Tag Archives: pandemic

Metageographical Pavement

We were increasingly existentially isolated in those days of the pandemic, as the anxieties ramped up around a virus crossing borders came to offer evidence of a health care infrastructure unable to defend us or to be extended across the nation. There was long the danger of turning inward, to protect oneself, but also a shock at the unaccustomed sense of the evanescence of life, that made us turn to Defoe, Manzoni, or Camus for bearings on a topography of death rates that we were not accustomed to process in any way. While I was less able to concentrate to narratives, I preferred to immerse myself in short stories, interruptions of the problems of processing rising tallies. And if one pandemic drive was a compulsion to follow rates of infections, mortality, virus variants, and, now vaccination rates, to try to make order of world whose disorder seems more prominent than ever, I took breaks in small fiction, while going on walks, without any destination, to seek some bearings on the situation.

Perhaps walking led me to seek a perspective in an imagined sort of convalescence–a respite from the oppressive data visualizations that were hardly a means to come to terms with the collective obituaries framed in the foreign or unfamiliar concept of cumulative deaths. And as I returned to the somewhat random dates on the sidewalk outside my house, from the “1911” that arrested my eye–before the Spanish Flu pandemic!–to the stamps of 1930, 1936 that pavers left nearby. If I started to think of myself as a flâneur of the pandemic, as if finding and collecting the names of pavers might constitute an alternate necrology of the neighborhood, emerging onto the street a form of dealing with death, as the numbers of estimated deaths rose regularly–even if they were all undercounts–walking became a form of tallying, as each encounter with the name of a paver, akin to an imagined meeting, as if gathering information for an imagined report about the neighborhood itself; my income low, and indeed dubious, there seemed to be some ready temporary comfort in the small enchantments of the sidewalk to balanced with the global tragedy.

I found inappropriate comfort in a “boring passion for minutia” by displacing attention. Sophie Atkinson described how the pandemic helped her appreciate Robert Walser’s The Walk–and his attachment to walking without destinations–fitting for her extended walks in lockdown London–in search of an unexpected suddenly “significant phenomena, valuable to see and to feel,” by which “the lore of the country and the lore of nature are revealed,” as Walser had it in searching for terms to discuss the comfort of his walks, observing and studying “every smallest thing,” in an effacing self-surrender to attend to local details, as distancing one’s current complaints–less with an eye to one’s destination. For turning to the local detail as a site of something like transcendence became a way of distancing a global disaster, or holding it at bay–and a profession of tracking a local topography of mortality as well. If Walser’s walking led to the melancholic realization that “I was a poor prisoner between heaven and earth, and that all men were miserably imprisoned in this way,” after his flights of fancy, the dates and names on the ground provided some sort of grounding that I needed to process mortality rates and the shifting maps of infection rates.

For all the rapid creation of charts of mortality rates that were painstaking crafted by epidemiologists and journalists in line charts that projected different possible counts, our expectations for certain data were frustrated as if looking into the abyss of mortality: the very fact that only a bit more than half of global deaths are registered–six in ten, the ballpark figure of the World Health Organization tells us, if 98% in Europe and 91% in America; the death toll of the novel coronavirus in Wuhan is guesstimated to be up to ten times as great as the reported 4,848 in the capital of the Hubei province, or as much as half a million, if reported global deaths pushed beyond four point two million, dizzying numbers if incomplete.

Financial Times, confirmed COVID-19 morality rates in UK and USA, March 2020-March 2021

The complexity of crafting a simple line graph of confirmed deaths and those due to complications of COVID-19 had us contemplating line graphs as specters of human mortality, whose complicated crafting don’t conceal so much as reveal the limits of certainty, and made me search not for global but grounds for transcendence underfoot. And in the days of social distancing, on walks that seemed perhaps aimless, but tried to find a sense of balance before the rising curves, following traces of the past set in the pavement seemed a sort of escape from the rising numbers, if not a destination. Daily walking was a rediscovery, as the trips from the house where I lived became less important for their points of arrival, pressing against the boundaries of the present condition, less in flight from something, than a type of convalescence from watching disparate rates of mortality and hospitalization rise, as my attention attended to something else.

If figures of infections, hospitalization, and mortality death haunted the air, solitary walking became a response to a restlessness–in the morning or late afternoon–and I was readily accepting the sense of the walks as haunted, or with added melancholy, in ways that seemed states of distraction and something of a befriending of loneliness, if not what past as sociability. Walking, Robert Walser put it, not with peacefulness but in a way of seeking out being arrested by coming across the individual name, and the odd specificity of the date at which the pavement was lain, smoothed and left to set. Walter Benjamin felt that the walks the author devotedly took must be understood as with a spirit of discovery as a form of convalescence, “newly sensitized to the outside world,” there was perhaps a search for collective convalescence in the undue attentiveness birdsong, flowers, pavers’ names, as if struggling to emerge from a dominant melancholia.

I gathered names on the ground as if points of orientation, finding stamps and strikes of pavers whose names were set in the pavement with century ago an alternate register of mortality. The dizzying sense of temporal distance offered a perspective a century ago–before the 1918 pandemic of the Spanish Flu arrived in California, were somehow a distance on our own sense of modernity and the disarming unpreparedness for the pandemic, which I read as if I were uncovering an often unread archive paved beneath my feet in the micro-geography of my neighborhood, in images with only retrospective senses of clarity, as we tried to come to terms with the historic nature of the pandemic’s spread. Strikes left by early pavers–“Burnham-1908;” “F. Stolte-1930;” “P. Barelle-1938;” “J. Anderson 1936”–of names and dates presented as epigraphic evidence beneath my feet akin to levels of time, v snapshots of a stratigraphy of the Berkeley-Oakland neighborhood I lived, “Burnham” resonantly echoing that of a contemporary urban planner, as I gathered evidence about the area I wandered, as if it were a profession.

For if earlier years of the possible pandemics that almost spread globally had been numerous–the near-misses of the fear of H1N1 expanding globally in 2009, of MERS in 2013, Ebola in 2014, and Zika in 2016–the coronavirus spread in ways we had only seen since the avian-born Spanish Flu pandemic of 1918-19, and was far harder to map, track, or conceptualize over space, as visualizing the virus became a cottage industry and a collective rush to create the best visualizations possible. As I tried to retreat from the spread of infections and hospitalization, and indeed the growing uncertainty of both tallies, the dates beneath by feet on the pavements along the Oakland-Berkeley border provided a form of retreat, pavement punctuated by dates that seemed–1909; 1923; 1938; 1930–to mark a sense of the anonymous architects of this urban border. With less of a sense of transport and reverie than Walser, if with a similar dedication to what he called, only partly facetiously, his berüf–“without walking, I would be dead, and my profession would be destroyed”–the sense of opening oneself to “thinking, pondering, drilling, digging, speculating, investigating, researching, and walking” gained a sense of investigating the quite deep history of breaks in neighborhoods in the micro-geography that I started to examine as etched in concrete. Whoever “walks only half-attentive, with only half his spirit . . . is worth nothing,” Walser said of the dedication he assumed, while walking, attentive to houses, advertisements, social transactions, as if to refamiliarize himself with the world as a therapy–to “take fresh bearings,” with a degree of industry, as a “Field Marshall, surveying all circumstances, and drawing all contingencies and reverses into that net of his,” in a calculus of metropolitan space, if with far fewer social transactions–but in fact mostly to “maintain contact with the living world,” lest we be shut at home, before the virtual remove of Zoom.

The paving of the street that defined the edge of the exclusive Oakland neighborhood formerly a farm until 1905–set aside for an upscale residential community–had been paved by the local quarry in 1912. The date gave me new bearings on the present, that gained a spiritual side, as well as a form of taking bearings: Walser found a microcosm of the world and lovely homes, “walking and contemplating nature,” richer than what Walter Benjamin cast as f”botanizing the pavement,” albeit a lovely phrase–for me, the collection of older marks on the pavement began as a curiosity, but turned to navigating historical levels inscribed in a surface as lines of exclusion and inclusion that the earliest dated pavers’ strikes bore witness, and made up for the few numbers of people on the street, in what seemed among the earlier surviving sidewalks that were paved in the this neighborhood.

3086 Claremont Avenue, Berkeley CA
2340 Ward St., Berkeley CA

The paving of this Oakland-Berkeley area was The border was increasingly legible in the local maps of mortality and COVID-19 infections. Putting into relief my sense of the fuzzy border of gentrification, one could not be struck by the discrepancy of increased infections-as, later, increased vaccination rates–between Berkeley and Oakland. The barrier seem, in my own neighborhood, loosely defined, but defined different expectations and experiences of the virus, poorly understood if only read by that odious term, concealing so much, of “comorbidities.” As we discussed how much the novel coronavirus was indeed a sort of rupture, or how significant COVID-19 was both epidemiologically and, at a deeper level, historically–wondering if the possible narrative of an endpoint of escalating infections would be a return to “normal,” or if “normal” really made sense as a place to return–the architecture of this local municipal border seemed to make sense as something I sought. to decipher in what might be called, perhaps uncharitably, an episode of pandemic flânerie, or a search for a space for reflection and a hope for distance that city walking might offer to cope.

Did it make sense to look retrospectively at the spread of the Spanish Flu, and to ask what sort of break in time it created by its spread? The maps offered a chilling reminder of the difficulty of stopping its spread to populated areas, across the nation, that was oddly comforting in the progression of pandemics over space if haunted by rising curves of mortality. And as we watched our own time-series graphs of the temporal progression of rates of death and mortality, questioning the undercounts, role of co-morbidities, and trying to peak under the hood of the data visualizations to grasp its spread, the dizzying global scale of infection rates, hospitalization rates, and mortality rates gave us all on the fly crash-courses in demography and epidemiology which we had to admit our grasp was pretty unclear. The learning curve was so daunting, if so basic, that it seemed for a historian more important to gain distance in the past, and preceding pandemics.

Second Wave of Spanish Flu Reaches California as it Spreads across America, 1918

As we tried to map the progress of the coronavirus, its origins, and contraction in different rates, we turned with security to the clearest form of visualizing the pandemic, the time-tested time-series line graph, that basic tool of visualization most fit for something so daunting as mortality, which had been a basis for tallying the estimated total of the fifty million killed in the 1918-19 Spanish Flu pandemic, a tally of mortality we would later approach. While the 1918-19 pandemic was a removed event, the curves of mortality on time-series graphs tracked a sense of the compression of deaths to a linearity of time; rates were tallied weekly of the avian-born pandemic in an eerily identical graphic space of data visualization, which was echoed in the similar kinship of tools adopted to contain its spread–masks, hand washing, quarantine–as tracking the progression of time across the old x-axis and the rates of hard to comprehend escalating deaths along the y-axis distanced them with a helpful sense of anonymity.

Spanish flu

As much as we were braced by how the progress of the pandemic revealed vulnerabilities of public health systems, the pandemic had posed stress test of the global information network–both in charting and sharing information about infections and identification of the coronavirus genome, and in educating the public about its treatment, and locating access to accurate sources of information.

The difficult to process nature of arranging these humblest of graphs in terms of total cases of COVID-19–a basic tally, but one hard to say was accurate; new cases per day, a metric that seemed to suggest how much of a handle we had on the pandemic’s spread; confirmed cases per million; or the rates of infection in different nations, that oddly removed the spread of mortality as if we were viewing the challenge of combatting the virus as a spectator sport.

Due to the official public denial of its danger or threat in the United States, and in the proliferation of online newsletters, uneven public tracking of infection rates by the CDC, multiple sources of ostensibly authoritative advice from whether it was healthy to exercise outdoors given the dangers of droplet dispersal from others, needs for frequent hand washing or gel disinfectant, and dangers of pubic space grew. We moved through space differently, in the Bay Area, projecting to different degrees a cone of six feet distance, internalizing distance as a social good as we sought to remeasure our relation to a fractured social body.

Public Notice for Social Distancing, San Francisco

And it was fit that in the time of social distancing, I started looking at the pavement in new ways, and scrutinized on morning walks the clues stamped in paving of the East Bay sidewalks that seemed to parallel the exponential growth of residential housing in the city, about a century ago–before the Spanish Flu arrived!–as a tangible heritage. If the spate of growth of Berkeley occurred after the great fire of the 1906 Earthquake, the contractors who let their names on the pavement near my house–“1930,” “1938,” “”1939,” “1912” in a staccato of strikes on sidewalks near my house–an illusory sense of stability set in the shifting landscape of mortality as if detected underfoot. I looked at these almost epitaphic registers often combining names and dates in a grim way, as if they measured a sense of individual presence in confrontation with the huge sway of time-series graphs–a micro-geography that kept making me wonder how much of a new or changing temporality the pandemic would create, and what sort of geography shaped the neighborhood I lived in which I was not so keenly aware.

The geography of social distancing during the pandemic cannot be fully rendered, so existential is the psychic effects of the curtailment of face-to-face contact. Even if we have used tracking of locations to determine the extent of travel that folks with cell phones and androids allow themselves, the effects of distancing were interior, as much as they can be mapped in graphs or state-by-state choropleths. The enforcement of public health decisions of distancing or masking were met by uncertainty. And as the pandemic assumed global form and contours, I bore down in new ways on the microgeography of my neighborhood, looking for meaning and scrutinizing social relations hoping for a hint of of redemption, on morning walks; as I tried to negotiate what seemed a threshold of a new temporality of space and disease, with few precedents, avoiding dystopic narratives, the need to confront isolation was balanced by a need to try to map what seemed a deep historical change.

As we sought out ways of measuring the effects and consequences that would play out of the pandemic’s spread, the local seemed the best way to preserve meaning, and to look for grounding, amidst newsletters promised to offer concision and trust in the sea of COVID-19 information, as COVID Tracking Project helped to fill the gap of accurate counts of infections, where the government had failed. And was we searched for on-the-ground accounts of living through the biggest public health crises of our new millennium, we looked for ways of existentially processing unprecedented levels of death for which we lacked mental tools to grasp.

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Filed under Berkeley CA, border cartography, border policy, border studies, urban geography

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.

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 —

The Upshot/New York Times/March 17, 2020

–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.

httpsPhilip Bump, Washington Post, March 17 2020

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, data visualization, global pandemic, Shelter in Place

Get Me Out of Here, Fast: Escape from D.C.?

The forced monotone of Donald Trump’s public address to the nation on March 12 was a striking contrast from his most recent State of the Union address. He sought to calm the nation as it faced the pandemic of the novel coronavirus COVID-19 in what was perhaps his most important public address. On the verge of breaking beneath the gravity of circumstances that spun far out of his control, however, rather than show his customary confidence, Trump seemed a President scrambling and in panic mode trying to rehearse stale tropes, but immobilized by events.

President Trump tried to look as presidential as possible, re-inhabiting a role of authority that he had long disdained, as he was forced to address a nation whose well-being he was not in control. The national narrative, as it was begun by WHO’s declaration of a pandemic, was perhaps seen as a narrative which seemed to spin out of his control, below his eyes, as he tried to calm markets by addressing the nation in what he must have imagined to have been as reassuring tones as he could summon. With his hands grasped but thumbs flickering, as if they were a fire under which he sat, as if he were wriggling like a kid strapped in the back seat of a car where he was a passenger to God-knows-where, wrestling with the increasing urgency that his aides demanded he address the outbreak of the virus in the United States that he had long tried to deny. Serial flag-waving continued to fuel President Trump’s attacks on China and the World Health Organization, as if trying to toe the line of adherence to America First policies of nationalism before a global catastrophe, that did not compute. If America First as a doctrine allows little room for empathy, affirming national greatness and the importance of a logic of border closures was all he could offer, and would be predictably lacking reassurance or empathy as he attempted to create a connection at a defining moment of his Presidency, but looked particularly pained.

March 11, 2020

If Trump rarely trusted himself to make hand gestures as he plighted through the speech, thumbs flickering, hands clasped, he every so often seemed distinctly out of synch with his austere surroundings, gold curtains drawn to reveal two flags, barely aware, perhaps, that the eyes of the world were very much on his performance in this new sound studio to which he was not fully accustomed, trying to explain that he had undertaken measures that had made us safe, even if he must have been worrying that the lack of worry he had been projecting and urging in previous weeks had risen across the nation, and his performance was not calming them at all. He was tasked with describing the vulnerability of the nation to the novel coronavirus whose effects he had downplayed repeatedly, but was no longer able to dismiss, and no longer able to concede posed a far greater threat to the American economy than the danger of “illegal” migrants he had so often pointed to as a cause of national decline: the virus that had already crossed our borders repeatedly, since the first cases of COVID-19 were diagnosed in San Jose and Seattle, would potentially bring down his presidency, and he lacked any ability to explain the scale of the effects of the virus that he had effectively helped release by ignoring warning signs.

Oval Office address of Wednesday, March, 11, 2020. Doug Mills / The New York Times)

The link of America to the world defined in his America First candidacy–even made the very identification of a pandemic difficult to process. And he did so in the starkest national backdrop possible, vaunting his closing of borders, suspension of “flights” from China, and ties to Europe–even as he encouraged Americans to return from abroad, and had allowed unmonitored entrance of Europeans and world travelers into New York that would make it the site of the entrance of the disease to the majority of American cities where the viral load arrived, with over 900 people entering America through New York daily for months after China suspended travel from Wuhan on January 23–after China called the outbreak “controllable” on New Year’s Eve. The declaration that echoed the concerns of the World Health Organization may have been buried in global celebrations, even as Trump blamed it for starting a sense of false complacence before undeniably “real” news that he feared would come to define his Presidency.

Trump was unable to accept declarations of the World Health Organization had just called the coronavirus outbreak–an outbreak which, we now know, he had in fact been hearing alerts from American intelligence as early as November 17, about the outbreak of cases of the novel coronavirus in Hubei province, rather than January, when initial infections in the United States were reported. As much as Trump found it difficult to admit the vulnerability of the United States to a global pandemic–or to the recommendations issued by WHO–who set the caduceus that symbolized medical ethics authority over the North American continent–at which he bristled at the notion of a global scope of edicts across boundaries, as if a map where national divides were erased as if it compromised national authority for a disease the President has been uncannily persistent in localizing in China, even before an increasing preponderance of evidence of its global circulation and transmission over a series of months.

Fabric Coffrini, AFP

As cascading fears grew in markets across the world, Trump was perhaps forced to realize his new relation to the world, even as the German stock exchanges plummeted as the measures he announced seem either difficult to process, or failing to address the importance of maintaining trade ties–or of taking adequately prudent steps of public health.

Slumping in his seat at the Resolute Desk, perhaps contemplating how no predecessor had ever delivered on air unprepared remarks from the desk, and visibly discomfited in doing so. He must have hoped to make up for his televised performance by sending surrogates scrambling to social media, issuing clarifications for misstatements–as the exemption offered U.S. citizens to return from China, or the exemption of Ireland, as well as England, and an assurance that trade would “in no way be affected” by the ban, as markets had reacted poorly to his performance. While it seemed that Trump was cognitively unable to process the possibility of a crumbling American economy–and a decline of America’s place in a global economy–under his watch, a prospect faced since he had met with airline executives with whom he discussed the effects of stopping flights of foreign nationals from China in a March 4 meeting, offering them a bailout that limited the impact economic effects of heightened travel advisories, is it possible he had no sense of the massive fallout on the national economy?

March 11 Address/Ralph Orlowski/Reuters

As Trump spoke, global markets not only failed to register confidence–but plummeted, as he revealed no clear plans to to call for social distancing to contain the spread of the virus, and revealed that lack of national preparation for confronting an infectious disease that had no vaccine. He may have remembered that he had outright fired a former cabinet member, barely remembered in the rogue’s gallery of administration, Tom Bossert, who had demanded preparedness “against pandemics” and a “comprehensive biodefence strategy” of the sort the previous administration of Pres. Barack Obama had tried to institute, or that a simulation of a pandemic that could devastate the American economy and kill up to half a million revealed in October 2019 “just how underfunded, underprepared and uncoordinated the federal government would be for a life-or-death battle with a virus for which no treatment existed.”

It seems likely he was rather trying to conceal the massive scale of lying to the nation about the effects of an economic downturn unprecedented in scale, but which the increased lines at Wuhan’s Tianyou Hospital the previous November had already indicated had a problem of infectious diseases on their hands that would have a potentially global consequence. Trump tried to spin the consequences as purely local, in an unprecedented wishful thinking whose scale of deception far exceeded the pathological deceits he had long taken to perpetrate on investors, business partners, and even on family members–from hiding his older brother’s treasured trucks that were a Christmas gift and then admonishing him not to cry, or he would destroy them before his eyes. Even as satellite imagery showed a clear rush to hospital emergency rooms in Wuhan in November, as clusters of cars marked in red crowded the emergency rooms that revealed “a steep increase in volume starting in August 2019 and culminating in a peak in December 2019,” when China began epidemiological investigations that led to identifying and sequence of the novel coronavirus by January 12, ten days before the city went on lockdown to contain its spread.

Annotated Satellite Photographs of Wuhan’s Tianyou Hospital in September 2019

While Trump registered no alarm at the arrival of the very pandemic whose global impact American simulations feared would cripple the national economy, he tried to offer spin on having closed borders to the virus, as if it were not already diffused within the country, in a mind over matter sort of exercise that suggested limits purchase on reality, as if he was able to recognize the risk earlier administrations had identified as a national priority.

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Filed under borders, Coronavirus, COVID-19, data visualization, national borders