling on the global research community to resist treating the urgency of the current COVID-19 outbreak as grounds for making exceptions to rigorous research standards in pursuit of treatments and vaccines.

Ethicists from Carnegie Mellon and McGill universities are calling on the global research community to resist treating the urgency of the current COVID-19 outbreak as grounds for making exceptions to rigorous research standards in pursuit of treatments and vaccines.

With hundreds of clinical studies registered on ClinicalTrials.gov, Alex John London, the Clara L. West Professor of Ethics and Philosophy and director of the Center for Ethics and Policy at Carnegie Mellon, and Jonathan Kimmelman, James McGill Professor and director of the Biomedical Ethics Unit at McGill University, caution that urgency should not be used as an excuse for lowering scientific standards. They argue that many of the deficiencies in the way medical research is conducted under normal circumstances seem to be amplified in this pandemic. Their paper, published online April 23 by the journal Science, provides recommendations for conducting clinical research during times of crises.

“Although crises present major logistical and practical challenges, the moral mission of research remains the same: to reduce uncertainty and enable care givers, health systems and policy makers to better address individual and public health,” London and Kimmelman said.

Many of the first studies out of the gate in this pandemic have been poorly designed, not well justified, or reported in a biased manner. The deluge of studies registered in their wake threaten to duplicate efforts, concentrate resources on strategies that have received outsized media attention and increase the potential of generating false positive results purely by chance.

“All crises present exceptional situations in terms of the challenges they pose to health and welfare. But the idea that crises present an exception to the challenges of evaluating the effects drugs and vaccines is a mistake,” London and Kimmelman said. “Rather than generating permission to carry out low-quality investigations, the urgency and scarcity of pandemics heighten the responsibility of key actors in the research enterprise to coordinate their activities to uphold the standards necessary to advance this mission.”

The ethicists provide recommendations for multiple stakeholder groups involved in clinical trials:

  • Sponsors, research consortia and health agencies should prioritize research approaches that test multiple treatments side by side. The authors argue that “master protocols” enable multiple treatments to be tested under a common statistical framework.
  • Individual clinicians should avoid off-label use of unvalidated interventions that might interfere with trial recruitment and resist the urge to carry out small studies with no control groups. Instead, they should seek out opportunities to join larger, carefully orchestrated studies.
  • Regulatory agencies and public health authorities should play a leading role in identifying studies that meet rigorous standards and in fostering collaboration among a sufficient number of centers to ensure adequate recruitment and timely results. Rather than making public recommendations about interventions whose clinical merits remain to be established, health authorities can point stakeholders to recruitment milestones to elevate the profile and progress of high-quality studies.

“Rigorous research practices can’t eliminate all uncertainty from medicine,” London and Kimmelman said, “but they can represent the most efficient way to clarify the causal relationships clinicians hope to exploit in decisions with momentous consequences for patients and health systems.”

Com pandemia de covid-19, cartórios registram alta de 43% em mortes por causa indeterminada (Estadão)

saude.estadao.com.br

Fabiana Cambricoli, 27 de abril de 2020

SÃO PAULO – Os cartórios brasileiros registraram alta de 43% no número de mortes por causa indeterminada notificadas no País desde o início da pandemia de covid-19 em território brasileiro. Os dados, antecipados pelo Estado, serão divulgados nesta segunda-feira, 27, em novo painel do Portal da Transparência do Registro Civil, mantido pela Associação Nacional dos Registradores de Pessoas Naturais (Arpen-Brasil). Segundo especialistas, o aumento de óbitos sem causa definida pode estar associado a vítimas de coronavírus que morreram sem ter o diagnóstico da doença.

A alta refere-se ao período de 26 de fevereiro, data em que o primeiro caso de infecção por coronavírus foi registrado no Brasil, até 17 de abril – como os cartórios tem até dez dias para repassar os registros para a Central de Informações do Registro Civil (CRC Nacional), a reportagem optou por um recorte até dez dias atrás.

Em 2020, o País teve 1.329 mortes por causa indeterminada no periodo mencionado. Em 2019, 925 óbitos do tipo foram registrados pelos cartórios no mesmo intervalo. De acordo com especialistas, o dado pode ser mais um indício de subnotificação do número de óbitos por coronavírus no País. Com a falta de testes e a alta demanda sobre o sistema de saúde em algumas regiões, doentes podem estar morrendo sem ter uma avaliação médica.

Para Fátima Marinho, professora da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG) e integrante do grupo de especialistas que auxiliou a Arpen-Brasil na elaboração do painel, é provável que o aumento de mortes por causa indefinida tenha como uma das razões a morte de pessoas por covid-19 que não tiveram acesso ao sistema de saúde. “Em uma situação de uma doença nova, uma pandemia, a gente espera um aumento de mortes em casa, sem que a pessoa sequer consiga ter atendimento médico. Isso pode estar acontecendo agora”, explica.

Se analisadas as mortes também por faixa etária, o aumento de óbitos por causa indeterminada é maior entre idosos, principal grupo de risco para complicações do coronavírus. O número de mortes sem causa definida entre pessoas com idade a partir de 60 anos passou de 568 em 2019 para 879 em 2020, alta de 54,8%. Já entre indivíduos com menos de 60 anos, a variação foi de 30,5% – subiu de 321 para 419 no mesmo intervalo de tempo.

Fátima diz que outra razão que pode estar impactando na alta de mortes por causas indeterminadas é o provável crescimento de óbitos por outras causas que não estão chegando aos hospitais pela dificuldade de conseguir leitos no meio da pandemia ou pelo eventual medo de pacientes em procurar unidades de saúde e se contaminarem. “Provavelmente teremos um aumento de mortes por infarto, AVC e outros problemas registrados em casa porque as pessoas estão adiando a ida ao pronto-socorro ou tendo que disputar leitos com pacientes com covid-19”, diz ela.

Salto em mortes por Síndrome Respiratória Aguda Grave

O portal da transparência mantido pela Arpen-Brasil também passa a disponibilizar o número de mortes por Síndrome Respiratória Aguda Grave (SRAG), que registrou aumento de 680% entre 26 de fevereiro e 17 de abril de 2019 e o mesmo período de 2020. Os números contemplam casos dessa condição respiratória em que não foi especificado o agente causador da síndrome, que pode ser coronavírus, mas também influenza ou outro vírus respiratório.

De acordo com o portal, o número de mortes do tipo passou de 156 para 1.217 no período citado. A alta nos óbitos por SRAG não especificada registradas em cartórios seriam outro indício de subnotificação. Ela é ainda maior em Estados com muitos casos da doença. No Amazonas, o aumento foi de 1.214%. No Ceará, de 3.828%. Em São Paulo, Estado com o maior número de infectados, o crescimento observado foi de 916%.

Outros dados anteriormente divulgados pela Arpen-Brasil mostravam indícios de que o número de mortes por coronavírus no Brasil pode ser maior que o computado oficialmente pelo Ministério da Saúde. Como revelou o Estado em 13 de abril, o número de registros de mortes por insuficiência respiratória e pneumonia no Brasil teve um salto em março, contrariando tendência de queda que vinha sendo observada nos meses de janeiro e fevereiro. Foram 2.239 mortes a mais em março de 2020 do que no mesmo período de 2019.

O número de mortes suspeitas ou confirmadas por covid-19 registradas nos cartórios também vem se mostrando maior do que as registradas pelo Ministério da Saúde (que considera só os óbitos confirmados por coronavírus). Na tarde desta segunda, por exemplo, os cartórios já registravam 4.839 vítimas com confirmação ou suspeita da doença. Já o Ministério contabilizava 4.543 registros.

Para Luis Carlos Vendramin Júnior, vice-presidente da Arpen-Brasil, a disponibilização dos dados dos cartórios ajudam a entender o avanço da epidemia. “Como temos esses dados com atualização diária, avaliamos que ampliar a transparência e divulgar dados também sobre mortes por SRAG e causas indeterminadas, além das que já vínhamos divulgando, vai auxiliar tanto o poder público quanto a imprensa e a população em geral na análise de números”, destacou.

We Still Don’t Know How the Coronavirus Is Killing Us (The Intelligencer)

nymag.com

David Wallace-Wells, Apr. 26, 2020

Omar Rodriguez organizes bodies in the Gerard J. Neufeld funeral home in Elmhurst on April 22. Photo: Spencer Platt/Getty Images

Over the last few weeks, the country has managed to stabilize the spread of the coronavirus sufficiently enough to begin debating when and in what ways to “reopen,” and to normalize, against all moral logic, the horrifying and ongoing death toll — thousands of Americans dying each day, in multiples of 9/11 every week now with the virus seemingly “under control.” The death rate is no longer accelerating, but holding steady, which is apparently the point at which an onrushing terror can begin fading into background noise. Meanwhile, the disease itself appears to be shape-shifting before our eyes.

In an acute column published April 13, the New York Times’ Charlie Warzel listed 48 basic questions that remain unanswered about the coronavirus and what must be done to protect ourselves against it, from how deadly it is to how many people caught it and shrugged it off to how long immunity to the disease lasts after infection (if any time at all). “Despite the relentless, heroic work of doctors and scientists around the world,” he wrote, “there’s so much we don’t know.” The 48 questions he listed, he was careful to point out, did not represent a comprehensive list. And those are just the coronavirus’s “known unknowns.”

In the two weeks since, we’ve gotten some clarifying information on at least a handful of Warzel’s queries. In early trials, more patients taking the Trump-hyped hydroxychloroquinine died than those who didn’t, and the FDA has now issued a statement warning coronavirus patients and their doctors from using the drug. The World Health Organization got so worried about the much-touted antiviral remdesivir, which received a jolt of publicity (and stock appreciation) a few weeks ago on rumors of positive results, the organization leaked an unpublished, preliminary survey showing no benefit to COVID-19 patients. Globally, studies have consistently found exposure levels to the virus in most populations in the low single digits — meaning dozens of times more people have gotten the coronavirus than have been diagnosed with it, though still just a tiny fraction of the number needed to achieve herd immunity. In particular hot spots, the exposure has been significantly more widespread — one survey in New York City found that 21 percent of residents may have COVID-19 antibodies already, making the city not just the deadliest community in the deadliest country in a world during the deadliest pandemic since AIDS, but also the most infected (and, by corollary, the farthest along to herd immunity). A study in Chelsea, Massachusetts, found an even higher and therefore more encouraging figure: 32 percent of those tested were found to have antibodies, which would mean, at least in that area, the disease was only a fraction as severe as it might’ve seemed at first glance, and that the community as a whole could be as much as halfway along to herd immunity. In most of the rest of the country, the picture of exposure we now have is much more dire, with much more infection almost inevitably to come.

But there is one big question that didn’t even make it onto Warzel’s list that has only gotten more mysterious in the weeks since: How is COVID-19 actually killing us?

We are now almost six months into this pandemic, which began in November in Wuhan, with 50,000 Americans dead and 200,000 more around the world. If each of those deaths is a data point, together they represent a quite large body of evidence from which to form a clear picture of the pandemic threat. Early in the epidemic, the coronavirus was seen as a variant of a familiar family of disease, not a mysterious ailment, however infectious and concerning. But while uncertainties at the population level confuse and frustrate public-health officials, unsure when and in what form to shift gears out of lockdowns, the disease has proved just as mercurial at the clinical level, with doctors revising their understanding of COVID-19’s basic pattern and weaponry — indeed often revising that understanding in different directions at once. The clinical shape of the disease, long presumed to be a relatively predictable respiratory infection, is getting less clear by the week. Lately, it seems, by the day. As Carl Zimmer, probably the country’s most respected science journalist, asked virologists in a tweet last week, “is there any other virus out there that is this weird in terms of its range of symptoms?”

You probably have a sense of the range of common symptoms, and a sense that the range isn’t that weird: fever, dry cough, and shortness of breath have been, since the beginning of the outbreak, the familiar, oft-repeated group of tell-tale signs. But while the CDC does list fever as the top symptom of COVID-19, so confidently that for weeks patients were turned away from testing sites if they didn’t have an elevated temperature, according to the Journal of the American Medical Association, as many as 70 percent of patients sick enough to be admitted to New York State’s largest hospital system did not have a fever.

Over the past few months, Boston’s Brigham and Women’s Hospital has been compiling and revising, in real time, treatment guidelines for COVID-19 which have become a trusted clearinghouse of best-practices information for doctors throughout the country. According to those guidelines, as few as 44 percent of coronavirus patients presented with a fever (though, in their meta-analysis, the uncertainty is quite high, with a range of 44 to 94 percent). Cough is more common, according to Brigham and Women’s, with between 68 percent and 83 percent of patients presenting with some cough — though that means as many as three in ten sick enough to be hospitalized won’t be coughing. As for shortness of breath, the Brigham and Women’s estimate runs as low as 11 percent. The high end is only 40 percent, which would still mean that more patients hospitalized for COVID-19 do not have shortness of breath than do. At the low end of that range, shortness of breath would be roughly as common among COVID-19 patients as confusion (9 percent), headache (8 to 14 percent), and nausea and diarrhea (3 to 17 percent). That the ranges are so wide themselves tells you that the disease is presenting in very different ways in different hospitals and different populations of different patients — leading, for instance, some doctors and scientists to theorize the virus might be attacking the immune system like HIV does, with many others finding the disease is triggering something like the opposite response, an overwhelming overreaction of the immune system called a “cytokine storm.”

The most bedeviling confusion has arisen around the relationship of the disease to breathing, lung function, and oxygenation levels in the blood — typically, for a respiratory illness, a quite predictable relationship. But for weeks now, front-line doctors have been expressing confusion that so many coronavirus patients were registering lethally low blood-oxygenation levels while still appearing, by almost any vernacular measure, pretty okay. It’s one reason they’ve begun rethinking the initial clinical focus on ventilators, which are generally recommended when patients oxygenation falls below a certain level, but seemed, after a few weeks, of unclear benefit to COVID-19 patients, who may have done better, doctors began to suggest, on lesser or different forms of oxygen support. For a while, ventilators were seen so much as the essential tool in treating life-threatening coronavirus that shortages (and the president’s unwillingness to invoke the Defense Production Act to manufacture them quickly) became a scandal. But by one measure 88 percent of New York patients put on ventilators, for whom an outcome as known, had died. In China, the figure was 86 percent.

On April 20 in the New York Times, an ER doctor named Richard Levitan who had been volunteering at Bellevue proposed that the phenomenon of seemingly stable patients registering lethally low oxygen levels might be explained by “silent hypoxia” — the air sacs in the lung collapsing, not getting stiff or heavy with fluid, as is the case with the pneumonias doctors had been using as models in their treatment of COVID-19. But whether this explanation is universal, limited to the patients at Bellevue, or somewhere in between is not yet entirely clear. A couple of days later, in a pre-print paper others questioned, scientists reported finding that the ability of the disease to mutate has been “vastly underestimated” — investigating the disease as it appeared in just 11 patients, they said they found 30 mutations. “The most aggressive strains could generate 270 times as much viral load as the weakest type,” the South China Morning-Post reported. “These strains also killed the cells the fastest.”

That same day, the Washington Post reported on another theory gaining traction among American doctors treating the disease — that one key could be the way COVID-19 affects the blood of patients, producing much more clotting. “Autopsies have shown that some people’s lungs are filled with hundreds of microclots,” the Post reported. “Errant blood clots of a larger size can break off and travel to the brain or heart, causing a stroke or a heart attack.”

But the bigger-picture perspective the newspaper offered is perhaps more eye-opening and to the point:

One month ago, as the country went into lockdown to prepare for the first wave of coronavirus cases, many doctors felt confident that they knew what they were dealing with. Based on early reports, covid-19 appeared to be a standard variety respiratory virus, albeit a very contagious and lethal one with no vaccine and no treatment. But they’ve since become increasingly convinced that covid-19 attacks not only the lungs, but also the kidneys, heart, intestines, liver and brain.

That is a dizzying list. But it is not even comprehensive. In a fantastic survey published April 17 (“How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes,” by Meredith Wadman, Jennifer Couzin-Frankel, Jocelyn Kaiser, and Catherine Matacic), Science magazine took a thorough, detailed tour of the ever-evolving state of understanding of the disease. “Despite the more than 1,000 papers now spilling into journals and onto preprint servers every week,” Science concluded, “a clear picture is elusive, as the virus acts like no pathogen humanity has ever seen.”

In a single illuminating chart, Science lists the following organs as being vulnerable to COVID-19: brain, eyes, nose, lungs, heart, blood vessels, livers, kidneys, intestines. That is to say, nearly every organ:

And the disparate impacts were significant ones: Heart damage was discovered in 20 percent of patients hospitalized in Wuhan, where 44 percent of those in ICU exhibited arrhythmias; 38 percent of Dutch ICU patients had irregular blood clotting; 27 percent of Wuhan patients had kidney failure, with many more showing signs of kidney damage; half of Chinese patients showed signs of liver damage; and, depending on the study, between 20 percent and 50 percent of patients had diarrhea.

On April 15, the Washington Post reported that, in New York and Wuhan, between 14 and 30 percent of ICU patients had lost kidney function, requiring dialysis. New York hospitals were treating so much kidney failure “they need more personnel who can perform dialysis and have issued an urgent call for volunteers from other parts of the country. They also are running dangerously short of the sterile fluids used to deliver that therapy.” The result, the Post said, was rationed care: patients needing 24-hour support getting considerably less. On Saturday, the paper reported that “[y]oung and middle-aged people, barely sick with COVID-19, are dying from strokes.” Many of the patients described didn’t even know they were sick:

The patient’s chart appeared unremarkable at first glance. He took no medications and had no history of chronic conditions. He had been feeling fine, hanging out at home during the lockdown like the rest of the country, when suddenly, he had trouble talking and moving the right side of his body. Imaging showed a large blockage on the left side of his head. Oxley gasped when he got to the patient’s age and covid-19 status: 44, positive.

The man was among several recent stroke patients in their 30s to 40s who were all infected with the coronavirus. The median age for that type of severe stroke is 74.

But the patient’s age wasn’t the only abnormality of the case:

As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before. On the monitors, the brain typically shows up as a tangle of black squiggles — “like a can of spaghetti,” he said — that provide a map of blood vessels. A clot shows up as a blank spot. As he used a needlelike device to pull out the clot, he saw new clots forming in real-time around it.

“This is crazy,” he remembers telling his boss.

These strokes, several doctors who spoke to the Post theorized, could explain the high number of patients dying at home — four times the usual rate in New York, many or most of them, perhaps, dying quite suddenly. According to the Brigham and Women’s guidelines, only 53 percent of COVID-19 patients have died from respiratory failure alone.

It’s not unheard of, of course, for a disease to express itself in complicated or hard-to-parse ways, attacking or undermining the functioning of a variety of organs. And it’s common, as researchers and doctors scramble to map the shape of a new disease, for their understanding to evolve quite quickly. But the degree to which doctors and scientists are, still, feeling their way, as though blindfolded, toward a true picture of the disease cautions against any sense that things have stabilized, given that our knowledge of the disease hasn’t even stabilized. Perhaps more importantly, it’s a reminder that the coronavirus pandemic is not just a public-health crisis but a scientific one as well. And that as deep as it may feel we are into the coronavirus, with tens of thousands dead and literally billions in precautionary lockdown, we are still in the very early stages, when each new finding seems as likely to cloud or complicate our understanding of the coronavirus as it is to clarify it. Instead, confidence gives way to uncertainty.

In the space of a few months, we’ve gone from thinking there was no “asymptomatic transmission” to believing it accounts for perhaps half or more of all cases, from thinking the young were invulnerable to thinking they were just somewhat less vulnerable, from believing masks were unnecessary to requiring their use at all times outside the house, from panicking about ventilator shortages to deploying pregnancy massage pillows instead. Six months since patient zero, we still have no drugs proven to even help treat the disease. Almost certainly, we are past the “Rare Cancer Seen in 41 Homosexuals” stage of this pandemic. But how far past?

Opinion | When Will Life Be Normal Again? We Just Don’t Know (The New York Times)

nytimes.com

By Charlie Warzel, April 13, 2020

Many Americans have been living under lockdown for a month or more. We’re all getting antsy. The president is talking about a “light at the end of the tunnel.” People are looking for hope and reasons to plan a return to something — anything — approximating normalcy. Experts are starting to speculate on what lifting restrictions will look like. Despite the relentless, heroic work of doctors and scientists around the world, there’s so much we don’t know.

We don’t know how many people have been infected with Covid-19.

We don’t know the full range of symptoms.

We don’t always know why some infections develop into severe disease.

We don’t know the full range of risk factors.

We don’t know exactly how deadly the disease is.

We don’t have answers to more detailed questions about how the virus spreads, including: “How many virus particles does it even take to launch an infection? How far does the virus travel in outdoor spaces, or in indoor settings? Have these airborne movements affected the course of the pandemic?”

We don’t know for sure how this coronavirus first emerged.

We don’t know how much China has concealed the extent of the coronavirus outbreak in that country.

We don’t know what percentage of adults are asymptomatic. Or what percentage of children are asymptomatic.

We don’t know the strength and duration of immunity. Though people who recover from Covid-19 likely have some degree of immunity for some period of time, the specifics are unknown.

We don’t yet know why some who’ve been diagnosed as “fully recovered” from the virus have tested positive a second time after leaving quarantine.

We don’t know why some recovered patients have low levels of antibodies.

We don’t know the long-term health effects of a severe Covid-19 infection. What are the consequences to the lungs of those who survive intensive care?

We don’t yet know if any treatments are truly effective. While there are many therapies in trials, there are no clinically proven therapies aside from supportive care.

We don’t know for certain if the virus was in the United States before the first documented case.

We don’t know when supply chains will strengthen to provide health care workers with enough masks, gowns and face shields to protect them.

In America, we don’t know the full extent to which black people are disproportionately suffering. Fewer than a dozen states have published data on the race and ethnic patterns of Covid-19.

We don’t know if people will continue to adhere to social distancing guidelines once infections go down.

We don’t know when states will be able to test everyone who has symptoms.

We don’t know if the United States could ever deploy the number of tests — as many as 22 million per day — needed to implement mass testing and quarantining.

We don’t know if we can implement “test and trace” contact tracing at scale.

We don’t know whether smartphone location tracking could be implemented without destroying our privacy.

We don’t know if or when researchers will develop a successful vaccine.

We don’t know how many vaccines can be deployed and administered in the first months after a vaccine becomes available.

We don’t know how a vaccine will be administered — who will get it first?

We don’t know if a vaccine will be free or costly.

We don’t know if a vaccine will need to be updated every year.

We don’t know how, when we do open things up again, we will do it.

We don’t know if people will be afraid to gather in crowds.

We don’t know if people will be too eager to gather in crowds.

We don’t know what socially distanced professional sports will look like.

We don’t know what socially distanced workplaces will look like.

We don’t know what socially distanced bars and restaurants will look like.

We don’t know when schools will reopen.

We don’t know what a general election in a pandemic will look like.

We don’t know what effects lost school time will have on children.

We don’t know if the United States’s current and future government stimulus will stave off an economic collapse.

We don’t know whether the economy will bounce back in the form of a “v curve” …

Or whether it’ll be a long recession.

We don’t know when any of this will end for good.

There is, at present, no plan from the Trump White House on the way forward.

We’re working on a project about the ways people’s lives might be permanently altered by the coronavirus, even after the pandemic subsides. In what ways do you think your life will change in the long term? What will be your new “normal”?

‘Instead of Coronavirus, the Hunger Will Kill Us.’ A Global Food Crisis Looms (The New York Times)

By Abdi Latif Dahir – April 22, 2020

The world has never faced a hunger emergency like this, experts say. It could double the number of people facing acute hunger to 265 million by the end of this year.

In Kibera, the largest slum in Nairobi, Kenya, residents already live in extreme poverty. Coronavirus lockdowns have caused many more to go hungry.
Credit…Tyler Hicks/The New York Times

Published April 22, 2020; Updated April 23, 2020, 6:39 a.m. ET

NAIROBI, Kenya — In the largest slum in Kenya’s capital, people desperate to eat set off a stampede during a recent giveaway of flour and cooking oil, leaving scores injured and two people dead.

In India, thousands of workers are lining up twice a day for bread and fried vegetables to keep hunger at bay.

And across Colombia, poor households are hanging red clothing and flags from their windows and balconies as a sign that they are hungry.

“We don’t have any money, and now we need to survive,” said Pauline Karushi, who lost her job at a jewelry business in Nairobi, and lives in two rooms with her child and four other relatives. “That means not eating much.”

The coronavirus pandemic has brought hunger to millions of people around the world. National lockdowns and social distancing measures are drying up work and incomes, and are likely to disrupt agricultural production and supply routes — leaving millions to worry how they will get enough to eat.

The coronavirus has sometimes been called an equalizer because it has sickened both rich and poor, but when it comes to food, the commonality ends. It is poor people, including large segments of poorer nations, who are now going hungry and facing the prospect of starving.

“The coronavirus has been anything but a great equalizer,” said Asha Jaffar, a volunteer who brought food to families in the Nairobi slum of Kibera after the fatal stampede. “It’s been the great revealer, pulling the curtain back on the class divide and exposing how deeply unequal this country is.”

Already, 135 million people had been facing acute food shortages, but now with the pandemic, 130 million more could go hungry in 2020, said Arif Husain, chief economist at the World Food Program, a United Nations agency. Altogether, an estimated 265 million people could be pushed to the brink of starvation by year’s end.

“We’ve never seen anything like this before,” Mr. Husain said. “It wasn’t a pretty picture to begin with, but this makes it truly unprecedented and uncharted territory.”

The world has experienced severe hunger crises before, but those were regional and caused by one factor or another — extreme weather, economic downturns, wars or political instability.

This hunger crisis, experts say, is global and caused by a multitude of factors linked to the coronavirus pandemic and the ensuing interruption of the economic order: the sudden loss in income for countless millions who were already living hand-to-mouth; the collapse in oil prices; widespread shortages of hard currency from tourism drying up; overseas workers not having earnings to send home; and ongoing problems like climate change, violence, population dislocations and humanitarian disasters.

Already, from Honduras to South Africa to India, protests and looting have broken out amid frustrations from lockdowns and worries about hunger. With classes shut down, over 368 million children have lost the nutritious meals and snacks they normally receive in school.

There is no shortage of food globally, or mass starvation from the pandemic — yet. But logistical problems in planting, harvesting and transporting food will leave poor countries exposed in the coming months, especially those reliant on imports, said Johan Swinnen, director general of the International Food Policy Research Institute in Washington.

While the system of food distribution and retailing in rich nations is organized and automated, he said, systems in developing countries are “labor intensive,” making “these supply chains much more vulnerable to Covid-19 and social distancing regulations.”

Yet even if there is no major surge in food prices, the food security situation for poor people is likely to deteriorate significantly worldwide. This is especially true for economies like Sudan and Zimbabwe that were struggling before the outbreak, or those like Iran that have increasingly used oil revenues to finance critical goods like food and medicine.

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In the sprawling Petare slum on the outskirts of the capital, Caracas, a nationwide lockdown has left Freddy Bastardo and five others in his household without jobs. Their government-supplied rations, which had arrived only once every two months before the crisis, have long run out.

“We are already thinking of selling things that we don’t use in the house to be able to eat,” said Mr. Bastardo, 25, a security guard. “I have neighbors who don’t have food, and I’m worried that if protests start, we wouldn’t be able to get out of here.”

As wages have dried up, half a million people are estimated to have left cities to walk home, setting off the nation’s “largest mass migration since independence,” said Amitabh Behar, the chief executive of Oxfam India.

On a recent evening, hundreds of migrant workers, who have been stuck in New Delhi after a lockdown was imposed in March with little warning, sat under the shade of a bridge waiting for food to arrive. The Delhi government has set up soup kitchens, yet workers like Nihal Singh go hungry as the throngs at these centers have increased in recent days.

“Instead of coronavirus, the hunger will kill us,” said Mr. Singh, who was hoping to eat his first meal in a day. Migrants waiting in food lines have fought each other over a plate of rice and lentils. Mr. Singh said he was ashamed to beg for food but had no other option.

“The lockdown has trampled on our dignity,” he said.

Refugees and people living in conflict zones are likely to be hit the hardest.

The curfews and restrictions on movement are already devastating the meager incomes of displaced people in Uganda and Ethiopia, the delivery of seeds and farming tools in South Sudan and the distribution of food aid in the Central African Republic. Containment measures in Niger, which hosts almost 60,000 refugees fleeing conflict in Mali, have led to surges in the pricing of food, according to the International Rescue Committee.

The effects of the restrictions “may cause more suffering than the disease itself,” said Kurt Tjossem, regional vice president for East Africa at the International Rescue Committee.

Ahmad Bayoush, a construction worker who had been displaced to Idlib Province in northern Syria, said he and many others had signed up to receive food from aid groups, but that it had yet to arrive.

“I am expecting real hunger if it continues like this in the north,” he said.

The pandemic is also slowing efforts to deal with the historic locust plague that has been ravaging the East and Horn of Africa. The outbreak is the worst the region has seen in decades and comes on the heels of a year marked by extreme droughts and floods. But the arrival of billions of new swarms could further deepen food insecurity, said Cyril Ferrand, head of the Food and Agriculture Organization’s resilience team in eastern Africa.

Travel bans and airport closures, Mr. Ferrand said, are interrupting the supply of pesticides that could help limit the locust population and save pastureland and crops.

As many go hungry, there is concern in a number of countries that food shortages will lead to social discord. In Colombia, residents of the coastal state of La Guajira have begun blocking roads to call attention to their need for food. In South Africa, rioters have broken into neighborhood food kiosks and faced off with the police.

And even charitable food giveaways can expose people to the virus when throngs appear, as happened in Nairobi’s shantytown of Kibera earlier this month.

“People called each other and came rushing,” said Valentine Akinyi, who works at the district government office where the food was distributed. “People have lost jobs. It showed you how hungry they are.”

Yet communities across the world are also taking matters into their own hands. Some are raising money through crowdfunding platforms, while others have begun programs to buy meals for needy families.

On a recent afternoon, Ms. Jaffar and a group of volunteers made their way through Kibera, bringing items like sugar, flour, rice and sanitary pads to dozens of families. A native of the area herself, Ms. Jaffar said she started the food drive after hearing so many stories from families who said they and their children were going to sleep hungry.

The food drive has so far reached 500 families. But with all the calls for assistance she’s getting, she said, “that’s a drop in the ocean.”

Reporting was contributed by Anatoly Kurmanaev and Isayen Herrera from Caracas, Venezuela; Paulina Villegas from Mexico City; Julie Turkewitz from Bogotá, Colombia; Ben Hubbard and Hwaida Saad from Beirut, Lebanon; Sameer Yasir from New Delhi; and Hannah Beech from Bangkok.

The Pandemic Isn’t a Black Swan but a Portent of a More Fragile Global System (New Yorker)

newyorker.com

Bernard Avishai – April 21, 2020

Nassim Nicholas Taleb at his home in Larchmont N.Y.
Nassim Nicholas Taleb says that his profession is “probability.” But his vocation is showing how the unpredictable is increasingly probable.Photograph Michael Appleton / NYT / Redux

Nassim Nicholas Taleb is “irritated,” he told Bloomberg Television on March 31st, whenever the coronavirus pandemic is referred to as a “black swan,” the term he coined for an unpredictable, rare, catastrophic event, in his best-selling 2007 book of that title. “The Black Swan” was meant to explain why, in a networked world, we need to change business practices and social norms—not, as he recently told me, to provide “a cliché for any bad thing that surprises us.” Besides, the pandemic was wholly predictable—he, like Bill Gates, Laurie Garrett, and others, had predicted it—a white swan if ever there was one. “We issued our warning that, effectively, you should kill it in the egg,” Taleb told Bloomberg. Governments “did not want to spend pennies in January; now they are going to spend trillions.”

The warning that he referred to appeared in a January 26th paper that he co-authored with Joseph Norman and Yaneer Bar-Yam, when the virus was still mainly confined to China. The paper cautions that, owing to “increased connectivity,” the spread will be “nonlinear”—two key contributors to Taleb’s anxiety. For statisticians, “nonlinearity” describes events very much like a pandemic: an output disproportionate to known inputs (the structure and growth of pathogens, say), owing to both unknown and unknowable inputs (their incubation periods in humans, or random mutations), or eccentric interaction among various inputs (wet markets and airplane travel), or exponential growth (from networked human contact), or all three.

“These are ruin problems,” the paper states, exposure to which “leads to a certain eventual extinction.” The authors call for “drastically pruning contact networks,” and other measures that we now associate with sheltering in place and social distancing. “Decision-makers must act swiftly,” the authors conclude, “and avoid the fallacy that to have an appropriate respect for uncertainty in the face of possible irreversible catastrophe amounts to ‘paranoia.’ ” (“Had we used masks then”—in late January—“we could have saved ourselves the stimulus,” Taleb told me.)

Yet, for anyone who knows his work, Taleb’s irritation may seem a little forced. His profession, he says, is “probability.” But his vocation is showing how the unpredictable is increasingly probable. If he was right about the spread of this pandemic it’s because he has been so alert to the dangers of connectivity and nonlinearity more generally, to pandemics and other chance calamities for which COVID-19 is a storm signal. “I keep getting asked for a list of the next four black swans,” Taleb told me, and that misses his point entirely. In a way, focussing on his January warning distracts us from his main aim, which is building political structures so that societies will be better able to cope with mounting, random events.

Indeed, if Taleb is chronically irritated, it is by those economists, officials, journalists, and executives—the “naïve empiricists”—who think that our tomorrows are likely to be pretty much like our yesterdays. He explained in a conversation that these are the people who, consulting bell curves, focus on their bulging centers, and disregard potentially fatal “fat tails”—events that seem “statistically remote” but “contribute most to outcomes,” by precipitating chain reactions, say. (Last week, Dr. Phil told Fox’s Laura Ingraham that we should open up the country again, noting, wrongly, that “three hundred and sixty thousand people die each year “from swimming pools — but we don’t shut the country down for that.” In response, Taleb tweeted, “Drowning in swimming pools is extremely contagious and multiplicative.”) Naïve empiricists plant us, he argued in “The Black Swan,” in “Mediocristan.” We actually live in “Extremistan.”

Taleb, who is sixty-one, came by this impatience honestly. As a young man, he lived through Lebanon’s civil war, which was precipitated by Palestinian militias escaping a Jordanian crackdown, in 1971, and led to bloody clashes between Maronite Christians and Sunni Muslims, drawing in Shiites, Druze, and the Syrians as well. The conflict lasted fifteen years and left some ninety thousand people dead. “These events were unexplainable, but intelligent people thought they were capable of providing convincing explanations for them—after the fact,” Taleb writes in “The Black Swan.” “The more intelligent the person, the better sounding the explanation.” But how could anyone have anticipated “that people who seemed a model of tolerance could become the purest of barbarians overnight?” Given the prior cruelties of the twentieth century, the question may sound ingenuous, but Taleb experienced sudden violence firsthand. He grew fascinated, and outraged, by extrapolations from an illusory normal—the evil of banality. “I later saw the exact same illusion of understanding in business success and the financial markets,” he writes.

“Later” began in 1983, when, after university in Paris, and a Wharton M.B.A., Taleb became an options trader—“my core identity,” he says. Over the next twelve years, he conducted two hundred thousand trades, and examined seventy thousand risk-management reports. Along the way, he developed an investment strategy that entailed exposure to regular, small losses, while positioning him to benefit from irregular, massive gains—something like a venture capitalist. He explored, especially, scenarios for derivatives: asset bundles where fat tails—price volatilities, say—can either enrich or impoverish traders, and do so exponentially when they increase the scale of the movement.

These were the years, moreover, when, following Japan, large U.S. manufacturing companies were converting to “just-in-time” production, which involved integrating and synchronizing supply-chains, and forgoing stockpiles of necessary components in favor of acquiring them on an as-needed basis, often relying on single, authorized suppliers. The idea was that lowering inventory would reduce costs. But Taleb, extrapolating from trading risks, believed that “managing without buffers was irresponsible,” because “fat-tail events” can never be completely avoided. As the Harvard Business Review reported this month, Chinese suppliers shut down by the pandemic have stymied the production capabilities of a majority of the companies that depend on them.

The coming of global information networks deepened Taleb’s concern. He reserved a special impatience for economists who saw these networks as stabilizing—who thought that the average thought or action, derived from an ever-widening group, would produce an increasingly tolerable standard—and who believed that crowds had wisdom, and bigger crowds more wisdom. Thus networked, institutional buyers and sellers were supposed to produce more rational markets, a supposition that seemed to justify the deregulation of derivatives, in 2000, which helped accelerate the crash of 2008.

As Taleb told me, “The great danger has always been too much connectivity.” Proliferating global networks, both physical and virtual, inevitably incorporate more fat-tail risks into a more interdependent and “fragile” system: not only risks such as pathogens but also computer viruses, or the hacking of information networks, or reckless budgetary management by financial institutions or state governments, or spectacular acts of terror. Any negative event along these lines can create a rolling, widening collapse—a true black swan—in the same way that the failure of a single transformer can collapse an electricity grid.

COVID-19 has initiated ordinary citizens into the esoteric “mayhem” that Taleb’s writings portend. Who knows what will change for countries when the pandemic ends? What we do know, Taleb says, is what cannot remain the same. He is “too much a cosmopolitan” to want global networks undone, even if they could be. But he does want the institutional equivalent of “circuit breakers, fail-safe protocols, and backup systems,” many of which he summarizes in his fourth, and favorite, book, “Antifragile,” published in 2012. For countries, he envisions political and economic principles that amount to an analogue of his investment strategy: government officials and corporate executives accepting what may seem like too-small gains from their investment dollars, while protecting themselves from catastrophic loss.

Anyone who has read the Federalist Papers can see what he’s getting at. The “separation of powers” is hardly the most efficient form of government; getting something done entails a complex, time-consuming process of building consensus among distributed centers of authority. But James Madison understood that tyranny—however distant it was from the minds of likely Presidents in his own generation—is so calamitous to a republic, and so incipient in the human condition, that it must be structurally mitigated. For Taleb, an antifragile country would encourage the distribution of power among smaller, more local, experimental, and self-sufficient entities—in short, build a system that could survive random stresses, rather than break under any particular one. (His word for this beneficial distribution is “fractal.”)

We should discourage the concentration of power in big corporations, “including a severe restriction of lobbying,” Taleb told me. “When one per cent of the people have fifty per cent of the income, that is a fat tail.” Companies shouldn’t be able to make money from monopoly power, “from rent-seeking”—using that power not to build something but to extract an ever-larger part of the surplus. There should be an expansion of the powers of state and even county governments, where there is “bottom-up” control and accountability. This could incubate new businesses and foster new education methods that emphasize “action learning and apprenticeship” over purely academic certification. He thinks that “we should have a national Entrepreneurship Day.”

But Taleb doesn’t believe that the government should abandon citizens buffeted by events they can’t possibly anticipate or control. (He dedicated his book “Skin in the Game,” published in 2018, to Ron Paul and Ralph Nader.) “The state,” he told me, “should not smooth out your life, like a Lebanese mother, but should be there for intervention in negative times, like a rich Lebanese uncle.” Right now, for example, the government should, indeed, be sending out checks to unemployed and gig workers. (“You don’t bail out companies, you bail out individuals.”) He would also consider a guaranteed basic income, much as Andrew Yang, whom he admires, has advocated. Crucially, the government should be an insurer of health care, though Taleb prefers not a centrally run Medicare-for-all system but one such as Canada’s, which is controlled by the provinces. And, like responsible supply-chain managers, the federal government should create buffers against public-health disasters: “If it can spend trillions stockpiling nuclear weapons, it ought to spend tens of billions stockpiling ventilators and testing kits.”

At the same time, Taleb adamantly opposes the state taking on staggering debt. He thinks, rather, that the rich should be taxed as disproportionately as necessary, “though as locally as possible.” The key is “to build on the good days,” when the economy is growing, and reduce the debt, which he calls “intergenerational dispossession.” The government should then encourage an eclectic array of management norms: drawing up political borders, even down to the level of towns, which can, in an epidemiological emergency, be closed; having banks and corporations hold larger cash reserves, so that they can be more independent of market volatility; and making sure that manufacturing, transportation, information, and health-care systems have redundant storage and processing components. (“That’s why nature gave us two kidneys.”) Taleb is especially keen to inhibit “moral hazard,” such as that of bankers who get rich by betting, and losing, other people’s money. “In the Hammurabi Code, if a house falls in and kills you, the architect is put to death,” he told me. Correspondingly, any company or bank that gets a bailout should expect its executives to be fired, and its shareholders diluted. “If the state helps you, then taxpayers own you.”

Some of Taleb’s principles seem little more than thought experiments, or fit uneasily with others. How does one tax more locally, or close a town border? If taxpayers own corporate equities, does this mean that companies might be nationalized, broken up, or severely regulated? But asking Taleb to describe antifragility to its end is a little like asking Thomas Hobbes to nail down sovereignty. The more important challenge is to grasp the peril for which political solutions must be designed or improvised; society cannot endure with complacent conceptions of how things work. “It would seem most efficient to drive home at two hundred miles an hour,” he put it to me.“But odds are you’d never get there.”

A Guide to the Coronavirus

Bernard Avishai teaches political economy at Dartmouth and is the author of “The Tragedy of Zionism,” “The Hebrew Republic,” and “Promiscuous,” among other books. He was selected as a Guggenheim fellow in 1987.

The anti-quarantine protests seem spontaneous. But behind the scenes, a powerful network is helping (Washington Post)

washingtonpost.com

Isaac Stanley-Becker and Tony Romm, April 22, 2020

A network of right-leaning individuals and groups, aided by nimble online outfits, has helped incubate the fervor erupting in state capitals across the country. The activism is often organic and the frustration deeply felt, but it is also being amplified, and in some cases coordinated, by longtime conservative activists, whose robust operations were initially set up with help from Republican megadonors.

The Convention of States project launched in 2015 with a high-dollar donation from the family foundation of Robert Mercer, a billionaire hedge fund manager and Republican patron. It boasts past support from two members of the Trump administration — Ken Cuccinelli, acting director of U.S. Citizenship and Immigration Services, and Ben Carson, secretary of housing and urban development.

It also trumpets a prior endorsement from Ron DeSantis, the Republican governor of Florida and a close Trump ally who is pursuing an aggressive plan to reopen his state’s economy. A spokesman for Carson declined to comment. Cuccinelli and DeSantis did not respond to requests for comment.

The initiative, aimed at curtailing federal power, is now leveraging its sweeping national network and digital arsenal to help stitch together scattered demonstrations across the country, making opposition to stay-at-home orders appear more widespread than is suggested by polling.

“We’re providing a digital platform for people to plan and communicate about what they’re doing,” said Eric O’Keefe, board president of Citizens for Self-Governance, the parent organization of the Convention of States project.

A longtime associate of the conservative activist Koch family, O’Keefe helped manage David Koch’s 1980 bid for the White House when he served as the No. 2 on the Libertarian ticket.

“To shut down our rural counties because of what’s going on in New York City, or in some sense Milwaukee, is draconian,” said O’Keefe, who lives in Wisconsin.

Polls suggest most Americans support local directives encouraging them to stay at home as covid-19, the disease caused by the new coronavirus, ravages the country, killing more than 44,000 people in the United States so far. Public health officials, including epidemiologists advising Trump’s White House, agree that sweeping restrictions represent the most effective mitigation strategy in the absence of a vaccine, which could be more than a year away.

Still, some activists insist that states should lift controls on commercial activity and public assembly, citing the effects of mass closures on businesses. They have been encouraged at times by Trump, whose attorney general, William P. Barr, said in an interview with radio host Hugh Hewitt on Tuesday that the Justice Department would consider supporting lawsuits against restrictions that go “too far.”

The swelling frustration on the right coincides with major policy changes in some states, especially those with Republican governors. Georgia, South Carolina and Tennessee have all begun relaxing their restrictions in recent days after bowing to pressure and imposing far-reaching guidelines.

The protests are reminiscent in some ways of the tea party movement and the demonstrations against the Affordable Care Act that erupted in 2010, which also involved a mix of homegrown activism and shrewd behind-the-scenes funding.

For the Convention of States, public health is an unusual focus. It was founded to push for a convention that would add a balanced-budget amendment to the Constitution. That same anti-government impulse is now animating the group’s campaign against coronavirus precautions.

“Heavy-handed government orders that interfere with our most basic liberties will do more harm than good,” read its Facebook ads, which had been viewed as many as 36,000 times as of Tuesday evening.

Asking for a $5 donation “to support our fight,” the paid posts are part of an online blitz called “Open the States,” which also includes newly created websites, a data-collecting petition and an ominous video about the economic effects of the lockdown.

The group’s president, Mark Meckler, said his aim was to act as a “clearinghouse where these guys can all find each other” — a role he learned as co-founder of the Tea Party Patriots. FreedomWorks, a libertarian advocacy group also active in the tea party movement, is seeking to play a similar function, creating an online calendar of protests.

“The major need back in 2009 was no different than it is today — some easy centralizing point to list events, to allow people to communicate with each other,” he said.

Meckler, who draws a salary of about $250,000 from the Convention of States parent group, a tax-exempt nonprofit organization, according to filings with the Internal Revenue Service, hailed the “spontaneous citizen groups self-organizing on the Internet and protesting what they perceive to be government overreach.”

So far, the protests against stay-at-home orders in states including Washington and Pennsylvania have captured headlines and drawn rebukes from some governors and epidemiologists. Experts say a sudden, widespread reopening of the country is likely to worsen the outbreak, overwhelming hospitals and killing tens of thousands.

The protesters so far have not aimed their ire at Trump, though it is his administration’s experts whose guidelines underlie many of the states’ actions.

Trump’s public comments — including his recent tweets calling for supporters to “liberate” states including Michigan, a coronavirus hot spot — have catalyzed some of the broader public reaction. Following those tweets, tens of thousands of people joined Facebook groups calling for protests in states including Pennsylvania and Ohio, where the efforts are coordinated by a trio of brothers who typically focus their efforts on fighting gun control.

In recent days, conservatives have set their sights on Wisconsin, where a few dozen protesters turned out at the Capitol to air their frustrations with Gov. Tony Evers, a Democrat, after he extended his state’s stay-at-home order until late May. Ahead of the demonstration, Moore, the Trump ally, revealed on a live stream that he was “working with a group” in the state with the goal of trying “to shut down the capital.”

Moore, who served as a Trump campaign adviser in 2016, said he had located a big donor to aid in the effort, though he never elaborated. “I told him about this, and he said, ‘Steve, I promise to pay the bail and legal fees for anyone who gets arrested,’ ” Moore said in the video. He likened his quest to the civil rights movement, adding, “We need to be the Rosa Parks here and protest against these government injustices.”

Moore, who has also worked at the right-leaning Heritage Foundation, did not respond to a request for comment.

In Michigan, among those organizing “Operation Gridlock” was Meshawn Maddock, who sits on the Trump campaign’s advisory board and is a prominent figure in the “Women for Trump” coalition. Funds to promote the demonstrations on Facebook came from the Michigan Freedom Fund, which is headed by Greg McNeilly, a longtime adviser to the family of Education Secretary Betsy DeVos.

McNeilly said the money used to advance the anti-quarantine protests came from “grass-roots fundraising efforts” and had “nothing to do with any DeVos work.”

Many of the seemingly scattered, spontaneous outbursts of citizen activism reflect deeply interwoven networks of conservative and libertarian nonprofit organizations. One of the most vocal groups opposing the lockdown in Texas is an Austin-based conservative think tank called the Texas Public Policy Foundation, which also hails the demonstrations nationwide.

“Some Americans are angry,” its director wrote in an op-ed promoted on Facebook and placed in the local media, telling readers in Texas about the achievements of protesters in Michigan.

The board vice chairman of the Texas Public Policy Foundation, oil executive Tim Dunn, is also a founding board member of the group promoting the Convention of States initiative. And the foundation’s former president, Brooke Rollins, now works as an assistant to Trump in the Office of American Innovation.

Neither Dunn nor Rollins responded to requests for comment.

The John Hancock Committee for the States — the name used in IRS filings by the group behind the Convention of States — gave more than $100,000 to the Texas Public Policy Foundation in 2011.

The Convention of States project, meanwhile, has received backing from DonorsTrust, a tax-exempt financial conduit for right-wing causes that does not disclose its contributors. The same fund has helped bankroll the Idaho Freedom Foundation, which is encouraging protests of a stay-at-home order imposed by the state’s Republican governor, Brad Little.

“Disobey Idaho,” say its Facebook ads, which use an image of the “Join or Die” snake woodcut emblematic of the Revolutionary War and later adopted by the tea party movement.

In 2014, the year before it launched the Convention of States initiative, Citizens for Self-Governance received $500,000 from the Mercer Family Foundation, a donation Meckler said helped jump-start the campaign. Mercer declined to comment.

While groups and individual activists associated with the Koch brothers have boosted this far-flung network, Emily Seidel, the chief executive of the Koch-backed Americans for Prosperity advocacy group, sought to distance the organization from the protest activity, which she said was “not the best way” to “get people back to work.”

“Instead, we are working directly with policymakers, to bring business leaders and public health officials together to help develop standards to safely reopen the economy without jeopardizing public health,” Seidel said.

But others see linkages to groups pushing anti-quarantine uprisings.

“The involvement of the Koch institutional apparatus in groups supporting these protests is clear to me,” said Robert J. Brulle, a sociologist at Drexel University whose research has focused on climate lobbying. “The presence of allies on the board usually means that they are deeply engaged in the organization and most likely a funder.”

Brulle said the blowback against the coronavirus precautions carries echoes of efforts to deny climate change, both of which rely on hostility toward government action.

“These are extreme right-wing efforts to delegitimize government,” he said. “It’s an anti-government crusade.”

Philippe Descola: “Diante do monstruoso choque epidêmico das grandes conquistas, os povos ameríndios usaram a dispersão para sobreviver” (France Culture)

20 de abril de 2020 – traduzido por Google Translator; revisado por Renzo Taddei

Você pode ouvir a entrevista completa, em francês, no artigo original.

Enquanto o mundo está parado, observamos a primavera florescer da nossa janela. E se, paradoxalmente, ser separado da natureza nos aproximar dela? Como repensar a coabitação entre homens e não-humanos?

Philippe Descola, anthropologue, professeur émérite au Collège de France et chaire Anthropologie de la nature est l'invité exceptionnel des Matins ce lundi
Philippe Descola, antropólogo, professor emérito do Collège de France e titular da cadeira de antropologia da natureza, é o convidado especial nesta segunda-feira • Créditos: FREDERICK FLORIN – AFP

Embora o vínculo do homem com o meio ambiente esteja diretamente envolvido nessa crise de saúde, devemos repensar nosso relacionamento com a natureza? É o que propõe Philippe Descola, a quem estamos recebendo hoje. Em 1976, ele partiu como estudante para descobrir os Achuars, um povo Jivaro localizado no coração da Amazônia, entre o Equador e o Peru. A experiência gerou uma longa reflexão sobre o antropocentrismo que abre o caminho para uma nova relação entre os seres humanos e seu ambiente.

A epidemia é uma consequência da ação humana sobre a natureza? É uma doença do Antropoceno? O que podemos aprender com o vínculo que certas pessoas têm com o meio ambiente?

Philippe Descola é professor emérito do Collège France, titular da cadeira de antropologia da natureza de 2000 a 2019. Ele é o autor de Les natures en question (Ed. Odile Jacob, 2017).

Qual a resposta dos achuars às epidemias?

“Não há lembranças do desastre. Estima-se que cerca de 90% da população ameríndia desapareceu entre os séculos XVI e XIX. Existe uma espécie de imaginação implícita do contato com a doença dos “brancos”. Portanto, quando os “brancos” chegaram nos remotos ambientes ameríndios, o primeiro reflexo dos ameríndios foi a desconfiança e o distanciamento.”

A doença é apenas um elemento em uma procissão de abominações provocada pela colonização. Philippe Descola

“Cada povo reagiu às suas epidemias de acordo com sua concepção de contágio. A noção de contágio levou algum tempo para se espalhar na Europa, diferentemente dos povos ameríndios. Foi isso que lhes permitiu adotar as ações corretas.”

Falando em “natureza”: um erro?

“A natureza é um conceito ocidental que designa todos os não-humanos. E essa separação entre humanos e não-humanos resultou na introdução de uma distância social entre eles”.

Você pode pensar que o vírus é uma metáfora para a humanidade. Temos o mesmo relacionamento instrumental com a Terra que um vírus. De certa forma, os seres humanos são o patógeno do planeta. Philippe Descola

“Essa ideia muito humana de que a natureza é infinita resultou nesse sistema singular, baseado em produtividade e lucratividade, que causou uma catástrofe planetária”.

O ideal do “mundo depois”

“Espero que o próximo mundo seja diferente do anterior. A pandemia nos dá um marcador temporário. Essa transformação, eu vejo isso com interesse, está tomando forma e vínculos com seres não-humanos são tecidos novamente. Temos que viver com uma mentalidade que não destrua o meio ambiente “.

A idéia não é possuir a natureza, mas ser possuído por um ambiente. Philippe Descola

The Impossible Ethics of Pandemic Triage (The Atlantic)

Original article

Aaron Kheriaty – April 3, 2020


Is there a formula for deciding which patients doctors try to save?

If help does not arrive quickly, several hospitals in New York will soon run out of ventilators. Doctors at these hospitals will then face anguishing choices — if the word “choice” is even applicable when every available option is an awful one.

Imagine that Mr. Jones was intubated yesterday in an NYC hospital. He is not imminently dying, though his chances of surviving Covid-19 are uncertain. Mrs. Smith, another Covid-19 case, now requires intubation in the same hospital’s emergency room. She is twenty years younger than Jones, and without his diabetes and hypertension, so her prognosis for recovery is better. But yesterday Jones took the last ventilator in the ICU. If we leave Mr. Jones on the vent, Mrs. Smith will die. If we take Jones off the vent to give it to Smith, then he will die.

If we choose the younger, healthier Mrs. Smith over the older, sicker Mr. Jones, this might appear to be age discrimination. On the other hand, the coronavirus itself engages in age discrimination, killing those over 70 at a much higher rate — so age itself appears to be a medically relevant prognostic factor in many cases.

Most physicians are not trained as wartime medics. We have never before faced these battlefield triage decisions. And with the coronavirus pandemic, there are additional ethical complications. That NYC hospital is also running out of N95 masks and proper gowns to protect staff from infection. Health care workers certainly have a duty to care for the sick. Just as firefighters run into burning buildings while others run away, so also we treat contagious patients while others are socially distancing.

But just as firefighters never signed up to run into burning buildings in their boxer shorts, so also doctors and nurses did not sign up to treat infectious diseases without basic personal protective equipment — gowns, gloves, and masks that cost pennies apiece yet somehow are in short supply. When this PPE is gone, and doctors lack even the most basic barriers against infection, should the 70-year-old physician have to stay in the game? What about the 28-year-old pregnant medical resident who has an elderly immunocompromised grandfather living at home?

Suppose during this crisis we stretch the duty to treat contagious patients to heroic proportions. This is part of the physician’s job, so it is all hands on deck. After a few weeks of this strategy, and before more N95 masks arrive, half of the emergency and ICU physicians in this NYC hospital are home sick with the cursed virus, and one of the hospital’s docs is sick enough to need — guess what? — a ventilator. So this doctor returns to her hospital as a patient.

Should we then pull Mrs. Jones off the ventilator and offer it to the infected physician, who after all acquired Covid-19 while on the front lines heroically risking her own health to care for patients? If we are not convinced by the argument from reciprocity (that she deserves some reward for these efforts), what about the “multiplier effect”? If our central ethical principle under crisis conditions is to save as many lives as possible, it seems plausible that saving this ICU physician — if she recovers and returns to the fray — could help save the lives of more patients. Doctors are in short supply and cannot be easily replaced.

Okay, fine — perhaps we can prioritize doctors, all other things being equal in terms of prognosis. But many other workers are also critical to the pandemic response. Perhaps we can “replace” food service workers and janitors — as distasteful as it is to put it in those terms and think of our fellow human beings in that way — but what about the lead scientist on a project to develop a coronavirus vaccine? Or the police chief of New York? Or any police officer or firefighter, for that matter? What about a priority nudge for pregnant patients on the basis of this same multiplier effect? How should we draw the line around this category of “critical workers” or others who can get a bump up the triage list?

Draw the line too broadly, encompassing anyone still working during the crisis, and such priority quickly becomes meaningless. Draw it too narrowly and you exclude others who are also essential. In any case, if we consider some to be indispensable in this hour, does this not imply that others — the artists and poets, the homeless and unemployed — are dispensable? How will such practices shape our attitudes and impact social solidarity once the virus is gone and the dust has settled?

Suppose we attempt to resolve these puzzles by sticking only to objective clinical criteria: no special priority for anyone, no triage categories that are not directly related to prognosis. We do our best to predict which patients will have the best short-term survival outcomes, give them first priority on scarce resources like ventilators, and save as many people as possible. This seems sensible enough, until we realize that those Covid-19 patients with the best prognosis are typically the ones without medical conditions like diabetes, hypertension, and cardiac disease. But these people are often healthier because they eat healthy food (which is more expensive than McDonald’s), work out at fancy gyms (also expensive), and have access to good medical care (very expensive).

So a triage system that appears at first glance to be fair and medically objective turns out to have the potential for exacerbating social inequalities. The populations that were most vulnerable before a disaster are likely to be among the most vulnerable during a disaster. On the other hand, our mandate is to save as many lives as possible, not to right all wrongs. If devising a medically fair pandemic triage system is frightfully hard, devising a socially fair system seems impossible.

Triage scenarios are not hypothetical fantasies: they are happening in Italy and they are on the verge of happening here. Even as we hope and pray for the best, we have to plan for the worst — and prepare for it quickly.

For the past several weeks, these and a thousand other bewildering questions have been keeping my colleagues and me awake at night. After working on these issues round the clock with colleagues at my hospital who specialize in ethics, critical care, anesthesiology, emergency medicine, and nursing, I recently joined a task force to devise a pandemic triage protocol for all hospitals in the University of California system. These are some of the most remarkable people I know, and most have skin in the game as physicians on the front lines.

UC hospitals are well prepared for a large coronavirus surge, but many of California’s smaller private and community hospitals may not be so fortunate. These times call for the sharing of resources between hospitals, for transfers of care, for institutional solidarity. Our hospitals’ resources belong not to us, but to the citizens of California, and even to those beyond our state borders.

We are not starting from scratch or reinventing the wheel in our deliberations. Many thoughtful ethicists and dedicated clinicians have examined these questions in the bioethics research literature. And several states have published guidelines on these thorny questions, often with input from citizens. Yet most of this background work was done when these questions were hypothetical, while the guidelines we are producing now may soon be deployed on the ground.

In the few moments when we slow down, we occasionally think about the opportunistic lawyers and prosecutors who will later go after doctors no matter what choices we make. This is not to mention the Monday morning quarterbacks who will second-guess these choices with the benefit of hindsight, limitless time, and much more retrospective data. Well, fine — let armies of graduate students earn their Ph.D.’s in the coming years by telling us what we could have done better.

Honestly, most of the time we just worry about our patients. We picture the droves of sick people, barely able to breathe, who will arrive any day now at our hospital doors in ever expanding numbers. We wonder how we will explain our decision to an anguished daughter when we have to look her in the eye and say, “We are sorry, your father will not be placed on a ventilator but will be transitioned to comfort care only.” How will we explain this when a month ago he would have received treatment without question, and might have recovered?

None of this makes sense and none of us thought we would ever be in this position. Yet here we are.

We have deliberated about duty, justice, equality, fairness, transparency. These principles can never be abandoned even in a crisis. Yet something lingers always in the background of our efforts. There is an inescapably tragic undercurrent to all of this, however upright our intentions. This one unsettling fact always remains to haunt us: If hospitals exceed their surge capacity, patients who otherwise would have lived will die. Lives will be lost simply because we lacked the resources to offer everyone the basics of modern medicine.

T. S. Eliot saw the limits of our ability to rectify all wrongs and balance the scales of justice when he wrote, “For us, there is only the trying. The rest is not our business.” My colleagues and I, like so many others in these strange times, are trying our best. But controlling and managing this pandemic is beyond our abilities, indeed, beyond anyone’s abilities. In the absence of a God’s-eye view, in the absence of unlimited resources, in the absence of a crystal ball that can perfectly prognosticate outcomes, physicians are left to humbly do whatever we can — even as we know that this will not be enough. For us there is only the trying. The rest is marked by tragedy.


Aaron Kheriaty, M.D., is an associate professor of psychiatry and human behavior, and director of the Medical Ethics Program, at the University of California Irvine School of Medicine.

Aaron Kheriaty, “The Impossible Ethics of Pandemic Triage,” TheNewAtlantis.com, April 3, 2020.