Category Archives: disease maps

Cartographies of COVID-19: Our Unclear Path Forward

While we watch the progress of the pandemic on screens, in a difficult circumstance of trying to orient ourselves to the GPS-enabled scales of its spread, we look at pretty limited and almost superficial data. We track reported cases, hoping that these limited datasets will provide orientation, while not really following the pathways of its transmission, and the microscopic scale of the progress of the pathogen in bodies. And if we rely on or expect data visualizations will present information in readily graspable terms, we rarely come to question the logics that underly them, and the logics are limited given the poor levels of global testing for COVID-19.

Even as we map what seem total global knowledge of the disease, analogous to what we have come to expect from Global Positioning System, the multiple holes in our picture of the spread of the disease provide little sense of mastery over the pathways of communication, contraction, and infection we have come to expect from maps. These maps may even be especially disorienting in a world where expertise is often dismissed in the United States–not only by the U.S. President, but out of frustration at the inability to distance, diagnose, track or supervise the disease that is increasingly threatens to get the better hand. Have our visualizations been something of a losing battle, or a war of atrophy we will not win? If we were cautioned by a dismissed biomedical researcher who ran efforts to develop a vaccine we lack that the failure a trusted, standard, and centralized plan for testing strategies must play a part in the coordinated plan “to take this nation through this response,” said Dr. Bright, who was abruptly removed last month from his position as head of the Biomedical Advanced Research and Development Authority. We have limited statistics, alas, in large part as fear of providing too many tests–or fanning the flames of insecurity that testing might promote in the general public and in our financial markets, seem to have created the most dangerously deceptive scenario in which the United States seems to be committed to projecting confidence, even if it is the global epicenter of the spread of the highly contagious novel coronavirus.

Have we developed a language to orient ourselves to the scale of emergency in the spread of COVID-19? While we turn to images of natural disasters in describing the “epicenter” of the outbreak in Wuhan, this hardly conjures the species jump and under-the-radar communication of the virus that was not tracked for months before it emerged as a global threat. In tracking COVID-19 globally, or over a broad expanse of nations or states, we often ignored the pathways by which the novel coronavirus is spread in crowded spaces, where the single strand of RNA may hang in droplets that linger in the air, and are looking at the small scale maps to track a microscopic pathogen. But we are increasingly aware the spread of these strands, of the virus SARS-CoV-2, that infect populations along increasingly unequal fault lines that divide our cities, nations, health care systems, and crowding, or access to open space, are all poorly mapped in the choropleths into which we continue to smooth the datasets of infections and hospitalizations. While the problems are posed for national health services in each region, the devastation and danger of overloading public health systems and hospitals outweighs are local manifestations of a global crisis of the likes we have not confronted.

And the crowding of such numbers beyond the buffers that began with lead to a visual crowding by which we continue to be overwhelmed–and will have been overwhelmed for some time.

For although the global pandemic will clearly be with us for a long time, spatial narratives might be more likely to emerge in networks and in forms of vulnerability, in ways that might reveal a more pronounced set of narratives for how we can respond to a virus than the deep blues of even the limited and constrained datasets that we have, as we struggle against the blindness we have in containment and mitigation, and the frustration of the lack of anything like a vaccine. (This pandemic is almost a metastasis of the anti-vaxxers: confirmation that a vaccine cannot check a disease, it gives rise to concerns that vaccinations might have left us immunologically more vulnerable to its spread . . .and a sense that the hope of eradicating COVID-19 by the availability of a vaccination in four to five years will be widely resisted by anti-vaxxers and their acolytes, to whom the pandemic has given so much new steam. Yet as the virus interacts with the viral posting of anti-vaxxers resisting social distancing or collective policies of response, the stresses that exist in our society will only be amplified.) And if as late as February 24, only three laboratories in the United States did test for COVID-19–artificially lowering public numbers–even confirmed numbers through March and April were as a result tragically low. Could maps even help to track the disease without a testing apparatus in place?

Global Covid Infections/Datascraped by Avi Schiffman, May 11, 2020

The prestige of the data visualization has been a basis for reopening the nation. Yet if less than a tenth of the world’s population has yet to be exposed to the disease–and perhaps only 5% of the American population, in one estimate, if not lower–the virus is bound to be endemic to the global landscape for quite a considerable length of time. At the same time, one must wonder if the many fault lines that have created such peaks and valleys in the virus’ spread, if confirming its highly infectious nature, to be sure, are not removed from us in some degree by the smooth surfaces of the screens on which we watch and monitor, breath bated, with some terror, its spread, unsure of the accuracy or completeness of the data on which they are based but attentive to whatever they reveal. In many ways, these maps have created an even more precarious relation to the screen, and to the hopes that we find some sign of hope within their spread, or hope to grasp the ungraspable nature of COVID-19.

These datamaps suggest a purchase on a disease we don’t understand, and we don’t even have good numbers on contraction. Yet we are discussing “reopening” the United States, while we do not have anything approaching a vaccine, let alone the multiple vaccines that medical authorities desire before resuming social contact at pre-pandemic levels. How to process the data that we have, and how to view the maps not only by hovering, zooming in, or distancing the growing rates of infection, but tracking the virus in spaces, mapping levels of infection against adequacy of testing, mortalities against comorbidities, against with the chronic nature of the virus must be understood, as well as levels of hospitalization levels; and distinctions or mutations of the virus and against age ranges of afflicted–by, in other words, drilling beneath the datasets to make our maps’ smooth surfaces more legible, as horrifying as they are?

Can we use what we have to pose problems about the new nature of this contagion we don’t fully understand, but has been mapped in ways that seek to staunch fears of a decline in the stock market, as much as an emergency of public health, with up to one third of the population at risk of infection? The instinctive reaction of the Trump Health and Human Services to create public-private “community testing sites” for drive-thru or drive-up testing at Walgreens, CVS, Rite Aid, Kroger and other pharmacies seems reflexive for a government wanting to minimize federal overhead, but a far less exact means, and a far less intuitively sensible basis to attract potentially infected individuals to sites of public congregation. The hope of Verily–a subsidiary of Alphabet, whose Project Baseline boasts the slogan, “We’ve Mapped the World, Now Let’s Map Human Health,” in a bizarrely boosterish rhetoric, aggregates medical for medical screening in California–

Select States for Project Baseline Testing/Verily

–and select states–was the primary response that Trump had promised of a network of drive-up testing sites that has never materialized, even as it expanded to a hundred sites in thirty states. After Walmart opened two sites, and Walmart 40, the difficult accuracy of creating multiple testing sites was prohibitive, the testing sites that were rolled out with the assistance of private entrepreneurs that Jared Kushner enlisted, that filled the absence of any coherent public health response–perhaps, terrifyingly, in concert with his brother’s health care company, Oscar, which also partnered with CVS and some of the same pharmaceutical services, focussing on drive-thru sites more than sustained medical care, focussing largely on calming retailers who feared the arrival of infected patients on their parking lots, more than on the efficacy of testing, which they didn’t understand. If only 40% of promised test kits were made available, the absence of providing staffers or selling, as in Massachusetts, self-testing kits–and failing to provide many in large cities like New Orleans, as if to keep the final tally of infected artificially low. While hoping for eight million tests by mid-May, or a doubling of existing rates, the kits relied on automated testing of Thermo Fisher, and lacked clear oversight, and the machine was unknown to Medicare’s innovation chief, and based on trust..

The network expanded to those places judged to be of “greatest vulnerability,” but leaving multiple underserved communities at considerable cost to developing an accurate databank. The initial decision to ration test kits played out by early May into a situation when only 3% of Americans were tested, dangerous for a virus who displayed few signs of the illness when most contagious. The fear of spooking the markets may have outweighed the need for responding to the health threat, suggesting the prudent nature of a reaction that would have most appealed to Trump to not rankle the public or provoke widespread panic, more sensitive to his public perceptions than the demand of his office..

The slow spread of the idea of “testing sites” in such public-private drives, as much as serve patients, created an absent baseline for public testing, to be provided by Verily’s Baseline platform not in a form of medical coverage or in HIPPA security standards, if it supports compliance. The project is intended as a roll-out of a new form of medical record keeping for the long term, not specific to COVID-19, or a minimal data collection service for initial run-through of a model to allow medical tracking and widespread screening and testing to compile public health data–not a means of ascertaining levels of infection, which prevented Americans from developing anything like a clear picture of the spread of the epidemic–even as we looked to the world, viewing the spread of the novel coronavirus through buckets and lenses of national sovereignty. Initial tests were confined to those who were within six feet of something infected with COVID-19 or had been in China or Wuhan. Unlike the regular updates on H1N1, SARS, or Ebola, the public health threat was minimized, and no clear infrastructure of pandemic response was created.

“Above all,” said Anthony Scaramucci about his experience in the Trump administration, “you must never make him feel ignorant.” Did an absence of medical expertise in confronting the disease Trump was able to field make it difficult to read the disease but as a possible threat to the booming stock market Trump viewed as his greatest accomplishment? The content at the metric of economic growth outweighed the absence of a cabinet-level position of public health. The problem of embodying the disease extends to how well we are able to bring ourselves to read the dizzying tallies of the infection rates we seek no longer to contain–there are no clear edges with the pandemic, almost by nature–and it may make far more sense to learn to map susceptibilities and vulnerabilities to the disease by digging into the large aggregates of infections that dizzy, but demand to be better grasped if they can be translated into health care, rather than alarm. And the deeper problem, that will be the focus of the bulk of the post, is the difficulties of scale at which we continue to parse the disease by localities, acting as if the geotracking that we developed for humans make sense to track migration of a zoonotic virus that does not know frontiers, but travels in pathways of shared space and surfaces, in ways we have not learned how to track.

And if we are constrained in mapping or processing COVID-19 by the resistance to consider it a global pandemic, retaining national counts as we depend on national senses of order, well-being, and national health services if not universal health care, the alleged national problems of confronting COVID-19 should not conceal the the unfolding narrative is global, and global in ways we are not used to map–especially not in our narratives of pathogens’ transmission, or in distracting narratives of national levels of infected populations in different nations–as if the virus respected boundaries, or tabulation practices were uniform or uniformly distributed across the globe. The limited data we have for our maps, and frustrating inability to frame narratives from the maps, reveals the dependence of good data visualizations on good data, and the complexity of trying to map the virus on sufficient scales to comprehend its global spread. Perhaps this is because there is no clear narrative that has emerged, but it is also because we are viewing the sheer numbers of reported infections in a freeze-frame, overwhelmed by needs of mitigating its spread, no longer able to contain the virus that we seem destined to live with for a far longer period of time than we were able to admit.

And the Distractor-in-Chief seems bound to introduce red herrings that obscure the spread of COVID-19, imagining that not wearing a mask is a sign of strength and resistance, as he questions the accuracy of testings, rather than using Presidential authority to expand testing nation wide in a true emergency–the first encountered, perhaps, in his presidency–although abilities of mitigation are not being considered broadly so much as deregulation, tax breaks, financial incentives, and while best practices have not been defined. As if embracing the false data maps of national differences in tallies of infection for his own ends, Trump has insistently warped the need for international global virus response to national competition for lower numbers, pointed the blame abroad, and failed to expand testing in critical ways, as if to obscure the map intentionally and muddy our waters. (Indeed, without needed testing, we don’t even have a sense of the accuracy of the maps we make.)

As we move toward hopes for mitigation of the virus that has explosively arrived in our major cities, penitentiaries, centers of butchery, old age homes, and hospitals, we face problems of lacking a close-grained maps able to track the different scales by which it has been contracted to gain much stability on the virus’ spread that might give us a better bearing on its future, but are seized by often unwarranted senses of false security from existing maps. While infections spread around the globe, it was somehow fitting that the American President spread disinformation, seeking to provide encouraging spin, probably with the advice of Jared Kushner, a man who believes spin is all, as his father-in-law, as Laura Ingraham and other Trump surrogates declare hydroxychloroquine’s availability to be the “the beginning of the end of the pandemic” as we know it, as infections confirmed in the United States approach 900,000.. For the logic of the “America First” premise on which Trump was elected President, and is conducting a new campaign for re-election, run against the very global nature of the pandemic.

While the pandemic is a stress test for our societies, and for the global response to a disease that has spread along the very lines that bind the world together–from airline routes to public transit, from markets and public spaces to institutions of learning, public health, schools–it is also a stress-test on mapping tools, putting new pressures on how we can better track the diseases, reveal the continued validity of maps and tracking apps, and use sufficiently finely grained tools whose dashboard remains global by default from March 11, when it was declared a pandemic,–reflecting global spread of confirmed infections across seven continents–

–to early May, when the United States, after having subtracted itself from global health authorities, and cut its substantial contribution to the World Health Organization, which it accused of undercutting American interests, had itself become the new “epicenter” of infections worldwide.

Johns Hopkins COVID-19 Global Dashboard/May 5, 2020

The maps are striking, but the small-scale conventions of their global purview are almost designed to mislead. These aggregations of confirmed cases of the disease, that show a global map riddled with red dots, fail to describe the pathways that the virus takes, although they stand as a riveting proxy for its spread across a national map. Toward the end of March, the global nature of the disease was overwhelming, identification of “hot-spots” overwhelming, and tallies of cases and mortality cognitively overwhelmed. Was this globalism, or globalization as we had never so vividly seen it, presented on our screens in vivid color, a newly frozen world trying to process its losses and their scale, as we finally acknowledged the global pandemic? Could we re-orient ourselves to the global scale of the pathogen’s spread?

Or did we need a new sense of the multiple scales on which COVID-19 was transmitted by human contact in crowded spaces the increasingly overlap with one another–and another of the United States’ increased separation from the global accords before the disease? If lingering diseases were associated with poorer countries and environments, the global migration of the novel coronavirus has become a point of fascination and a terrifying passively received spectacle on global media, transcending any government’s control, and reminding us of the difficulty of containing the ease with which it is contracted, drowning the viewer in confirmed cases with little actual geographic or demographic specificity and little distance.

March 20, 2020

We faced an immediate existential level of meaning and alarm in the appearance of infections that seem to proliferate like an actual organism over a huge expanse, triggering a sense that there is not only no “escape” from the virus, but that is proximate to much of the world’s population. And if the Trump administration has almost worked to prepare us for a global pandemic in the cruelest of ways, by cutting back our own scientific presence in the health care system in China to monitor emergent zoonotic pathogens like the novel coronavirus SARS-CoV-2, or the international branches of the CDC and NSF, or even by demeaning the recommendations that the CDC and other health officers offer the nation as overly restrictive, the failure to prioritize or value testing and best practices of the mitigation and containment of infection, which began far earlier than the United States officials or government publicly noted.

1. We watch the progress of the pandemic on screens, while sheltering in place, uncertain of how what is moving across the country can be tracked with precision. The drama of mortality scenes that have multiplied to become far more present in our consciousness than we ever thought possible in a modern era seem to haunt us, destabilizing our sense of life and death, leading us to turn to cultural resources we hope will provide some form of orientation, because the data is so hard to look at, and so difficult to parse. Never has Washington, D.C. seemed more removed from a global crisis, and America, the new epicenter of the virus’ spread, seemed harder to orient ourselves to as we enter a new stage of emergency and a new status quo of disorientation, the inequities of health care and paucity of testing equipment parallel a problem of gaining bearings by our maps.

The pandemic outbreak was for far too long mis-mapped as lying only in China–exploiting the rhetoric of nationalism not commensurable with the meaning of a pandemic–before the narrative became global, if it of course we long suspected that it was not only local. On January 30, Commerce Secretary Wilbur Ross affirmed energetically to the nation the infection afflicting up to 8,100 in China “will accelerate” jobs’ return to the US, predicting a “reshoring to the US. and some restoring to Mexico” that used the obsolete markers of shores as a unit of economic integrity that should have left us worried for its dissonance with an globalized world, as interruption of supply chains affected American industry based in Hubei, from processors to electronics: but as Apple hurriedly shifted jobs from computers and phones from China, Trump’s desire the United States companies act to relocate operations from China seemed more in sight as the coronavirus was almost readily interpreted as, in fact, a financial bonanza for the United States.

Is it surprising that there is not a health officer in the Cabinet?

The dominant White House interpretation of data about the disease is a logic of the continued extraction of profits, not only of tax breaks and stimulus packages, but outright profitability from pharmaceuticals that have no clear relation to the virus (hydroxychloroquine . . . ); tests that prove to offer little useful accuracy in testing (the “great test” Trump promoted from Abbott Labs, ID NOW . . . ); limits of the reliability of serological tests; and the involvement of members of the “first family” in automated health advice that provides a poor, tragic, empty substitute for health care. Trump had promoted hydroxychloroquine on March 19 as a “game-changer,” echoing the words by which FOX’s Laura Ingraham endorsed the drug in an interview tie Gregory Rigano, a Long Island attorney who had been promoting the treatment in a much-retweeted GoogleDoc, broadcast March 16: the broadside designed with the appearance of scientific validity incorporated the theories of French virologist Didier Raoult–whose work had spurred a rise in internet rumors as to its efficacy, from late February to early March: Raoult’s findings gained currency through block-chain investors and Elon Musk, who valued the lack of clinical validation or trials, claiming hydroxychloroquine “efficient on SARS-CoV-2, and reported to be efficient in Chinese COV-19 patients.”

Trump promoted the drug championed by investors and speculators without clinical grounds: without endorsement from the medical community, the rash of social media interest led to accelerated stockpiling and strong-arming scientists to approve an emergency authorization of the antimalarial for widespread patients hospitalized with COVID-19 infections. With revaluation of real dangers of cardiac arrest after taking the anti-malirial was it withdrawn, and the National Institute of Health undertaken the large study of the very untested cocktail of drugs Dr Raoult had promised, after stockpiling of twenty-min million hydroxochloroquine pill Despite fears of its ties to paranoia and psychosis, and cardiac arrest, Trump endorsed the dangerous drug in a widely shared March 21 tweet, following discussion Dr Raoult, who found the President a true entrepreneurial mindset needed to promote a drug without testing: the drug during White House briefings in early April, and advocating its use by non-symptomatic Americans take the drug–before telling the nation he was regularly taking it himself by mid-May. At that point, the FDA withdrew its qualifying cautions of side-effects, as Trump gloated that “What has been determined is [the compound of drugs] doesn’t harm you,” attacking studies that questioned its safety as partisan. While the Food and Drug Administration restricted hydroxychloroquine as a coronavirus treatment in hopsital settings, given “reports of serious heart rhythm problems” in virus patients who had received the drug, Trump questioned the study as “a Trump enemy statement,” deploying Manichean logic of a paranoid by discrediting the Veterans Association study as the work of “people who aren’t big Trump fans,” elevating demonization above scientific verification and linking the drug to his brand. Was the popularity of the drug to boost collective consent to his opinions amidst a public health emergency as COVID-19 infections grew across multiple states.

Was the promotion of this potentially deadly drug that has not been tested an attempt to restore trust in an administration that has failed to assemble a coherent public health strategy, but eager to promote a market for drugs ? The weaknesses reveal the dangers of trusting in “the private sector” Trump celebrated to respond to a public health crisis.

After the fourth product form Abbott Labs testing for COVID-19 was fast-tracked for “emergency use authorization,” an emergency authorization of hydroxycholoquine issued, and 30 million tests ordered for May with 60 million to be shipped in June, for administration at CVS stores for drive-through testing in mid-April, were serious questions raised about the very tests intended to replace WHO test-kits the United States had refused. Whereas Trump had promised that the fast-tracked would start “a whole new ballgame” in containing COVID-19, it seems as if it may be the same game of for-profit corruption: with the efficacy questioned as of clinical viability by Langone Medical Center, the test is tied to a health insurance company Kushner and his brother Joshua founded, Oscar, whose fast-tracking eliminating review strikingly occurred after the FDA tightened rules for coronavirus antibody tests, based on Abbott Labs’ own claims.

Trump seemed to be defending American enterprise in providing tests in his public addresses. What seemed product placement to many–if not an endorsement–may have backfired as an attempt to seem in possession of actual testing technology. Rather than accompanied less by an effective roll-out overseeing state testing, the promise to provide a list of labs promising to fill tests that has not produced viable results for state health agencies, and insecurity about the clinical value of testing devices’ results, prematurely proclaiming his administration’s victory over the pandemic.

Drew Angerer/Getty Images
Mandel Ngan/AFP

Seeming every more like a TV host, or as if he were foregrounding a prize in a series of Reality TV, the President-with-Teleprompter promised a revolution of diagnostic practice as if it ws about to arrive, yet again, even though the promise of further testing and better data did not arrive.

Was this even recognized as a crisis in public health? Far from it, for this administration. President Trump’s own economic advisors looked at maps with little interpretive skill or outright duplicity, noting “We see no material impact on the economy,” leading Larry Kudlow to insist “the pandemic is, of course, in China, not the United States,” underlining “no material impact” on America’s vibrant economy.

Google Trends for “Pandemic,” February 3 2020-April 15, 2020

Was this a misunderstanding, distortion, or pathological? Was not any pandemic a global event? Americans would only rush to clarify the meaning of “pandemic” a week into March–even as some within the administration noted the absence of any protection for the novel coronavirus in terms of a cure or vaccine left the country vulnerable, as if it was failed to be included in the pandemic or could be localized. In early February, the government was assuring the nation that the United States has only had 13 confirmed cases of the virus, on Feb. 11,–mis-mapping the virus to dissuade closer scrutiny of the pandemic’s scope–“pandemic” only really jumped as a Google search after March 9 in the United States, despite a bump in searching in late February: we were watching something else on our screens, bracketing the possibility of a pandemic. Yet even as we acknowledge the pandemic, the flatness of the maps we watch on screens seems all to easy to place at a remove, and paralyze us before its spread, much as they mask the divides within the nation that is exposed to infection or the topography of risks that might be managed or addressed.

The rhetoric of COVID-19 was tantamount to an epidemiological re-centering, mis-mapping of attention in a time of emergency. The adoption of the talking points social media supplied through the that was born in the anesthetized cocoon of social media offered a meme more than a logic: the retweeting of the charge that linked China, the danger of the novel coronavirus, and the Border Wall conceit was born in the feed of a combative coordinator of right-wing student outreach, eager to map the danger Trump promoted in combative terms: the meme tying protection a “Border Wall” could offer against infection only amplified Trump’s earlier assertions it was the border wall that would prevent the entrance of the coronavirus COVID-19 on late February, in Charleston, S.C., turning attention to his signature piece of policy, so often described as “going up fast” and recasting it as a basis to stop the spread of coronavirus, which led Trump to retweet the specious speculation of a man who cut his teeth on Breitbart: “With China Virus spreading across the globe, the U.S. stands a chance if we can control our borders”–to his 77 million followers. The mismapping gained so much traction to identify the origin of the novel coronavirus that the geographic origin was elided with national agency in talking points of Trump’s followers, as the virus–blamed on America in Iran–was blamed on bad human actors for having globally circulated or mismanaged without credibility:

The March 10 tweet was expanded in Trump’s address to the nation that described his closure of borders as a response to the COVID-19 outbreak, as if a proven panacea among States of Emergency might credibly recycle the maps of previous one.s that he had welcomed on the southwestern border Even as Trump endorsed mapping of a containment of COVID-19 in Europe and China, he seemed to manufacture a sense of national safety removed from the actuality of global viral transmission, whose rates of infections were already exponentially growing in the United States.

Is the notion of localizing a pandemic in China outright deception or sloppy thinking, or an attack on logic, projecting the pandemic onto an obsession of walling up national space? Is the poor mapping of the disease to blame, or did an image of global economic competition between nations provide a lens through which viral transmission was mediated, among members of Trump’s team less familiar with epidemiology, and more habituated to defer to The Donald, lest they be fired from the White House or COVID-19 Emergency Response Team, which when it was formed in mid-March, just after the search for “pandemic” on Google escalated in the United States, used a designated landline (not even toll-free!) to report cases of suspiciously high temperatures of a fever over 100.4 o F, 202-586-COVID?

Can we create more cartographies that show the inequities of the virus’ spread, or the danger in which its spread has based vulnerable populations? There was less interpretation of the advance of disease against the range of national vulnerabilities or susceptibilities about which we knew already–or suspected–

–that should force us to look at the uneven landscape of health and wellness, with sudden clarity, in an era when the danger of COVID-19 comorbidity elevates the presence of hypertension to the leading cause of death among the terrifying jump in fatalities in New York City in its worst days of increased mortality, which underlies the need to map against health risks particularly present in those most at risk.

In part, this can be localized. The danger of susceptibility to the highly infectious coronavirus in assisted living facilities and those of nursing care in the nation, privately developed by the Society for Post-Acute and Long-Term Care Medicine to confront the need to distribute protective equipment (PPE) and other resources to contain COVID-19

 “Heat map” of COVID-19 within assisted living communities and nursing homes

The range of dangers from diabetes to asthma to senescence provide problems to integrate into statistical maps or data modeling, because they invert the categories of danger of man diseases, like diabetes–that create a different map of health risk.

Danger of Diabetes: County-by-County Risk/U.S. Health Map

IN the case of quickly advancing dangers of infection, often managed remotely in an age of distance-learning and tele-medicine, there is also the risk of entering a new topography of medical care, defined by in regions far from medical care less well-served by access to medical expertise–often important in a disease where quick diagnosis may be late in arriving, and proximity to ICU wards, respirators, and caregivers may be as crucial as proximity to a testing center.

–or access to hospital beds.

Hospital Bed Availability by Region in a Moderate Scenario for COVID-19 Infections

2. What was the dominant narrative of viewing the potential spread of the virus, and what sort of narratives were associated with them?

A wishful thinking informed choropleths of outbreaks that suggested that the health care crisis could be contained–or was contained!–that obscure the deep disparities to health care and even of maintaining distancing and cleanliness, vital to issues of national security as well as forms of empowerment and tools of survival. Should we start a finer-grained map of the country, whose layers called attention to the dangers of places where social distancing is less in place or easy to maintain–like ocean liners, Wuhan markets, New York City’s outer boroughs, or more crowded neighborhoods, with less access to open space? It increasingly seems that the uneven geography to which the choropletss we have inherited from old models of data visualization are spectacularly blind from levels of class, uneven health care, exposure to pollution or overcrowded living conditions, that they, indeed, seem to naturalize in their appeal to a miasmatic notion of disease transmission or effluvia–common to many of the first statitistical data visualizations of cholera, like the London maps developed by Richard Grainger, and Dr. John Snow. The uneven geography of the nation should not be bleached from our own choropleths in an attempt to explain or communicate the topography of infection that is increasingly apparent.

For the changing actual maps of national distribution of the illness as they evolve reveal an expanding growth of infection rates along the Mississippi, in Florida and the US South, as well as southern California, Chicago, and Detroit.

Although notions of containment were long gone by April 15, 2020, the notion of sites of focus for the disease still seem to underly the maps of “hotspots” that were made by mid-April, a month after the declaration of the pandemic, as we should have been watching, studying, and responding to the populations affected in greater detail than as below, COVID-19 infections in total in ocher and per 100,000 in red–an attempt to suggest some specificity of density, bt which results in grouping New York/New Jersey and Massachusetts as one red almost vibrating blob that troublingly recalls a radiating miasma.

The intersection of such maps and those of “hot spots” of disease with places where social distancing is impossible or unable to be performed is striking, as is the relation to poor air quality and ambient pollution that could create a virtual comorbidity by compromising the linings of lungs. Long-term exposure to air pollution–a metric of asthma and respiratory impairment–may well map onto vulnerability to greatest compromise by COVID-19. We might consider how such exposure affects the lungs and surfaces of the lungs that COVID-19 attaches, and seems to make some more susceptible to infection and death on the cells lining the lungs, settling in the alveoli that tiny air sacs where oxygen enters the blood stream–and which the virus uses as a launching pad to enter the body, presenting a respiratory illness able to leave lasting damage to the lungs?

For once the virus invades the respiratory tract of the individual, as it makes its way into the lining of the lungs, it seems as if it would be encouraged by any compromise in the lungs’ functions–from circulation to senectitude–for those among whom any irritation or infection could be more consquential.

The often ignored fault lines that exist in the landscape of health in America that underlie this uncertain data distribution, underscored by the fact that low-income jobs in the service economy, retail, delivery, or gig economy fields both offer few health care options or sick leave and cannot be performed remotely, and the tie of income to higher rates of chronic health conditions that can provide cases of comorbidity–from diabetes to asthma to heart disease, significantly increasing vulnerability to COVID-19.

The concentration of air pollutants is by no means a sole filter to interpret the data maps, but high particulate matter is one metric and needed sort of stability to read the overpowering spikes of mortality on the east coast, hard to maintain any bearing to, in the midst of an increased stress at the witnessing the rapidity of COVID-19’s spread and high infectivtivity. As the nature of overcrowded spaces encourages its notorious infection rate, the concentration of particulate matter in the atmosphere has been linked to increased COVID-19 morbidity by Harvard’s T.H. Chan School of Public Health, who find sustained exposure to air polluted by particulate matter above 13 micrograms/cm maps map onto increased mortality, affirming the pronounced role of anthropogenic environmental changes on chances of contracting the disease. Francesca Dominici, co-director of the Harvard Data Science Initiative, argued “only 1 gram per cubic meter in fine particulate matter in the air associated with a 15% increase in the COVID-19 death rate;” we now find increased incidence of infections in polluted Southern California counties, as well as the rise of cases of infection, presumably from a lesser load, as confirmed cases grow by over 2,000 daily and collective deaths have passed 80,,000–drenching the continent by mid-April in red, as cases of infection bleed across the entire land.

But the “cartographies of COVID-19” that we are invited to navigate on digital platforms are often organized by the inheritances and tools of data visualization that, as statistical models, see outbreaks and diseases in relation to the state, even if our state is unable to contain the highly infectious novel coronavirus, and we aren’t developing the best tools to visualize its spread. For as we are mapping mortality and hospitalization, we are registering shock at the virulence of a pandemic of the sort that seems as if it should be foreign to the modern world, or modernization, but is sending ripples across the world difficult to hold together with the need toot contain but eliminate the pandemic virus as it spreads. We can review the range of visualization tools at our disposal, but even we fail to have complete data, run the risk of relying on older models of mapping the coronavirus that don’t successfully communicate the risks posed by crowding, inabilities to distance, and unhealthy ecosystems that are apt to encourage and facilitate its spread: even if we could control the forced crowding in jails, camps of refugees or deportation, and the powder kegs of old age homes where the presence of comorbidity is impossibly multiplied–and remember, in New York, the presence of comorbidity defined h86% of COVID-19 deaths, with hypertension and diabetes being the leading factors present, above coronary disease or cancer–as what were seen as non-mortal illnesses are flipped to causes of death.

As we begin to make better “prognostic maps” of the regional vulnerability of counties across the nation, we see disparities in cumulative rates of infection. Such maps might integrate the breadth of the project of need for national testing that has spread across the country, and demands congressional oversight–rather than left to a fragmented national administration. Such vulnerability to contracting the virus are based on cumulative incidence, but reflect a widespread contraction of the virus not limited to population density or metro areas, but of disturbing broad-stroke correlation to airborne pollution–which has been argued to increase sensitivity to contracting airborne diseases and compromising immune systems.

April 13, 2020/Mapbox; New York Times

3. All the meaning that we are used to press out of maps and data visualizations are among the resources by which we process the spread of COVID-19.

The pathogen was given foreign identity from Trump’s first address to the nation, of March 11, about a “foreign virus” that was to be seen in national terms that demanded to be confronted as a nation. The interpretation of sovereign terms was accentuated in Trump’s continued mis-mapping of the novel coronavirus as a “Chinese plot”–or, as Trump prefers, a “Chinese virus,” in danger of being brought by migrants, rather than able to illuminate fault-lines within our health care systems in a globalized world. Is such intentionally mipmapping the virus by investing it with nationality, Trump sought to deny the global nature of the emergency facing the nation? The termwhich Mike Pompeo seems to have introduced on FOX on March 7 was used by Trump on social media, and after being tweeted out by Republican congressmen–“Chinese coronavirus” (Kevin McCarthy, March 9) or “Wuhan virus” (Paul Gosar, March 8) became a viral shorthand for alt right bloggers for the novel coronavirus that Trump embraced in public policy debates.

Jabin Botsford/Wasthington Post (March 19, 2020)

The remapping of the virus with a national geographic origin injected the raunchy Trump persona of an attack dog into the staid tones of a national scripted address read directly off the teleprompter. But the false “correction” that Trump performed by Sharpie on the speech he later gave to the Coronavirus Task Force was a canny injection of inarticulateness, above, was a dramatic attempt to displace the danger of the virus as a national emergency form foreign agents. Akin to the remapping of the course of a hurricane by sharpie to elevate a national threat to our borders, Trump tired to start a meme of altering the scientific name of COVID-19 in two tweets of March 16 that invested the virus with national provenance. And if he defended as akin to the Spanish Flu–“because it comes from there!”–he mapped the virus spreading in the United States as a foreign threat, as if offering talking points to energize a crowd. By intentionally transforming the virus in unhelpful terms of national sovereignty, Trump seemed to remap the contagion as a national contest by wielding his sharpie wand of disinformation with clearly disruptive intentionality.

Did Trump not intend to introduce a meme in his tweet and address to the Coronavirus task force, to be carried in major news sources, infect debate, and shift attention from his own mismanagement of a public health crisis, so that the reality of its discussion would displace the attention?

Insistent mis-mapping of the virus by casting it as a national threat, a creation of other foreign laboratories, as Pompeo returned to mischaracterize the virus as an enemy plot in early May, 2020, alleging that COVID-19 derived from “a Wuhan lab” almost mask the disruption of United States’ scientific monitoring of a global threat in the Trump administration. Pompeo’s strikingly poor command for a Secretary of State of the global map, which he had fetishized as the blank map he wielded to challenge NPR’s Mary Louise Kelly in his living room in January, by challenging her even to locate Ukraine on a map, stripped of toponymy, haunted his assertions, as Pompeo wielded a map of viral spread to confound the site of origin of the novel coronavirus with a map of global politics: he argued without grounds that China that was to bear the blame for its failure to prevent a global “descent into an economic malaise” and prevent the deaths of “hundreds of thousands of people worldwide” and indeed “perpetrated” a zoonotic virus on the globe, confounding the contraction of the virus with amorphous global fears.

Did Americans need to know anything else but that it originated abroad?

May 3, 2020: Mike Pompeo Announces “Enormous Evidence” of Chinese Laboratory’s Fabrication of Novel Coronavirus

The outbreak of the novel coronavirus that began on the China mainland before it spread worldwide has confirmed that we live, the rhetoric of governments who seek to reveal their control of events notwithstanding, in an edgeless world, where the pathogen knows no edge; we track its appearance in human hosts and mortality rates, at a time-lag from its actual contraction or spread, with uncertain and shaky means of testing, trying to view it through the refraction of civil government. If maps are increasingly authoritative presentations of data, our maps may be on the wrong scale. In a time when we are beyond containment, maps have a curious role.

To steady ourselves before a global pandemic whose scale we don’t know and haven’t undertaken testing to detect have led us to depend, unsurprisingly, on maps, driven by the need to determine our relation to the pandemic virus’ global spread, most often to try to grasp our danger of exposure–or the exposure of loved ones and family–before global acceleration rates of the virus’s spread, and to map the relation of the nation, and indeed the state, and city, or county, to the global dispersion of SARS-CoV-2, the primary topic of global media attention, and the topic of increasing global stress and concern.

2. We trust visualizations as forms that can be consumed, digested, and grasped in better ways, the questions of the availability of good data to orient us to the disease to the side, our maps track cases that cannot describe the fine grain on which the virus moves through bodies, or even moves through space. As is so often true for a GPS-derived base-map, the story of COVID-19 is increasingly about our changing relation to global space; the recent proliferation of maps seek to track that relationship. But the danger of these global maps is both that they neglect the vulnerability of specific populations that are decimated by the disease–often without health care and living in crowded conditions–and that they lack any narrative that allows us to process the progress of the disease with has globally spread as the United States government has spread disinformation about the pandemic and often not enabled full counts of infected.

We lacked a sense of the narrative of this spread, of course, and were not ready to link the proliferation of data to an interpretation of the virus’ rapid spread. Even as we were barraged by maps, as the benificiaries of new location technologies, that have helped facilitate and improve the provision of maps, even if based on bad data, they were produced at a disconnect from the lack of official response to the disease.

This gap may have been enabled by an absence of many on-the-ground CDC officials or representatives in China: their number reduced, the United States’ official reaction to the spread of COVID-19 was subsumed into a personal relation of Trump and Xi, so often the optic of foreign relations and affairs, with less epidemiological expertise:  “You have to consider the possibility that our drawdown made this catastrophe more likely or more difficult to respond to,” confessed one familiar with the consequences of eliminating three-fourths of Chinese medical and disease experts whose “institutional knowledge” provided stability in Beijing, now headed by a temporary deputy director. The sole epidemiologist embedded in China’s disease control agency where she trained field epidemiologists had been fired, her position unfilled, and agencies designed to combat global disease and build scientific relations had been shuttered in China since 2019, ending research into multi drug resistant malaria and other viruses.

The Center for Disease Control hamstrung its global knowledge of the zoonotic disease, as CDC officers in China by half before the pandemic, giving us far fewer epidmiological eyes on the ground–cutting a Beijing staff from almost fifty to fourteen, under the Trump administration, including all local employees; in two years, only two thirds of its staff remained–agencies for international development in Beijing closed, curtailing the ability to monitor outbreaks as if setting us up for a pandemic. The cutting of Chinese on U.S. payroll and shuttering of National Science Foundation and CDC offices was deeply damning evidence of the denial that anything outside of the United States was relevant to its well-being, as much as being “anti-science”: shuttering of NSF offices in Beijing led by respected scientists like Nancy Sung, critical in establishing ties between United States and Chinese scientific communities who ran the NSF’s international Science Program, closed outreach ties to Beijing before the outbreak. The concealment of such mismanagement of scientific open-ness in the assertion in anti-globalist terms that the novel coronavirus was “inflicted on the USA and the rest of the world” viewed the spread of COVID-19 as an actual war.

By the time a pandemic was declared on March 10, after the virus had long spread on the ground, strains had arrived in multiple cities in the United States, with no coherent strategies–and those testing positive revealed only hinted at the scope of the virus’ spread. Yet anti-science attacks that began with the end of National Institutes of Health to help fund research in a Wuhan Institute of Virology to develop a cures for emerging pandemics, and zoonotic diseases that jump species from bats; the alt right Florida Representative who slandered work with an institute that “may have birthed a monster” or the novel coronavirus,–debased the value of its research in the anti-globalist rhetoric of the alt right, as President Trump described the virus as “inflicted on the USA and the rest of the World,” as he sewed doubts about the accuracy of mortality counts in ways predicted to occur by Trump’s biographer, Tony Schwartz, as staff members queried the accuracy of figures as due to “lack of uniform standards in the United States or internationally”–undercutting World health Organization tallies–for the reason that “America’s out of practice of how to deal with something like this and to report it accurately,” as if a similar pandemic had ever occurred. Schwartz predicted that the tally would be identified as a departmental conspiracy against him, but concealed the undoubtedly low nature of the mortality count where many deaths are due to comorbidities, and multiple deaths are not even diagnosed.

Tony Schwärt, May 6 2020

The assertion from senior administration officials that the numbers of dead were imprecise and that “we need more autopsies” seemed to undermine one of the oldest forms of proof. The assertion of better tools to diagnose death blurred not only the limited capacities of prioritizing COVID-19 as a cause of death in relation to comorbidities that were increasingly present in the diagnosis of death, and blurred the consistency of any national tallies of death. The demotion of the accuracy of statistics blurred not only a standard of proof, but multiple needs, all important to prioritize: from protective equipment among medical staffers (PPE); better and more accessible testing; full tallies of the extent of deaths among undercounted communities of elderly, Native Americans, poor populations, homeless, incarcerated, and migrants deportation camps. Autopsies were, indeed, a basis for proof and evidence of the sort that Trump takes pleasure in destablizing.

But as much as obfuscating, the demand for better autopsies suggest the difficulty in detecting the blood clots that began to appear in multiple patients with severe SARS-CoV-2 infections, not only in the lungs, but in the brain, causing strokes, in the heart, in the kidneys, and the different diagnostic categories to read autoopsies and diagnose the virus: the medical record-keeping processes allowed little basis to cross-check the many deaths that the virus hastened or introduce through clots that were not recognized as the ause of death. Austopsies were the first discovery of bacterial infections, those performed by doctors who cleaned their hands carefully rarely being vectors of viral communicate–but if autopsy was a classic form of proof, the autopssies that accounted for actual mortality rates tied to SARS-CoV-2 might change understanding infection and emergency response, as we lack adequate forms of testing.

And the absence of accurate testing tools was deeply frustrating. And when Trump has doubted escalating mortality counts to conceal the gravity of the pandemic, he may conceal actual undercounts lying in officially reported numbers that offer the basis to develop better diagnostic models, and the scale and proportions of the current national health emergency–the basic lay of the land. If the mid-March “testing gap” was acute both globally and among states– Interactive map of Total Tests for Conrimed Cases in State/March 20 2020

–improved, tests were notoriously inaccurate and in short supply, and policies from the Center for Disease Control and guidelines of the Food and Drug Administration were increasingly muddied as to the ability of private label to provide or develop home testing kits for SARS-CoV-2, even as testing supplies were widely divergent, as if no coherent policy had been developed. The increased reliance on “community-based testing sites” that were public-private partnerships, rather than government policies, continued even as one third of Americans were at risk of infection.

And by mid-April the COVID Tracking Project estimated almost all states performed fewer than the 152 tests per 100,000 demanded to identify the range of individuals infected.

The consistent absence of good data in such numbers prompted a rise in to remedy their undercounts in self-organized sites from motivated individual aggregators, from Alexis Madrigal’s CovidTracker, or the clever web-scraping of high schooler Avi Schiffman in Seattle, both of whose sites were relying on official statistics, filling a need underscored by evidence of a substantial if fairly stable gap from mid-March between excess deaths across the nation and those deaths attributed to SARS-CoV-2. As Madrigal and Schiffman, among others, collated and broadcast evidence of the rising mortalities and infection rates that underpinned our maps of the potentially deadly coronavirus’ spread–Anthony Fauci felt a compelling need to add an edge of objectivity and pronounce that “the numbers of deaths are most likely higher” than officially certified counts, risking his job by acknowledging the lack of good numbers–and the danger implicit in the fact that only about 5% of the American population had been exposed to the virus raised increased concerns about the prospect of “opening up” the country–and that we were “opening it up” to further viral spread.

Washington Post/April 27, 2020

And when by early April that a single app became available to track testing across counties and states, large swaths of the country remained greyed out, but most of the nation was bright red. The best data of COVID-19 infections on county and state levels, both of total infected, mortality, and new infections, showed case numbers for most the nation elevated; total morality was projected to rise from 1.7 to 2.2 million in mid-April, if only 30,000 were infected by the virus.

Chris Barker, UC Davis

If there was no clear narrative in maps, and no clear sense of how best to integrate the graphs, legends, and scales which cartographers may increasingly come to depend, and data visualizations can fail to foreground, this is because their is of course not only no clear narrative for COVID-19, and no sense of how the narrative will unfold. We turn to maps in the desire for orientation in a time of crisis, and for a sense of stability. Desiring orientation, and coherence, we elide crucial questions of what makes data “good,” in our eagerness to find comfort in visualizing the spread of the pathogen: with limited testing around the world, from the most developed to undeveloped countries, the gaps in data about the disease is both masked over in many maps, or how data is massaged or ignored: the prestige of data makes some terrifyingly sure of their ability to pronounce on the disease’s advance or its retreat, and the insecurity of tracking non-living RNA strands in human societies is balanced with the brute force of mapping mortality rates that seem somehow to constantly escalate, breaking the barriers of our expectations, to pierce the very capacities of the news to cover adequately.

What do such maps show? Increasingly, the story is itself blurred, and if the maps no longer present a sense of desperation of the lack of any space on the map where one might take refuge from the novel coronavirus, the question of there interpretation is increasingly coming down to the difficulty of integrating the multiple scales at which the coronavirus can be mapped–while we adhere to the national chloropleth, the figure familiar from the operations of statistics and state-based knowledge-making from the mid-nineteenth century, the tried and true bread-and-butter of data visualization antecedents, we are going to be forced to integrate and toggle between the multiple scales of the coronavirus–not only the global and national, which have been the preferred building blocks of mapping data, but the microscopic level of the course of the virus in bodies, and the pathological results of mortalities that suggest the range of variables like age, occupations, health, and senescence among the dead, as well as the mutation of the virus’ different strains. For the question of mutation is not only central to the viability of a vaccine–the basic desideratum for opening up the nation or returning to life as “normal” among virologists and medical experts–but to how the coronavirus travels.

But the question of dismissing the expert knowledge of doctors or virologists that Trump & Friends promote, in the brand of false populism that they purvey, are in danger of running against the lack of knowledge we face about the disease. And only by parsing, sifting, and defining that data on different scales can we get beyond the gross aggregations of choroplethic distortions that only distance the spread of disease.

COIVID-19Iinfections Globally by Country/Clustrmaps May 12, 2020

3. The scale of such tracking maps grapple with the spread of infections, but don’t orient us to communication of a pathogen whose spread depends on proxemics, often tied to population density, but also social proximity and shared spaces, chance, and droplet dispersion in different crowded ambient settings–in ways that suggest that the spread of the pandemic may alter personal space, social space, and interpersonal space: genetic material of the virus found floating in the Wuhan hospitals, indoor spaces filled by large crowds, and the spaces medical staff removed their protective gear suggest the virus lingers in the air of crowds.

If novelist Don DeLillo felt that “the future belongs to crowds,” where people can lose themselves, fit in, blend in, lose themselves in something larger, in his powerful American global novel of the place of the writer and novelist in the impending dissolution of nations, Mao II, it is what is smaller about COVID-19 that moves in the air crowds occupy, that is so hard to map. While the coughing or sneezing of those infected with SARS-CoV-2 is most dangerous in communicating the virus in public spaces and to health care workers, rather than the passersby who are biking, jogging, or walking, the danger of droplets suggest the viral micro-crowds dispersed so easily in clinics, elevators, theaters, public transit or public lavatories. If the sneeze was indeed among the first filmed sequences of Edison’s Kinetoscope, communicating COVID-19 by atmospheric droplet dispersion in coughs, sneezes, and heavy exhalations pose risks that demand social distancing in public spaces–and increased the danger of ease of contraction in crowds. Can COVID-19 define a new proxemics? The possibility is not high.

The differentials among these spaces may well be, in fact, the most crucial questions to map. If the range of arresting data visualizations challenges us to try to come to terms with its spread, it is clear that New York had served as an incubator for the pathogen, late as it was to be able to adopt practices of mitigation or containment before the virus’ spread. And in the crowded spaces of New York, where the virus had arrived far earlier than restriction of transatlantic travel was able to effect, the tragic intensity of a wave of mortality of 5,000 deaths by early April created a terrifying image of the dangers of contraction in crowded public spaces, raising the stakes on mitigation.

Would the rest of the nation be prepared for the dangers implicit in its spread? The printers red to which the Times returned on its front page in a graphic that punctured the masthead in arresting ways a premonition of the future, or could new measures contain its spread?

Would a rolling wave of mortality grown across the country, in coming weeks and months, which better or earlier-enacted mitigation processes might prevent? Or do the aggregated tallies mask how the virus will be a crisis that will divide us from ourselves, and leave the most vulnerable?

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Filed under data visualization, disease maps, infectious diseases, public health, US Politics