Covid-19 pandemic response - Reprise

I believe that our personal and social responses to the covid-19 pandemic have some gaps that I wanted to address.  Here are the main risk factors for you dying from the pandemic virus:

[click the picture to enlarge it ]

In order to die from covid-19, you have various risk factors that policies like "social distancing" are supposed to address.     Briefly, left-to-right, you have odds of being exposed, which "social distancing" is supposed to improve. If you're exposed you have odds of being infected, and if infected you have odds of it becoming serious.   Most of us, 80% of us in fact, if we get infected,  will not have a serious illness requiring hospitalization.    If we were that serious, we have some odds of not getting admitted to a hospital, because it's already full,  or even if we get into a hospital bed, of the hospital not having the resources they need to care for us -- those two are factors, again, that social-distancing and "shifting the curve" are supposed to improve.   Finally,  even with the best of care, you could die anyway.   No one is looking at changing that factor right now.

What I do not see addressed in social media are the two important boxes on the left -- the ones that protect 80% of us already!    What factors would make it less likely that we would be infected by the virus if we were exposed to it?   And,   even if we got infected, what factors prevent the infection from becoming life-threatening and requiring a hospital visit?   

It's become increasingly clear that the human immune system can be depressed by many social determinants.   Here's a scholarly paper on what's known about how simply reducing stress can improve resistance to infection:

Effectiveness of Stress-Reducing Interventions on the Response to Challenges to the Immune System: A Meta-Analytic Review

Many studies show that these psycho-social,  non-medical interventions can affect both of two boxes I highlighted above -- resistance to being infected if exposed,   and,  resistance to developing serious complications if infected.

The effect of this sort of non-medical intervention is real,  evidence-based,  and in some cases quite powerful.  

So, why aren't we talking about doing something about those two things?    Studies have shown that there are many "social-determinants" of health,   such as exercise and eating right,  or overcoming stress, anxiety, and depression, which can have a strong impact on increasing our immune system.

One of the most powerful impacts on our immune system is the least understood -- the power of social connectivity and emotional intimacy to increase our odds of living.  [  That's "intimacy" as in deep friendship or closeness,  not "intimacy" in a sexual way! ]     Perhaps anxiety about things even remotely sounding sexual as research topics is a good thing -- but if it is blocking us from having a powerful boost to our immunity that doesn't require quarantines or shutting down the economy,  it's a bad thing!

I have a deep suspicion that if a company could figure out how patent and package such intimacy we'd be flooded with ads and everyone would be buying it.   As it is, no one can patent it -- its not only a power boost to our immune system, it's absolutely free, no health insurance required. 

Maybe that's why it, like the "placebo effect" -- the impact of our brain on our body which is so powerful it's the gold standard for clinical trials -- there is no commercial interest in the "product" and it slips from our attention.

The exact route by which human intimacy improves our immune system is unclear, but no one knows how aspirin works either but we use it all the time.  The effect of intimacy is not easily controlled and may sometimes be counter-productive -- but for drugs we take every day the original discovery was almost certainly a small,  perplexing effect that we spent billions of dollars on studying in order to enhance it, clean it up,  remove unwanted side-effects, etc.     Right now we're spending two thousand billion dollars on this virus problem, with more yet to come.  

You might think one billion dollars would not be out of line to spend on an effect that has shielded 80% of us successfully from dying,  wouldn't you?   Heck if we could make that number 85% of us instead of 80%, that could equate to 2 million lives saved even without needing a quarantine or social distancing.

I'm bringing our attention back to it.  If we want to reduce deaths even more than the 80% due to such factors already,   we should focus more attention on it, and maybe more dollars on advertising and advocating it, and on research to make it even more effective.

One big plus for more attention on such psycho-social factors is that, unlike vaccines or other specific drugs,  an improvement in the immune systems and general fitness of Americans provides protection against all future pandemics as well as against Covid-19.   

In fact, if you could do the math, an improvement in the mental and physical fitness of American workers probably more than pays for itself with fewer sick days and higher morale and productivity during days when employees are at work.   This kind of improvement and improved social cohesion may in fact help people, companies, and the country deal with other crises besides pandemics. 

Not surprisingly, the former US Surgeon General recently declared that the number one health problem in America is "loneliness".   You can read about this or listen to the 3/23/20 talk here.

"Long before coronavirus spread around the world, former Surgeon General Vivek Murthy was sounding the alarm about a different, quiet epidemic: loneliness. We’ll talk to him about why so many Americans are suffering from loneliness and what we can do to take better care of each other even as we’re asked to be physically apart."

I should comment that I have no stock in any company that would benefit from such investment, no "skin in the game" other than my own.  I just don't see what's wrong with the logic above.  Please feel free to comment in the comment section and enlighten us all!  I welcome comments, even critical ones, or new directions, if they help us make better decisions now, when it matters the most.

Finally,  it's a little rough around the edges, but I recently published in this blog some thoughts on how to operate in crisis conditions,  when the normal rules no longer apply and nothing is where it used to be, in this post:  Tips for Reliable Operation During the Covid-19 Crisis.   These are suggestions such as "buddy up with someone", "don't trust your memory", and "be tolerant of other people who are near their breaking point and having trouble concentrating."   Please feel free to add your own gems in the comments.

Anyway...

Here's a tweet chain from this morning,  slightly amplified and annotated:

===============================

Karen Rachel Heckert

@RachelHeckert

Do Americans ever stop to think what they're doing? Would you call on an IT guy to fix your car? Drill your teeth? Fix your plumbing? So why on earth do we trust every idiot with a computer background to expound on epi?

Quote Tweet

All I don't wanna do is zoom-a-zoom-zoom-zoom

@hypervisible

· Apr 19

“While neither man has a background in health or epidemiology, the same statistical modeling that applies to fast company growth might also be useful for tracking virus growth.” Stop bros. Just stop. https://bloomberg.com/news/articles/2020-04-17/instagram-founders-build-website-tracking-spread-of-covid-19

7:38 AM · Apr 20, 2020·Twitter Web App

 -----

Wade Schuette

@shuweide

·

1h

Replying to

@RachelHeckert

Great point, Karen! The pandemic has exposed a loss of American social systems which place the most qualified experts into respected leadership roles. Epi modelers are one such group. 

 https://newbricks.blogspot.com/2020/02/systems-thinking-about-outbreak-science.html

-----

That said, the entire complex adaptive social system is way larger than modeling a virus, or the collective responses to it, or recursively, to prior models, responses, etc. The risk of unjustified predictions is about 100%.

Mixing ABM and policy...what could possibly go wrong?

Invited talk at 19th International Workshop on Multi-Agent Based Simulation at Stockholm on 14th July 2018. Mixing ABM and Policy ... what could possibly go wrong?

https://www.slideshare.net/BruceEdmonds/mixing-abm-and-policywhat-could-possibly-go-wrong

 -----

Meanwhile, fixation on huge system-wide actions from FEMA to social distancing to hospital systems neglects a key intervention point -- what can be done on a personal level to reduce: (a) odds of becoming infected if exposed, and (b) odds of becoming serious if infected.

 -----

Obvious candidates are stress-reduction, exercise, enough sleep, nutrition, micro-scale mutual-support networks, all of psychoneuroimmunolgy including clinical-trial supported power of social connection to boost our immune system more than drugs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816362/

 -----

"Love and intimacy are [ crucial] ...If a new drug had the same impact ...it would be malpractice not to prescribe it. ... the breakdown of the social structures that used to provide us with a sense of connection and community ...are [the key.]

 https://www.goodreads.com/book/show/1054066.Love_and_Survival

The Medical Basis for the Healing Power of Intimacy 

We all know that intimacy improves the quality of our lives. Yet most people don't realize how much it can increase the quality of our lives -- our survival.

In this New York Timesworld-renowned physician Dean Ornish, M.D., writes, "I am not aware of any other factor in medicine that has a greater impact on our survival than the healing power of love and intimacy. Not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery."

He reveals that the real epidemic in modern culture is not only physical heart disease but also what he calls spiritual heart disease: loneliness, isolation, alienation, and depression. He shows how the very defenses that we think protect us from emotional pain are often the same ones that actually heighten our pain and threaten our survival. Dr. Ornish outlines eight pathways to intimacy and healing that have made a profound difference in his life and in the life of millions of others in turning sadness into happiness, suffering into joy. 

Note - UCLA launches New Ornish Lifestyle Medicine Website

UCLA Health has launched a state-of-the-art new website to support their Ornish Lifestyle Medicine program. Dr. Dean Ornish’s Program for Reversing Heart Disease is the only scientifically proven program to stop the progression and even reverse the effects of heart disease.

This nationally-recognized program has been so effective that the Centers for Medicare & Medicade decided to make it available to Medicare members under a new benefit category called “Intensive Cardiac Rehabilitation Programs.” UCLA Lifestyle Medicine is the first integrative medicine treatment program of its kind to receive this level of support.

-----

[ it seems appropriate here to insert a slide-show I mashed up over the weekend with a range of tips and suggestions for how to thrive in a time of crisis.

Here's the link to the GoogleDoc with the full slide-show,

and here's some excerpts from that slide show with the hot-links a little easier to follow if you are so inclined:

Learn tips for community organizing and maintaining well-being during COVID-19

The COVID-19 pandemic is challenging individuals, communities, and businesses across the globe to work together like never before.

On this course – led by experts from the Center for Positive Organizations at the University of Michigan – you’ll learn how to develop practices to help you get through this crisis.

You’ll discover the scientific grounding behind terms like thriving, resilience, and compassion.
You’ll also consider the value of gratitude and staying connected in a time of social distancing, including tangible steps to take as an individual or part of a larger community

This course is designed for anyone interested in learning more about how to thrive during difficult times and how to respond to crisis effectively.

https://online.umich.edu/teach-outs/thrive-in-trying-times-teach-out-fl/

Jewel - (song)   Hands

If I could tell the world just one thing

It would be that we're all OK

And not to worry 'cause worry is wasteful

And useless in times like these

I won't be made useless

I won't be idle with despair

I will gather myself around my faith

For light does the darkness most fear

My hands are small, I know

But they're not yours, they are my own

But they're not yours, they are my own

And I am never broken

https://www.youtube.com/watch?v=AfsS3pIDBfw

full lyrics:  https://www.google.com/search?client=firefox-b-1-d&q=lyrics+hands+jewel

Suzanne - by Leonard Cohen, sung by Judy Collins:

...And Jesus was a sailor when he walked upon the water

And he spent a long time watching from his lonely wooden tower

And when he knew for certain only drowning men could see him

He said all men will be sailors then until the sea shall free them...

Suzanne [ song ]

Leonard Cohen

sung by Judy Collins:

https://www.youtube.com/watch?v=NkamRumVXn4

If men do not build how shall they live?   ( T.S.Eliot)

The men you are in these times deride

What has been done of good, you find explanations

To satisfy the rational and enlightened mind.

...

They constantly try to escape

From the darkness outside and within

By dreaming of systems so perfect that no one will need to be good.

…

I will show you the things that are now being done,

And some of the things that were long ago done,

That you may take heart. Make perfect your will.

Let me show you the work of the humble. Listen. 

...

In the vacant places

We will build with new bricks

There are hands and machines

And clay for new brick

And lime for new mortar

Where the bricks are fallen

We will build with new stone

Where the beams are rotten

We will build with new timbers

Where the word is unspoken

We will build with new speech

...

The river flows, the seasons turn
The sparrow and starling have no time to waste.
If men do not build
How shall they live?
When the field is tilled
And the wheat is bread
They shall not die in a shortened bed
And a narrow sheet. In this street
There is no beginning, no movement, no peace and no end
But noise without speech, food without taste.
Without delay, without haste
We would build the beginning and the end of this street.
We build the meaning: 

T.S. Eliot -- Choruses from “The Rock”

https://www.goodreads.com/en/book/show/39346786-walking-each-other-home

Walking Each Other Home: Conversations on Loving and Dying ( Ram Dass)

( goodreads)

We all sit on the edge of a mystery. We have only known this life, so dying scares us—and we are all dying. But what if dying were perfectly safe? What would it look like if you could approach dying with curiosity and love, in service of other beings? What if dying were the ultimate spiritual practice?

Ram Dass and Mirabai Bush began their friendship more than four decades ago at the foot of their guru, Neem Karoli Baba, also known as Maharaj-ji. He transmitted to them a simple philosophy: love everyone, tell the truth, and give up attachment to material things. After impacting millions of people through the years with these teachings, they have reunited once more with Walking Each Other Home to enlighten and engage readers on the spiritual opportunities within the dying process. They generously share intimate personal experiences and timeless practices, told with courage, humor, and heart, gently exploring every aspect of this journey. And, at 86 years old, Ram Dass reminds us, “This time we have a real deadline.”

In Walking Each Other Home, readers will learn about: guidelines for being a “loving rock” for the dying, how to grieve fully and authentically, how to transform a fear of death, leaving a spiritual legacy, creating a sacred space for dying, and much more.

“Everybody you have ever loved is a part of the fabric of your being now,” says Ram Dass. The body may die, but the soul remains. Death is an invitation to a new kind of relationship, in the place where we are all One. Join these two lifelong friends and spiritual luminaries as they explore what it means to live and die consciously, remember who we really are, and illuminate the path we walk together.
 

In the Google-doc slide show I go off into more emotional, philosophical, and religions directions from there,   possibly or probably leaving many readers behind.

In my understanding,  extending our  emotional and psychological self out to our neighbors,  perhaps in a metaphysical or spiritual sense, making them true friends,  has a clinically proven measurable effect, a very large effect it turns out,  on our own physical well-being.

In a mathematical and systems sense,  the boundaries of our "self" seem to be unlimited by our skin, and can extend out to include other people,  groups of people,  entire religions and nations, or the entire planet... and perhaps, beyond that.

It would seem that we should be exploring not only how to be better friends with each other on a local scale, but on ever-larger, even a global scale as well.

We are all on one small planet,  and as our numbers increase it is also increasingly clear that we are in the same lifeboat, and our fates are inextriciably linked on a planet-wide scale.    The old boundaries of nation and culture are fading away,  as supply-chains,  zoom-meetings, and pandemics ignore them and simply form world-wide connectivity.

I think we should go with the flow, accept that, and figure out ways to preserve the best of our heritage and culture while the old boundaries dissolve and new ones form,  retaining diversity but also recognizing unity.     It makes no sense to talk about or rejoice in "holes in their end of the life-boat."       There is only one life-boat.      We are all going to sink or all going to survive together.

Eat the meat, spit out the bones.

Wade