Reflections on The Contagion Next Time | The Healthiest Goldfish

In last week’s column, I introduced my new book, The Contagion Next Time, in advance of its November 1 release. In that column, I wrote about why I felt compelled to write a book about a pandemic during a pandemic. I have since had a chance to engage with friends and colleagues who are in the process of reading the book and engaging with its ideas. This has long been a favorite part of the writing process. The aim of writing has always been, for me, to sharpen my thinking, with the goal of informing a broader conversation about the issues that matter most for health. Once a piece is out in the world, engaging with readers—in addition to being simply fun—helps sharpen my thinking still further. This has been the case in the days since the launch of The Contagion Next Time. It has been a joy to be able to speak with readers, to hear their reflections.

In a way, these conversations have been consistent with the spirit in which the book was written. While the act of writing is a solitary endeavor, producing a book—shaping its ideas and thinking through its structure—is a collaborative process. The thoughts in The Contagion Next Time emerged from countless conversations with friends and colleagues, from reading the work of authors and journalists I admire, and from the unique academic setting in which I am privileged to work. Academia is a discipline founded on rigorous debate, on the airing of ideas in the public conversation. I was deeply influenced by this context in writing The Contagion Next Time.

A Hard Weight | The Turning Point

Long before Covid-19, obesity was a serious health concern, a major contributor to cardiovascular and cancer deaths. More than one in three adults in the United States are living with obesity, many more are overweight. The arrival of Covid-19 has shed a new light on this longstanding health risk. The pandemic led many Americans—housebound, working fewer hours in the world, exercising less, drinking more, depressed—to gain weight.

At the same time, it became clear that having excess weight worsened Covid-19 outcomes. Obesity tripled the risk of hospitalization, and increased intensive care unit admission and death from Covid-19, particularly for those under 65 in the US. Internationally, nearly 90% of deaths from the pandemic disease have been in countries with high levels of obesity. Only old age is a stronger risk factor for severe illness. Overweight, at least, may be reversible.

Read the full post at The Turning Point.

Why write a book about a pandemic during a pandemic? | The Healthiest Goldfish

I have long been inspired by the songs and message of the musical Hamilton. There is a moment in the show when the titular character faces an hour of maximum crisis, when it seems like his world is crumbling. He sings of being in the eye of a hurricane, before declaring “I’ll write my way out,” expressing his intent to use words to both process the chaotic moment and also, hopefully, find some deliverance from it. 

That moment particularly resonated with me. I have long turned to writing to make sense of challenging events, and to try to inform a conversation that helps support a better future. And, in recent years, we have all known what it is to feel like we are in the eye of a storm. The COVID-19 pandemic has been a tempest, turning our world upside down, radically changing how we live. We have all processed the pandemic differently. My way has been writing. During the crisis, I wrote about why we found ourselves in the situation we were in, and what it will take to avoid another, potentially worse, pandemic. Those writings became my new book, The Contagion Next Time, which will be out Monday.

Read the full post at The Healthiest Goldfish.

When Do We Stop Counting? | The Turning Point

All over the country, over the course of a few months, there were about 21,000,000 symptomatic cases, 290,000 hospitalizations, and 37,000 deaths.  More than 25,000 of the deaths were in the 65+ age group. 

It seems likely that this type of case and death count recitation is familiar to the reader, seen through the lens of Covid-19, where we have assiduously documented cases and deaths for the greater part of two years. But these numbers were not Covid-19 numbers. They were cases, and deaths, from flu, during the 2010-2011 influenza season, one of the worst seasons in the past decade. We wonder: how many of us were aware of the daily case and death count during that flu season more than a decade ago?  And, perhaps more importantly, would we have behaved differently as a society if we had beenkeeping track of cases and deaths the way we have been during Covid-19?

In some ways Covid-19 case and death counting, 18 months into the pandemic, has taken on an uncomfortably familiar role, with tallies being reported in all media in much the same way as, say, the weather, which is also reported daily. But what impact does this abundance of reporting have on how we think about the pandemic? 

Read the full post at The Turning Point.

How sunk-cost bias can obscure our vision of a post-COVID world | The Healthiest Goldfish

In science, it is customary for researchers to disclose any potential bias, as part of the process of publishing work. While this is often considered in the realm of financial biases, I have previously suggested that our other biases—our mental architectures that shape how we think, why we do what we do—matter as much, or perhaps more than, easily quantifiable other biases. With this in mind, I will here disclose my own bias, one which has relevance for how I see, and write about, the COVID moment. My bias is this: if presented with a choice between, on one hand, absolute safety at the cost of the interactions and experiences that make life worth living, and having these experiences with the understanding that doing so entailed some amount of risk, I would choose the latter.

Let us call this the sunk cost bias. This bias is our tendency to continue with a given approach to health not necessarily because the data support it, but because we have already invested much in pursuing this approach. The sunk cost bias echoes the sunk cost fallacy, where we continue with a behavior or investment because it is something we have long done. The sunk cost bias is the last in a series of three biases I have discussed in recent columns, as part of the lead-up to the November 1 launch of my new book, The Contagion Next Time, which aims to help us see the true causes of health during a pandemic, which our biases can obscure.          

In some ways, I think my bias is a product of being an immigrant, one who has—like many immigrants—worked to construct a life in a new country, often in the face of uncertainty and risk. While my journey from Malta to Canada to the US has been far less difficult than the journey of other immigrants, I nevertheless know what it is like to experience the challenges that are ever-present in the life of the immigrant. I also know what it is to choose to undertake such challenges in search of a better life, to willingly accept uncertainty and risk because moving forward seems to demand it. This perhaps helps counter the sunk cost bias—I may have a particular perspective on the status quo we have traded in exchange for a feeling of greater security during COVID-19, understanding that it was never as certain as it perhaps seemed. This sense of permanent uncertainty, and the ability to live with it, can help us avoid persisting with approaches that seem to lock down a sense of security which is, in fact, more illusory than we may care to admit. Once we recognize this uncertainty, we are that much closer to realizing that life always entails some measure of risk, and the challenge is to learn to coexist with, rather than eliminate, it.   

Read the full post at The Healthiest Goldfish.

Can Contact Tracing Work Here? | The Turning Point

One of the disappointments in our pandemic response has been the limited ability of our contact tracing—one of the fundamental activities of public health during an infectious disease outbreak—to control Covid-19 transmission. Hong Kong and Singapore initially contained their outbreaks by deploying thousands of public health workers to track down every person with a newly positive test, figure out whom they had been in contact with, and quickly get those people to quarantine. The United States did not. Which raises the question: have we now learned something about how to better perform this ancient public health function to make us confident that we could do better the next time around?

The US public health system faced three challenges in its attempt to make contact tracing work. First, we had inadequate Covid-19 testing early on: we could not identify all positive cases. The testing system failed—long waits to get tests and then more waiting for results. Without being able to readily identify and test those who have been in contact with an infected person, the chain of infection continued. By the time testing was readily available, rapid, and mostly free, the number of people infected far outstripped the supply of contact tracers.

Even if we had accurate testing available soon after Covid-19 was identified, workforce limitations was our second problem. Four months into the pandemic, in May 2020, we had only a fraction of the public health workers needed to launch an effective national contact tracing effort. At that time—with only 30,000 persons having tested positive—public health experts told Congress the country needed to increase the number of contact tracing staff tenfold to 100,000 or more. Yet even in December 2020, at the peak of US case load, there were still only 70,000 contact tracers nationwide.  Widespread community transmission across the country occurred within a few months of Covid-19’s arrival; it is unclear that any number of contact tracers could have kept up. The numbers grew too big too fast.

Read the full post at The Turning Point.

The problem of positional bias | The Healthiest Goldfish

In last week’s Healthiest Goldfish, I discussed how our individualist bias can stop us from seeing the full picture of what matters most for health. Today, I would like to talk a bit about how our positional bias can do the same. I do so as part of a series of columns leading up to the November 1 release of my new book, The Contagion Next Time, which aims to help us look past our biases to see the true causes of health during the pandemic, so we can prevent the next one.  

Positional bias is, broadly speaking, when our vision of health is blinkered by our socioeconomic status—when we cannot see past the confines of our own immediate circumstances, to recognize the true drivers of health. I recently wrote about a form of positional bias when I touched on the suburban impulses that helped shape attitudes towards COVID policies, as stricter lockdowns were more widely embraced by the populations most able to easily navigate them.

For today, I will use a different example, that of vaccine hesitancy and the challenge of understanding it. As I write this, the US is currently undergoing the delta wave of COVID-19. What is distinct about this wave is that nearly all COVID deaths are among the unvaccinated. While the vaccinated can still be infected—although this is rare—we have seen a dramatic decoupling of infection rates from death rates. This speaks to the effectiveness of vaccines and the danger posed by vaccine refusal. On April 19, 2021, the date by which President Biden said all adult Americans would be eligible for the COVID-19 vaccine, there were 567,314 total COVID deaths in the US. On October 15, there were 742,008 total deaths. While the 174,694 deaths which occurred between these two dates cannot be laid entirely at the feet of vaccine hesitancy, it is undeniable that mistrust of vaccines informed the conditions that made these deaths likelier.

Read the full post at The Healthiest Goldfish.

Why did we Keep our Schools Closed? | The Turning Point

By March 2020 the Covid-19 pandemic had taken hold in America, and within a few days the country had moved to an unprecedented slowdown of civic and professional life in an effort to limit the spread of the virus.  As part of this general shutdown we closed K-12 schools. In spring of 2020, 48 states required or recommended the closure of public schools; more than 50 million children and their teachers stayed home. In the face of a new, poorly understood virus, our collective shut down was entirely reasonable, and to a large extent remarkably successful.  

And yet, by the summer of 2020, data were emerging that showed that children were less likely to contract Covid-19, and if they did, their disease was mild, and they had a low probability of transmitting it. Data quickly accumulatedshowing that children were unlikely to be an important cause of viral transmission. This, coupled with other data showing the educational and social developmental losses that were being incurred due to persistent school closure—often affecting marginalized children more than others—made a strong argument for re-opening schools in the fall of 2020.  

And yet, schools continued to remain closed, affecting as many as half of allchildren in the US in the fall of 2020 with only about a quarter of schools remaining fully open for in-person learning. Why did schools stay closed when we knew that the risk of them staying closed probably outweighed the risk of them re-opening?  Of course, societally, we are always particularly tentative if we can imagine even the smallest risk of children dying. But we suggest that there were three additional reasons, and that we might do well to learn from each of them.

Read the full post at The Turning Point.