Aging, suffering, and the inevitability of death: Let's keep it real, and ignore the quacks

My friend Paul Taylor, longtime journalist and former executive at the Pew Trusts, has just published a new book called “This Is Getting Old: Two Boomers and Their Generation at Dusk”. It has two main topics. The first is an often-disturbing analysis of the impact of the “Boomer generation” as a whole, focused on their (our) massive accumulation of money, fighting for society’s resources to be directed to us, and shockingly, away from those who need it most, children. There are clearly many different indviduals in this generation, as well as subgroups (since boomers were born 1946 to 1965, the usual characterizations of us in our youth, activism in the late 1960s, obviously are only about the older part of that cohort). He makes the point that not only did this generation, as many before, get more conservative as they aged, but that only a portion of them were ever progressive. And the contrast between their generosity to their own children and grandchildren, and their parsimony toward most of society’s children is, at least coincidentally (as he states it), or definitely (as I think) about the color, race, and ethnicity of the majority of today’s children. Did I say this was shameful? If not, I do!

The other focus of the book is the aging of his, their, and our generation, focusing particularly on one couple (a terrific, impressive, warm and active couple), but also full of data on what is happening to all of us. Which is the same thing that happened to everyone before us, getting old and eventually dying. We may be dying older, and dying of different things, and (many of us) having more healthy and productive years before we die, but we all die. And for many of us, perhaps most of us, as all through history, that dying will be preceded by a period – which can be short or be many years – of suffering, of being sick, in pain, losing our mental faculties, or all of these. Guaranteed. While billionaires are being quite successful in avoiding (at least for themselves) the other of that famous pair, taxes, avoiding death is, even for them, only a science fiction cryogenic dream for them that has not yet happened. Thank goodness. If there are any people that the future does NOT need preserved for them to deal with, it is the billionaires most assiduously working on it!

So, we need to remember not only the inevitability of death, but the suffering that so often precedes it. We boomers have been watched it in our parents, our older relatives, and, sadly, many of our peers. It is well to remember the myth of Tithonus, who was granted eternal life by Zeus, but not eternal youth. He continued to age, alive and living sicker and more decrepit. A more modern self-deception: a few decades ago, I was the only physician in a health policy class. Each week one student had to make a presentation to the class on a particular topic. The student who addressed the issue of “long term care” did present data, but then added that in their opinion the need for long-term care would decrease because people were taking better care of themselves, exercising and eating better and not smoking. I pointed out that this would obviously increase the need for long-term care, as people would less often die young from heart attacks and more often live older and older (if not eternally, like Tithonus) with more and more care needs. I suspect I even said something like “if you want to decrease the need for long term care, have people smoke, drink, eat poorly, not exercise and drop dead in the 40s and 50s”.

But that student, and others, were young. Somehow, they conflated living a more healthful lifestyle, and having better health in the near and medium term, with not ever confronting getting old, sick, and dying. That is purely wishful thinking. While living more healthfully is a good idea, it cannot prevent the inevitable. And yet, many people, even today, believe this that somehow they can and (more venally and evilly) are selling it to others. Some of these ideas are commonly associated with folks like Secretary of Health and Human Services Robert F. Kennedy, Jr. (how painful to associate that name and that title!) and the MAHA (Make America Healthy Again) movement. Like the MAGA (Make America Great Again) of Donald Trump, the key point is the “again”. In the case of MAGA, it depends on what your definition of “great” is – probably America was if it means slavery, racism, subjugation of women, and constant wars, with military budgets making up the biggest part of public spending, the funding of which comes disproportionately from those with lower incomes.

In terms of MAHA, while there may be a bit less subjective flexibility about defining “healthy” than “great”, there is definite disagreement about the road to health. For example, a recent study by the Edelman Trust Barometer produced the table below. About a quarter to a third
of Americans believe each of these falsehoods, and 70% believe at least one, with a whole bunch of folks who “don’t know”. Edelman calls these claims “false or unproven”, which is generous. To a greater or lesser degree, they are all false. The most dangerous are the claims about vaccines, which are good, and to a large degree the reason that boomers and others are likely to live as long as they are. As a t-shirt I have seen correctly asserts “Vaccines cause adults”!

 

 

Unpasteurized (ie, raw) milk has in fact caused lots of deaths because of bacterial contamination. Testimonials from dairy farmers who drink it all the time are not valid for urbanites who are consuming it days after milking, when the bacteria in it that would have been killed by pasteurization has had time to multiply, The other false claims may not cause death, but sure can cause suffering; I suffered a lot of dental cavities as a kid before our water was fluoridated. Fluoride is definitely helpful to dental health (excessive amounts can cause unsightly, but NOT dangerous, mottling of teeth). Avoiding acetaminophen in pregnancy can cause pain. And on animal protein: it is not more healthful than plant protein, it is in fact, generally less healthful. As is animal fat (e.g, tallow, lard). 

These false claims are relatively easy to refute, although it is not easy to convince people who believe them that they are wrong; these are two different things. But what of the amazing plethora of other magical health claims, today’s equivalents of snake oil (in promises for great health, not to mention quackery). Early in his book, Taylor writes 

Don’t pick up this book expecting to find the magic formula for staying forever young. I ain’t got one. You’re better off cruising TikTok, where a bustling industry of anti-aging influencers serves up a bottomless banquet of science and quackery. They treat aging as a curable condition, death an avoidable fate. 

Sigh. It would be wonderful if these nostrums could keep you healthy and keep you from dying. But they don’t. That doesn’t keep them from being a “bustling” (and profitable!) industry.

Three points:

1) Natural is not necessarily better or safer. That is a fallacy. Anything that actually has biologic effects can have the ones you want, and the ones you don’t (side effects). If it doesn’t have any biologic effect, it’s not helping either.

2) Don’t be a sucker. Yes, Big Pharma is evil, but there is much better data on whether and how its products work than those of the MAHA-hood.

3) If it sounds to good to be true, it probably is.

Keeping safe from COVID: Apparently it's all up to you

The most recent COVID-19 subvariants, currently accounting for at least half of US infections (and probably comparable world-wide) are the BA.4 and BA.5 subvariants of the Omicron variant. The bad news is that they are spreading rapidly, infecting many people. The good news is that a high percentage of those infected are getting milder illness, and the percentage of people requiring hospitalization or dying is lower than for previous infections (such as the original Omicron variant and its first variant from last winter, BA.1). This is explained (see “Family Practice News” article, here on MEdge) by the fact that we have (a bit simplistically) two different types of lymphocyte cells that produce immunity. B-cells produce antibodies (called humoral immunity), while T-cells directly attack invading germs that they have been primed to recognize by prior exposure through infection or immunization, which is called cellular immunity. Essentially, the new subvariants have mutated to avoid detection by antibodies (thus resulting in more infections) but not to resist destruction by T-cells (thus the less severe infections).

The other piece of bad news is that you can still get sick, can still get hospitalized, and can still die from COVID. And, of course, you can still infect other people, whether in public or in your home, and if some of those are more susceptible with lower immunity (say, older parents or grandparents, or those with chronic disease) and are infected by you, they can die. You will have been, sorry to say, the vector for their death. Like a deer who carries a tick that carries Lyme disease. And then there is “long COVID”, persistent serious symptoms lasting for months or years (from the CDC, over 13% at one month, several percent at a year, over 30% in people who were hospitalized). Sometimes getting infected is essentially unavoidable; people do have to go out, and even if they have been immunized, and boosted, and take care like wearing masks and staying reasonably distanced, and not eating indoors at restaurants, they can still get infected. But I have just listed a lot of things that a lot of people could do and many are not doing, and to the extent that they are not, infection is much less “unavoidable”. When you cross the street, you can be careful, cross on the green in a crosswalk, look both ways, and still be hit by a person careening around the corner at high speed who isn’t looking. But if you cross in the middle of a busy street, with no light, trying to dodge cars, you have greatly increased your risk. There is, to put it mildly, a LOT of misinformation about COVID that persists (see cartoon!)

 

A lot of people talk these days about individual responsibility and not being able to trust the government, and they definitely have some justification. But they often are looking at the wrong problems and coming up with the wrong solutions. No matter how many guns you carry, or how fast they shoot, or how big the magazine is, you can’t shoot the virus. You can do the things I mentioned above (get vaccinated and boosted, try to not be indoors with lots of other people, wear a good mask if you have to be in public, and also a mask if you are around vulnerable family or friends). A note on masks: any mask will help protect other people from you because it is right in front of your mouth and nose. Unfortunately, for you, this isn’t protective if other people are not wearing masks, certainly the norm these days. To protect yourself from others, you need an N-95, well and tightly fitting, since if folks are infected they will have been spewing virus all over.

Government agencies (and they don’t always have their acts together and agree even at the federal level, not to mention all the 50+ states and territories and thousands of local jurisdictions) have generally not been requiring masks recently. The federal government has been sending access to home test kits, and they and local governments have been closing sites that can do more accurate testing. Getting a vaccine is not always so easy, even if you want one. The CDC and FDA and Secretary of HHS Xavier Becerra and Anthony Fauci (whatever his title) often seem to not agree with each other, and often disagree with something else that they recently said themselves. And what agency is responsible for doing and saying what is a mystery to most people. Yes, sometimes the pronouncements of these agencies and individuals change because the scientific knowledge has changed – this is what Fauci is fond of saying, even when he contradicts himself because the science did not change – but there is another major reason, and, sadly, this gets back to you and to me.

Governments make policy and implement it (more or less effectively -- less, in general, for mask mandates) but they are nothing if not political. Political means that they (or those who appointed them) need to be elected and re-elected, and this is their main goal. If they pursue policies (like, say, mask mandates) that people find intrusive and don’t want to do, they can lose votes. And if they pursue policies that keep people from working and shopping and such then businesses lose money, and the politicians can and will lose donations. So they try to walk a fine line between encouraging some restrictions (sotto voce) and loudly proclaiming that things are getting better, that society should open up, that our economy will be growing, and you can go back to work.

So, those of us who are concerned about us and our families getting COVID and maybe getting very sick and maybe dying, and even more likely suffering the continuing problem of “long COVID”, should be very cautious about jumping on the “things are getting better; you should go back to normal” bandwagon. Things are not the “old” normal, but everywhere you go people have taken the “blue pill” (The Matrix, 1999 reference), drunk the Kool-Aid (Jonestown, 1978 reference) or are on soma (Brave New World, 1932 reference) and are not being careful, so you need to be extra careful. There are a lot of places to get infected, and they are sometimes places that you hadn’t though about or planned for. A friend recently went to an outdoor concert with adequate distancing, wearing masks – but prior to entering was in a tightish line to get in. And got COVID. Waiting in the passport control line at an international airport, people were jammed together, and few were wearing masks. Being safe most of the time doesn’t protect you from when you are not safe. [see: Anything. Because something didn’t happen once, or twice, or fifty times, doesn’t mean it won’t happen next time.]

There are a lot of really bad things going on now. Domestically, the Supreme Court (#SCOTUS-6) is doings its best to put you and everyone else at risk, abandoning Roe v. Wade, increasing the probability people with die, allowing almost anyone to walk around with almost any kind of gun, increasing the probability people will die, limiting what the government can do to slow (forget prevent!) global warming increasing the probability people will die, threatening democracy, which will not necessarily direct cause people to die but increases the risk of all the others. They are moving on to making almost anything else that will protect us illegal with one hand, while things that put us at risk are legalized with the other. Plus the world, the wars including that in Ukraine, and world-wide climate change. That is how they get you – how many things can you worry about, fight to change? Well, it has to be all of them. Including the virus causing a world-wide pandemic that could kill you.

Government needs to make easy free effective accurate testing widely available on virtually every corner, not depend on home tests which are not only much less accurate but do not allow accurate data collection. It needs to make it very easy and free to get immunized. It needs to require masks for people gathering indoors. It needs to have a consistent and broad policy on the use of paxlovid and other treatments. It needs to enforce effective protections – only the BEST kind of masks and respirators – for healthcare workers, particularly in hospitals. It needs to, with all the problems listed above, not be distracted by actual red herrings, like refugees and immigrants.

But too much of this will be politically unpopular. Many of us want to stay in the Matrix, at least while we can. Amazingly, the American Public Health Association (APHA) has just announced that masks will be optional at its November meeting in Boston! Can any public health person tolerate this? Do they understand the optics?

So if APHA won’t mandate masks, the government probably won’t take the risk. So you have to take care of yourself and your family. Do what you can, do more, be extra cautious.

Maybe it will help enough.

Twenty years after 9/11: a health worker perspective

This is a guest post on the 20th anniversary of September 11, 2001, by Seiji Yamada, MD, a family physician at from the University of Hawai'i John A. Burns School of Medicine

All those of us who are old enough recall what we were doing when we heard of the attacks of September 11, 2001. Since I live in Hawaiʻi, I was awakened by a friend living on the East Coast. He called to tell me to turn on my TV. When I did so, I saw the two towers of the World Trade Center on fire. I then watched the towers collapse.

On the following day, the University of Hawaiʻi Department of Family Practice (before the name was changed to Family Medicine) held a debriefing session with all staff, residents, and faculty in attendance. We came to some conclusions that we wrote about in the medical school newsletter:

We are humans before we are healthcare workers; our humanity is still a core component of our effectiveness as healers. Thus, our presence and genuineness, in the form of compassion and, when appropriate, openness about our own feelings, are therapeutic. When we can share some of our feelings about a recent disaster, it encourages a healing partnership by making the relationship less hierarchical. . . .

 

We must seek productive ways that translate our responses to distant suffering into a medicine more responsive to the suffering before us.  In this way, we can strive to incorporate social justice, equality, and compassion into both the practice of medicine and into the political response to acts of jarring violence.  We suggest that we should feel, think, and act not as members of a particular ethnic group, religion, or nation - but, rather, as humans.[1]

One participant, a Muslim and Arab woman, was silent through most of the session, but at the end, she related that she first wanted to hear what others had to say. She told us that she had grown up with, and constantly lived with anti-Muslim, anti-Arab sentiments being expressed around her – such that she often found it most prudent to hide her ethnicity.

We wondered what the future would hold.  Would this tragedy make Americans ponder why their country is hated by many around the world?  Or would the U.S. hunker down like Israel and embody the national security state, arms pointed in every direction?  The fearful consensus was, as has been borne out, that this trial would only serve to strengthen the impetus to meet force with force.

Indeed, 9/11 was followed by much flag-waving and George W. Bush’s declaration of a “War on Terror.” As the mastermind of the September 11 attacks, Osama Bin Laden (a Saudi), and the training camps of Al-Qaeda were in Afghanistan – the U.S. military began to plan for an assault on Afghanistan.

Richard Horton, the editor of The Lancet, wrote in a commentary published on October 6, 2001, suggesting that “The war against terrorism, announced by President Bush and endorsed by western political leaders in the immediate aftermath of the Sept 11 assault on America, will fail.” He suggested instead that “health, development, and human rights” be the objectives of a public health approach to Afghanistan.[2]

The U.S. started bombing Afghanistan on October 7, 2001.

I attended the American Public Health Association in Atlanta in late October 2001. Against the backdrop of daily bombing runs projected on the megascreen of the CNN Center, I thought that I might find fellow health workers opposed to the war. After all, UN agencies such as the World Food Program and UNICEF had been drawing attention to the humanitarian crisis in Afghanistan that pre-dated 9/11. Severe drought and twenty years of war in Afghanistan had led to conditions bordering on widespread famine. Shouldn’t public health workers, who are concerned about the health and well-being of people, oppose the U.S. war on Afghanistan?

I buttonholed Victor Sidel, grand old man of social medicine, and invited him to chat over a coffee. His take on bombing Afghanistan was, “The U.S. has to do something.  It can’t stand by and do nothing.” He criticized what he saw as my pacifist stance.[3]

It has taken nearly 20 years for the U.S. to leave Afghanistan. September 11 also served as one of the pretexts for the Iraq War of 2003-2011. All told, the first ten years of the “War on Terror” took on the order of 1.3 million lives.[4]

Since September 2001, we have endured twenty years of U.S. invasions of Afghanistan, Iraq, and wherever else the U.S. deploys its Special Forces, whether it is Africa or the Philippines. Twenty years of drone attacks, reaching its height under “Hope and Change” Obama, who devoted his Tuesday mornings to choosing the week’s targets for extrajudicial assassination (“Sorry about the wedding party collateral damage”).  Twenty years of torture chambers at Guantanamo and Abu Ghraib and Bagram Air Base and those hidden black sites around the world (“Yeah, Gina Haspel, you sure did a bang-up job running that black site in Thailand - we’re going to give you the top job of CIA Director”). Oh, Julian Assange, Chelsea Manning, Edward Snowden, do you think you’re going to let the people know what’s really going on? Well, for your troubles, you’re going to be psychologically tortured and placed in solitary confinement or exiled.

One economic sector saw its stock prices jump upward after 9/11, those of the arms manufacturers. As soon as the generals who oversaw the destruction of Afghanistan and Iraq and Libya retired from the U.S. military, they moved straight onto the boards of the weapons manufacturers. Lloyd Austin went from being commander of CENTCOM to the board of Raytheon. Meanwhile, the other pillar of the U.S. economy was the gambling house of debt financialization. When the casinos (i.e., the investment banks and their insurers) couldn’t cover their own debts and crashed the world economy, the U.S. taxpayers (via Congress) bailed out the banks, and workers were foreclosed on their houses. Subsequently, the Affordable Care Act (ACA, or ‘Obamacare’), touted as expanding the social good of health care to more people, essentially turned it over to the insurance and pharmaceutical industries.

However much the fabric of U.S. society has deteriorated in the twenty years since 9/11, it does not compare with the deliberate kinetic destruction wrought on the health services, access to water and food, infrastructure, and economies of Afghanistan and Iraq. Prior to the Gulf War (1991-1992, waged by George H.W. Bush), Iraq had been a thriving society, a leader in science in medicine in the Arab world. [5] Now, subsequent to the U.S. invasion (2003-2011, started by George W. Bush and Dick Cheney), and the war against ISIS (2013-2017), Iraq is a shambles. And thanks to Donald Trump’s utter incompetence, George W. Bush is now looked upon as a statesman. We are reminded that the U.S. destruction of the Middle East has been going on for much longer than the past twenty years. As Noam Chomsky often says, massive reparations are in order.

As noted by Chris Hedges, as the U.S. leaves, Afghanistan is, like when the U.S. invaded, in the midst of another humanitarian crisis:

Things are already dire. There are some 14 million Afghans, one in three, who lack sufficient food. There are two million Afghan children who are malnourished. There are 3.5 million people in Afghanistan who have been displaced from their homes. The war has wrecked infrastructure. A drought destroyed 40 percent of the nation’s crops last year. The assault on the Afghan economy is already seeing food prices skyrocket. The sanctions and severance of aid will force civil servants to go without salaries and the health service, already chronically short of medicine and equipment, will collapse.[6]

As Hedges points out, the response of the civilized world is to freeze the assets of the Afghan central bank and deny the new government access to loans or grants.

In retrospect, it is obvious how the desire for revenge in the immediate aftermath of 9/11 has led us to where we are now. What if, instead, the pain engendered by 9/11 had encouraged us to recognize the pain of others - those who suffer from hunger, poverty, ill health, and exploitation? What if narrative and images death and destruction had prompted us health workers to demand an end to war?[7]

What if we had sought instead to alleviate social ills and sought to ensure clean water, good nutrition, education, and health? Might we not all be better for it now?

---

[1] Yamada S, Maskarinec G, Bohnert P, Chen TH.  In the aftermath:  reactions to September 11, 2001.  News from the John A. Burns School of Medicine 2001 Winter;2:1-2. https://www.researchgate.net/publication/354116332_In_the_aftermath_-_reactions_to_September_11_2001

[2] Horton R. Public health: a neglected counterterrorist measure. Lancet 2001 358:1112-1113.

[3] Yamada S. On The Responsibility of Health Workers to Oppose the War. ZNet. Nov. 2, 2001. https://www.researchgate.net/publication/354116411_On_The_Responsibility_of_Health_Workers_to_Oppose_the_Afghanistan_War

[4] International Physicians for the Prevention of Nuclear War. Body count: casualty figures after 10 years of the “War on Terror” Iraq Afghanistan Pakistan. 2015 March: International Physicians for the Prevention of Nuclear War. https://www.psr.org/wp-content/uploads/2018/05/body-count.pdf

[5] Yamada S. Health workers and the Afghanistan-Pakistan War. ZNet.  December 14, 2009. Reprinted at Medicine and Social Justice. January 11, 2010. https://medicinesocialjustice.blogspot.com/2010/01/health-workers-and-afghanistan-pakistan.html

[6] Hedges C. The Empire does not forgive. ScheerPost. August 30, 2021. https://scheerpost.com/2021/08/30/hedges-the-empire-does-not-forgive/

[7] Yamada S, Smith Fawzi MC, Maskarinec GG, Farmer PE.  Casualties:  narrative and images of the war on Iraq.  Int J Health Services, 2006;36(2):401-15. http://web.mit.edu/humancostiraq/further-reading/casualties.pdf

COVID-19 is hard and horrible and exposes existing gross inequities in our society. But don't drink the snake oil

The COVID-19 global pandemic is hard. It is just a little bit hard for those of us who can work from home or are retired, and live in lowish-incidence areas with a high outdoors/people ratio who can go for walks, and just have to worry about not going to the gym or our hair getting shaggy, or whether to try to go to the store to get things to cook or get takeout, or being able to see our children and grandchildren in faraway places. It is harder for those who live in more congested and affected areas, and really hard for those who have lost friends or family to the disease, or have had it themselves.

I read the NY Times, published at the epicenter of the US pandemic, and am torn up by the suffering of so many there. It is really hard if you are not any of the things I mentioned in the first sentence; if you have a very low-paying job and no savings and either cannot work and get paid or have to go to work because you are essential, despite the fact that no one ever told you that before – or certainly paid you as if you were. It is showing us not only which workers are essential even if very low paid, it is showing us which are absolutely not even though highly paid, like the manipulators of finance in the legal gambling casinos of Wall St. An article by a NYC subway conductor in the NY Times says “we are not essential; we are sacrificial”. It is really hard if you have pre-existing conditions such as diabetes, obesity, chronic lung disease, or all of them. Nursing home patients were the initial victims and remain the hardest hit.

It is really, really hard if all these things come together. If you are a low-wage health worker in New York, or a farmworker (documented or not) picking vegetables and fruit and living in dangerous conditions at the best of times, or a Native American on a reservation where services are meager and the virus is spreading. The two counties of Arizona including the Navajo reservation have just about 2.5% of the state’s population and 15% of its COVID-19 cases. If you are a racial or ethnic minority, whether Asian and being blamed by the President for the virus and harassed and worse by people on the streets, or Black or Latinx, and having your usual differential level of risk and harassment exacerbated, not mitigated, by the virus.

The virus has not affected countries across the world, or parts of countries, or communities equally, but the pandemic is far from over. The rates of infection are not fading; the NY Times coverage frankly says ‘The reality of the coronavirus in the U.S. is an unrelenting crush of cases and deaths.’

More than a month has passed since there was a day with fewer than 1,000 deaths from the virus. Almost every day, at least 25,000 new cases are identified, meaning that the total in the United States — which has the highest number of known cases in the world with more than a million — is expanding by 2 to 4 percent daily.

Rural towns that one month ago were unscathed are suddenly hot spots. It is rampaging through nursing homes, meatpacking plants and prisons, killing the medically vulnerable and the poor, and new outbreaks keep emerging, an ominous harbinger of what a full reopening of the economy could bring.

As New York, which has the largest burden of cases, sees plateauing and even decrease it brings down the national rate, but if NY is excluded, the rate is continuing to rise, moving more and more into the rural states and counties who have seen the least, and, despite their frequently suffering from poverty and drug addiction and unemployment, have sometimes deluded themselves into thinking this was a big-city problem.

Both the Trump administration and independent (e.g., University of Washington) sources estimate that the deaths from COVID-19 in the US will be at least double what has been previously predicted, up to 120,000. This is not coincidentally associated with the relaxation of public-health motivated controls including social distancing mandates, business closures, etc. The states that are taking the “lead” in this regressive movement are mostly in the South and Midwest, have Republican leadership, and are creating a macabre natural experiment to demonstrate how bad public policy can kill.

Despite the morbid, if accurate, predictions that come from his own administration, and that the administration has set federal guidelines for reducing restrictions based on decreasing rates of cases and deaths and increased testing, the President himself has provided a different message. He has overtly lauded the “opening” of states that have not met these criteria, visited a mask factory in Arizona without wearing a mask. and encouraged the shocking, stupid, and dangerous demonstrations by overwhelmingly white, armed men against the appropriate restrictions in states with Democratic governors such as Michigan. These folks may think that they look cool and tough, but in fact what they look like is the yahoos they are. It is impossible for me to look at a photo like this and not imagine what would happen to these demonstrators if their skin were a darker color. It doesn’t take much imagining, and it is an awful reminder of our ongoing racism that they are allowed to do this.

With all of the hard-to-terrible impact of the pandemic, it is also hard to resist the temptation to latch on to hope in the form of new magical miracle treatments, cures, tests, vaccines. It is clearly hard for the President, who enthusiastically touted the wonders of hydroxychloroquine before there was real evidence of whether it was truly beneficial – and the evidence came in overwhelmingly negative. He also, of course, has suggested the benefits of “disinfecting” the body with chemicals or UV light. These would seem as ridiculous as they in fact are, except for the folks who drank fish-tank cleaner because it had chloroquine, or ammonia or bleach, or did Tide-pod enemas. As much as I rue it, there are a large number of Americans who view his pronouncements as gospel, and act on his every suggestion.

In addition, the complexities of the science are hard for most people to understand, and the uncertainties can seem unbearable. What level of antibodies are produced by natural infection? Do they protect against reinfection? If they do, how long will this immunity last? Can their antibody-containing plasma be used to effectively treat other sufferers? We don’t know, and won’t know, until we know. That takes time.

Another recent article in the NY Times, said

Researchers and politicians in China, the United States, Germany, Britain and beyond have latched onto antibodies as a potential solution to the virus and an outlet from containment measures. But that talk, always ahead of the science, has grown more muted in recent weeks. With the research refusing to cooperate, experts in Italy say the promise of antibodies may not be what people have imagined. At least for now.

This needs to become the new mantra for essentially every medical and scientific intervention for the novel coronavirus (officially “SARS-CoV-2”). Our talk can be ahead of the science when we are expressing our hopes and desires, but we cannot allow these hopes and desires to become something we act on until we have real evidence. Too much has already been disappointing, or misstated. “Compassionate” use is sometimes advocated, but we had better be sure that our compassion does not create more problems for people than they already have. Hydroxychloroquine does, certainly drinking disinfectants does; high-dose vitamin C is water-soluble and thus may not – unless you are a stone-former; vitamin D is fat-soluble and you can overdose on it.

A moving article in the NY Times about Rep. Alexandria Ocasio-Cortez, whose district includes the hardest-hit areas of the hardest-hit city (including, with sad irony, the neighborhood of Corona in Queens), addresses the challenges of the community and the sadness it engenders in her, in her constituents, and in us. It says ‘The wreckage in her community has made a darkly eloquent case, she said, for her agenda of universal health care and less income inequity. “This crisis is not really creating new problems,” she said. “It’s pouring gasoline on our existing ones.”

She is correct. We need to move forward not following snake-oil salesmen but resolving to address the structural problems that have made this crisis worse than it had to be.