Monday, October 19, 2020

Swiss Miss

Via CEFA Aviation.

This is a couple of weeks old already, but I just heard about it on the radio, a Covid piece by Dr. Jonathan Schiffer ("Against Covid-19, Imperfect Measures Do the Most Good"), and it's a bit cheering: 

Schiffer, an associate professor in the Vaccine and Infectious Disease Division at the Fred Hutchinson Cancer Research Center, discusses the benefits of some effective, although far from flawless, tools in the battle against COVID-19. It’s an approach that reminds him of swiss cheese, he says, because “each of these strategies has holes but, if you apply all of them, fewer infections break through.”

The Swiss cheese is a reference to a kind of biz school model of risk assessment, envisaging safeguards against harm as an array of cheese slices, each of which blocks the oncoming threat except where it has holes; if each slice comes from a different part of the cheese, its holes are in different places, so if you have enough of them you can block just about everything (see illustration).

So if all our tools are flawed, all of them—the washing of hands and wiping down of surfaces, the masks, the distancing, the testing and tracing, the quarantine, the temperature check, eventually the vaccine that may be as little as 50% effective—have flaws in different places. I was inclined to feel despair at the thought of a vaccine that's only 50% effective, and I still see 70% would be a lot better, but the point is that trying to get where you need to go with the perfect method, the one that doesn't have any flaws at all, is a mistake—it's really better to have imperfect techniques, if you have a bunch of them.

This is in part because the thing we need to do is a little more complicated than we think. We've learned in recent months that we should be aiming around a "reproduction number" of 1.0 or less, the situation in which each infected person passes the virus on to an average of no more than one other person, but it turns out that that average is based on a wide range of different cases: 80% of Covid-19 infections aren't passed on to anybody, while those that are can be transmitted to quite a big number of people, at "superspreader" events, where one person might infect five, six, ten people.

And the rate at which the infected person sheds the virus varies a huge amount, but follows a basic pattern: it's at its worst a day or two before symptoms arise, which is why the temperature checks are stupid, but the masks are vital in most places: me wearing a mask is the only thing that protects you from me infected with Covid 48 hours before I get a fever, or any other indication I'm sick, which is the time I'm most likely to give it to you. And masks plus distancing plus meeting outdoors plus restricting your gathering size to no more than five or ten people plus being extra careful around asthmatics or people with heart disease or people over 60 all mean the virus has to get by a series of obstacles each of which has its holes in a different trajectory.

Which is why my daughter, unlucky enough to catch the virus, succeeded in not giving it to anybody else, roommate, friends, or work colleagues, which was what she was really terrified of, because she's a really good person, because she was practicing all of these imperfect techniques together.

The imperfect test—the paper-strip test that gives you a result in half an hour but may not be totally accurate—plays a role too, another vital cheese slice, and so are the not-very-good medications like remdesivir, which Schiffer thinks ought to be used earlier (like when Trump used them). And stopping horror shows like the planned 10,000-guest wedding of the Satmar rebbe's grandson in Williamsburg on Monday is absolutely vital (pleased to report that Rabbi Teitelbaum, whose brother was infected in March up in Kiryas Yoel in Orange County, has seen reason and will restrict the gathering, though I'm not clear if it's going to be good enough). Fuck religious freedom, if you'll excuse my French.

Speaking of which, another really heartening moment this weekend is this piece in The Times by Michael Tomasky ("There's a Word for Why We Wear Masks, And Liberals Should Say It"):

The word I mean is “freedom.” One of the key authors of the Western concept of freedom is John Stuart Mill. In “On Liberty,” he wrote that liberty (or freedom) means “doing as we like, subject to such consequences as may follow, without impediment from our fellow creatures, as long as what we do does not harm them even though they should think our conduct foolish, perverse or wrong.”

(I like "liberty" meaning "liberté" better, of course.) That "as long as what we do does not harm them" is what matters, because it's the other person's liberty that you're in charge of, not your own.

“Freedom” belongs almost wholly to the right. They talk about it incessantly and insist on a link between economic freedom and political freedom, positing that the latter is impossible without the former. This was an animating principle of conservative economists in the 20th century like Ludwig von Mises, Friedrich Hayek and Milton Friedman.

Because economic "freedom" as defined by conservatives entails ignoring the harm you're doing to others, by holding their wages down, leaving their safety unprotected in the workplace, and nowadays preventing them from getting affordable family planning because that somehow interferes with your precious "freedom". I don't think so.

This is something I've been on about for a long time, and it's a good moment to repeat it. In the Wilhoit formula, conservatives are talking about the freedom that is for "those who are protected, but not bound, by the law" at the expense of those who are "bound, but not protected". On the left we aim more directly at equality, because only through equality can we all be equally free. But it's liberty, the liberation of everybody, that has always been the "socialist" aim, from Marx through Frankfurt through Abby Hoffman, and that's just what has to be our aim.

Rightwingers keep complaining that being asked to wear a mask is an infringement of their "freedom". I'm sorry, I wear a mask to protect your freedom and you need to do the same for me. If you can't understand that, then go the fuck away.

Just been listening to this Brahms symphony, which is kind of at the center of who I feel I am, same conductor but Berlin Philharmonic, in a version that seemed awfully slow at 49 minutes, and I was too busy writing, but the last movement made me crazy emotional. This one looks a lot faster, and I want to just listen.

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