Six Degrees of COVID-19

How many degrees of separation are you from COVID-19?

There are different ways to count degrees of separation–the number of relationships one person is away from another.

Generally, everyone is six degrees of separation from any other person. You can reach any person on earth by crossing six social connections. The game Six Degrees of Kevin Bacon asks for an actor’s shortest path of costarring roles to reach Kevin Bacon.

There are also degrees of COVID-19 phenomena. They measure how many patients are different degrees of separation from you. In early January, most of the patients were 6 degrees of separation from me. As the pandemic continues, the world is shrinking. When did the degrees of COVID-19 change to 5 for most patients? As the pandemic spreads, that number will get smaller and smaller.

An interesting psychological transition must happen before a disease feels real and threatening. People could be three or four degrees of separation from many COVID-19 patients and not realize it. Cognitively, the number of cases in the US is just a big number without emotional impact. However, knowing your connection to those people might be more visceral.

I’m sure that when people are one or two degrees of separation from COVID-19, the disease will seem to be an obvious threat. The degrees of separation for people who were hospitalized for COVID-19 will be higher, but could be more impactful for people who pooh-pooh the disease’s risks.

I hope that the more macabre statistic, the degrees of COVID-19 deaths will not get low. Leaders must not be heedless because the possibility is real. Decisive action can keep the Degrees of COVID-19 from drifting down further.

How many sick people are 3 or 4 degrees of separation from you is hard to gauge. It’s a crucial fact that is hidden by case counts.

COVID-19 might be a tsunami, but we can always move farther from the shore. Animations that show projections of how my degrees of COVID-19 are changing could be a meaningful display of how close the tsunami is to me.

Film Review: 12 Monkeys (1995)

Twelve Monkeys is a story about the world after a viral plague kills 6 billion people in 1996. The time travel story jumps between the 1990s before the pandemic and decades into the future. The future is run by strange scientists who hope to track down the virus’ origin. They send James Cole (Bruce Willis) back in time with a mission to gather information.

Another protagonist in the movie is the psychiatrist Kathryn Railly (Madeleine Stowe). She is interested in the history of people who present a Cassandra complex. The Cassandra myth describes someone who knows the future but cannot do anything to change it. She wrote a book documenting examples of such people appearing in the past.

She is unfazed when she meets Cole who has the same outlook. She believes that he is mentally ill and she first meets him in her psychiatric hospital in 1990. She tries to maintain a clinical and objective interest in Cole. Cole vanishes for several years after his first hospital stay. He meets her a few years later and he kidnaps her for several days. Much of the story takes place during that kidnapping as she learns more about Cole’s remarkable story.

The future scientists are interested in a mysterious Army of the Twelve Monkeys which their surveillance indicates is responsible for the virus’ release. The Army of the Twelve Monkeys was led by Jeffrey Goines, played by Brad Pitt. His wannabe insurgents appear to be central actors in the plague because Goines father is a biologist studying deadly viruses. However, the exact role of Goines’ team is unclear until the end of the film. Goines and Cole meet when he shows Cole around the psych ward in 1990.

Bruce Willis and Brad Pitt provide excellent performances in the film. Willis portrays Cole as disoriented by time travel who does not know whether he is delusional or a “volunteer” traveling back in time on behalf of the scientists. He clearly demonstrates the sense of confusion and helplessness that his character experienced. Pitt portrays Goines as privileged, crazy and unpredictable with many goofy antics. Often institutionalized, Goines acts paranoid, manic and defiant. While in the hospital in 1990, he has a wild pillow escapade to help Cole escape. Goines has boundless energy and Pitt plays him very convincingly. Gradually Goines’ friends in the Army of the Twelve Monkeys realize he is unhinged and that his plans are going to end badly.

Little Kindnesses

A clockThe COVID-19 pandemic makes me think deeply about my mortality and the mortality of the people I love. Making it to the next birthday seems more of an accomplishment now than last year. I don’t know what will happen between now and December. Who that I know will have become sick? Who will have never recovered? How will I deal with so much grief?

I think about what to do while I’m at home. (I won’t say “stuck at home.” It’s a privilege that I have a home.) Fortunately, I’ve got projects to keep me busy. I can focus on them more intently if I’m not thinking about going out for groceries, planning my next trip to Fort Wayne and looking for the best gas price.

With heavy feelings so infectious, it’s easy to forget the humanity of the people I don’t know. But, it is more important than ever to recognize my neighbor as like me. The one who lives in the next apartment or the stranger who comes to the store at the same time as me. The neighbor that is the “other” I don’t trust. In this crisis, there is no “other” in the eyes the coronavirus. I don’t know their names, who their kids are and whether putting food on the table is a burden. But, they are all facing the same end as me.

Unity in suffering.

It’s more important to me than ever to do small kindnesses for the people I meet. They might be hungry, angry at the people stuck inside with them, lonely for human contact that they’re trying to distance themselves from. I don’t know what they face, but I can be confident that it is hard. I can acknowledge their burden with respect and not add to it.

I’m alone in my house, but I don’t feel lonely. I am busy and can talk to a person or two each day by phone. It is kind for someone to take or return my call. I try to do the same.

The mathematics are against us. Italy is an example of the nations a few days ahead of us that is suffering badly. Others countries that have been taking stronger measures appear to be keeping up. I want to not add to the suffering in my country. Being willing to do whatever I need to is a way to do that.

If the guidance I get is not based in the epidemiology and science, I can be confident that ones providing that guidance don’t value my life or the life of my loved ones. I don’t have time for that.

How the U. S. health system could catch up to Nigeria

In 2014, Nigeria had 19 cases of Ebola. They marshaled their resources to trace contacts and quickly fought back a deadly, contagious disease. [1]

With the tool of contact tracing, Nigeria won their Ebola battle. They used experience that was already in place to fight back Ebola. Nigeria’s health system had eradicated polio and it stopped Ebola too. This is a lesson that health systems can have flexible responses and fight different kinds of epidemic.

Contact tracing is an important activity that needs community support. Effective contact tracing also requires planning. If no one knows how it works, they can’t react quickly. We should develop epidemic response teams. They need experience so that they can be vigilant and fight any new disease.

An parallel to epidemic response teams are the tornado sirens in the Midwest. The sirens are regularly tested and people know what they mean. Epidemics are a natural disaster equivalent to tornadoes. When people know the steps to prevent an epidemic, they will be willing to aid the process instead of fight it. Communities’ experience with epidemic responses will help overcome individual’s lack of trust.

To let the health reaction teams do their best, it would be prudent to have the systems already functioning. With test runs and vigilance, our reaction to any epidemic disease can be rapid and effective. Each disease is different. The model for combating measles and the mumps are similar, but they are not identical to the one needed for Zika. Creativity and experience are a must.

The testing of the system does not need to be theoretical. We already have periodic small epidemics that can test epidemic response teams. Measles is one example because outbreaks happen randomly when the disease is imported [2]. Another real-life example is the mumps. Outbreaks periodically happens on college campuses. One is happening now in Indiana and our reaction should be more effective. HIV & AIDS are an ongoing test. AIDS doesn’t spread as rapidly as measles or the mumps, but the same tools can help.

Existing vaccinations help prevent epidemics. The U. S. is backward in this area because of our attitudes on freedom. Those attitudes aren’t compatible with what the country needs to prevent unnecessary deaths.

The CDC reports another barrier for an epidemic response is financial. Epidemic response teams need discretionary funds and the authority to release those funds immediately. Any delay will worsen an epidemic. Epidemic responses teams need their funding allocated before the epidemic starts. The budgets for disease tracing and other tools need to be flexible. [3, p. 11]

Support for thorough contact tracing is critical. We need teams trained and ready for an epidemic. Their services should be used automatically when a potential epidemic is detected. We need to develop public experience and education on the steps that will defeat an epidemic. We need extensive use of vaccinations when they are available. Finally, money is needed for a rapid response. This economic support can allow the other components react decisively.

With these components, the U.S. health system will be able to easily defeat any currently unknown epidemic or bio-terrorism and surpass Nigeria’s Ebola success. We could have more confidence in our health system and in its ability to protect us.

[1] “Nigeria is now free of Ebola virus transmission.” http://www.who.int/mediacentre/news/ebola/20-october-2014/en/. Retrieved June 6, 2016.
[2] “Measles: Cases and Outbreaks.” http://www.cdc.gov/measles/cases-outbreaks.html. Retrieved June 6, 2016.
[3] “Emergency Guideline: Implementation and management of contact tracing for Ebola virus disease.” http://apps.who.int/iris/bitstream/10665/185258/1/WHO_EVD_Guidance_Contact_15.1_eng.pdf. Retrieved June 7, 2016.

[edit 2016-06-10: clarified last paragraph]