Health – BergLabs

2020-06-07

2020 Week 23: Protests, Poisons, and Pasta

Following the Killing of George Floyd in Minnesota, protests against racism have spread across the US and the world, including here in Oxford. The police should not kill people. People should not fear violence or death from the police. Black lives matter. Going beyond these general, and hopefully obvious, statements requires looking into an incredibly complex set of historical, socio-economic, and policy questions. I tried to read and synthesise a meaningful comment this weekend, and was overwhelmed. I fear that the outpouring of emotion in these protests becomes twisted into a force for further political polarisation. In 2014 Police Chief Edward Flynn made comments that have stuck with me since; it is worth remembering that the ugliness of the world is faced and fought daily by good people, and we ought not forget their courage and sacrifice when people who look like them do terrible things.

Chemistry and Cleaning

When people are frightened, and poorly informed, they tend to act against their own interests. The US president speculated at a press conference if something like disinfectant could be used by injection to treat COVID-19. If a student posed this question to me I would attempt to guide them via the Socratic method to the nature of Denaturation. If the leader of the Free World poses it, a non-trivial minority poisons themselves.

Photos from the Week: Pasta

There have been many surprises in 2020; I would not have expected The Economist to print a recipe for making pasta from scratch in response to a global pandemic. Photos from my attempt:

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2020 Week 20: Professional Interactions

It has been a week filled with conversations. I spend a lot of time in my new role talking to people, some of whom I have worked with for years now and others who I am meeting for the first time. I have relished the opportunity to learn so much from so many, and I hope I am able to offer some insight in return.

Don’t lie to your dentist

People lie about flossing to the dentists providing them a service, and that bug of human behaviour is important to understand generally, and overcome personally. Rational adults, when asked by their own health care professionals about their behaviour, will provide inaccurate information. That information is intended to guide a decision that will affect the patient, so the incentive is for the patient to provide accurate information to receive the best possible care. Yet the desire to provide the answer they feel is “correct” overcomes their own interests. I would imagine similarly people tend to underestimate their drinking and smoking, and overestimate their exercise habits, when visiting their doctors.

Deception is a complex topic. All acting is based on the ability to assume an identity that is not ones own. The Economist lauds the benefits of teaching your children how to bluff. But deception, particularly financial or sexual, can destroy relationships. In this specific instance though, the harm of the dishonesty accrues directly to the person being dishonest, and yet the self-harm occurs. My guess would be that the combination of guilt, the desire to please, and a misunderstanding of the underlying reason for the question, combine to create a sense that providing the “socially acceptable” answer is more important than the truth. The frequency of instances of such behaviour suggests that those motivating factors are common.

Office Emotions

In the (thankfully distant) past, I have suppressed negative emotions in an attempt to overcome them, and while there were some short term benefits, the overall effect was detrimental as the deeper causal issues were ignored. Generally places of work expect employees to “act professional”, i.e. without consideration or expression of individual emotion. This is flawed on several counts, it is difficult to do, it constrains identities, and it diminishes the ability to build trust between colleagues that can be so vital for well functioning teams. There is of course a dichotomy, too much unconstrained emotion can lead to disruption of a team’s work, and places difficult burdens on others. Something I’ve been thinking a lot about lately is where the optimal position is on this, an environment that has positive relationships and provides emotional support, without spreading the (inevitable) negative experiences of an individual throughout the organisation.

Photo from the Week

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2020 Week 12: Exponential Whiplash

Since I wrote last week about the pandemic, putting it in the context of other global health issues, the total fatalities due to COVID-19 have more than doubled, and major European economies have essentially halted. I had some awareness of the likely rate of spread, but was not anticipating how events have played out, and so count myself among those hit by “exponential whiplash”:

“a cognitive phenomenon that sars-cov-2, the virus which causes covid-19, has been provoking around the world: exponential whiplash. Knowing in principle that something may take only a few days to double in size does little to prepare you for the experience of being continually behind the ever-steepening curve such doubling creates.” The Economist

I shared on LinkedIn this week that ONI is working on research to support the fight against COVID-19 and since Wednesday my productive energy has been focused there. Like many businesses across the UK, a majority of ONI’s staff are working from home, but my skills let me keep working on new projects directly related to SARS-CoV-2. It is exciting and rewarding to be able to do so, but it is also sapping time and energy from my usual pursuits. Given that, I have only a few incomplete thoughts to share:

Things to share this week

Proximity bias
It is noticeable to me that these deaths are causing so much more economic and social pressure than the deaths by the causes I listed last week. I guess it is because these deaths are more proximate to wealthy societies, which have won huge victories against infectious diseases. Combined with the panicked behaviour I note below, I feel most people demonstrate they do not find all lives are equally valuable, even though they might espouse that value.

Pandemics vs. Climate Catastrophe
Something I’m thinking about: if society knew that these radical measures were necessary to prevent a much larger disaster much further away, would we be able to make the same cuts on air travel, entertainment, and consumption? Could we reinvent our way of life to prevent deaths from climate change, without anyone needing to die first?

Some people are panicking
I am hearing first hand accounts of stockpiling from both Australia and the UK; supermarket shelves being emptied despite no larger issues on the supply side. A friend had toilet paper snatched out of her shopping cart. There has been a spike in gun sales in the US. It saddens me to see people act out of fear, and with so much selfishness. I wonder if it is merely a lack of understanding, or a symptom of a more fundamental social focus on individuals vs. collectives.

Some people are too relaxed
I was very surprised to see stories in my twitter feed of crowds flocking to climb Mt. Snowdon and filling out beaches in Florida and Bondi. While I am feeling relaxed when it comes to my personal safety, wider compliance with public health directives such as social distancing are needed for those policies to be effective (see also vaccines).

Misleading headlines make me angry
Please take care of the media you engage with. I generally feel positive about coverage from the guardian, but headlines like Australian man, 36, diagnosed with coronavirus dies in Iceland are deceptive. It is designed to grab your curiosity (or fear) about the pandemic, and clearly implies that the Australian man was killed by COVID-19. The disease is most lethal in older people, so a younger person dying is notable. But the reality brought by the third sentence is:

“While he was found to be infected with the coronavirus, it is unlikely to have been the cause of his death,” epidemiologist Dr Thorolfur Gudnason,

I.e. an accurate headline is “Australian man, 36, dies in Iceland of unknown causes whilst infected with coronavirus”. This is a problem; in a media saturated landscape many will scroll past the headline in a feed, and it will add to anxiety needlessly.

Harvard Medical Students COVID-19 Curriculum
A friend passed on this resource, which I think provides a good balance of brevity and comprehensiveness on the disease.

Photos from the week

Marathons have been cancelled which takes the pressure off. I can take my time to get back into higher mileage running. It also means I enjoy the scenery a little more.

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A note on fear and death under the current pandemic

Short version:

Since I posted last week, coronavirus continues to dominate media and conversation. First, my advice is unqualified, go to the NHS and CDC instead. If you’re here for my thoughts they are:

1. Don’t panic. It doesn’t help, and this is relatively normal.
2. Journalists know less than clinicians and epidemiologists. Avoid media, instead use the NHS and CDC. For scientific updates, the WHO and journals (The Lancet, The New England Journal of Medicine, and Nature). Engaging more than once per day is not helping you stay healthy. Stress weakens the immune system.
3. If you’re healthy and under 50, your personal risk is very low (but the elderly should isolate).
4. If this pushes you to take care of your hygiene and health as you should have been doing already, that’s great.

Long version:

Death

Currently, my media (and conversation) are saturated by the coronavirus pandemic. People seem generally frightened. As I write this, there have been just over 5000 deaths, the first being on January 11th in China. Of course as you read this that number will be higher, and if you are reading it relatively soon it will likely climbing at a faster rate. The final death toll will likely be in the millions. That is, of course, terrible, but it is only terrifying if these numbers are the first point of engagement with public health statistics. This paper from the Journal of Emergency Management points out that the flu outbreaks in 1957 and 1968 both had death tolls over a million, and while the flu of 1918 is being cited as analogous, it hit a population exhausted by 4 years of world war, and when life expectancy was under 50 due to bacterial infections (penicillin being discovered in 1928). People are dying constantly, for example in our modern context:

About 150,000 people die every day
42,000 die from heart attacks and strokes
11,000 die daily due to air pollution
8,000 die from lower respiratory infections (like COVID-19, but this data is from 2016)
4,300 die from diabetes
4,000 die from tuberculosis, every day
4,000 die from malaria, every day
3,800 die from motor vehicle accidents

So, in context, the total deaths we have seen over two months are on a similar order of magnitude to the deaths associated with car accidents or diabetes that happen every day. That said, the death rate will climb, and public health interventions can flatten the curve (worth the click through) to help save lives, but I feel that a significant part of the fear of death is the relative unfamiliarity of most people with it, when it is a very common occurrence.

A note where I hedge: As discussed in 2019 Week 32: Unsympathetic Science, mass shootings draw attention (and therefore public fear) to gun deaths despite being a regular occurrence in the US. I feel the situation here is similar in that the initial fear creates media interest which in turn creates more fear and the feedback drives a frenzy. Unlike the diseases we are familiar with, there are many unknowns to coronavirus, and there is a possibility that it overtakes the causes of death described above.

Reactions

So the psychological behaviours of this pandemic is also interesting.

1. Hoarding toilet paper seems extremely odd to me, and I made the observation that no one has ever died from a lack of toilet paper. Large parts of the world don’t use toilet paper at all. I assume people, being afraid, want to take action to attempt to feel prepared. Panic buying is a self fulfilling prophecy: since stores stock shelves based on what they usually sell, when a sufficiently large minority feels they need to stockpile, they create the shortage they are attempting to prepare for.
2. This virus seems to sit at some optimal point for generating a media frenzy. Health issues like obesity or opiates have not been able to capture the public consciousness to the same extent. Even the return of previously eradicated diseases like measles has not fully captured the public consciousness. Perhaps the authoritarian lock down by the Chinese government creates a setting that lends itself to the public imagination.

A thought experiment I have been playing with:

If you are afraid of the current coronavirus pandemic, how much would you pay to avoid it. £10? £100? £1000? Much more? I would guess you are more afraid of (and therefore willing to pay much more to avoid) coronavirus than you would be of a regular flu, but the flu kills many tens of thousands each year and many people don’t feel the need to buy the annual vaccine. Presumably you are more concerned with death than with suffering the fever or cough, and so whatever the amount you price avoiding coronavirus, I would expect you would also pay to avoid a heart attack, stroke, cancer, or lethal car accident. Given that, here are some things you can do to decrease your chance of death by a much more significant amount!

Stop smoking

Smoking statistics are intense. Smoking kills more than 0.1% of the US population each year (a likely estimate for the total coronavirus deaths), but 5% of the US population has a smoking related disease right now. With 300 under 18s becoming daily cigarette smokers every day, this is not a problem that comes from “before people knew it was bad for them”.

Drive safely

You probably know of someone who died in a car accident. Driving under the influence of drugs or alcohol and speeding are known to be dangerous, but in the US alone 9 people die each day from distracted-(using a smart phone while)-driving.

Maintain a healthy weight

Costing obese UK citizens 9 years of life expectancy, poor diet is catching up to smoking as the single worst health decision a person can make. Cutting back on high calorie low nutrition food (e.g. sugary drinks and snacks) and finding time to exercise regularly makes you less susceptible to a wide range of diseases (including coronavirus).

Prepare to get help for mental health

Addiction kills slowly. Suicide kills quickly. Both are preventable if people can get help, but when help is needed most it is hardest to navigate towards it. Start talking to friends, loved ones, and your health services about mental health and drug use, so that if things do go bad one day, you’re familiar with the system when you actually need it.

Note, I did not have time to convert DALYs into expected years of life saved for each of the above decisions, but this paper has a very useful table if you want the numbers.

Other things that didn’t fit above but I wanted to share:

A disease burden of influenza special issue from 2018

Netherlands infectous disease burden

Highly shared summary on slowing the disease progression from Tomas Pueyo

How long the virus survives on stuff

Economist explains the structure of the virus and how it relates to possible drug targets.