Shelter-in-Place?

And even though we had clear signs that restrictions were demonstrably slowing infections, geolocated thermometers allowed us to gain a more detailed national picture by late March. As the spread of geolocated thermometers of Kinsa with drops of fevers associated to the novel coronavirus across the nation, at the end of March, among the twenty-nine states that had sheltering orders in place in ways that mapped “fever” incidence and seriousness as a bellweather of the place of the virus in human hosts, based on branded thermometers that uploaded temperatures to Kinsa Insights.

The interactive distribution allowed us to map variations and gradations of illness and trend in ways that seemed to escape the pitfalls of the remove of choropleths from the progress of infection over time in bodies; the elegantly searchable map merged data from a million thermometers sold in the nation to aggregate bodily temperatures in most regions. The practice of “tracking fevers” suggested an invasion of personal privacy, Kinsa Health used internet-connected thermometers to define a metric to generate a national map able to track fever severity across space in aggregate–by anonymized data from thermometers–not cell phones!

The minimally intrusive level of collective surveillance maps the degree of incidence of atypical fevers, and charts downward trends in individual fevers allowing us to aggregate “fevers” over time, against closures of restaurants, schools, and daycare facilities, and revealing a considerable downward trends with closures of non-essential businesses (in New York and Massachusetts, for example, truly striking to see, and to read against other metrics of sheltering the from cel phone data or just orders in place. If not of uniform coverage, the datamap had a small lag, revealed local progress of lowering infections in gross detail, offering a possibly crucial metric to validate the experimental scenarios created by sheltering in place outside models. The spatial distribution seemed the needed metric of measuring the progress of the disease with local intelligence, looking it straight in the eyes through the serviceability of best practices states adopted, outside of the haze of ideological intransigence: former hotspots of New York State and Washington celebrated the findings of the trends as ample evidence that social distancing had beneficial collective effects.

Kinda Healthweather Interactive Map/April 7, 2020
Atypical Fevers in Population Sampled

9. Although the data vis was late in coming, by some measures, at the end of march it confirmed the relative decline of the virus’ virulence in some sites where sheltering policies were adopted early–although the continued virulence of a disease raging where stay-at-home policies were more recently adopted, increased pain and suffering on the horizon in places where sheltering policies were reduced–Texas and Pennsylvania–or curtailed and rebuffed–Florida–that bode badly for the nation. Some areas are still going to be grappling with the idea of the impact that they can have in containing the disease’s spread, but the reduced presence of cases of fever in Alameda county–my home–was a bit reassuring at least: if Kinsa had found that within a week of stay-at-home or shelter-in-place orders were enacted, fevers in that community began to drop, after two weeks we saw both a broad low atypical fevers, or a low rate of fevers.

Kinsa Healthweather Map: Alameda County, CA April 7, 2020
Scale of Temperatures Registered by Kinsa

The attractive CARTO visualization allowed one to return to sites where friends were struggling with rates, as my mother in Manhattan or brother in Brooklyn, and my aunt in Ft. Lauderdale, looking at a recently dated snapshot of collective body temperatures; even without considerable granular detail on the local level, it could reveal progress, even if higher temperatures in some regions were of a frustrating monochrome opacity.

Kinsa Healthweathe, Kings County and Bronx County, April 17, 2020
Around Ft. Lauderdale, Florida, April 17, 2020

After the lack of clarity in President Trump’s Friday, March 13 address, the nation wrestled with the quite circuitous acknowledgement the World Health Organization as having “announced that the COVID-19 outbreak can be characterized as a pandemic” omitted the term “global” and used sufficiently torturous language to dilute the anxieties about data visualizations that suggested the arrival of the virus to our shores: Trump declared his readiness to take “sweeping action to control the spread of the virus in the United States,” awfully limited in scope: limiting “entry of foreign nationals” in jurisdictions where the virus outbreak occurred, including China, the Islamic Republic of Iran, and European nations, placed the disease far from our shores, and the quarantines instituted for those evacuated hardly created an adequate response for “public well being”: we were a nation without anything like needed health insurance coverage, without adequate testing supplies, and without medical equipment necessary to process the adequate intake of the ill, or care for those in jails, nursing homes, and detention camps in adequate or safe manners. While Trump described ” preventive and proactive measures to slow the spread of the virus” with some fancy alliteration, the poetics of viral spread were poorly acknowledge. Indeed, the dissensus opened the path for local governors to issue varied measures to respond to calls for well-being–a level of dissensus in the face of the very national emergency that the notion of a chief executive was designed to forestall.

Indeed, while the world is increasingly networked in ways that shrink the global surface, the fracture lines of individual regions, states, and health insurance systems that create the crazy quilt breakup of the United States suggest a complex filtering of reception of health policies. The very first image of the infection’s spread as it arrived in California of late January seem to lack adequate scale to depict the movement of the global scale of the infection to the United States: there is something deeply disquieting about reviewing this image accentuating the low number of confirmed cases of infection in the nation. The scale of the state-by-state choropleth is woefully inadequate to the scale needed for measuring the COVID-19 outbreak, as if we lacked the ability to situate the United States to the world–the Los Angeles Times proclaimed the paucity of confirmed cases in the United States, as the number of confirmed cases of infection and deaths in China exceeded 80,000, with over 5,000 already found elsewhere in the world, without any sense of registering its global transit.

“Los Angeles Area Prepared for COVID-19,” Lorena Iniguez/LA Times/January 26, 2020

Did the image rely on bad data, as it surely did, or did it fail to even suggest the scale of the danger of the arrival of the virus, marking the vast majority of Americans who were infected as aboard cruises, like the Diamond Princess, rather than in the boundaries of the nation, and suggesting an almost comical paucity of infections–one in Texas? one in Wisconsin? huh? two in Illinois? one in Washington? where is this data deriving from?–that concealed the inadequate level of testing in the United States. Perhaps that inadequacy was the real story, if not the inability to really register the virus’ communicability and danger of future contraction. The continued failure to adjust our paradigms of infection, encouraged no doubt by the President’s pronouncements, left us in the dark, awaiting the inevitable arrival of far higher infection rates, and with no sense of the changing nature of health risks.

10. The lack of orienting the nation to the risk of the infection was perhaps rooted in the dependence on choropleths–as many have observed–that seemed to suggest the single digits of confirmed cases in most states suggested a needle in a haystack, ignoring that these numbers were almost certainly significant undercounts, using bad data to suggest small odds that the individual cases observed would not be widely contracted on a broad scale.

The several cases of COVID-19 that had already been seeded in American states suggested the broad scale of the danger to the nation, and demanded a united response. Trump had dismissed warnings his Health Advisor coordinating the national coronavirus task force, Alex M. Azar II, made on Air Force One of possibilities of an approaching pandemic on January 30, however, the second as the sturdy pathogen raged across China, infecting almost 10,000 individuals, according to China National Health, dismissing Azar as an “alarmist” unduly disturbing Trump’s presidency. At the time, to buy sure, the number of confirmed “reported cases” of COVID-19, already numbering nearly 8,000 were predominantly based in China, as this elegant cartogram of world mapper Ben Hennig suggests, in the below still from a nice animated cartogram–

Ben Hennig

–but the lungs of China, inflated like a blowfish or a character of Japanese animator Hayao Miyazaki, suggested something like a cartoon rendering of the actual global risks that the disease posed: the incubation period that allows symptoms to become manifest would have revealed a richer map of infection, and the number of reported cases were clearly undercounts: if one was not that threatened, at that point, in Africa or Mexico, or the spindly Australia, this would all clearly soon change.

Globalization implies the odd link of any space in the globe to a variety of other places with which it lacks clear continuity, and the difficulty of representing continuity of contagious transmission with the objectivity we expect from data visualization may mean that the scale of the disease’ transmission was refused in several sites that situate themselves outside the global space in which the novel coronavirus travels. They consumed maps of the spread of the virus to distance themselves from the nature of its spread, if not cocoon themselves from danger, to the point of assenting to undercounts of the infection that has perhaps spread far further than we have imagined.

The roll out of the intensification of confirmed cases from that same date in January–when China by the following day claimed almost 10,000 cases of infection, exploded in ways that a domestic roll-out of defense was almost immediately revealed inadequate. It is true that datamaps are, indeed, only as good as the data that they plot. Yet it is likely Trump viewed the global pandemic primarily through the optic of his Presidency, even as cases of infection escalated beyond 42,000, and tried by magical thinking to conjure unbreachable barriers in public speeches without grasp of the virulence of the disease, clouding a national response and entertaining theories that it was overblown or would pass.

Was there a paradox that the Alarmist-in-Chief, who had declared six national emergencies, and his first on public health, resisted declaring an emergency a month after his health adviser estformulated a clinical network of surveillance to detect the presence by clinics based in New York, Los Angeles, Seattle, San Francisco, and Chicago, to measure the potential spread of the virus to project future hot spots, that was projected to expand nationally? Although fifteen cases in the United States were linked to travel from the Hubei province, the transmission of the disease from asymptomatic individuals was not imagined, and test kits were unavailable when it was suddenly discovered in late February. Monitoring by testing negative for flu was not commensurable to the virus causing COVID-19, and the test kits that were the centerpiece for a national roll-out of COVID-19 surveillance that never occurred, as confirmed cases in the United States grew from 15 to 4,226 by March 16.

11. In the weeks after Trump issued his Emergency Order, even as chances to stop the virus that seemed to move along vectors of globalization by putting mobility on pause, rural areas that insisted they were immune from infectious transmission that was still identified as a flu “from China” were loathe to impose or mandates recommendations for constraining local mobility as a measure of public health. Clear failures in the systems of testing, and a failure of aggressive screening, that could have constrained the novel coronavirus, with public health committees of the Coronavirus only devoting “minutes” to testing for the spread of the global pandemic that shattered on the shoals of regional tribalism.

There seemed an interest in blocking out the prospect of large-scale testing or psychological preparation for the pandemic that ravaged China’s Hubei province, and revealed the spread of probably upwards of 50,000 cases in the nation, obscuring the scale of a global health catastrophe as if most all believed it “couldn’t happen here”: the “incredibly limited” views of the pathogen’s potential impact on the nation created a lapse of readiness Dr. Margaret Hamburg, former commissioner of the F.D.A. felt enabled “exponential growth of cases” of infections whose scale we still don’t fully know; the failure of national mobilization extended from a failed warning systems to the failure of extending beyond “community-based surveillance” incommensurate to the pathogen’s virulence, and based on old models of infection that fail to account for airborne communicability of SARS-CoV-2.

The testing of those in quarantine was mistakenly limited to those exhibiting symptoms, even if they offered a false security, given the highly infectious nature even of those not presenting symptoms, and an incomplete understanding of the contagious nature of SARS-CoV-2, the pathogen whose symptomatology was a poor indication of its highly contagious nature. The evaluation of their levels of contagion were taken by health workers, who monitored their temperatures twice daily, without protective gear, a question that continued to haunt healt workers in Japan in mid-February. (Did poor protection increase the chances that health workers were themselves vehicles for the virulence of the disease?)

Meanwhile, a sense of the local reassurance of calm, and limitations on stay-at-home orders, reflected unremittingly tribalistic the United States. Indeed, a congregation of clustered states of the ‘old south’ that suffer from low health insurance coverage and high poverty rates–Alabama, Arkansas, Missisippi, and Missouri–have done the least of all states to enact state policies to ready their populations for arrival of the epidemic, refusing the notion of a directive to “bunker in place” in ways that echo their resistance to federal oversight. (The Governor of Oklahoma, feigning prudence, proposed an ostensibly prudent “Safer-At-Home” policy for those aged 65 and above, or with compromised immunity, encourages them to restrict outdoor exposure stay save for shopping or filling prescriptions, as if both did not have home delivery.). Missouri saw an escalation of a 600% rise in coronavirus cases in the last week of March, as if Petri dishes fostering contraction of coronavirus for future epidemiologists; its governor resisted school closures or stay-at-home orders, called a “blanket order” just “very difficult . . . to put in place.” Yet as city leaders in the state urge him to reconsider, identifying the man who assumed office due to his predecessor’s resignation “in contention for governor whose done the least to contain COVID-19,” the need for new measures of containing contagion is difficult to avoid. (The vulnerability o African Americans and those with hypertension inject racially tinged dimensions to such irresponsibility.)

If quarantine refers to a period of forty days, Shelter-in-Place orders have been regularly extended over several months, in an attempt to flatten the curve of increased contagion of COVID-19 across the country in recent weeks.

For the adoption of directives on almost partisan lines, as the below electoral cartogram reveals, suggests that ability to distance from the absence of collective direction for responsibility that the President revealed in his national address of March 13 was able to be adopted by those governors confident of independence from the White House, as much as they broke on purely partisan positions–no matter how loudly the President and allied news sources promoted the notion that fears of viral contagion was promoted to destabilize normalcy, rather than give agency to the virus which had already ravaged the global landscape.

As if clearing the air of a fog perpetuated in daily news conferences of a Narcissist-in-Chief, the Governor of California to issued unilaterally the nation’s first stay-at-home order on March 19 seems to have cleared the air enough to prompt the issuing of vitally necessary “stay-at-home” in 37 states, 74 counties, 14 cities, the District of Columbia, and Puerto Rico have. By April 1, it almost seemed a tragic joke that some regions of the country still resisted urging their populations to remain at home.

While many rural regions found it difficult to impose such restrictions on workers, and even in California there was less compliance in the Central Valley or Imperial Valley, areas on which the nation depends for fresh lettuce and winter greens, the split topography of the nation that echoed a red-state/blue-state divide, and an almost tribal divide of the country according not to partisan positions, but different world-views, even if the split topography broke by proximity to confirmed outbreaks of COVID-19.

Partisan Breakdown of Statewide Shelter-in-Place Orders as of March 30/Axios

But the blue square of California played an outsized place, in many ways, in calling for a collective response of caring for one another in couching a ‘stay-at-home’ policy as a temporary act of collective responsibility, when the absence of responsibility in the Oval Office. Newsom, as his predecessor Jerry Brown no fan of the “border wall,” and instrumental in providing a welcoming place for refugees, offered a collective order across the state that expanded “Shelter-in-Place” policies in six East Bay counties was enacted May 16, which followed themselves on the decision of several Silicon Valley titans to start work-from-home policies.

Newsom’s statewide mandatory decision invited all to “flatten the curve together” in a rhetoric distinct from the President’s —

–as City Lights bookstore in San Francisco went dark.

Carlos Avila Gonzalez, The Chronicle

12. The uneven implementation in late March of such “Shelter Directives” met a deeply tragic image of national responsibility. It was born not only of the deep anger that Donald Trump seems to have retained for the World Health Organization, for declaring a global pandemic without consulting American health authorities or his own office, in affront to his image of American global leadership. But it reflected, more broadly, his relinquishing of any role in global accords as Trump only trumpeted the safety of the United States, closing borders, and redirecting attention to his ability to single-handedly protect Americans from external threats.

The state of affairs, Trump seems content to assure much of the nation in his near nightly messaging, is good, even if the state of infection had spread across the most populated areas of the nation, and showed no sign of containment, readiness to respond to, or retreat. The topography of “confirmed cases” was incomplete, but did Trump seek to keep it that way? We could only wonder, waiting for the results of uneven acceptance among Republican governors of stipulating their residents shelter in place.

March 29, 2020/New York Times

As Italian health authorities place primacy on staying at home among means to limit exposure to the novel coronavirus COVID-19: social distancing is the primary way to slow the contagion’s spread, so terrifyingly rendered in heat maps of the different metrics of cases announced, hospitalizations, or morality; but the difficulty of measuring the spread of this coronavirus suggest the maps may represent steep undercounts.

But in the United States, disunited as ever, if suffering from misdirection in a critical way before the risks of a global pandemic appearing to center its expanding reach across the continents of North and South America, without respect of border line, the contrast between epidemiological realities and small government gospel is increasingly stubborn. Tasked with lending his professional legitimacy to President Donald Trump’s COVID-19 task force, Dr. Anthony Fauci invited and indeed recommended all states participate in staying at home “broadly throughout the country,” outside hotspots, in a policy of physical separation, has enjoined Americans rather firmly that even “though they feel that in certain respect there are relatively few cases in their cities and their towns and their states . . there no regions in our country that are going to be exempt from an outbreak if you do not do the appropriate mitigation issues namely [of] physical separation.”

13. But what is prudence? Dr. Fauci refrained from top-down directives, even in an extraordinary situation, no doubt, as he knew the limited nature of measures that he could propose to a man who regularly cut him off and prevented his responses. Even as disparities across the nation suggest many not abiding with these guidelines of distancing and local governors dallied in moving quickly to maintain public health orders where they did not see a spike in death rates or public records of infection that would warrant work stoppages. To be sure, the few states with agrarian economies were in a drastically different position, and faced far less compliant and agreeable acceptance of Shelter-in-Place or stay-at-home directives. Yet there were no maps that would compel public consensus to adopt distancing directives in mid-March, even as a national emergency was declared.

Did it help that the novel coronavirus outbreak arrived on coasts and afflicted health care structures in blue states and Democratically-leaning cities and left red states that can be defined as “Trump country” less in danger of a spike? It is clear that there were certain areas where there simply were established patterns of telecommuting, and the model of working at home was more easily accepted and adopted as an alternative: high numbers of telecommuters in Washington State, Oregon, California, Colorado (in parts!), and Illinois and New Jersey and Massachusetts suggested an easier road ahead; ares like Michigan, with a far more fractured an uneven sense of telecommuting, or Pennsylvania or the majority of the “old South” (Alabama, Mississippi, much of Georgia outside of greater Atlanta, and Arkansas outside Little Rock), reveal a more complex picture to “impose” stay-at-home or Shelter-in-Place acts: New York States’s Governor Andrew Cuomo was immediately skeptical.

14. But could one predict in late March, or in early April, that Donald Trump would, as President, taken revenge on the very governors to whom he had effectively relinquished responsibility for their residents, in a series of all-caps tweets, that only seemed to refuse to relinquish control, and sew further dissensus? Was it Trump who was adopting the strategy that Putin’s team had put together for the 2016 election of sewing as much dissensus as possible within the American public? Trump declared such slogans on social media as “LIBERATE MICHIGAN!” and “LIBERATE MINNESOTA!” — as if to upend the populace in two states where Democratic governors decided upon carefully deliberated social distancing measures, affecting many small businesses, and tweaked Virginia’s Democratic Governor who closed non-essential businesses and banned gatherings of more than ten through at least May 8.

Trump shot at Northam the asinine tweet “LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege!”, posing as a defender of constitutional rights, before the inadequate preparation of a nation in a national emergency for protestors who have adopted Confederate flags–signs of secession–or the libertarian Gadsden flag, holding Trump-Pence 2020 signs, carrying AK-47s, and not wearing masks, in defiance of national orders, insisting on rights to work during the COVID-19 epidemic.

It seemed that this was not really “Trump” talking, but the social media minions on the Alt Right that had adopted the notion of resisting governors’ regional edicts–Alt Right commentators from Gateway Pundit to Steve Bannon to FOX diehards Jeanine Pirro and Sean Hannity who have long questioned the value of issuing “Stay-at-Home” directives as curtailments of rights.

1 Comment

Filed under Coronavirus, COVID-19, data visualization, global pandemic, Shelter in Place

One response to “Shelter-in-Place?

  1. Pingback: Our Unclear Path Forward: Contagion Advances | Musings on Maps

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