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Coronavirus Advances

While we are increasingly deadened by data visualizations that track the infectious spread of COVID-19 across the world and country, their logic has often been implicit. As much as tracking real-time data of deaths and “hot-spots” in the world and the nation, we trust the data viz to orient us to the infectious landscape to better gain understanding of viral spread. We seek to grasp nature of the virus’ transmission, and perhaps hope that we can better grasp its spread. We depend on these daily updates to retain a sense of agency in the chaos, but realize that they are provisional, contingent, and selective snapshots, based on testing, and exist at a time delay from the virus’ actual distribution–without much predictive value. We maddeningly realize they are dependent on testing rates and reporting, and only as good as the datasets which they re-present.

On the heels of a 5% statewide positivity rate on December 5, 2020, California was declared in a state of shut down in all its counties. It almost seems that such graphics have started to fail us, as the spread of the virus overflows the boundaries of the map and permeates its space. The choropoleth renders individual counties all but indistinct, the state drowned in widespread infections, with only a few of its less populated regions as refuges. With a flood of purple overflowing the coastal counties, the delta, the Central Valley, and the entire south of the state, was there even any point in mapping the danger of viral spread beyond a state of red alert?

Dec. 5, 2020

While mapping offers little comfort in the era of saturation of heightened risk, the color-codes alert inhabitants to the danger of increased stresses on the public health system–as much as visualization challenges to translate tools of data aggregation to visualize the pandemic., as December 6 rates grew by December 19. As we shift to map a decreasingly multi-colored state by the moderate, substantial and widespread virus, and widespread cases seem to flood the state, the map offers a security of some sort of monitoring of the pandemic’s spatial spread.

The sea of purple is like Spinal Tap going raising the volume “up to eleven,” and are a sign that we are in unexplored territory that won’t be accommodated by a simple color ramp–or, indeed, a familiar cartographic iconography among our current tools of styling space. While we are used to maps embodying meaning, what the colors of the map embody–beyond risk–is unknown. To be sure, at a time when fatalities from the coronavirus in the south of the state have skyrocketed from the middle of the month, hitting records in ways terrible to even contemplate, the field of purple is a deeply human story of loss, as a surge of hospitalizations have flooded the entire healthcare community, and stretched facilities of critical care beyond anything we have known, filling half of intensive care beds in LA County at Christmas. 2020 enough to make it hard to feel any relief in the close of a calendar year, as if that unit still held any meaning, and very grim about 2021: and while the CDC allowed that there may already be a new, more contagious strain, in the nation two days before Christmas, the arrival of the more contagious strain in California and Colorado increased alarm before New Year’s.

San Francisco Chronicle, December 6 2020
SF Chronicle, December 19, 2020

How to get a handle on the novel coronavirus that we have been pressing against COVID-19 dashboards since March to grasp better, and will we able to do so in 2021?

Whatever sense agency the maps impart, it is an agency that is only as good as the compromised sense of agency that we expect in an era of geolocation, on which most maps track reports of infection. Even as we face the rather grim warning that we are waiting for the arrival of a vaccine that, in the Bay Area, rates of immunization face steep obstacles of vaccine distribution due to pragmatics of freezer space required, training of extra health care workers, and monitoring and tracking the two-stage process of vaccination, we will depend for public sanity on maintaining clear communication in maps. The actual tracking of the novel coronavirus doesn’t translate that well to a state-wide model, or a choropleth, although it is the method for public health advisories that makes most sense: we do not have small-scale public health supervision in most of the nation, although they exist at some counties. The stressed Departments of Public Health in areas are without resources to manage COVID-19 outbreaks, public health compliance, or retaliations for public health violations: and the effort to create public health councils to manage compliance and violations of public health orders may be seen by some as an unneeded bureaucracy, but will give local governments resilience in dealing with an expanding epidemic, at the same time as governmental budgets are stressed, and no body of law about COVID violations exists.

Rather than map on a national or state-wide level, we can best gain a sense of how much virus is out there and how it moves through attempts of contact tracing–even if the increasing rates of infection may have gone beyond the effectiveness of contact tracing as a methodology that was not quickly adapted by a federal government the prioritized the rush to a vaccine. The basis for such a map in LA county can reveal the broad networks of contagion, often starting in small indoor gatherings across the region, and moving along networks of spatial mobility across the city and San Fernando Valley, and help embody the disease’s vectors of transmission as we watch mortality tallies on dashboards that give us little sense of agency before rising real-time tolls.

ESRI

If such ESRI maps suggest a masterful data tracing and compilation project, the data is large, but the format a glorification of the hand-drawn maps of transmission that led to a better understanding of the progress of Ebola on the ground in 2014, used by rural clinics in western African countries like Liberia and Rwanda to stop the infectious disease’s transmission and monitor the progress of contagion to limit it–as well as to involve community members in the response to the virus’ deadly spread.

We may have lost an opportunity for the sort of learning experience that would be most critical to mitigate viral spread in the United States, as no similar public educational outreach was adopted–and schools, which might have provided an important network for diffusing health advisories to families, shifted predominantly to distance learning and providing meals, but we became painfully aware of the lack of a health infrastructure across America, as many openly resisted orders to mask or to remain indoors that they saw as unsubstantiated restrictions of liberty, not necessary measures.

Hand-Drawn Public Health Map of Ebola Transmission in Liberia (2014)

We are beyond contact tracing, however, and struggling with a level of contagion that has increased dramatically with far more indoor common spaces and geographic mobility. Yet the broad public health alerts that these “news maps” of viral spread offer readers omits, or perhaps ignores, the terrifying mechanics of its spread, and the indoor spaces in which we know the virus is predominantly acquired. The rise of newly infectious mutated strains of the novel coronavirus was in a sense inevitable, but the rising tension of what this means for the geographical distribution and danger of the coronavirus for our public health system is hard to map to assess its wide distribution, and we take refuge in mitigation strategies we can follow.

Why have we not been more vigilant earlier to adapt the many indoor spaces in which the virus circulates? It bears noting that the spread of virus in the state was undoubtedly intensified by over a hundred deaths and 10,000 cases of infection to spread in the density of a carceral network, which seems an archipelago incubating the spread of viral infections in the state. We only recently mapped the extent of viral spread across nineteen state prisons by late December 2020, tracked by the Los Angeles Times, but often omitted from public health alerts–

Coronavirus Cases Reported in Nineteen California Prisons, Dec. 21, 2020

–and the density of Long-Term Care centers of assisted living across the state, which were so tragically long centers of dangers of viral spread, as the New York Times and Mapbox alerted us as the extreme vulnerabilty of elder residents of nursing homes, skilled nursing facilities, retirement homes, assisted-living facilities, residential care homes who cannot live alone was noted across the world. The data that was not provided in the grey-out states interrupted the spread of infections among those often with chronic medical conditions was not surprising, epidemiologically, but terrifying in its escalation of the medical vulnerability of already compromised and vulnerable populations–and steep challenges that the virus posed.

unlike those greyed out states that fail to release data on deaths linked to COVID-19 infections, congregate on the California coast: while the New York Times depicted point-based data of the over 100,000 COVID-related deaths in nursing homes are a small but significant share of COVID deaths, exposure for populations with extraordinarily high probability of possessing multiple possibilities for co-morbidities is probably only a fraction of infections.

Coronavirus Deaths linked to Nursing Homes in United States, December 4, 2020

We strain to find metrics to map the risk-multipliers that might be integrated into our models for infectious spread. It seems telling to try to pin the new wave of infections in a state like California to increased contact after Thanksgiving–a collective failure of letting up on social distancing in place since March–as the basis for a post-Thanksgiving boom in many regions of the state, using purely the spatial metrics of geolocation that are most easily aggregated from cell phone data in the pointillist tracking of individual infections in aggregate.

New York Times/CueBiq Mobility Data

Based on cell-phone data of geolocation, a proxy for mobility or social clustering that offered a metric to track Americans’ social proximity and geogarphical mobility–including at shopping centers, oceanside walks in open spaces, and even take-out food curbside pickups, as well as outdoor meals and highway travel, few counties curbed aggregation as one might hope–although the fifty foot metric accepts the many outdoor congregations that occurred, well within the Cuebiq metric, wearing or without masks. A magenta California registered pronounced proximity, grosso modo, discounting any mindful innovative strategies in the state.

Increased Spatial Closeness within Fifty Feet/CueBiq/Graphic NBC News, Nigel Chiwaya and Jiachan Wu

It is stunning to have a national metric for voluntary mobility, rough as it is, to measure internalization of social distancing protocols and potential danger of a post-holiday COVID-19 bump. To be sure, we are stunned by geolocation tools to aggregate but risk neglecting the deeper infrastructures that undergird transmission, from forced immobility. While geolocation tools offer opportunities for collective aggregating whose appeal has deep historical antecedents in measuring contagion and anticipating viral transmission by vectors of spatial proximity, geospatial tools create a geolocation loop in visualizations which, however “informative” perpetuate a spatiality that may not clearly overlap with the actual spatiality of viral transmission.

Even if we demanded to map what were the novel coronavirus had “hot-spots” in mid- to late March, as if processing the enormity of the scale we didn’t know how to map, aggregating data without a sense of scale.

March 26, 2020

Across the summer, it seems best to continue to map daily numbers of cases, relying on whatever CDC or hospital data from Hopkins we had, trying to aggregate the effects of the virus that was spreading across the country whose government seemed to provide little economic or medical plan, in maps that tallied the emergence of new cases, as new hotspots appeared across the land, meriting attention difficult to direct.

We are plowing infections and mortality with abandon in a steady diet of data visualizations that purport to grasp disease spread, that were once weighted predominantly to the New York area, even as they spread throughout the nation by the end of March, but remaining in the thousands, at that point, as even that low threshold was one by which we were impressed. The tracking of the local incidence of reported cases seemed to have meaning to grasp the meaning of transmission, with a pinpoint accuracy that was assuring, even if we had no way to understand the contagion or no effective strategy to contain it. But we boasted data visualizations to do so, focussing on the nation as if to contain its spread in antiquatedly national terms, for a global pandemic, not mapping networks of infection but almost struggling to process the data itself.

After all, the John Snow’s cholera maps of John Snow are the modern exemplars foregrounded in data visualization courses as game-changing images as convincingly precise pictures of infection progressing from a water pumps in London neighborhoods is often seen as a gold standard in the social efficacy of the data visualization and information display. The elevation of the pinpoint mapping of cholera mortality in relation to a water pump from which the deadly virus was transmitted in a nineteenth-century London neighborhood:

John Snow, “Cholera Deaths in Soho”

The Snow Map so successfully embodies a convincing image of contagion that it has taken on a life of its own in data vis courses, almost fetishized as a triumphant use of the plotting of data that precisely geolocated mortality statistics allow, and can indeed be transposed onto a map of the land to reveal the clustering of death rates around the infamous Broad St. pump, that created a legible vector of the transmission of diseases in the Soho neighborhood, so convincing to be touted as a monument of the data sciences.

Open-Air Water Pumps Tainted by Cholera measured in John Snow’s Map

Snow is lauded for having effectively showed that, in ways that changed scientific practices of collective observation and public health: rather than being communicated by miasmatic infections that spread to low-lying London from the Thames, mortality rates could gain a legibility in proximity to a pump that transmitted an infectious virus, often presented as a conceptual leap of Copernican proportions (which it was, when contrasted to miasma that emanated from the Thames to low-lying areas–if it anticipated a bacteriological understanding of viral transmission). The association of danger with the water procured on errands from neighborhood pumps however replaced the noxious vapors of a polluted river, as in earlier visualizations of the miasma that lifted the noxious fumes of the polluted Thames river to unfortunate low-lying urban neighborhoods, who were condemned by urban topography to be concentrations of a density of deaths of more striking proportions and scale than had been seen in the collective memory.

Snow made his argument by data visualizations to convince audiences, but he mapped with a theory of contagion. But if Snow’s maps works on how the virus is communicated in outdoor spaces–and how a single site of transmission can provide a single focus for the aggregation of mortality cases, COVID-19 is an infection that is most commonly contracted in indoor spaces, shared airspace, and the recycled unfiltered air of close quarters. And the indoor spaces where COVID-19 appears to be most often transmitted stands at odds with the contraction in outdoor common spaces of the street and service areas of water pumps, that create the clear spacial foci of Snow’s map, and the recent remapping by Leah Meisterlin that seeks to illuminate the urban spaces of the contraction of cholera in a digital visualization as a question of intersecting spatialities.

Current visualization tools compellingly cluster a clear majority of cholera deaths in proximity to a publicly accessible pump where residents drew water where viral pathogens that had colonized its handle. But we lack, at this point, a similarly convincing theory of the transmission of the novel coronavirus SARS-CoV-2.

But the logics of COVID-19’s communication is nowhere so crisp, and difficult to translate to a register that primarily privileges spatial contiguity and proximity–it is not a locally born disease, but a virus that mutates locally across a global space: a pandemic. And although contact-tracing provides a crucial means of trying to track in aggregate who was exposed to infection, we lack any similarly clear theory to metaphorically grasp the contagion–and are increasingly becoming aware of the central role of its mutation to a virus both more infection and that spreads with greater rapidity in confronting the expansive waves of infection in the United States–as if an escalated virulence grew globally in the first months of this rapidly globalized pandemic.

Our dashboards adopted the new versions of web Mercator, perhaps unhelpfully, to offer some security in relation to the nature of viral spread, which, if they served as a way of affirming its truly global scope–

NextStrain

–also suggested that global traffic of the virus demands its own genomic map, as the virus migrates globally, outside strictly spatial indices of global coverage, and that perhaps spatial indices were not the best, in the end, for accounting for a virus that had began to develop clear variants, if not to mutate as scarily as many feared, into a more virulent form.

And it may be that a genomic map that allow the classification of viral strains of genomic variability demand their own map: for as we learn that genomic mutation and variation closely determines and affects etiology, communication of the viral strains offers yet a clearer illustration that globalization articulates any point in terrestrial space to a global network, placing it in increased proximity to arbitrary point not visible in a simple map, but trigger its own world-wide network of markedly different infectiousness or virulence.

NextStrain

From December 4 2019, indeed, we could track emergent variants of the virus best outside of a spatial scale, as much as it reminded us that the very mobility of individuals across space increased the speed and stakes of viral contagion, and the difficulty to contain viral spread, in the interconnected world where viral variation recalled a flight map, set of trade routes, or a map of the flow of financial traffic or even of arms. Mutations were understood to travel worldwide, with a globalism that a spatial map might be the background, but was indeed far removed, as we moved beyond questions of contact tracing to define different sizes of genomic mutation and modifications that we could trace by the scale of mutations, not only the actual places where the virus had arrived.

Was place and space in fact less important in communicating the nature of COVID-19’s increasing virulence?

The maps of genomic variation traced not only the globalization of the virus, but its shifting character, and perhaps etiology across some thirty variants by late April, that show both the global spread of the virus, and the distinct domination of select strains at certain locations, in way that researchers later theorized the ability to “track” mutations with increasing precision. If researchers in Bologna defined six different variants of coronavirus from almost 50,000 genomes that had been mapped globally in laboratory settings to map variants of the virus whose signatures showed little more variability than strains of the flu in June, variations of signatures seemed a manner to map the speed of coronavirus that had traveled globally from by February 202 to the lungs of the late Franco Orlandi, an eighty-three year old retired truck driver from Nembro, Italy, whose family could not place China on a map when, following diagnostic protocol, attendant physicians in Bergamo asked if Orlandi had, by chance, happen to have traveled to China recently.

NextStrain

Despite lack of serious mutation, thankfully, the data science of genomic sequencing of the COVID-19 cases triggered by genomic mutations of SARS-CoV-2 genome of just under 30,000 nucleotides, has experienced over time over 353,000 mutation events, creating a difficult standard for transmission into equivalent hot spots: some hot spots of some mutations are far more “hot” than others, if we have tried to plot infections and mortality onto race, sex, and age, it most strikingly correlates to co-morbidities, if all co-morbidities are themselves also indictors of mortality risk. While the mutations have suggested transmission networks, have the presence of different levels of mutations also constantly altered the landscape of viral transmission?

Global Distribution of Sars-CoV-2 Variants, March 15, 2020/Los Alamos National Laboratory

It makes sense that the viral variant was tracked in Great Britain, the vanguard of genomic sequencing of the novel coronavirus as a result not only of laboratory practices but the embedded nature of research in the National Health Services and the monitoring of public health and health care. Enabled by a robust program of testing, of the some 150,000 coronavirus genomes sequenced globally, England boasts half of all genomic data. Rather than being the site of mutations, Britain was as a result the site where the first viral variant was recognized and documented, allowing Eric Volz and Neil Ferguson of Imperial College London to examined nearly 2,000 genomes of the variant they judged to be roughly 50% more transmissible than other coronavirus variants, magnifying the danger of contagious spread in ways feared to unroll on our dashboards in the coming months. As teams at the London School of Hygiene and Tropical Medicine studied the variant in late 2020 in southeast England, they found it to be 56% more transmissible than other variants, and raised fears of further mutations in ways that rendered any map we had even more unstable.

The virus SARS-CoV-2 can be expected to mutate regularly and often. While England boasts about half of all global genomic data on the virus, of the 17 million cases of SARS-CoV-2 infections in the United States, only 51,000 cases of the virus were sequenced–and the failure to prioritize viral sequencing in America has exposed the nation to vulnerabilities. And although California has sequenced 5-10,000 genomes a day of the novel coronavirus samples by December, and Houston’s Methodist Hospital have mapped 15,000 sequences as it watches for new viral variants; an American Task Force on viral variants will be rolled out early in 2021, as the discovery of viral mutations haves spread across five states in the western, eastern, and northwestern United States. While it is not clear that the viral variant or mutations would be less susceptible to polyclonal vaccines, most believe variants would emerge that would evade vaccine-induced immunity.

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Filed under California, California Politics, Coronavirus, data aggregation, data visualization

Cartographies of Covid-19: Unclear Paths Forward

A pandemic is by its nature both local and global by definition–and begins from a local outbreak. But if the only way to gain orientation to a pandemic is by accurate local counts, the problem of balancing–or toggling between–the local and global has become staggeringly pronounced in the case of COVID-19, as if the point-based cartography that we use to track the disease has the better of us, and upper hand, with the absence of accurate local counts. The lack of clear data that came from Wuhan in the days that followed the outbreak of the virus revealed worrisome problems of transparency. The difficulties Chinese government authorities faced in getting bearings on the zoonotic virus, lab-born or not, raised problems of even trying to map its rise, and we tired to look at maps as tea-leaves of future responses, as well as retrospective diagnoses of the point of origin of disease spread–as if maps could explicate our uncertain conditions, and increased vulnerability.

Data visualizations since seem to proliferate in response to uncertainty and an absence of consensus, as we turned to maps as a hope for truth in an age of increased uncertainty: as local officials were loathe to shoulder responsibility, the tally of infected in Hubei Province jumped, astoundingly, forcing the government to recognize the ease of its transmission among humans, was far more virulent than believed. But at this point, looking back in the mirror provides little sense of orientation to the multiplication of dispersed local outbreaks of coronavirus that we are increasingly challenged to map in relation to ourselves. Were the first maps of the New World similar responses to the deep sense of religious and eschatological uncertainty of the early modern period? Whether or not that was the case, we all felt especially early modern now, plague victims of a sort that led us to look back on the mapping and mapping of responses to the spread of pestilence, and hoping that past experience–or our current increased ability of empathy–gave us more meaningful access to the epidemics and pandemics of the past.

The sudden uptick of cases reveals a reticence in tallying the infected out of fears of reprisals for apparent incompetence, an institutional blame-shifting triggering mechanisms of concealment that has led American meat-packing plants to hide numbers of infected workers, and numbers of tests for infection to be far lower than official records suggest: the absence of ability to control the spread of SARS-CoV-2 led us to proliferate maps in hopes to grasp its rapid doubling, uncomfortable at the world they began to show, apprehensive at how to come to terms with the rapidity of local outbreaks of confirmed cases with sufficient granularity, and enough continuities, hoping to track contagion as hopes of containment were beginning to fade in the new aggregates that were increasingly evident.

New York Times

The warning of the virus’ spread was raised by Li Wenliang on December 30 from Wuhan, inter-agency shifting of blame and responsibility in Wuhan– a reflexive institutional blame-shifting by “throwing woks”–abruptly ceased with summons of Shanghai Mayor Ying Yong, he who lured Elon Musk to Shanghai, to restore order: as a new hospital was built, tallies of new cases of coronavirus in Hubei astronomically grew by nine from 1,638 to 14,840, shocking the world–a figure was in keeping with the nearly 1,400 people dead in the country, but suggesting a viral load of unprecedented proportions. Americans apprehensively watched the disease afflicting passengers of cruise liners as if it would arrive ashore, its virulence was in fact already of pandemic proportions: yet American disinformation here took over, as we were told to stick our heads in the sand, ostrich-like, as fears were overblown, and tried to keep calm. And then, the tables were turned, as the United States President described, or suggested, a national policy of intentional undercounts, and limited testing, lest the counts discovered tank his popularity–the stock market value of Trump, International, or, rather, Trump-in-Office, Trump-as-Chief-Executive, whose new season might be canceled due to low ratings. And although the virus began in China, how the United States increasingly came to be the outlier in the numbers of infection confirmed weekly suggested a national story of mismanagement, as the narrative we told ourselves of American exceptionalism before illness seemed to have boomeranged, with the three-day averages of confirmed infections skyrocketing, and setting us apart from the very nations we compare ourselves to, but whose health-care policy we increasingly realize we are distinct from.

Americans were soothed by deceptive common-sense talk. But the results of a lack of investment in public health are all too evident, if our maps are . Robert Redfield, a virologist who served as the public spokesperson of reassurance who had long sustained false theories about retroviruses causing HIV and AIDS, argued that even if the fourteen confirmed cases of the novel coronavirus were monitored and traced, “the virus more exploded . . beyond public health capacity,” he seemed to forget he had not developed that capacity. Virology is of course Dr. Redfield’s area of expertise, but he won his political post in no small part by being practiced in massaging truth statements for political ends. During AIDS outbreak, the last major plague in the United States, he had advocated unproven drugs billed as HIV vaccines and encouraged quarantine, abstinence, and stripping the medical licenses of HIV-infected medical workers, more than accelerating cures; Redfield took time to blame the Obama administration for implementing clinical tests, to please his patron. Bt he obscured the level of infections that in truth were not known, blinding the nation to a cartography of COVID by not advancing adequate levels of testing, that returned us to the simple equation of the dog days of AIDS, only able to make us yell, yet again, this time with Larry Kramer, stalwart resistor of the silencing of AIDS by the failure to use on-trial medicine–

–at the utter deception with which we met the pandemic. Dr. Redfield must have met his commission to radiate calm by assuring Americans in late February. As he assured us only fourteen cases had been diagnosed in the United States, the number meant little, as any virologist should kmow; while hindsight is a benefit that obscures us from the need to life life forwards, we suspect urban hotspots were already laden with infected individuals by March 1, a silent ticking bomb of urban outbreaks already infecting 28,000 as it spread broadly its “hotspots”–New York, Chicago, San Francisco, Seattle, Boston and Chicago–all of massively different density, without tests being able to affirm the scale of its spread.

There was no map. And then, all of a sudden, the globalization of coronavirus hit home; any place in the world could be related to any other place, as rates of infection bloomed globally in geographically disjointed hotspots, spatially removed from one another, even as a standard for uniform testing lacked. And there was no sense of an art of dying, as the amazingly rapid contraction and worsening of illnesses left many without a script, and many more silent before a dizzying multiplication of statistics of mortality in the face of COVID-19, several weeks later.

Every other map of COVID-19’s spread seems an attempt to persuade the viewer of its accuracy and totality, in retrospect, even as we have no clear sense of the total figures of infection-or even of the paths infection takes. We are mystified by the geography and spatial dynamics of the virus’ travel, but realize the severe communicability of a virus whose load is stored in the naso-laryngeal passages, and can be communicated by airborne drops. Is distancing the best way we can constrain the geographic spread of infection? Can statistics demonstrate the success of curtailing its spread?

It was a hidden agenda in the maps of news agencies and to register the accurate levels of infection, promising the sorts of transparency that had been clouded in much of January. And while we watch the progress of the pandemic on screens, there is a sense of truth-telling, as a result, of revealing the scope of the virus’ actual spread that compensates for the lack of clarity we once had. But it is also increasingly difficult to orient ourselves to the GPS-enabled scales of its spread, for we still are looking at pretty limited and almost superficial data, in the sense we have trouble plotting it in a narrative context, or find a reaction more than shock. The virus is easy in ways to personify as a threat–it wants us outside; it comes from afar; it pervades public spaces and hospital grounds; it demands vigilant hand-washing and sanitizing–but the very numbest are elusive. While we try to track reported cases, hoping that these limited datasets will provide orientation, we have been lumping numbers of tests that might be apples and oranges, and have not found a consistent manner of testing. Deaths are difficult to attribute, for some, since there are different sites where the virus might settle in our bodies.

Even 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. It is frustrating that our GPS maps, which we seem able to map the world, can map numbers of surrogates for viral spread, but we have yet to find a way to read the numbers in a clear narrative, but are floored by the apparently miasmatic spread of such a highly contagious disease that makes us feel, as historian of science Lorraine Daston put it, that we are in “ground zero of empiricism,” as if we are now all in the seventeenth century, not only in being vulnerable to a disease far less dangerous or deadly than Yersina pestis, but without explanatory and diagnostic tools.

This was, to be sure, a past plague come to life, requiring new garb of masks, face-shields, and protective gear for health workers–

–as the cloaks, leather gloves, staffs and masks that made up early modern protective gear returned to fashion, as if in a time warp, in new form.

We find a leveling between folk remedies and modern medicine, as we live collectively in what she calls a “ground-zero moment of empiricism”–if one in which we are deluged by data, but short in knowing what is data, as we are lacking in explanatory models. This is a bit unfair, as we still can profit from autopsies, and have been able to contain spread by hand-washing–but the images of a single magic bullet, or antiviral cure, are far, far away in time. But there is no longer any familiarity with an art of dying, although we found we encountered death with an unforeseen and unpleasant rapidity: we moved from hopes for awaiting immunity or antivirals to a basic need for some consolation of our mortality. There was no possibility of transcendence in a crisis of mortality of dimensions and scope that seem outside the modern era.

And it is ironic that distancing is the best mode to prevent infection–and many deaths may have been enabled by quicker decisions to adopt practices of distancing that could manage viral spread, Trump seemed not to notice that the very globalization he had resisted, and swung against with all his force to win votes, had facilitated the spread of a viral agent whose arrival was denied even as SARS-CoV-2 had already begun to flood the United States, in ways we only mapped in retrospect, as a global village that by March 1 had already grown satellites of viral loads in South Korea, the Middle East, Iran (Teheran), Europe (Milan; Gotheborg), South East Asia, and Hong Kong, as we anticipated its arrival with no health policy in place and no strategy for containing what was already on our shores. The global crossroads defied any choropleth, but we had only mapped the virus for some time in choropleths, as if believing by doing so we could not only map it by national boundaries to keep the virus at bay.

New York Times

But if we lacked a model of infection and communication of COVID-19, we lacked a sense of the geography by which to understand its spread–and to map it–and also, deeply problematically, an inter-agency coordination to assess and respond to the virus’ spread as we sought to contain it: and in the United States, the absence of any coordinating public health agency has left the country in something like free-fall, a cluelessness emblematic by a map cautioning American travelers to take enhanced protections while traveling in Italy or Japan, two major destinations of travel, and avoid all nonessential travel to China, but refrained from ceasing travel plans.

1. The most compelling language of the novel coronavirus is “false positives” and “false negatives,” that seem to betray the unsure nature of standards; the most haunting is the multiple sites COVID-19 can appear in the sites of the body we use to map most disease. While we associate the virus with our respiratory tracts, the virus can do damage to multiple organ systems, as well as create blotchiness of “covid toes” due to burst peripheral blood vessels; it can damage multiple organ systems simultaneously, including the kidneys, heart, lungs, brain, and linger in our intestinal tract where it can flourish and proliferate; the virus can reduce the ability of our blood to form clots, or disable our ability to form clots.  The ACE-2 receptor protein, a launching pad for viral infections, lies in our lungs and respiratory tract but in stomach, intestines, liver, kidneys, and brain. Increased sensitivities among those suffering from high blood pressure, cardiac disease, and diabetes reflect the nosological difficulties of classifying the virus as a cause of death or to grasp it as an illness, let alone to read data about the disease. If the virus lodges in the most delicate structures of the alveoli, which it causes to collapse as it infects their lining, it can take multiple pathways in the body, and as its pathway of infection may be multiple, medical response must be improvised with no playbook for clinical care.

All we know is that our medical staff desperately need protective gear. On top of that, it hardly helps that we are without a clear national policy, and find that the United States government has engaged in far less transparency that one could have ever expected.

We can only say its spread is accelerated dramatically by structures of globalization, and it stands to disrupt them. utterly 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? Or do we even know what sorts of data to look at–indeed, what is information that can help us process a sense of what might be the geography of the contraction or the transmutability of the virus? Is the virus eluding our maps, as we try to make them? These sort of questions of making sense may be the process of science, but they trace, suddenly, a far steepder learning curve than we are used.

A dismissed biomedical researcher who ran efforts to develop a vaccine cautioned that we still 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.” Dr. Bright, who was abruptly removed last month from his position as head of the Biomedical Advanced Research and Development Authority, bemoaned the 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 pandemic.

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.

2. 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.

April, COIVID-19Iinfections Globally by Country/Clustrmaps May 12, 20202020

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. Even if the Center for Disease Controls had never done clinical tests on hydrochloroquine, whose dangers on humans were not studied, and despite some benefits of the antiviral on cell cultures, none appeared in mice, the drug was promoted widely on social media as late as April, although its mention on Twitter grew, even as the government delayed any roll-out of testing sites.

The demand to calm the nation, a position dangerously close to concealment, delayed action on a wave of infection that President Trump had long sought to deny, claim to be overblown, or call Fake News. The lack of a public testing initiative, and rejection of the tests of other nations, forced the United States to adopt a disorganized go-it-aloneist approach, akin to isolationism, not benefiting from the potential ties to Chinese doctors’ response, or the testing kits that would have been available that the World Health Organization (WHO) had suspected since January, and made test kits for poorer countries that might be replicated in the United States–which chose to make its own tests to ensure the highest quality. When WHO had urged countries “test, test, test” for the coronavirus to contain its spread, the global health organization provided 1.5 million tests to 120 countries who lacked the ability to test by March 16; the United States went without the diagnostic tests developed in Berlin by la Charité, implemented in Germany. If the United States had submitted a test to WHO as well, the German test the health organization adopted was never used or ordered–and by mid-March processed a sixth the specimens as in Italy, with found over six times as many cases, and an eleventh as in South Korea, which found double the cases.

By April, the picture had improved, but not much.

COVID Tracking Project (Data)

And based on later data of the virus that spread to other American cities, the virus that had infected so many in New York seems to have spread to other American metropoles by May, as we were still awaiting broad testing.

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Shelter-in-Place?

If elites have long harangued lower classes for continuing behavior that continued to spread disease, interpretation of the spread of illness has rarely divided so strikingly along separate interpretations. It is as if life or death matters were open to public debate: rarely have reactions to an infection been able to be received so clearly along partisan lines. While reaction to COVID-19 were long cast in partisan terms by the President, our Fearless Leader of Little Empathy, as far overblown, the surprise was perhaps that even as the data grew, and the exponential growth of infections in American cities began, the decision to announce Shelter-In-Place directives in hopes to “flatten the curve” shuttering non-essential businesses with increased fears of overloading public health facilities. As anti-vaccination movements grew in the United States, the skeptical strain of coronavirus denialism grew with anti-federal government movements, and the weak national public health policies in America created an uneven topography of health care as the mapping of infections provided no real sense of orientation at all: no one knew what to expect, but the uncertainty of prognosis created levels of unprecedented anxiety about disease spread, as we all visualized the worst, and grew more addicted to maps than ever before, and on more insidious platforms, remapping the causes, consequences, and corollaries of Covid’s spread–and trying to “stack” data visualizations, as if we were all experts not only in infectious disease and epidemiology, but of data visualizations–how hard could that be, actually?–too.

Faced by drastically uneven hospital bed capacities in individual states, reflecting existing fears of hospital bed capacities for intensive care units or floor beds, and deepening fears of needs to add increased beds across the nation, to confront a major public health emergency. Using different scenarios of increased needs for beds based on infection rates, a relatively moderate need for beds: infection of a fifth of the population in six months would compel expanding existing capacity for beds in multiple western states already hard-hit form infections, like Washington and California, east coast states, including Massachusetts and New York, and Midwest’s like Ohio, Michigan, and Minnesota, and many pockets of other states, including Louisiana. Actual fears of such an impending emergency of public health emergency —

–grows even sharper if one allows oneself to imagine an expansion of infection rates to 40%–not unheard of for the highly infectious novel coronavirus–over the same six month period:

.The Upshot/Interactive Version/March 17, 2020

1. Even as “Shelter-in-Place” measures sought to staunch the spread of infections across the nation, the uneven nature of the measures adopted by state governors, mayors, and counties suggested a fragmenting of the nation, as the governors of many states reacted to the issuance of shelter-in-place orders or stay-at-home directives by declaring their separate rule of law, in the words of Alabama’s Governor, “we are not New York state, we are not California–right now is not the time to shelter in place.”

Shelter in Place Measures Confined to Bay Area/Washington Post, March 15

Yet if the confirmed infections of the novel coronavirus seemed concentrated in preponderance in Louisiana, California, and New York, the virulence of its transmission was far more widely distributed, Philip Bump created a simple overlay to show, and the readiness of imposing measures of restriction were often resistant to accept school closures, or shuttering bars and restaurants as a means to restrain the virus’ spread.

Such choropleths are poor indicator of concentration and dispersion of infection, or of the “hot-spots” early watchers of the novel coronavirus hoped to isolate, folks commuting from counties of identifiable outbreaks created an immediately far more complicated map of viral dispersal, often crossing state lines and state jurisdictions at the very start of March, as work commuting alone bled from 34 counties into 1,356–even into Mississippi!

County-to-County Commutes from Confirmed Cases of Coronavirus COVID-19/March 3
BRENNEJM, r/dataisbeautiful/

Despite some a lone call the President impose a national shelter-in-place order, but the response of asking for a collective sacrifice would be hard to imagine. But the animosity that Trump revealed to any governors who tried to impose a policy of social distancing has intensified a new sense of federalism, as the increasing opposition that President Trump has directed toward Governors who have responded with attempts to enforce social distancing led, mutatis mutandis, to a new call for “liberating” states from social distancing requirements, President Trump announced April 21 that “We are opening up America again,” with great content, heralding an “opening” across twenty states comprising two-fifths of the nation’s population, if partial reopening are only slated in eighteen states.

But how could one say that the need for social distancing was not increasingly important, in a nation where health care is not only not accessible to many, but that hospital bed capacity is uneven–and would need to be ramped up to serve the communities–

–but that many areas are distant from ready testing, diagnosis, or indeed the ability for easily accessible health care? What is COVID-19, if not a major wake-up call for disparities in public health and medical access?

New York Times

–and many regions suffer severe health care professional shortages, that have been obscured in the deep shortages of health professionals, according to Rural Health Info, who have revealed these gaps in the following infographic, but many towns in each county remain difficult to get to hospitals in time in cases of emergency or need.

2. The legitimacy offered to “re-opening” states for business channeled a rousing sense of false populism across the nation, courting possible onset of a second wave of infections by easing llocal restrictions on social distancing–although testing is at a third of the level to warrant safe a transition, several governors claim “favorable data” to justify opening shuttered businesses. But when @RealDonaldTrump retweeted an attack on public safety measures against COVID-19 that were enacted in California and other states to slow airborne viral infection that labeled the closures of bars, restaurants, and theaters as revealing local states’ “totalitarian impulses” in the face of COVID-19, as having effectively “impaired the fundamental rights of tens of millions of persons” and flagrantly abrogating constitutional rights and natural liberties: the endorsing of a tweet of former judge, Andrew Napolitano, of an open “assault our freedom in violation of Constitution” demeaning sheltering policies as”nanny-state rules . . . unlawful and unworthy of respect or compliance,” inviting the sort of social disobedience, encouraging the stress-test on our nation that the pandemic poses be generalized?

COVID-19 Infection Rates in United States/New York Times/March 27, 2020

While the calls to prevent violations of the U.S. Constitution have grown in recent weeks from March to April, it makes sense to question the validity of an eighteenth-century document to a public health emergency–or to abilities to respond to a zoonotic disease of the twenty-first century. Never mind that such arguments ignore the reserving of rights of state governors in the U.S. Constitutions Tenth Amendment to protect the safety, health, and welfare of the inhabitants of their territory, is the ability to manage state health not a calculus for public health officers, rather than a partisan debate? There is a despicable false populism and rabble rousing in decrying “nanny-state rules” as “unlawful and unworthy of compliance,” and covers for “assaults on freedom” as a Lockeian natural right. Yet in retweeting such charges and denigrating policies of social distancing as “subject to the whims of politicians in power,” President Trump perpetuated the notion that medical consensus was akin to an individual removed from public concerns. In doing so, Trump echoed the opinion of a member of his own Coronavirus Economic Advisory Task Force, Heritage Foundation member Stephen Moore, to protest “government injustices” echoing false populist calls to “liberate” Michigan and Minnesota from decrees of Democratic governors. As Moore called for further protests, opening a group, Save Our Country, dedicated to agitating for the reopening of states, out of concern for the “abridgment of freedom” of sheltering in place.

The call to arms over a rejection of social distancing emphasized the translation of the pandemic into purely partisan terms, and echoed the partisan resistance to the states-right discourse of a rejection of health care, using the panmdemic to divide the nation along party lines.

3. The weekend before SIP was announced in the East Bay, my daughter’s High School suspended, and I snuck out in the mask-free days for a Monday morning coffee at my favorite café, where my friend Mike caused some consternation in line by ordering through his black 3M facemask. The mood was survivalist and grim, but we stopped outside our local Safeway, as if to provisions before an impending lockdown, looking for half-and-half. Staring me in the eyes, Mike said with some resignation that the massive mortalities in northern Italy were our future in a week at most, as the spreading waves of infections migrated crosscountry, approaching in something like a delayed real time; the question was only when “It’s gonna happen here.

What was happening across the Atlantic Ocean was trending not only on social media, but was being attentively followed by epidemiologists like Dr. Cody, apprehensive of the state of development of pubic health across the entire East Bay.

The Public Health Officers in the region had been haunted by the vision, alerted by the tangible fears of the Santa Clara Public Health Officer, Dr. Sara Cody. That very day, Cody was convening the coming early Monday morning, gripped by a sense of panic for a need for action, as the public drinking festivities of St. Patrick’s Day loomed, and as Chinese health authorities curbed travel and cancelled New Years celebration, even if its airborne communication was doubted, in hopes to contain an outbreak that still seemed centered in its largest numbers in Wuhan province–

Quartz, January 22, 2020

4. It was if we were watching in real-time image the global ballooning of COVID-19 infections in the Bay Area feared was on its way to Silicon Valley, or the entire Bay Area, as the virus traveled overseas. The lockdown that had begun in northern Italian towns in a very localized manner from late February when a hundred and fifty two cases were found in Turin, Milan, and the Veneto, had, after all, only recently expanded to the peninsula, filling Intensive Care Units of hospitals or transforming them to morgues. Although elegant graphics provided a compelling narrative, with the benefit of retrospect, that “Italy’s Virus Shutdown Came Too Late,” the interactive story of a “delayed” shutdown after the February 24 shutdown of sites of outbreak within days of the first identification of an infection in Milan, across two “red zones” around Italian cities, and the March 3 cordoning of larger areas.

February 24, 2020 Lockdowns in Northern Italy
Lockdown in Response to COVID-19, March 8 2020

The reluctance to impose a broader shutdown over the northern economy created a tension between commerce and public health that led to a late ‘shutdown’ of the movement across the peninsula by March 10 to prevent infection risks, haunted by public health disaster.

Multiplication of COVID-19 Cases in Italy, February 27-March 12, 2020 BBC

Fears of the actuality of a similar public health disaster spreading under her nose led Dr. Cody to convene a quick check-up with local public health officers to see if they registered a similar alarm, and what policy changes were available across a region whose populations are so tightly tied. And the need to convene a mini-summit of Public Health Officers to take the temperature of willingness to recommend immediate public policy changes was on the front burner, as one looked at the huge difficulty of containing the outbreak in Italy–often argued to not have been responded to immediately enough, but revealing a full public health response that the Bay Area might not be able to muster, as Italy’s hospitals were flooded by patients with infections and was on its way to become the site of the most Coronavirus deaths.

Vivid fears a growth of COVID-19 filling the hospitals and emergency rooms after St. Patrick’s Day–an event for a far larger audience contracting the aggressive virus–led Dr. Cody to arrange a group call among the Public Health Officers in San Matteo and San Francisco early Monda. Dr. Cody had broad epidemiological training was rooted in an appreciation of contagious disease–including contagious diseases outbreaks like SARS, H1N1 influenza, and salmonella, and had worked on planning for public health emergencies and completed a two yer fellowship in Epidemiolgoy and Public Health, managing E. coli outbreaks as an Epidemic Intelligence Service Officer with CDC. Fears “crystallized” quickly of a scenario of similarly exponential rise in case loads making Silicon Valley a new epicenter outbreak of an epidemic overwhelming the public health services. As she quickly contacted Public Health Officers in San Francisco and San Matteo, to contemplate a response, by March 8, a lockdown in all Lombardy and other states was declared, as COVID-19 cases multiplied, in a chilling public health disaster replicating the lockdown in China.

In contrast to the uncertain public health numbers from China, as the city’s airport, highways, and rail stations, images of massive mortality from health care disasters in Italy were haunting and suddenly far closer in space, even if cases of viral infection were already reported in each province, Macao, Hong Kong, and Taiwan–revealing a global pandemic that linked place to a global space in ways difficult for some to get their minds around. The honesty that came out of Italy was an alarm.

The Bay Area health authorities were looked with apprehension at the arrival of St. Patrick’s Day celebrations, after the exponential growth of infections from COVID-19 in the region: Dr. Mirco Nacoti had just published an eye-catching account of the catastrophic conditions of Ospedale Pap Giovanni XXIII in Bergamo that weekend, describing the levels of general contamination of caring for COVID-19 patients, for whom over two thirds of ICU beds were reserved, and filled a third of 900 rooms in thd peer-reviewed NEJM Catalyst; he described phantasmagoric scenes of a hospital near collapse as patients occupied mattresses on the grounds, intensive care beds had long waiting lines and with shortages of both masks and ventilators, and poorly sterilized hospitals became conduits for the expansion of diseases. The clinical model for private care incapacitated, as patients were left without palliative care; a surge of deaths in overcrowded wards overtook China’s community-based clinics at such higher death rates of 7,3% Italian doctors plead felt incapacitated by the surge of cases overflowing at intensive care units from March 9-11 as a model for mass infection, before COVID-19 was declared a pandemic.

The desperation of a staged re-enactment of Michelangelo’s Pietà of L’Espresso were a few weeks or so off. While the spread of infections in our region had not yet begun, ant eh below photoshoot by Fabio Buciarelli did not appear until April 5, we were still formulation the desperation of confronting the ravages of disease we lacked time to develop any reactions, processing current or impending mortality rates.

Fabrizio Bucciarelli/COVID-19 Pietà. 5 aprile 2020, L’Espresso

The danger of trusting scientific modeling, or data, and fostering deep suspicions of trusting data on confirmed infections, or modeling that suggested the danger of failing to practice social distancing.

5. Decisions to “shelter in place” promised to “slow the spread” of COVID-19 transmitted widely in group settings, and able to create a public health disaster in the Bay Area, and was quickly followed by Santa Cruz county. After the growth of cases in Santa Clara county–whose rates of infection doubled over the weekend to 138 as of Monday–the absence of a any national restraining order save a suggestion to social distance, as Seattle cases of infection had grown to 400–and some 273 cases of infection had appeared over th weekend, despite limited testing availability.

The clear eventuality of a public health disaster, after a directive closing bars, night clubs, and large gatherings, as well as many school closures in San Francisco and the East Bay–where my daughter attends Berkeley High, whose doors shuttered on March 13; Los Angeles’ mayor, Eric Garcetti, closed bars, gyms, movie theaters, bowling alleys and indoor entertainment on late Sunday night, as Gov. Newsom encourage all elderly to self-isolate immediately. The 6.7 million in the Bay Area early agreed on the need for a “shelter in place” order as a basis to control the spread of COVID-19 that had been discovered in the region on March 16, 2020, anticipating the nation by some time.

The closure of all non-essential businesses in the seven counties sprung from the epicenter of Santa Clara county–Silicon Valley–but included affected a much larger area of commuters, no doubt, across an interlinked region of commuting far across the northern state to twelve other counties.

The cases in Italy would only grow, creating a textbook case of the exponential expansion of illness that killed a terrifying number of physicians in hospitals on the front lines against its expansion, as the arrival of medical supplies and medical viral specialists from China increased the logic of the lockdown as a response to its spread.

The evident stresses on the health care system of Lombardy, where a terrifying number of physicians on the front line contracted the virus and died, in the wealthy region of Lombardy, distanced the disease whose effects were projected or distanced onto China, and provided a clear scenario that Cody understood could be repeated, with even worse consequences, in the crowded population and limited health facilities of Santa Clara County: her own close ties to public health authorities in Italy made the exponential growth of cases from February 21 across the peninsula seem a preparatory run-through for a future disaster, as China was sending increasing medical supplies and specialists to Italy in a global story as a pandemic was declared in China March 11; northern provinces were declared under lockdown March 8 quickly extended to the nation, as a spike in 1,247 cases were found on the previous day.

When Cody urgently alerted San Francisco Public Health Officer, Dr. Tomás Aragón, to discuss the fears of a new epicenter of COVID-19 spread in Silicon Valley, they did not start by contemplating their authority to issue a legally binding directive to shutter businesses in the region. But as they discussed consequences of the exponential increase in Santa Clara County and the greater danger of facing an analogous overwhelming of pubic health hospitals as in Italy, haunted by a danger of a similar scenario overwhelming public health, and Cody’s tangible fear, Aragón floated the idea of a shutdown, acknowledging their authority of acting without permission of governors.or mayors or county supervisors; the call touched on a series of calls to debate options, including the most dramatic — a lockdown order–which seemed the only certain means to enforce isolation and social distancing haunted by the image of the increased diagnosis of COVID-19 across the Italian peninsula that would indeed only be publicly released March 18. Two days later, Governor Newsom expanded the policy to the entire state; the time lag meant that by late April, almost half of all infected with the novel Coronavirus in California were found in Los Angeles County, and were facing the prospect of overloading its public health system and hospitals.

Diagnoses of COVID-19 in Italy/ Ministero di Sanitá, March 18 2020

The influence of the health care provider Kaiser Permanente was unseen, but the preventive agenda of the health provider can be seen in a sense in the shadows of this quick consensus among six Public Health Officers. But the qyuick defense of the decision–soon followed by dozens of states since–suggests the prominence of Kaiser Health Care in the dynamic of emphasizing preventive health care, and in anticipating epidemiological spread. Cody’s brave insight into the fact that northern Italy provided a rehearsal for the public health disaster, shifting from the ban on mass gatherings to a concerted effort to isolate millions, was less apparent to the nation.

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Filed under Coronavirus, COVID-19, public health, shelter-in-place, social distancing