Choice and vaccination

In a piece about tennis players as a population being less likely to be vaccinated than the actual U.S. population as a whole, French tennis player Gilles Simon is quoted as saying, "I’m not very scared of Covid, actually. My basic philosophy is: If you’re afraid of it, you get vaccinated; if not, no. It’s still a choice."

It's still a choice. A lot of people think that, especially in the U.S. Variations on "my body, my choice" are the rallying cry with regard to vaccination (for CoViD-19 and maybe all vaccines) among people who, I would guess, don't believe that when it comes to a woman's right to choose whether or not to have an abortion. But I digress.

Here's the thing, though. If you choose not to wear a seat belt, any bad consequence will be yours alone. Ditto if you choose to eat foods harmful to your health, or to go rock-climbing solo.

However, some choices don't just affect you. Cigarette smoke spreads beyond the smoker. Driving under the influence can injure or kill other motorists or pedestrians. And remaining unvaccinated just because you're "not afraid" of SARS-CoV-2 means you are more likely to catch and to spread it to others, especially those who can't be vaccinated or whose natural immunity is compromised.

And then there's the very high likelihood of getting seriously ill yourself. Think that only affects you? Not if you're in a relationship or need to be hospitalized. A lot of other people might have to endure the consequences of your illness.

In the U.S., for better or worse, getting vaccinated is a choice, yes. The government isn't going to strap you down and inject you.

But like driving drunk, your choice to remain unvaccinated "just because" or "because freedom" (another rationale, if one can use that term) puts others at risk.

As a country we put up with drunk driving for decades, apparently because it was a sacred freedom to be able to get behind the wheel without being able to control it. We finally wised up. Now driving drunk is despicable and you're a grade-Z putz if you do.

We're well on the way to the same consensus on choosing not to be vaccinated against CoViD-19. For the same reason: the risk isn't yours alone. You have no right to risk other lives.

Ed Yong clarifies where the U.S. is in the pandemic

The Atlantic's Ed Yong is credited as "a staff writer" who "covers science". That doesn't do him justice. He's really an acute, clear-eyed observer of not just science but the American political response to the natural world — particularly to CoViD-19.

In a quickie newsletter, he cuts through much of the fog of reporting surrounding the Delta variant. The result is a sober explanation of a few bottom-line facts:

• "Vaccinated people are not fully safe ... but they're much safer than unvaccinated people."
• "Breakthrough infections are relatively rare ... but won't feel rare."
• "Vaccinated people are unlikely to transmit Delta as easily as unvaccinated people ... but they can probably still spread it."
• "We are not back to square one ... but we're not out of the woods."

If you're dissatisfied with the foregoing — if you crave facts that don't leave so much room for interpretation — sorry. That's not how things are.

In a quietly devastating analysis last fall of why the U.S. response to CoViD-19 was so appallingly bad, Yong observed (among many other things) that we have a habit of assuming we can invent our way out of crises. That leads us to seek out, and to expect, magical technological fixes.

My instinct is to call such an expectation simplistic and foolish. However, that's too harsh. Looking for magic bullets bespeaks an optimism that is part of the national character, an optimism that even I must admit is crucial not just for the nation, but for humanity at large.

That said, we often let that optimism blind us to the need to take crucial action before any magic bullets are found. If you don't yet have a cure for zombieism, you'd better do what you can to avoid being turned into one. And you can't rely on just one defense: you have to have multiple layers of defenses, because those zombies will probably overwhelm or circumvent any single obstacle.

Vaccination is not a magic bullet for CoViD-19. It's a key defensive layer, though, just in case you become infected. To minimize the chance of becoming infected, you wear a mask (or masks), stay away from crowds if possible, wash your hands before touching your eyes, etc. — all the things you're tired of hearing about but that remain best practices no matter what you think. Taking all these steps gives defense in depth, which is the best you can hope for in the real world.

So that's where we are. It's neither as great as vaccine proponents hoped nor as dire as some fearmongering pundits think. The world isn't black and white: it's full of grays.

(The 5 August 2021 newsletter is a good summary of where we are, but if you want to know how we botched things as a country so badly, you must read the long piece from last year. He identifies multiple flaws in the national character that will cause us more suffering if we don't recognize and correct them.)

Let's vaccinate the willing

I sometimes think U.S. media forgets that there's a whole world out there that isn't the U.S.

We're drowning in stories about the unvaccinated all over the country contracting CoViD-19, especially the Delta variant. Many stories are framed as cautionary tales aimed at convincing the vaccine-hesitant to get vaccinated.

It's a worthy cause, in the abstract. It's even a practically useful one, inasmuch as the more unvaccinated hosts there are, the greater the likelihood that (a) breakthrough cases will occur, and, more troublingly, (b) a variant will evolve that is more successful at infecting vaccinated people, diminishing or negating the effectiveness of existing vaccines.

However, this is a worldwide pandemic, and with global travel slowly resuming, dangerous variants can arise anywhere and spread everywhere. While the proportion of vaccinated people in some parts of the U.S. is a lot lower than it ought to be, the proportion of vaccinated people in other parts of the world is even lower.

I fully support getting more, and more accurate, information to those who are genuinely uninformed about CoViD-19 and the vaccines against it. I fully support doing whatever's needed to work around whatever practical obstacles keep people from getting the shot(s), like the inability to take time off work or to get to vaccination sites because of a lack of transportation.

Yet at the same time we have to stop fantasizing that hardcore denialists, like those who think Robert F. Kennedy, Jr. makes sense, will ever get vaccinated. Efforts to reach out to them are a gigantic waste when there are literally billions of people around the world who would be thrilled to be vaccinated.

Right now, we have to prioritize getting the vaccines into the arms of willing recipients, because that will give us the best bang for our buck. Most of those willing recipients live in less affluent countries.

Yes, that means giving up, for the time being, on the idea of herd immunity in the U.S. Guess what? We have to do that anyway! Between the delusions of the ex-domestic Dear Leader, the fanatical irrationality of the existing anti-vaccine crowd, and the readiness of far-right media (traditional and social) to pander to both, we face a brick wall of reality-denial in something like a quarter of the U.S. population.

We have to stop wasting time beating on that brick wall, and redirect our energies to drying up the global supply of unvaccinated people to the fullest extent possible.

Once we've reached the billions of willing vaccine recipients, then we'll be in a position to tackle the truly hardheaded.

Live with respect

It might surprise you — it surprises me — that I'm mildly hopeful about the U.S. getting through this pandemic.

Don't get me wrong: I don't simply mean that I'm hopeful the U.S. will still exist after herd immunity is achieved. That has never seriously been in question, just as it's not in question that the Earth will continue to exist long after Homo sapiens has left the scene.

No, I mean that I'm mildly hopeful that epidemiologists' and public health experts' worst fears about rescinding stay-at-home orders won't be realized. I'm mildly hopeful that infection and death tolls won't be as high as projected.

Several weeks ago I read an intriguing piece (sorry, reference lost to the mists of time) wondering why, if Florida was full of beachgoers oblivious to the need for physical distancing, its hospitalization and death rates weren't higher. (Infection rates can appear artificially low if you simply refrain from testing — a tactic our domestic Dear Leader would love for us to embrace — but you can't hide hospitalizations or deaths as easily.)

It turned out that actual Florida residents were better at following stay-at-home guidelines, promulgated by local officials rather than the hands-off governor Ron Desantis, than those infamous beachgoers, who unsurprisingly were largely from out of state. In fact, Floridians had somewhat higher rates of staying at home than residents of other states.

This, along with anecdotal evidence from other states in news articles, suggests that much of the public has taken heed of public health guidance intended to slow the spread of infection. We won't disregard that guidance just because a governor, or even the domestic Dear Leader, declares the economy reopened.

To be sure, most of us have gone a little stir-crazy while remaining largely at home for a couple of months. There will therefore be some understandable relaxation of our vigilance, and there will likely be increases in the rate of infection as a result. That's regrettable.

However, if the majority of us don't resume life as it was in January or February — if we keep physically distancing, and wearing masks when physically distancing isn't possible, and doing all the other things we've learned will reduce the speed of the virus' spread — the worst fears of epidemiologists might well be avoided. The worst projections might well not be fulfilled.

There will remain some percentage of us who won't follow best practices for philosophical reasons: they don't believe SARS-CoV-2 is real, or they think the threat it poses has been wildly exaggerated. And maybe for them, especially if they live in areas of low population density, the novel coronavirus might as well not exist for all the health effect it has had or will have. Even if they come into contact with others who are infected, they might not contract CoViD-19, or might not suffer seriously from it: there is such a thing as getting lucky.

For those who view SARS-CoV-2 as a serious threat, understand that there's only so much you can do to keep other people from becoming infected, or from infecting others. In particular, you're not the mask- or physical-distancing police. Refrain from telling off strangers who aren't following what you think are best practices. You don't know their situation and in any case, your best bet is simply to keep well clear of them any way you can. And those feelings of resentment you get for having to inconvenience yourself when they're clearly the ones in the wrong? Get over them. Self-righteousness is a bad habit. Anyway, again, you do not know what difficulties they have in their lives.

On the flip side, if you don't think the threat of SARS-CoV-2 is serious (or even real), how about cutting the rest of us a break? It won't kill you to keep your distance from others who are wearing masks even if you think they're fools. And just as airlines can keep you off their planes if you won't comply with security measures (however pointless some of the measures might be), restaurants and stores can keep you out if you won't comply with best antiviral practices (however pointless some of those measures might seem). Follow their rules and be grateful they're open. Remember, too, that you might be wrong: the viral threat might be real.

Let's figure out a modus vivendi, shall we? Let's treat each other with a modicum of respect and humility in these weird times.

Calorie counts in restaurants

The Food and Drug Administration announced that restaurants will have to provide calorie counts for their foods and beverages. The rules will also cover grocery and convenience stores.

California already requires that some restaurants, notably fast food chains, post calorie information. In theory this is a good thing. In practice — well, it doesn't work as well as I'd like.

One problem is, the calorie counts are damned near impossible to read if your vision isn't very good. I'll admit, that may just be me. As the population ages, though, more of you are going to find your vision coming closer to mine. (Sorry about that.) The point is, if you can't read it, you probably won't pay attention to it.

The bigger issue is, the calorie counts may not matter to the majority of customers even if the information is legible. I pay close attention to the nutritional information in processed foods at the market. When I'm at a restaurant, though, I'm hungry and I don't much care about calories. My main defense against nutritional suicide is that I long ago weaned myself off fast food chains. I was lucky I had the option. If I didn't live in an area with a decent selection of non-chain restaurants serving not-too-unhealthful food, my hunger and my laziness would have doomed me to drive-thru dining.

Am I arguing against the new FDA rules? No. They might help, and I don't think they can hurt. However, don't get your hopes too high that they'll have a dramatic effect on the obesity epidemic.

Curbing the habit in the South

I was heartened to read that Atlanta has joined a number of other Southern cities in enacting bans on smoking in public places.

It's a good sign as far as I'm concerned. Smoking is a habit without any redeeming quality, save for making classic movies more interesting (I'm a sucker for smoking in black-and-white films).

I know that smokers feel besieged and angry. I probably would too if I were in their shoes. But we all need to recognize what smoking's real harm is.

Betty Price, a City Council member and doctor in Roswell, an Atlanta suburb, voted against her city’s ban on smoking in public parks. She said the city spent $20,000 on signs and has not issued any fines since the law took effect in 2010. Although Ms. Price called smoking “filthy” and “unhealthy,” she said people should be allowed to smoke outdoors if they are respectful of others.

“If someone wants to harm themselves by smoking, that’s awful, but it’s none of your business,” she said. “A constituent asked me, ‘Don’t you hate cigarette butts laying on the ground?’ Of course. But we have litter laws.”

Here we have somebody — actually, two people — willfully missing the point. Regarding cigarette butts on the ground, I can't get that worked up about a problem that can be handled with a broom. Compared with the other harm cigarettes inflict, litter is kind of trivial. Worrying about it first and foremost is like worrying first and foremost about the mildew in the aftermath of a tsunami.

Which brings us to smoking's bigger harm, the one that Price has to know about if she's any kind of competent doctor. And I'm not talking about the harm to the smoker: believe it or not, I agree with Price that people have the right to harm themselves if they really want. The trouble is that smoking harms other people. You have heard of secondhand smoke, haven't you, Dr. Price?

Your right to harm yourself becomes my business when your actions harm me. If I'm standing at a bus stop, I might be in a public space but I'm captive until that bus arrives. I resent having to endure the smoke from your cigarette, and I will support restrictions on your "right" to harm me in that space and anywhere else we both have the right to be and I don't have the option of moving away.

Autism and high tech

I'm ambivalent about linking to an article entitled, "More Autism Diagnoses in High-Tech Areas, Study Finds".

Researchers from Cambridge University in England found that nearly three times as many children were diagnosed with an autism spectrum disorder in a region of the Netherlands known as a center of high-tech industry than in two other regions with fewer high-tech jobs.

I've worked around enough engineering types to have more than a fleeting suspicion that many of them (er, us) have personalities that, depending on your definitional rigor, could be called autistic. The observation that some people relate better to machines than to other people is quite accurate.

However, the study in question has serious methodological flaws.

Researchers acknowledged their study had limitations, including the possibility that parents in the high-tech region were more attuned to the signs of autism and that the kids were more likely to be diagnosed, and that they relied on numbers from the schools but were unable to examine the kids themselves.

What this says to me is, the researchers worked off secondhand, anecdotal information. That should have invalidated this as serious academic research.

Nevertheless, if you work with seriously focused engineers and are frustrated by the experience, this article provides some interesting insights that might help you to find a modus vivendi.

Hospitals not hiring smokers

According to the New York Times:

More hospitals and medical businesses in many states are adopting strict policies that make smoking a reason to turn away job applicants, saying they want to increase worker productivity, reduce health care costs and encourage healthier living.

This isn't sitting well with some people:

“There is nothing unique about smoking,” said Lewis Maltby, president of the [National] Workrights Institute, who has lobbied vigorously against the practice. “The number of things that we all do privately that have negative impact on our health is endless. If it’s not smoking, it’s beer. If it’s not beer, it’s cheeseburgers. And what about your sex life?”

Previous attempts to deny smokers employment resulted in legislation in many states that prohibits "discrimination against smokers or those who use 'lawful products.'" Some of these laws carve out an exception for health care organizations, though.

As a live-and-let-live person, Maltby's argument resonates with me.

On the other hand, the smell of a cheeseburger isn't detrimental to your health.

Smoking is a troublesome habit because its effects aren't limited to the smoker: they encompass everyone within range of the smoke. And secondhand smoke is a health hazard.

So while in the abstract I don't care whether you smoke, in practice I care very much whether I have to suffer your cigarette's side effects.

I much prefer social pressure, rather than legislation or drastic measures like hiring bans, to change people's behavior. However, if I'm stuck in a hospital bed, I can do without an attendant reeking of stale cigarette smoke. If it takes a ban on hiring smokers to ensure that, so be it.

In the tradeoff between the freedom to smoke and the right to be free of smoke, count me in the latter camp.

New thoughts on care for Alzheimers patients

The New York Times has a decently detailed piece on how a Phoenix, Arizona nursing home is caring for some of the most difficult patients. Essentially, their approach is to cater to the patients' emotional well-being as a way to improve their overall well-being. That means they have some unconventional remedies on hand:

Dementia patients at Beatitudes are allowed practically anything that brings comfort, even an alcoholic “nip at night,” said Tena Alonzo, director of research. “Whatever your vice is, we’re your folks,” she said.

Once, Ms. Alonzo said: “The state tried to cite us for having chocolate on the nursing chart. They were like, ‘It’s not a medication.’ Yes, it is. It’s better than Xanax.”

I sat on the prior blog entry for months because it was a little uncomfortable to discuss the subject so openly. However, the Times piece made me reconsider. It's so rare to hear about ways of helping patients feel better that I wanted to mention it. Yet if the Times article has a fault, it is that the specifics of the challenges to coping with such patients is not much discussed. (The article is part of an ongoing series in the paper, though, so I've no doubt other pieces in the series go into sufficient detail.) In that light, the months-old, unpublished entry seemed worth dredging up.

Bus stop for Alzheimers patients

[Note: I wrote this back in July, so I don't know if the Telegraph article is still valid.]

A German nursing home installed a fake bus stop to keep some of its patients from wandering away.

Patients suffering from ailments that degrade their memory, including Alzheimer's disease, don't remember why they're in a facility rather than in their own homes. Confused and afraid, they seek the familiar places they still remember:

“... Their short-term memory hardly works at all, but the long-term memory is still active. They know the green and yellow bus sign and remember that waiting there means they will go home.” The result is that errant patients now wait for their trip home at the bus stop, before quickly forgetting why they were there in the first place.

This is a clever solution to a problem that breaks my heart.

50 First Dates is centered on a woman with an extreme form of short-term memory loss. Being a romantic comedy, you're supposed to take the romance part somewhat seriously (enough to make you care about the couple), and that bothers me a little.

It's wonderful to imagine that love can conquer a mental deficit that prevents one from remembering anything of the last twenty-four hours. In the real world, though, even less severe deficits produce results that are neither funny nor charming. Following complex stories, whether they be suspense novels or the narrative of the BP oil gusher in the Gulf of Mexico, becomes impossible since the details cannot be retained long enough to put the picture together. Memory is lost in last in, first out order, so the afflicted stop living in the present, mentally. The personality start unravelling, too, as more and more of what made up that personality disappears.

One of my parents suffered from Alzheimer's, or an ailment that effected similar degradation of memory. The only upside was hearing stories I'd never been told, stories from decades past that undoubtedly had been buried under the weight of accumulating later memories that now were vanishing. Otherwise, the experience was deeply unsettling. The forceful personality I'd known for my entire life became an apathetic shell that sometimes forgot to eat. Every day one of us children would visit, in part to check that all was well (even with a daytime caregiver, we worried), and in part to spend time talking; we knew that things likely would worsen to the point where conversation was impossible, and even recognition might be difficult, so we wanted to take advantage of the cogent mentality that remained.

Yet we heard the same stories again and again, which strained our patience. Our visits generally came at the end of long and stressful work days that left us with little energy or patience to cope with a reluctance to eat, or to clean house, or to do any of a hundred other tasks you and I perform as part of what we consider a civilized life.

Mental ailments like Alzheimer's disease do more than take away your memory: they take away your dignity and your deepest sense of self. I'm glad to hear of inventive approaches, like the fake bus stop, to keeping sufferers from these diseases safe without unduly agitating them. It doesn't diminish my sorrowfulness for them one bit, though.

Sitting kills?

The New York Times' health blog has a piece suggesting that sitting is unhealthful, regardless of how much strenuous exercise one gets. How unhealthful?

Men who spent more than 23 hours a week watching TV and sitting in their cars (as passengers or as drivers) had a 64 percent greater chance of dying from heart disease than those who sat for 11 hours a week or less.

Many of these men also exercised regularly.

I'm disposed to believe that remaining in any position for too long is bad for a person: our bodies aren't built for it. However, the crux of the problem doesn't appear to be sitting as such, but the associated lack of movement for most of us while we're seated. (It would be interesting to see if users of old-fashioned, non-motorized wheelchairs had the same probability of dying from heart disease as the seated-by-choice.)

Only time will tell whether further research will confirm or refute this initial conclusion. In the meantime ... well, it can't hurt to sit a little (or a lot) less, unless you've got bunions....