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| Mass Death Is Not Inevitable | Mass Death Is Not Inevitable |
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| Nearly 140,000 Americans have been lost to coronavirus, and many experts fear the deaths will only accelerate in the fall as cold weather forces us indoors. By year’s end, half as many Americans may have died as did in the four years of World War II. | Nearly 140,000 Americans have been lost to coronavirus, and many experts fear the deaths will only accelerate in the fall as cold weather forces us indoors. By year’s end, half as many Americans may have died as did in the four years of World War II. |
| And yet we are still arguing over how to prevent this — each state struggling over how much lockdown to impose and what its governor can make its citizens do. | And yet we are still arguing over how to prevent this — each state struggling over how much lockdown to impose and what its governor can make its citizens do. |
| “You know the five stages of grief — denial, anger, bargaining, depression, acceptance?” asked Dr. Emily Landon, a coronavirus expert at the University of Chicago medical school. “I think the American people are in all five of them — but different parts of the country are in different stages.” | “You know the five stages of grief — denial, anger, bargaining, depression, acceptance?” asked Dr. Emily Landon, a coronavirus expert at the University of Chicago medical school. “I think the American people are in all five of them — but different parts of the country are in different stages.” |
| As death stalks us, especially our elders, have we simply become inured to the idea that they are doomed? | As death stalks us, especially our elders, have we simply become inured to the idea that they are doomed? |
| The stock market appears to have priced in a huge wave of deaths. In the 2008-2009 recession, it fell 50 percent and took four years to recover. In March it fell only 34 percent and has made up much of that ground already. Looked at with Wall Street’s bloodless arithmetic, that makes sense: Most of the deaths are among the very elderly and nursing home residents, who no longer travel or dine out or contribute much to the economy, and who are a burden on the struggling Medicare and Social Security Trust Funds. | The stock market appears to have priced in a huge wave of deaths. In the 2008-2009 recession, it fell 50 percent and took four years to recover. In March it fell only 34 percent and has made up much of that ground already. Looked at with Wall Street’s bloodless arithmetic, that makes sense: Most of the deaths are among the very elderly and nursing home residents, who no longer travel or dine out or contribute much to the economy, and who are a burden on the struggling Medicare and Social Security Trust Funds. |
| One can even argue that the acceptance of death as master of us all is part of the human psyche. But because of modern medicine, we have been out of touch with our ultimate fate for generations. | One can even argue that the acceptance of death as master of us all is part of the human psyche. But because of modern medicine, we have been out of touch with our ultimate fate for generations. |
| We’ve all heard of the Black Death and perhaps the Plague of Justinian, events that may have killed up to a third of mankind and rewrote the fates of empires. They seem lost in the mists of time. | We’ve all heard of the Black Death and perhaps the Plague of Justinian, events that may have killed up to a third of mankind and rewrote the fates of empires. They seem lost in the mists of time. |
| But not that long back, our great-great-great-great-grandparents felt the omnipresence of death in ways we will never know. | But not that long back, our great-great-great-great-grandparents felt the omnipresence of death in ways we will never know. |
| There is chart famous among epidemiologists titled “The Conquest of Pestilence in New York City.” Produced by New York City’s health department, it tracks and explains deaths in the city from 1805 to the present. | There is chart famous among epidemiologists titled “The Conquest of Pestilence in New York City.” Produced by New York City’s health department, it tracks and explains deaths in the city from 1805 to the present. |
| At first glance, it looks innocuous, like the ups and downs of the Dow Jones index. But the longer you stare at the fine print, the more horrified you become. | At first glance, it looks innocuous, like the ups and downs of the Dow Jones index. But the longer you stare at the fine print, the more horrified you become. |
| This past March, before coronavirus cases began to mount, the annual death rate in New York City was about six per 1,000 New Yorkers. The virus’s first wave added about 2.5 more deaths per 1,000 to that baseline. By contrast, from 1800 into the 1850s, deaths in the city rose in a relentless series of epidemic spikes, year after year, with only brief respites in between. | This past March, before coronavirus cases began to mount, the annual death rate in New York City was about six per 1,000 New Yorkers. The virus’s first wave added about 2.5 more deaths per 1,000 to that baseline. By contrast, from 1800 into the 1850s, deaths in the city rose in a relentless series of epidemic spikes, year after year, with only brief respites in between. |
| The annual baseline back then was about 25 deaths per 1,000 New Yorkers, and in some years the toll reached 50 per 1,000. In other words, in bad years, New Yorkers saw twice as many people around them die as usual. And they were used to seeing about four times as much death as we now do. | The annual baseline back then was about 25 deaths per 1,000 New Yorkers, and in some years the toll reached 50 per 1,000. In other words, in bad years, New Yorkers saw twice as many people around them die as usual. And they were used to seeing about four times as much death as we now do. |
| The sharpest peaks were the cholera epidemics of 1832, 1849 and 1854. But plagues came in waves, sometimes more than one simultaneously: yellow fever, smallpox, measles, scarlet fever, diphtheria, typhus and meningitis. | The sharpest peaks were the cholera epidemics of 1832, 1849 and 1854. But plagues came in waves, sometimes more than one simultaneously: yellow fever, smallpox, measles, scarlet fever, diphtheria, typhus and meningitis. |
| Other than cholera and typhus, most of those were childhood diseases that adults were immune to because they had survived them, so the chart is a parabola of maternal grief, each spike another nail in a hundred small coffins. | Other than cholera and typhus, most of those were childhood diseases that adults were immune to because they had survived them, so the chart is a parabola of maternal grief, each spike another nail in a hundred small coffins. |
| Updated July 15, 2020 | |
| The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization. | The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| The death rate began dropping after the 1860s. New Yorkers — both citizens and doctors — had finally stopped arguing and reached consensus on some basic issues. | The death rate began dropping after the 1860s. New Yorkers — both citizens and doctors — had finally stopped arguing and reached consensus on some basic issues. |
| First of all, most finally accepted the “germ theory” of disease, acknowledging that it was caused by invisible enemies, not by swamps, trash, manure or the other nuisances that underlay the “miasma theory,” which held that bad smells caused disease. (Only a century earlier, Americans had given up on the “humors theory,” which posited that disease was caused by imbalances between blood, urine, sweat and bile that had to be rebalanced by bleeding, sweating or purging.) | First of all, most finally accepted the “germ theory” of disease, acknowledging that it was caused by invisible enemies, not by swamps, trash, manure or the other nuisances that underlay the “miasma theory,” which held that bad smells caused disease. (Only a century earlier, Americans had given up on the “humors theory,” which posited that disease was caused by imbalances between blood, urine, sweat and bile that had to be rebalanced by bleeding, sweating or purging.) |
| They also agreed that whether immigrants had brought some diseases or simply suffered from them, no one was safe until everyone was safe, so they made public health universal. | They also agreed that whether immigrants had brought some diseases or simply suffered from them, no one was safe until everyone was safe, so they made public health universal. |
| As a result, New Yorkers took certain steps — sometimes very expensive and contentious, but all based on science: They dug sewers to pipe filth into the Hudson and East Rivers instead of letting it pool in the streets. In 1842, they built the Croton Aqueduct to carry fresh water to Manhattan. In 1910, they chlorinated its water to kill more germs. In 1912, they began requiring dairies to heat their milk because a Frenchman named Pasteur had shown that doing so spared children from tuberculosis. Over time, they made smallpox vaccination mandatory. | As a result, New Yorkers took certain steps — sometimes very expensive and contentious, but all based on science: They dug sewers to pipe filth into the Hudson and East Rivers instead of letting it pool in the streets. In 1842, they built the Croton Aqueduct to carry fresh water to Manhattan. In 1910, they chlorinated its water to kill more germs. In 1912, they began requiring dairies to heat their milk because a Frenchman named Pasteur had shown that doing so spared children from tuberculosis. Over time, they made smallpox vaccination mandatory. |
| Libertarians battled almost every step. Some fought sewers and water mains being dug through their properties, arguing that they owned perfectly good wells and cesspools. Some refused smallpox vaccines until the Supreme Court put an end to that in 1905, in Jacobson v. Massachusetts. | Libertarians battled almost every step. Some fought sewers and water mains being dug through their properties, arguing that they owned perfectly good wells and cesspools. Some refused smallpox vaccines until the Supreme Court put an end to that in 1905, in Jacobson v. Massachusetts. |
| In the Spanish flu epidemic of 1918, many New Yorkers donned masks but 4,000 San Franciscans formed an Anti-Mask League. (The city’s mayor, James Rolph, was fined $50 for flouting his own health department’s mask order.) Slowly, science prevailed, and death rates went down. | In the Spanish flu epidemic of 1918, many New Yorkers donned masks but 4,000 San Franciscans formed an Anti-Mask League. (The city’s mayor, James Rolph, was fined $50 for flouting his own health department’s mask order.) Slowly, science prevailed, and death rates went down. |
| Today, Americans are facing the same choice our ancestors did: We can listen to scientists and spend money to save lives, or we can watch our neighbors die. | Today, Americans are facing the same choice our ancestors did: We can listen to scientists and spend money to save lives, or we can watch our neighbors die. |
| “The people who say ‘Let her rip, let’s go for herd immunity’ — that’s just public-health nihilism,” said Dr. Joia S. Mukherjee, the chief medical office of Partners in Health, a medical charity fighting the virus in Massachusetts. “How many deaths do we have to accept to get there?” | “The people who say ‘Let her rip, let’s go for herd immunity’ — that’s just public-health nihilism,” said Dr. Joia S. Mukherjee, the chief medical office of Partners in Health, a medical charity fighting the virus in Massachusetts. “How many deaths do we have to accept to get there?” |
| A vaccine may be close at hand, and so may treatments like monoclonal antibodies that will cut our losses. | A vaccine may be close at hand, and so may treatments like monoclonal antibodies that will cut our losses. |
| We need not accept death as our overlord — we can simply hang on and outlast him. | We need not accept death as our overlord — we can simply hang on and outlast him. |
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