Welcome to the eighth installment of the Range Report, which I hope will expand your personal “search function,” providing opportunities to connect previously disparate pieces of information and alight on new interests.
As you may have noticed, this inchoate newsletter took a bit of a hiatus, to put it dipomatically. It was (and still is) experimental, and I ended up busier than I expected after becoming the proud new overseer of both a baby and a book in close succession, and also [please fill in some more lame excuses on my behalf here]. In any case, I enjoyed doing this newsletter those few times, and have a backlog of topics I’d like to share, so I’m starting it up again, presumably with more consistency. I’m also going to try some new formats. For example, I have a draft of a Range Report guest written by a nuclear engineer with range, and another that is my Q&A with a successful corporate strategist turned successful fantasy author about her career transition. Hopefully some of you will let me know on email or Twitter what you like or don’t as I continue to experiment.
With all that out of the way, let’s get to this edition of the report, the [drumroll]…coronavirus edition, because you haven’t had enough of that yet. There are many excellent and obvious sources of essential coronavirus information, like the CDC, and the Johns Hopkins Coronavirus Resource Center. There are also some excellent but less obvious sources, like the always fascinating Our World In Data. No need to retrace that ground, so here I’ll just share a few interesting and unusual nuggets that stuck with me as I read about the novel virus. At average reading speed, this edition (which is a little longer than past editions) would take you about eight minutes to finish. I hope this edition’s six W’s will expand your range just a bit:
1) WHAT?
An outstanding conceptual data visualization, that’s what. You may have seen versions of the CDC graph below. I think it does a great job of quickly conveying why–with containment out the window–communities need to get on the same page in a hurry to deal with the coronavirus: even if we don’t alter the number of infections, we need to slow down the spread so as not to overwhelm the healthcare system, which would likely lead to a huge number of deaths from normally treatable conditions. I thought this data viz was a home run of science communication; it’s very simple, and my sense is that even folks who haven’t looked at a graph since high school frequently had a sort of “aha” moment when they saw it. Kudos to whoever designed it.
While I was admiring this bit of public science communication, I began to wonder what research might be available from the 1918 flu about “social distancing” given that containment was out the window in that case too. (As an aside, I’ve stopped calling it the “Spanish Flu”; turns out it only earned that moniker because Spain was neutral in World War I, so Spanish media were covering the flu while news coverage was light or suppressed in other countries. In Spain, they called it the “French Flu.”) I found note of an interesting natural experiment from the 1918 flu in a Science article:”St. Louis closed the schools about a day in advance of the epidemic spiking, for 143 days. Pittsburgh closed 7 days after the peak and only for 53 days. And the death rate for the epidemic in St. Louis was roughly one-third as high as in Pittsburgh.”
We don’t know to what extent this virus is like that one, and school closures come with complicated tradeoffs. But, in short, I think the strategy recommendation coming from public health experts can be summed up thusly: be St. Louis; don’t be Pittsburgh.
2) WHAT?
Another nice graph, this one from yours truly. Well, not really, it’s all from the CDC, I just made a version that’s easier to look at, because I think it’s an interesting way to reflect on the devastation of the 1918 flu amid an otherwise rapid decline of death from infectious disease. (Y-axis is deaths per 100,000 Americans.) If you’d like to see a version of the graph in Prezi, the zoom outs make for an interesting perspective; check it out here.
3) WHY…
Did I find this graph so interesting? First, it shows milestones in the decline of death from infectious disease, which was the biggest contributor to an increase of 29.2 years (!) in longevity over the 20th century. That is pretty phenomenal; pat on the back, humanity. (Btw, I asked several doctors and scientists about the rise since 1980, and the common suggestion was that with such a substantial increase in longevity, more people are dying of infectious disease later in life, often contracting infections in hospitals. Special thanks to Dr. Mike Joyner.) But one reason I really like the zooming version is that it conveys a sense that some of the most world-changing advances have been more on the public health side of the spectrum, as opposed to what we often think of as the medical technology side. In fact, the concept of collective “public health” action is something of a 20th century innovation. Outbreaks of TB, flu, cholera, dysentery (that ole demon of the Oregon Trail), and other diseases became less common thanks to government efforts to reduce overcrowding in housing (hello, social distancing), and to improve sanitation. Water chlorination reduced the impact of waterborne diseases. Organized disposal of solid waste and public education campaigns about hand washing (everything old is new again!) and food handling made enormous impacts. The so-called “First Public Health Revolution,” in the late 19th and early 20th centuries, saw the biggest increase in longevity, and it was well before antibiotics. In 1900, 194 of every 100,000 U.S. residents died of TB; by 1940, that was down to 46. Again, pre-antibiotics. It was largely due to improvements in housing conditions. Mosquito control eliminated malaria, and rodent control led to the last case of human-to-human transmission of plague.
Point being, many of these life-altering breakthroughs required the kind of “bird” thinking at which public health professionals excel. I’m referencing a favorite quote from Range, in which physicist and mathematician (and wonderful writer) Freeman Dyson said that we need both focused frogs and visionary birds; the frogs are down in the mud seeing the granular details, while the birds soar above not seeing those details but integrating the knowledge of the frogs. And we need both. The problem, Dyson said, is that we’re increasingly telling everyone to be frogs, so we’ll miss some of the biggest opportunities. I do think that’s something worth worrying about….
4) WHY WORRY?
Because in 2014, two researchers at Brigham Young University surveyed Americans and learned that adults typically attribute about 80 percent of the increase in lifespan since the mid-1800s to modern medicine. “The public grossly overestimates how much of our increased life expectancy should be attributed to medical care,” the researchers wrote, “and is largely unaware of the critical role played by public health and improved social conditions determinants.” They went on to worry that this mindset might endanger funding for public health, and lead to comparative overfunding of medical technology that would drive rising costs, albeit with more modest impact. These are obviously complex issues, but it’s not so far fetched. A few years ago, Congress passed the $6.3 billion “21st Century Cures Act,” the rare bill that received widespread acclaim on both sides of the aisle. The bill was created in large part to fund research on cancer drugs, and who can argue with that? And yet, while politicians lauded the bill, the heads of the American Academy of Family Physicians and the American Public Health Association spoke out against the new law. Why? Because it is funded by taking $3.5 billion away from public health efforts, including smoking cessation programs, which happen to have accounted for most of the precipitous decline of cancer deaths since the early 1990s; where smoking rates go, cancer death rates go twenty years later. Smoking rates began declining in the 1970s, and the mountain on the graph below shows lung and bronchial cancer deaths–by far the largest subset of cancer deaths–in American men falling from the 1990s. (Women have followed a similar but somewhat less dramatic trend, so I used below the visualization that made the trend easiest to see.):
Nobody thinks we shouldn’t invest in cutting edge medical research. As Dyson said, we need birds and frogs, but maybe we should value the less-sexy-but-incredlbly-effective public health initiatives such that we don’t impoverish the birds to feed the frogs.
5) WHO?
Arturo Casadevall, chair of the department of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health. I spent time with Arturo on multiple occasions while reporting Range. (He’s the central character for a large swath of the last chapter.) You can learn more about this remarkable researcher there if you’re interested–like why he has a degree in pest control and why he insisted on bringing up his work at McDonald’s in his Hopkins job interview. He is a man of expansive interests, and I wrote about him because he is piloting a graduate program meant to broaden the education of scientists–to de-specialize early training, as he told me. Arturo advises people in his lab to read something outside their field every day, and he himself reads voluminously in history. You can’t go a minute in a conversation with him without learning some historical tidbit, and his reading frequently informs his scientific work. So I was interested to see him pop up in the coronavirus headlines advocating for the use of blood from recovered coronavirus patients to develop a stopgap treatment. As he put it:
“I’m an infectious disease doctor who is interested in history,” Casadevall told NBC News. “I knew the history of what was done in the early 20th century with epidemics. They didn’t have vaccines then, they didn’t have any drugs then — just like the situation we face now. But physicians then knew that, for certain conditions, you could take the blood of the immune and use it to prevent disease or treat those who became ill.”
Last week, Casadevall and a colleague rush-published a paper on the topic. And I just heard from the Mayo Clinic’s Mike Joyner (thank you, again), that Arturo’s idea is being sped into action, and that the birds and frogs (i.e. research hyperspecialists and public health professionals) are coming together in a way they normally don’t. One of the last points in Range quotes Bill Gore, who founded the company that invented Gore-Tex; Gore modeled the company on his observation that organizations do their most creative work in a crisis, because disciplinary boundaries fly out the window. Sounds like we may be seeing that in action.
6) WHAT ELSE?
The quote of the week comes from a 2007 paper:
“The presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb. The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.”
Something tells me that paper will get a few new citations. ….And now for one last tidbit. This is sort of random, but, as usual, the news propelled me down a few rabbit holes. In this paper about flu transmission, scientists were examining different types of hand washing. They compared 30 seconds of washing with water only, to 30 seconds of washing with normal soap, to 30 seconds with antiseptic soap. They assumed soapless washing would be inferior. To their surprise, 30 seconds of water-only hand washing did just as well at getting rid of the flu. So next month when some guy dreaming big e-commerce price-gouging dreams buys up all the soap, or if you just find yourself without any, perhaps this is news you can use. Stay safe!
Thanks for reading. Until next time….
David
**BONUS WHAT…
….can you do beside social distancing? I’ve already thanked the polymathic Dr. Mike Joyner twice in this edition, and wanted to share his call for eligible donors to consider giving blood as soon as possible. Mike told me that as people stay home, donations will be way down, but blood needs will continue. “Also,” he said, “if there are a ton of septic people they may need blood products.” So if you’re looking for a way to help, this is a good one.
