What a Short History of Pandemics Taught Me About Covid-19 (Part 3)

The Rise of Strong States

The previous post discussed how New Deal Democrats / Soviet Communists / Italian Fascists eradicated malaria from the regions under their control by coercing people to change farming practices and alter the landscape. This is one example of a common pandemic phenomenon: increases in state control. This began with the Black Death, when some governments in Europe started sanitary control boards and imposed quarantines—an unprecedented government intrusion on commerce. Meanwhile, Muslim countries, India, and China refused to quarantine or impede commerce during plague outbreaks.

During all major pandemics, some governments try strong measures which interfere with everyday life in order to stop the disease, and it often makes the governments more powerful in the long run. When I lived in Taiwan, I was legally required to take two HIV tests, and if I’d tested positive I would’ve been required to leave Taiwan (that law is no longer in effect).

In early 2020, the speed with which the government banned gatherings above a certain size took me aback. Was it justified for containing a relatively unknown new virus? Maybe. In retrospect, it was a mistake for covid-19 specifically. Ramping up production of N95s (through wartime manufacturing measures if necessary to make them faster) then mandating the use of N95s would’ve been far more effective, and not curtailed the freedom of assembly.

Then, in 2021, came the vaccine mandates, which forced many people to either take the vaccine or lose their jobs.

What a Short History of Pandemics Taught Me About Covid-19 (Part 1)

I recently read Pandemics: A Very Short Introduction by Christian W. McMillen. In about 120 pages, it gives a history of seven pandemics: Plague, Smallpox, Malaria, Cholera, Tuberculosis, Influenza (specifically the 1918 influenza pandemic), and HIV/AIDS. I noticed some patterns in these pandemics which also apply to the Covid-19 pandemic. Let me share my insights:

People Underestimate the Slower Killer Pandemics

Cholera, when it kills, kills fast; tuberculosis kills people slowly. In the 19th century, the British freaked out way more about cholera, even though tuberculosis caused far more deaths. This isn’t some quirk of British culture—it’s human nature. We react more strongly to dramatic infections which kill within days than infections which take years to kill.

Is this impulse rational? Maybe, in the sense that you need to survive in the short term before you can survive in the long term. Taken too far, it causes people to be too careless about the slow killers. Did you know that, as of when this book was published (2016), tuberculosis kills more people per year than ever before in history? Me neither.

The way we regarded covid in early 2020 is like how the 19th century British people regarded cholera: it was a scary new disease which swept in from the East. Yes, cholera was closely tied with India, and fear of cholera mixed with xenophobic attitudes. Recent biological evidence casts in doubt whether cholera originated in India, but it doesn’t matter where it came from. What matters is that people in the 19th century believed it was from India.

Now, we treat covid like the 19th and 20th century British (and many other Europeans) regarded tuberculosis: it’s a ‘disease of modernity,’ a mark of progress. TB spread as urban working classes coalesced in crowded living conditions to fuel the industrial revolution. When TB rates grew in India in the early 20th century, the British celebrated it as evidence of their good governance. More TB meant India was becoming less ‘backwards.’

Let that sink in: British colonial administrators considered rising TB cases and deaths in India to be a good thing.

This Isn’t a ‘Positive Scenario,’ It’s a Disaster

This essay from The Covid Underground offers three plausible positive endgames for the Covid-19 pandemic. One of the three ‘positive’ scenarios includes this:

In the next three years, the majority of the world population will be infected 6 or more times.

That leaves billions of survivors biologically aged, brain-fogged, bedbound, and betrayed by weakened immune systems. As in past pandemics, the millions of dead and disabled will create a labor shortage that empowers surviving workers.

Those who manage to minimize our Covid exposure will have the advantage in pushing for these changes.

We will start to see our numbers grow as more see the wisdom of avoiding reinfection.

I agree that this is a plausible scenario. Highly unlikely, but plausible. But to me it’s not a ‘positive’ endgame, it’s a nightmare.

I just don’t see how a future in which ‘billions’ of survivors are brain-fogged and bedbound is positive. Sorry.

I’m Confused About What’s Going on With Covid

Time Sensitive: If you live in California, Oregon, or Washington, and want to keep the mask mandate in healthcare settings, you can participate in West Coast Covid Action. (I know that some people in healthcare settings who wear masks now would stop wearing them in the absence of a mandate, and that this change would cause some deaths and disability from long covid which would otherwise not happen, and thus it’s worth fighting to keep the mandate, but given how hard it is already to find a set of doctors and nurses who follow the mask rules, not to mention that they often use leaky masks instead of respirators, I admit I’m dispirited about this).

***

In this blog post, I said, “It’s possible that the last wave is over… but I won’t believe it until we go through a winter with low death and low hospitalization rates.”

Well, winter is almost over.

I didn’t define what I considered to be ‘low.’ I think what I anticipated was either a surge (like the Omicron wave in the winter of 2021/2022) or, if that didn’t happen, a clear decreasing trend. I can tell you I didn’t expect the plateau in covid deaths we’ve had for months (a plateau visible in both official covid death counts and excess deaths).

Since I didn’t anticipate this plateau, I lack ready explanations. I’m confused.

Abandoned Mausoleums as a Metaphor for Not Thinking About the Future

Last week, I watched JPVideos’ YouTube series about the abandoned Good Shepherd Mausoleum. The short version of the story is: the previous owner claims someone forged a check to steal all the money in the perpetual care fund and that because of his health problems he couldn’t fix the leaky roof, then he died, nobody paid property taxes for a few years so the local government sold the property through a tax auction in 2005, the new owners claimed they had no idea it was a mausoleum and cemetery when they bought it, they didn’t repair the roof, in 2010 they stopped paying property taxes, the overhang began collapsing which made it dangerous to access some of the crypts, water got in through the roof, so much mold grew inside the mausoleum that it was dangerous to breathe, in 2015 the local government condemned the building, every year the building falls deeper into disrepair, it’s only a matter of time until it collapses with the caskets inside.

About That 36-Year-Old Woman Who Was Healthy Until Covid Gave Her Heart Failure

I have so much to say about this news story that it became this blog post.

For those who don’t want to read the entire article, the tl;dr is: Jamie Waddell, a healthy vaccinated-and-boosted 36-year-old woman, got covid-19, recovered, then got heart failure so severe they put her on a heart transplant list, then recovered from that too.

Why Didn’t The Urgent Care Clinic Test Her for Troponins?

From the article:

Two days later, she was coughing and achy and asked her doctor for a chest X-ray, which came back normal. She called off work two days and went to her local urgent care clinic. She did not test positive for COVID-19 or flu.

“My vital signs at that visit were a little off. My heart rate was a little high. I had a fever,” she recalls. “I came home and basically went to sleep.”

*facepalm*

Given that she had myocarditis, a troponin test at this point would’ve come back positive. Then the doctors would’ve known that she had a heart injury, and she needed treatment. Good treatment at this point in time would’ve slowed or perhaps stopped the progression of her heart failure, and she wouldn’t have needed such intense life support.

Many Doctors Care More About Their Egos Than Saving Lives

State of the Heart by Haider Warraich ends with these words:

This means that if science continues to advance, perhaps half this book will one day be proven false. Perhaps one day, a historian will cite these words snidely to reflect how ignorant we were and how far we have come since. That thought gives me a lot of joy, and the sooner we can break the untouchable idols of today, the sooner we can strip the masters of dogma, the sooner we can focus on the sum of our organs.

Being proven wrong about his scientific understanding may make Warraich joyful, but many other people in a position of power in medicine and public health would rather cause many deaths than admit mistakes.

History is full of examples. Take for example, Ignaz Semmelweis, who found evidence that washing hands before helping women give birth greatly reduced deaths.

That said, it was Dr. Semmelweis who ordered his medical students and junior physicians to wash their hands in a chlorinated lime solution until the smell of the putrid bodies they dissected in the autopsy suite was no longer detectable. Soon after instituting this protocol in 1847, the mortality rates on the doctor-dominated obstetrics service plummeted.

“In 1850, Ignaz Semmelweis saved lives with three words: wash your hands” by Dr. Howard Markel, PBS News Hour

Did other obstetricians rejoice because they had a simple method to increase the survival rate of their patients? Nope.

Unfortunately, Semmelweis’s ideas were not accepted by all of his colleagues. Indeed, many were outraged at the suggestion that they were the cause of their patients’ miserable deaths.

The same thing happened in the United States when Oliver Wendell Holmes Sr. advocated that doctors wash their hands.

These “doctors” didn’t care about evidence or saving lives. Or at least, they cared less about that than the insults about their unwashed hands’ uncleanliness. To them, it was better than more of their patients die painful deaths than that they go through the inconvenience of washing their hands.

You might also know about the story of John Snow and cholera.

Warraich describes an example prioritizing their egos over following evidence or saving lives I hadn’t heard of before.

In the early 20th century, doctors regarded high blood pressure as a good thing. Some believed it was an effect of aging with no bearing on health, others believed that the higher the blood pressure, the better.

I can say two things in defense of doctors in the very early 20th century: nobody had collected evidence that high blood pressure is dangerous, and the only method they had to reduce blood pressure was extreme salt restrictions.

Then someone gathered and published evidence that high blood pressure is deadly: life insurance companies.

In 1925, the Actuarial Society of America published a report which noted a correlation between high blood pressure and earlier death. While doctors were dismissing the need for blood pressure readings, life insurance companies pushed to have it measured and factored into their policies.

The doctors and scientists ignored this.

In various parts of the book, Warraich describes the various pressures to conform to authority and hierarchy in science and medicine. In a top-down hierarchy, you get ahead by pleasing the people of higher rank. Saving many lives might impress the people of higher status, but a more reliable means to get ahead is to flatter them and not embarrass them. It’s safe to agree with the medical authorities even when they’re wrong, but it’s risky to point out their errors.

Life insurance companies are predictive markets of human death. They bet they can collect more money from living customers than money they spend on the dead. When their bets are accurate, they make money. When their bets are inaccurate, they lose money. Given a choice between conforming to people of high status in medical and scientific hierarchies and understanding reality, they choose to understand reality.

Then the Framingham study began in 1947. It tracked the lives of people in the town of Framingham, Massachusetts to better understand human illness and health. Warraich says, “when the Framingham study was threatened with its funding being cut, life insurance companies helped bail it out, seeing how important the actuarial benefits of the study were.”

The first report published on the Framingham study showed a strong correlation between high blood pressure and heart attacks, as well as high blood pressure and strokes.

Warraich says:

The Framingham study investigators thought their job was done after they began publishing their landmark findings but quickly realized they had run into a wall—that wall was their fellow physicians. The overwhelmingly strong data they had generated failed to change the practice of either the most preeminent doctors of their time or those running mom-and-pop-style clinics in the country. And all this time, people continued to die of untreated high blood pressure by the millions—after the Second World War, every other person died in part due to hypertension. Even in the 1970s, when some medical textbooks started to recognize the importance of blood pressure, they focused on the lower number, the diastolic blood pressure, even as the Framingham investigators continued to show that it was the systolic blood pressure that mattered a lot more. Yet it wasn’t until the 1980s and 1990s, after large clinical trials proved them right, that the medical community fully embraced the findings from Framingham that had been published sequentially over many decades and had long before been supported by the life insurance companies.

(I hope to write a post about what life insurance companies say about Covid-19. Until then, the tl;dr is that life insurance companies are still uncertain about how to adjust their policies.)

To be fair to the doctors of the 1950s and 1960s, they had no way to safely reduce blood pressure other than restricting salt. The first reliable medication for reducing blood pressure was discovered in 1975—though perhaps if scientists had taken blood pressure more seriously, the medication would’ve been discovered sooner (it came from pit viper venom of all places—the viper’s bite causes victims’ blood pressure to drop so low they faint, but a small dose of a chemical in the venom only causes a small decrease in blood pressure).

Today, we have Dr. Anthony Leonardi. Do I believe Dr. Leonardi is 100% correct? No, because scientists are rarely 100% correct. Dr. Leonardi himself would probably admit that he can make mistakes. However, he has predicted the course of the covid-19 pandemic more accurately than the ‘experts’ who claimed that an infection would grant lasting immunity, then claimed that the first generation vaccines would end the pandemic, then claimed hybrid immunity would end the pandemic. In predictions about the future of the covid-19, I think Leonardi is more likely to be right than the WHO or the CDC.

Contemplating this history gives me another perspective on the healthcare workers of today who refuse to wear masks, even around vulnerable patients indoors.

Or maybe, the healthcare workers who refuse to mask even when their patients beg them too has given me a new perspective on the obstetricians in the mid-19th century who, even after encountering Semmelweis’ evidence that handwashing saves lives, continued to touch women in childbirth with unwashed hands.

Western Europe’s Cost of Living Crisis Makes My Jaw Drop

I’ve seen numbers for how the cost of electricity and fuel in Western Europe is rising. Some Western European businesses say they can’t handle the surge in prices and that if this continues, they must close. Many people in Northern Europe need fuel to get through winter—to prevent pipes from bursting and keep the physically vulnerable alive.

All this I understand intellectually, but my feelings refuse to accept this as truth.

We’re going through our own energy crisis in California now. The heat wave has led to more air conditioning, which has overwhelmed our electrical grid. Some people (including some of my contacts) have had blackouts. This is minor compared to what Western Europe faces.

If change doesn’t happen fast, it’s obvious that some businesses will fail. (Dutch greenhouses have already closed). Jobs will be lost—and how will the people who lose their jobs pay these rising energy bills? It looks like a downward spiral. Once some of these businesses are taken down for the winter, some might not come back in spring, even if energy and fuel are cheaper.

Why Are My Novels Important Enough to Sink So Much Time Into Writing and Revising Them?

The stories which most influenced my novel-series-in-progress have this in common: they’re set in a social order which is about to collapse. So is my novel series.

One is about a French aristocrat… during the reigns of Louis XV and Louis XVI.

Early in the story, she fully believes in the social values of France’s ancien régime. Over time, she notices problems which make her lose confidence in her society’s stability. She finally concludes that the system must fall, fall in the pragmatic sense that it can’t sustain itself, fall because it’s unjust.

During the storming of the Bastille, she dies. The End.

In these stories, the protagonists often die amid the collapse. However, I’m more intrigued by the ending in which the protagonist lives. Alas, the story I have in mind doesn’t run much past the collapse.

My novel series is secondary world fantasy, so historical accuracy doesn’t bind me. (Though I research history for ideas and to check plausibility.)

The protagonist of my series has been raised to believe in her social order without question. The cracks in social order are so glaring even she’s aware of them, but she considers them to be setbacks, not a prelude to the fall.

A wonderful thing about beta reader feedback is getting granular opinions of how people interpret a story. They noticed a gap between what my protagonist observed and her interpretations. One beta reader referred to my protagonist as an ‘unreliable narrator’ (note: the protagonist isn’t the narrator, but it’s written from her point-of-view). None of them predicted the collapse, but they did figure out the true social-political situation is most likely not what the protagonist thinks it is. This is exactly how I want readers to interpret Book 1. I want them to know the protagonist’s interpretation of her world is off without predicting that this entire social order is going to fall apart in the middle of the series.

That’s right. The fall won’t end the series. It’s just the midpoint.

The Word Is Out: I’m Working on a Novel

Has it already been a year since I wrote the first draft? (Answer: almost a year, I finished the first draft in September 2020).

Sorry I didn’t tell y’all about it sooner. So, so, so many bloggers write novels and… I was self-conscious about being yet another blogger who wrote a novel (why? Looking back, I don’t understand why I felt that way). Since I didn’t tell y’all earlier, I’ve been waiting for the ‘right moment’ to mention it.

The moment has come, even if it’s the wrong moment.