22. The uneasy calm inspired by statistics of unclear accuracy allowed the provision of a number of different figures, without clear consensus from federal agencies, mostly designed to remind us that the death-rate was really not that big, designed as if to put the question of risk in perspective.
“Active emergency declarations” were oddly absent from many states surrounded by others where none existed, despite an uneven availability of data on the infection’s spread, in recent “safety” maps from the Federal Motor Carrier Safety Administration lacked red altogether by late March.
As we await the unfolding of infection maps in the two week incubation period for symptoms to develop for SARS-CoV-2, a drama that starts on the surface proteins of the novel coronavirus, extending to symptoms whose spread we seem condemned to watch expand from a position of inadequate preparation, low testing availability, and often inadequate monitoring for critical signs that would lead to a better understanding for limiting risk of infections. (Initial studies put the incubation period at anything from 2.1 to 11 days, with a median of 5.1.). We were warned in the newsmedia in future simulations that forecast as almost inevitable a mortality rate of almost a million and a half by late April, we looked to an uncertain future as a nation–with April 1 as the critical point when the coastal cities would turn bright red in a model of the lowest surveillance, monitoring, and social distancing; in a model of greater monitoring, infections grew red by April 30 only in coastal cities as New York, San Francisco, Miami and Los Angeles.
The good news is that after three weeks of sheltering in place, the local spread of coronavirus confirmed cases in the Bay Area seemed to be slowing–or rather, climbing far less rapidly. The infections reported in the country, and indeed the statewide image of California, present a contrasting picture, in a local map of April 4, 2020, showing a jump in cases in rural areas that is particularly telling, even as cases in California as a whole appeared to decline–but raised questions about the the gaps in state-wide testing, as many of the state’s counties were beset by a lack of swabs and vials for collecting samples, a shortage of kits, and insufficiently rapid processing of tests, limited to people with underlying health issues, and may not reflect the actual distribution of the illness at all–especially if, as now seems likely, the Central Valley and all of Southern California are afflicted by far more severe infection rates.
We were still waiting on April 2 to process 57,400 cases; testing among the state’s large homeless population progresses, but lies far below safety needs, and we have lacked antibody testing practiced in Europe–sero-surveys to detect exposure to the virus in the blood–that CDC began to do so only after the choropleth composed by the San Francisco Chronicle, combining exhaustive counts combining CDC numbers, California Public Health Officers, and independent reporting in a Coronavirus Tracker–
The timely realization cases were no longer by any stretch confined to metro areas suggests that despite championing a slowing of infection curves in counties of three weeks of shelter-at-home directives, the state looked far worse in rural regions where the policy was less adhered to, or less easily followed. Already, Gov. Newsom is instructing Californians to adhere in mid-April to shelter-in-place directives with greater regularity before irregularities in testing data that he based earlier predictions of a declining rate of infections, lugs in testing, and incomplete testing of the most vulnerable populations and most remote regions in the state.
The coming week in mid-April is marked by a rare convergence of Newsom, Dr. Fauci, and President Trump all recognizing that things will worsen in a difficult week. The deep question on which we would do well to reflect is whether time-stamped maps tallying confirmed infections are quickly outdated by the changing data sources. As benefits of social distancing was debated across the country, the new landscape of a nation where even counties without any cases of COVID=19 that were able to be confirmed as contracted were likely to be undergoing an epidemic, and that there was no reason to wait for actual evidence of an outbreak, as 94% of the nation’s population has indeed already been exposed to the risk of infection, not only in every states, but almost all counties in many states–Colorado; Arizona; California; Washington; Florida; Louisiana North Carolina; Massachusetts; Vermont; Michigan. All of a sudden, the country is distinguished by the near absence, aside from unpopulated sites in the high desert or Alaskan tundra, of sites where one faces a low chance of exposure to the epidemic.
While such chances of infection do not mean illness, pneumonia, and delusions, the more protracted exposure to the novel coronavirus, the more serious the infection seems to be, and perhaps the shorter the incubation period, epidemiologists suggest. There was little sense of sheltering in place in many counties in many states, and the chances of prolonged exposure increased where sheltering in place was not adopted.
23. The United States did, in late January, seem less present in the nation in a global context. But poor monitoring and no testing played a role. An initial frame of an animated cartogram from Ben Hennig suggests how much the global landscape changes as the coronavirus SARS-CoV-2 incubates in bodies: the cartogram, similar to those that Hennig has devised of different themes, resizes nations, as if anamorphically, in balloons that chronically bloat as reported numbers of infected grew as the pandemic works its way to global scope. The animated map of Hennig seemed to be oddly apt to transmission of SARS-CoV-2 to respiratory tracts, as the bloating of China denoting increasing shares of global cases of infection by January’s end.
The cartograms lack narrative support, but graphically demonstrate transmission of the contagion by rendering China bloated as an immense inflated blowfish, pausing at the month’s end to exhale droplets bearing infection across the world.
National buckets clearly aren’t the best way to understand COVID-19’s transmission, but they were compelling. Not only is the data counts broken down over nations, but parsing of infections that were detected, even if they reveal an undercount, fit the worldview of those who impose sovereign authority as an instrument to contain its spread.
The “real time” map of “actual cases” of course lags behind the map of diagnosed cases. The maps cannot capture the pathways of invisible viral transmission, and as such is a poor guide to national preparation, masking the incubation times of up to two-week incubation times, that seem to vary according to degree of exposure to the virus, more than age or blood type. If such proxies proved poor guides to prepare for the disease, the ballooning nations animated in the map rely on good counts. And so readiness depends on our abilities to model infections and best practices.
But even a map of national breakdowns of reported infections suggests numbers of missed critical moments of global monitoring in the partial narrative it offers, and the global distortion of infection numbers that make the pandemic global, and reveal the lack of adequate structures for its global management. For January was a true critical moment, a place to alter or watch the course of a disease and to prepare for its spread–a notion of “crisis” used by Hippocrates in the Epidemics and elsewhere, as a moment for the official determination of a disease’s course, but the moment of crisis--κρίςις–that demands clear-sighted judgement of individual diagnosis as well as of public health. For containing COVID-19 depended on the same abilities to manage the course of the disease as it developed in stages–first a loss of smell, a first fever or dry cough, and bodily exhaustion, later progressing to painful coughing up of blood, and exhaustion–that mark stages to monitor in COVID-19’s unpredictable spatial spread. If a difficulty of breathing presents a stealth disease lying in clear lungs, it needs to be anticipated as waiting to present itself in the bodies of all Americans, as COVID-19 is now in your neighborhood wherever you live.