----- 4 stars -----
I’m an E.R. Doctor in New York. None of Us Will Ever Be the Same. / New York Times
An extraordinarily good piece; part of me wanted to extend my rating scale to five stars for this one. Also, as you might expect, it's a rather gut-wrenching read:
A Covid diary: This is what I saw as the pandemic engulfed our hospitals. [...] Second Week of March, N.Y.C. Covid-19 cases, March 8: 14 [...] Brambillasca tells me about how he had two patients side by side one day. One man was around 65 and had been on a ventilator for 10 days. He had heart problems, and he wasn’t improving. To his left was another man, about the same age but healthy. His breathing was becoming faster and shallower. Over the course of two minutes, Brambillasca decided to take the ventilator away from the first man and give it to the second one. “If you think of it as saving the most number of lives, that’s it, you have to do it,” he says. “But I’ll become an ice-cream maker instead of a doctor if I have to go on this way.” Will I, too, feel that way soon? We are starting to see some cases in our hospitals, but it’s nothing like what doctors in Italy are describing. They warn me that we are about two weeks behind them. Could we really get to where they are in such a short time? [...] Fourth Week of March, N.Y.C. Covid-19 cases, March 22: 9,045 [...] It seems impossible to avoid getting infected. You would have to be perfect, and in the mayhem of the E.R., it’s nearly impossible to be even good. I make mental calculations to keep all protective equipment on for my eight-hour shifts; during my 12-hour shifts, I’ll remove it only twice, to eat or drink. Two Italian colleagues — a doctor and a nurse — have already warned me about the physical toll of wearing this equipment on their aching faces, their noses rubbed raw, the tracing of their masks etched into their skin. [...] Emails come through from hospital leadership and the city’s health department telling us to be “appropriate” and conserve our N95 masks. A physician assistant is baking her masks in the oven to sterilize them. She shares her recipe: 170 degrees for 30 minutes. Others spray theirs down with Lysol after every shift. I was shocked when they told us to use these single-use masks for the whole day; now we are told they must last multiple shifts. We can discard them only if they become visibly soiled. Otherwise, wear the same one — “for multiple patients, for multiple shifts.” How am I supposed to know when a mask should be thrown out? What does a virus particle look like, anyway? I start telling my residents that it’s better to be lucky than to be good. [...] First Days of April, N.Y.C. Covid-19 cases, April 1: 47,440 [...] An 89-year-old patient is brought in by ambulance, with an oxygen mask covering most of her small face. I don’t think she’ll be able to talk, but she is actually able to express herself and tell me: “I don’t want a breathing tube. I’m almost 90 years old. I’ve lived.” She’s originally from North Carolina, she says. I call her niece, who is her health care proxy. She conferences in other family members. “Well, can’t we overrule what she wants?” one of them asks me. [...] The patient is still awake, interacting with me. I call the patient’s family through FaceTime on my cellphone. Her niece comes on, her smooth cheeks shiny with tears. She tries an upbeat hello. My patient isn’t fooled. “Everyone’s got to stop crying,” she says. “They’re taking good care of me here.” We all laugh a little through our tears. I order some morphine for the patient. Her breathing gets easier. I run around, trying to care for more patients. I’m not sure if anything I do makes a difference. I can’t run away from Brambillasca’s words about the virus: “It does whatever it wants.” I wonder if I’m more useful FaceTiming patients’ families rather than applying my skills as a doctor.
----- 3 stars -----
Shirley Valentine / Slate
In the middle of her monologue, the director, sitting up near the booth, called out, “Hold, please, Johanna, we need to work on this cue.” She stopped talking—stopped acting, you could see it happen—walked over to introduce herself, and asked if we were going to be working together. “I’m Dan,” I said. “Hi. Yes, we will. I’m gonna be a stagehand on the show.” “Shirley, can we have you back onstage please?” Well, that was it. I realize now that my mom’s boyfriend was probably trying to demonstrate for me the drudgery of an actual day-to-day commitment—that theater was not glamorous and starry but hard work—but any lesson he might have hoped I’d learn vanished the instant they restarted the rehearsal, when Johanna, in her frumpy one-piece bathing suit, hungry for an audience in the middle of a dull tech-through, shifted her gaze to me. I still remember, nearly 30 years later, the force of that actorly attention, like the moment when the lamp in the Pixar logo turns and looks right at you. During tech week, rehearsals started at 3, so I got to leave pre-calc early every day. I would fidget in my desk for 10 minutes before collecting my things, and Mr. Young would say, “Oh, I guess Kois has to leave for his play”—giving the words a certain bite that he believed to be belittling but that I found richly rewarding. Of course a buffoon like that wouldn’t understand what was valuable about an experience like this. Mr. Young clearly thought I was an entitled little shit, which I was. Even in subjects I liked, I rarely worked hard, instead thinking about my girlfriend or things I was writing or the bands with which I was obsessed. So in pre-calc I basically did nothing.
Lee Holloway programmed internet security firm Cloudflare into being. Then he became apathetic, distant, and unpredictable—for a long time, no one could make sense of it. [...] At work, Lee was still the star engineer. At the end of the summer of 2014, he took on a project that earned Cloudflare its first bout of internet fame: The company would help websites become encrypted for free. (It was not yet standard for company websites to be encrypted.) Lee agreed to build the necessary software by the end of September. As the date approached, Prince asked for updates, but Lee blew him off. Then, on the day before the new system was supposed to go live, he pulled his hoodie down low on his head, put on his headphones, and sat down to bang out the code. It was a Sunday, but the office was packed with people writing up the pending announcement or delivering coffee and food. Lee's coding, though, was the main event. “And he is typing, typing, and I don't think anyone dared to interrupt,” says John Graham-Cumming, then an engineer and now Cloudflare's chief technology officer. “His hoodie is on, he's in the zone, he's doing brain surgery on this thing.” Then, late in the night, Lee stood up. He announced that he'd finished, and he wandered away. “It was like, bzhzhzhzh, type-type-type, ‘I'm done!’” Graham-Cumming says. The other engineers immediately started reviewing his code. By the morning, the debugging process began for real. The gambit worked, and all of their existing customers suddenly got encryption. It was a proud moment. Says Graham-Cumming: “The size of the encrypted web doubled overnight.” [...] Not long after, Lee and Kristin took a trip to Europe, spending a few days in France, just as Lee and Alexandra had years earlier. Kristin had never been to Paris, and she was excited to explore the city. She ended up doing that on her own, while Lee again spent days asleep in their hotel room. “This is so weird,” Kristin remembers thinking. On their trip to Italy, he'd been eager to jump out of bed and visit museums and cafés, and walk around. She was puzzled, but between his migraines and his heart issue, there was always an explanation at hand. At the office, he was becoming impossible to work with. He would lash out at people, and then in meetings he would zone out, openly playing games on his phone. During one meeting, Prince texted him: “Are you playing a game? People are noticing.” Then: “Not a great leadership signal.” [...] They put their friend on an official performance-improvement plan. Over many weekly lunches, Zatlyn and Prince tried to get through to him. Nothing seemed to stick. [...] Eventually, in 2016, they decided Lee had to leave the company. “He kind of just said, yup, that sounds about right,” Prince says. They threw him a going-away party that July. Prince thanked him in a speech with tears streaming down his cheeks. Lee stood beside him with a beer in hand, a thin smile on his face.
Since Hobbes’s time, the world has come full circle. When he wrote “Leviathan,” China rather than Europe was the center of administrative excellence. China was the world’s most powerful country with the world’s biggest city (Beijing had more than a million inhabitants), the world’s mightiest navy and the world’s most sophisticated civil service, peopled by scholar-mandarins who were selected from across a vast empire by rigorous examinations. Europe was a bloodstained battlefield ruled by rival feudal families, where government jobs were either allotted by birth or bought and sold like furniture. Gradually Europe’s new nation states overtook the Middle Kingdom because they underwent a series of revolutions unleashed by national rivalries and political ideas — not least those advanced by Hobbes. By mastering the art of government (even copying China’s “mandarins”) the West dominated the world for 400 years. The West’s governmental advantage is now questionable: Simply ask yourself whether you would feel safer today in New York and London or in Singapore and Seoul? Asia is catching up with the West, and in some smaller countries has overtaken it, in large part because Confucian Asia in particular has taken government seriously over the past few decades while the West has allowed it to ossify. [...] In 2014, we published a book about the state, “The Fourth Revolution: The Global Race to Reinvent the State.” Looking back, especially through Covid-tinted spectacles, we got one big thing right, and one wrong. We correctly argued that government was a vital source of competitive advantage and that the West was falling behind. But we were wrong to believe that Western countries would respond to China’s rise by modernizing their governments, putting aside petty squabbles and copying leaner countries like Singapore. Instead, in so far as it’s done anything, the West has turned to what might be described as big-government nationalism, typified by British Prime Minister Boris Johnson and U.S. President Donald Trump; reform has taken a backseat to rage. In continental Europe, there has been no change: The European Union has survived both the euro crisis and then Brexit without any serious attempt at self-improvement. Will the Covid-19 crisis be the spur? At first glance, the omens are not good. Everywhere you look, you see our Leviathans in a sorry state — overstretched and inefficient, driven by panic rather than careful planning. [...] But look more closely, and there are more positive signs. Countries that have rethought government, like Denmark, or valorized good government traditions, like Germany, are doing better at dealing with the virus not just than those Western countries that have not done so, like the U.S. and Italy, but also better than authoritarian secretive China. The pressure of the pandemic is producing exciting innovations as well as messy confusion. The West possesses the technology, the managerial expertise and the liberal tradition to reinvent the state. Now it has a life-and-death reason to do so, too. In the past that has usually worked. [...] Behind the ideological squabbling, the main problem with Western government is simple: It is out of date. If you want a symbol of this, look no further than U.S. school calendar, which was designed for an agrarian economy where children needed long summer holidays to bring in the harvest. Think of all the changes that America’s private sector has been through over the past century: vertical integration followed by contracting out; steep hierarchies followed by delayering; skyscraper headquarters followed by suburban campuses followed by a return to the city. Think of all the companies that have been created and destroyed in a never-ending whirlwind of creative destruction. Now think of Washington. The Department of Agriculture remains a giant despite the fact that agriculture accounts for only 2% of GDP.
But getting back to the media: Their main excuse is that they were just relaying expert opinion – the sort of things the WHO and CDC and top epidemiologists were saying. I believe them. People on Twitter howl and gnash their teeth at this, asking why the press didn’t fact-check or challenge those experts. But I’m not sure I want to institute a custom of journalists challenging experts. Journalist Johann Hari decided to take it upon himself to challenge psychiatric experts, and wrote a serious of terrible articles and a terrible book saying they were wrong about everything. I am a psychiatrist and I can tell you he is so wrong that it is physically painful to read his stuff (though of course I would say that…). Most journalists stick to assuming the experts know more about their subject of expertise than they do, and I think this is wise. The role of science journalists is to primarily to relay, explain, give context to the opinions of experts, not to try to out-medicine the doctors. So I think this is a good excuse. But I would ask this of any journalist who pleads that they were just relaying and providing context for expert opinions: what was the experts’ percent confidence in their position?
A new Stanford preprint was released earlier today. The authors claim that the true population prevalence of COVID-19 in Santa Clara County is 50–85X higher than the number of confirmed cases. They base their reasoning on a serosurvey of 3330 participants. If true, this would actually be good news for society. It would mean that the virus had already widely spread, and thus had a lower fatality rate than previously expected, so the disease wasn’t as severe as we thought. Indeed, the authors claim this explicitly, by putting rough caps on the number of deaths and the infection fatality rate (as distinct from the case fatality rate). However, I am skeptical of this result for several reasons. Before I begin, I want to say that (1) I’m very glad that the authors are doing serosurveys, (2) I offer this writeup in the spirit of a peer review from a fellow scientist and citizen, (3) I believe I am qualified to render a peer review in the field of molecular diagnostics and statistics, (4) I too would like to get people back to work without causing mass sickness, (5) I hope the feedback from this round of review (even if I myself am mistaken!) allows us all to develop improved serosurveys. OK, so why I am I skeptical of this paper?
On July 30, 1966, two days before she expected to be married, Estelle Evans received a letter from her lover. She was 22, fairly fresh to New York, sharing an apartment near Columbus Circle with her roommate, Laura (last name withheld for privacy reasons), and trying to earn some kind of coin as a model. Michael was nearly 34 and claimed to be a reporter investigating some secret government operation in war-torn Vietnam. [...] Then, seven months later, came the letter from her lover. He confessed to Estelle that he was not who he said he was. His name was not Michael King as he’d told her. He was married, with children, and could not leave them. He did not, in fact, live on the Upper East Side but with his family in Laurelton, Queens — 20 miles away. The romance was over, and he would not contact her again. He never revealed his true identity to her. Estelle read the letter. She read it several more times. The shock and disbelief did not abate, in part because Estelle had recently learned that she was pregnant with Mike’s child. Laura returned to the apartment to find her roommate in a deepening state of despondency. Laura didn’t feel right leaving Estelle alone. Between convulsive sobs, Estelle kept repeating how she could she have been such a fool. The roommates ventured out, heading crosstown. Somehow, the two women ended up all the way east at the pedestrian entrance to the Queensboro Bridge. Estelle kept threatening to throw herself off it. By this time, it was nearly 4:30 in the morning. [...] The patrolmen acted quickly. Their efforts to save Estelle Evans’s life resulted in a photo on the front page of the Sunday-morning Daily News. Most newspaper readers at that time would have seen this at home or on newsstands and only registered the story’s essential ingredients of lurid tragedy — the image suffused with terror and suspense. The woman is clearly suffering. It would have been their first notice of Estelle Evans, without any clue that her brief life was inextricably linked with the origins of a dark political movement about to unfold. Her name wasn’t Estelle Evans, and her story was even more tragic and upsetting beyond the dive off the Queensboro Bridge. She took her life because of a romance built on lies. For Michael King’s real name was Meir Kahane. She had fallen for a man who went on to become one of the most notorious and divisive figures in modern Jewish history. She would never know if he loved her or if he used her as he would come to be known for using others to further his own nefarious purposes.
The options are limited. Early inaction left the U.S. with too many new cases, and just one recourse: Press a societal pause button to buy enough time for beleaguered hospitals to steel themselves for a sharp influx in patients. This physical-distancing strategy is working, but at such an economic cost that it can’t be sustained indefinitely. When restrictions relax, as they are set to do on April 30, the coronavirus will likely surge back, as it is now doing in Singapore, China, and other Asian states that had briefly restrained it. As I wrote last month, the only viable endgame is to play whack-a-mole with the coronavirus, suppressing it until a vaccine can be produced. With luck, that will take 18 to 24 months. During that time, new outbreaks will probably arise. Much about that period is unclear, but the dozens of experts whom I have interviewed agree that life as most people knew it cannot fully return. “I think people haven’t understood that this isn’t about the next couple of weeks,” said Michael Osterholm, an infectious-disease epidemiologist at the University of Minnesota. “This is about the next two years.” The pandemic is not a hurricane or a wildfire. It is not comparable to Pearl Harbor or 9/11. Such disasters are confined in time and space. The SARS-CoV-2 virus will linger through the year and across the world. “Everyone wants to know when this will end,” said Devi Sridhar, a public-health expert at the University of Edinburgh. “That’s not the right question. The right question is: How do we continue?”
Why do we not have these things? Medical equipment and financial conduits involve no rocket science whatsoever. At least therapies and vaccines are hard! Making masks and transferring money are not hard. We could have these things but we chose not to — specifically we chose not to have the mechanisms, the factories, the systems to make these things. We chose not to *build*. You don’t just see this smug complacency, this satisfaction with the status quo and the unwillingness to build, in the pandemic, or in healthcare generally. You see it throughout Western life, and specifically throughout American life. You see it in housing and the physical footprint of our cities. We can’t build nearly enough housing in our cities with surging economic potential — which results in crazily skyrocketing housing prices in places like San Francisco, making it nearly impossible for regular people to move in and take the jobs of the future. We also can’t build the cities themselves anymore. When the producers of HBO’s “Westworld” wanted to portray the American city of the future, they didn’t film in Seattle or Los Angeles or Austin — they went to Singapore. We should have gleaming skyscrapers and spectacular living environments in all our best cities at levels way beyond what we have now; where are they?
Was Jordan actually the greatest ever? It’s something of a loaded question, the kind of which has launched a million RealGM forum debates. But MJ has the stats on his side: He remains the NBA’s all-time career leader in Win Shares per 48 minutes and Player Efficiency Rating, both of which can be computed going back to 1951-52. He owns the greatest single-game performance ever according to Basketball-Reference.com’s Game Scores. And when we crunched the historical numbers for our RAPTOR player ratings (which go back to 1976-77), we found that Jordan is also the modern leader in RAPTOR plus/minus, in addition to having the best mix of career and peak value.
The best way to measure the full damage caused by such a medical crisis is to look at “excess mortality”: the gap between the total number of people who died from any cause during a given period, and the historical average for the same place and time of year. These numbers take longer to emerge. Some countries publish them with a few days’ delay, others after more than a year. EuroMOMO, a group of academics from 24 European countries, releases a weekly index. But it does not publish absolute numbers of deaths for each country. [...] By March 28th, the excess deaths in this sample had reached more than 9,000 in the previous five weeks, covering the entire period of the outbreak. At that point, the official covid-19 tally was 4,000. This suggests that the true toll was about 120% higher.
But it’s also not the first modern virus we’ve faced. In the past two decades, the world battled Ebola, SARS and more than one major flu outbreak. Those left tragedies in their wake but didn’t cause the same level of societal and economic disruption that COVID-19 has. As a result, they can help us understand this new coronavirus — to capture how unique our new reality is, it helps to look back at similar outbreaks that threatened to upend society, but ultimately stopped short.
The best ending to any writer's interview ever? Paris Review asks Ray Bradbury about the origins of a character named Mr Electrico. His answer starts in our world, opens a trapdoor in the fabric of reality itself, and surges into an elemental realm of cosmic myth. Genuine magic.
Aided by Toshi Omagari, who wrote Arcade Game Typography, Vox’s Estelle Caswell explores the origins and history of 8-bit arcade fonts. From the description of the book: Video game designers of the ’70s, ’80s, and ’90s faced color and resolution limitations that stimulated incredible creativity. With each letter having to exist in a small pixel grid, artists began to use clever techniques to create elegant character sets within a tiny canvas.
Stuck at home during the pandemic, filmmaker Nicolas Heller decided to hold a contest on Instagram to find the person with the best New York accent.
I don’t want to revisit the debates about why Trump won but one of the reasons was that his base felt disrespected by coastal and media elites–their religion, their guns, their political incorrectness, their patriotism, their education, their jobs–all disrespected. And now maybe it is happening again. From the point of view of the non-elites, the elites with their models and data and projections have shut the economy down. The news is full of pleas for New York, which always seemed like a suspicious den of urban inequity, but their hometown is doing fine. The church is closed, the bar is closed, the local plant is closed. Money is tight. Meanwhile the elites are laughing about binging Tiger King on Netflix. It doesn’t feel right. I can understand that or feel that I must try to understand that. Here’s a picture from a protest in Ohio. It wasn’t a large protest, about 100 people, but they look pretty angry. They want to reopen the economy.