Tag Archives: Health

The Elephant and the Virus

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With respect to the coronavirus pandemic, I am concerned about India. Given their population density and more than 1.3 billion residents, the virus situation there could soon make what’s happening in Italy and Spain look tame.

Earlier this week India was reporting only 129 infections and 2 deaths. Today it’s at 249 cases and 5 deaths. While those numbers may seem ridiculously low relative to India’s population, they appear to be starting out much the same as any other country.

While mathematical illiterates might dismiss these numbers as trivial, fortunately India’s Prime Minister and their National Security Council are paying serious attention to what’s happening elsewhere. Consequently, India has been on lockdown since March 18 and plans to continue through March 31. I think they’ll need significantly longer, but it’s good to see them taking this step.

India’s director of the Center for Disease Dynamics, Economics, and Policy, Dr. Ramanan Laxminarayan, warns that India may have to deal with a tsunami of about 300 million coronavirus cases. He estimates that India has 70K-100K ICU beds in the entire country. Note that the total ICU beds in the USA are also estimated to be in this same range, and the USA is already on a path to overflow these beds in the weeks ahead but with a billion fewer people.

One of my concerns is that India may be severely under-testing. So I’d pay a lot more attention to the death count than to the infections reported and watch what that number does in the weeks ahead. When testing is weak, deaths are more likely to be noticed than infections, especially as more people who are struggling to breathe seek medical care.

If you look at other countries with death totals close to India’s, many are reporting significantly more infections. Austria, Denmark, Norway, Malaysia, and Portugal all report 3-7 coronavirus deaths so far, and their reported infections range from 1020 to 2491. Now there are lots of other countries with similar death totals but with lower infection counts closer to India’s, and by and large these are countries where testing appears to be very limited.

Since the death numbers are so low, they may not be significant right now, but this is something for people in India to watch carefully in the weeks ahead.

Note that just 25 days ago on February 24, Italy was at 229 reported cases and 7 deaths, which is very close to where India is today. Now Italy is at 47,021 cases and 4032 deaths – 5986 of those cases and 627 of those deaths in the last 24 hours – and still rising faster and faster. Also note that India’s population is 22 times the size of Italy’s.

That said, I am seeing solid evidence that India is being a lot more intelligent and cautious about this virus than many other countries. They’re way ahead of the USA, getting to lockdown much sooner. In the U.S. the inevitable lockdown is unfolding on a state by state and even city by city basis. California just went into statewide lockdown last night. Other U.S. states will soon follow. Slow-rolling a countrywide lockdown instead of going there immediately means more people will suffer and die, including more medical staff. This should be coordinated at the federal level like India has done. The leadership void at the top means that state governors have to step up now more than ever to help compensate as best they can.

Many countries are seeing their infections and deaths ramp up tremendously, and this will go considerably higher in the weeks ahead as we go higher up the exponential growth curve. In time this will reveal the price each country pays for underestimating this virus.

While practicing social distancing and going into lockdown are key steps that will save many lives, abundant testing is crucial as well to understand what’s happening and to know if measures are being effective or if more is needed.

One key risk I’m seeing in India is overconfidence. This is an easy trap to fall into when the numbers are still low and especially when you’re already in lockdown and practicing social distancing. While it’s commendable that India has implemented serious measures sooner than most, there’s still a potent risk of falling into the overconfidence trap by assuming that it’s enough.

Moreover, compliance can be a real problem too. In my home state of Nevada, we’re under partial measures for at least 30 days. The hotels and casinos are closed statewide, which hasn’t happened since President Kennedy’s assassination in 1963, and that was only one day of closure back then. As extreme as this may seem, especially for the 206K casino employees who are out of work now, we’re still just stair-stepping our way towards a full lockdown. Meanwhile it’s being reported that non-essential businesses remain open, including some restaurants and retail stores. Some businesses are still telling their employees to come into work, even where people must work in close proximity to each other, and the employees feel they have to show up because they don’t want to lose their jobs. Some will lose their lives because of it. So the existing directives aren’t being complied with yet. In fact, the Vegas police have been getting so many phone calls about these violations of the Governor’s order that they’re telling people to stop calling to report such businesses.

Even with really good government measures in place, the practical reality of this situation is that when we think we’re doing enough, it’s more likely that we’re being overconfident and not being cautious enough.

The challenge this virus presents is that in order to get aligned with its behavior and respond appropriately, we must consistently do more than we think is necessary, which is an uncomfortable place to be. When we think we’ve finally implemented what’s necessary and can settle in at that level because surely it’s enough now, we’ve succumbed to overconfidence, and the virus will make additional gains because of that, including overwhelming hospitals and medical staff.

So in this case, it’s good to feel like you’re overdoing it by being more cautious than you think is necessary. It’s also good to feel like you’re taking more social risk than usual to rein in sociopathic behavior.

The most caring and compassionate people I know are feeling very socially uncomfortable these days; they’re all getting some social blowback because they’re stretching themselves to do what it takes to save lives and reduce suffering. They can see plain as day that it’s the right response under the circumstances though. When they get overwhelmed, they do whatever they need to do to recharge, to accept reality, and to forgive, and they go right back into the fray. Heroes all of them. The people who’s lives they save may never know it, and the work they’re doing is largely thankless, but I want them to know that I personally appreciate and applaud their efforts.

Under current circumstances, the torrent of vitriol that was unleashed upon the Floridiot Governor for permitting spring breakers to crowd the beaches earlier this week was an appropriate response to sociopathic behavior. And it was effective. That Governor quickly caved to the onslaught of social and political pressure and shut those beaches down.

At the national and individual levels, we all need to stretch ourselves further into the zone of discomfort. For the next several weeks at least, we need to bid enoughness adieu and embrace the discomfort of toomuchness.

Perhaps India has achieved enoughness in their response, which may impress some humans but isn’t enough to earn the respect of this virus. This virus eats American enoughness for breakfast, Spanish enoughness for lunch, and Italian enoughness for dinner. And presently it seems to be developing an appetite for British enoughness at tea time. Along with the rest of us, India’s challenge is to push further into toomuchness and stay there for a while. Maybe they can teach this virus a thing or two about fasting.

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Virus vs Culture

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Some people may be surprised to learn that most viruses don’t have much respect for the following:

  • Optimism, blind or otherwise
  • Fearlessness
  • Mathematical illiteracy
  • Feelings
  • Opinions
  • Conspiracies
  • Spring break
  • Jobs
  • Economics
  • Lying
  • Denial
  • Ignorance
  • Irrationality
  • Insults
  • Politics
  • Excuses
  • Incompetence
  • Toilet paper abundance

Relative to human beings, who may be compassionate and understanding about some of the above, the behavior of viruses could be considered by some to be borderline rude.

For example, the recent coronavirus has shown a most unpleasant disregard for Italian culture and optimism, now claiming 3405 lives in Italy (more than 900 of them in the past 2 days) and infecting more than 41K. It seems particularly obnoxious in its treatment of Italian medical personnel, infecting more than 2600 of them so far. In response the Italians have opted to accelerate the graduation of thousands of medical students, so they can join the fight against the virus months ahead of schedule. So far the virus hasn’t revealed what it thinks about that when asked.

Many Spaniards noted how the virus treated the Italians and assumed it would treat them quite differently. The virus, however, seems to find Spanish bodies at least as hospitable as its Italian hosts, which may be why it proceeded to infect 18K and to claim 831 lives in Spain, promising more to follow.

The virus was nonplussed when Iran’s Deputy Health Minister denied its potential, even while he was coughing quite a bit due to being infected himself. Shortly thereafter, the virus proceeded to claim the lives of dozens of Iranian government officials. Presently it would appear that the virus considers more of the same to be a good use of its time.

Iranians have been sharing videos of bodies piling up and being placed into new mass graves – literally with a twist of lime. Iranian locals have shared that the bodies they’ve counted in certain limited areas exceed the official totals being reported for the entire country (currently 18K+ cases and 1284 deaths). Some estimate that Iran is heading towards millions of deaths, which may be impressive numbers for humans but not particularly so for the virus. It’s been said that in private, the virus considers the number 1,000,000 about as daunting as most humans would find the number 6. So not very.

Presently the virus is finding American culture most receptive to its propagation, having just finished its initial tour of all 50 states. So far it has infected 14K and claimed 214 American lives. It seems to be developing a fondness for American irrationality, although some say that it may be slightly disappointed that its initially pleasant spring break in Florida is being cut short.

Additionally the virus is warming up to the culture of Brazil, noting the welcoming words of Brazil’s President like “hysteria” and “fantasy.” There the virus is still working on its first 1000 infections, which it expects to surpass sometime this weekend.

The virus doesn’t seem to mind all the recent testing, having passed such tests nearly 250K times thus far. It considers the 10K lives it has recently claimed a modest achievement, while noting that reaching 100K from this point should take even less effort.

The virus has been quietly observing increased chatter about social distancing, which it considers a non-issue as long as the humans don’t actually practice it well. While normally possessing a rather reserved demeanor, the virus does appear to elevate its contentment slightly above baseline levels when humans spend more time discussing their economic concerns.

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The Stun Setting

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Lately I’ve been feeling like we’re living through a particular Star Trek: The Next Generation episode.

No, not “Contagion” – that’s about a computer virus.

Not “Thine Own Self” either, but that’s a good guess.

I’m thinking of “The Ensigns of Command.”

That’s the episode where Data, the android character, must convince a bunch of stubborn colonists that they need to immediately pack up and leave the colony they worked so hard to build. The human colonists must leave because thanks to a treaty, the planet where they’ve built their colony now belongs to an alien race called the Sheliak.

The Sheliak are all business and are coming to colonize the planet themselves. While they were willing to negotiate a lengthy and complex treaty with the humans to procure the planet, they otherwise regard humanity as a lesser species and would have no qualms about wiping out any human stragglers they discover upon arrival. The colonists are absolutely no match for the Sheliak.

The Enterprise must begin evacuating the colonists ASAP, and Data is beamed down to the planet to help them start packing immediately.

However, the colonists are very resistant to the idea of leaving, especially their leader, Gosheven. That isn’t surprising since Data did show up out of the blue to basically say, “Surprise! Now you must pack up and leave!” The colonists had been living on the planet for many years and sacrificed a lot to establish their thriving colony.

Gosheven tries to reassure everyone that there’s nothing to fear and that they’ll all be fine. He denies that the Sheliak are a threat (which sounds very much like the idiocy of saying “it’s just the flu” in our current situation). Others join him in their firm stance against fear. But are they being brave? Or just stubbornly irrational?

Here’s a scene from that episode where Data is speaking to the colonists, trying to get creative in convincing them to leave. Everyone in this scene other than Data is a colonist.

DATA: You know of the Sheliak threat. Starfleet wishes to evacuate you for your own protection. Yet Gosheven has decided otherwise. That is his right, and I will not waste time trying to reverse that decision. I admire your conviction in the face of certain defeat. Though doomed, your effort will be valiant. And when you die, you will die for land and honor. Your children will understand that they are dying for a worthy cause. Long after the battle is over, their courage will be remembered and extolled.

ARD’RIAN: Remembered by who?

DATA: Yes, that is true. There will be no one left alive to remember.

GOSHEVEN: (applauding) A valiant try, android, but what a low opinion you must have of us.

DATA: I was simply attempting to describe your inevitable destruction in a manner that would have an emotional effect.

HARITATH: And he describes it pretty damned well.

GOSHEVEN: Are you ready to follow this machine? Give up without a fight? He says we’re going to lose, but I think that’s just his cowardice talking!

KENTOR: What if he’s right and you’re wrong? Shouldn’t we consider that possibility?

GOSHEVEN: This colony exists because generations gave their lives for it. Many people died before we found a way to adapt to the radiation. And many more died bringing water to the desert. My grandfather –

ARD’RIAN: Is buried on that mountain. Well, who’ll be left to bury you?

GOSHEVEN: Have you considered what this evacuation means? Everything we have, we abandon. Everything that we have built turns into dust. Everything that we have accomplished means nothing. Well, I say no. You elected me your leader. Follow me now. I don’t think our chances are as hopeless as he says. And I’m willing to stake our lives on it. Any objections? Good, because here we stand.

ALL: Aye, We stand with you.

(The men slap Gosheven on the back, the women look worried)

DATA: Then here you die.

This episode reminds me of what we’ve seen in many people’s response to the coronavirus. We’ve seen it in Italy. We’ve seen it in Spain. We’ve seen it in France – throughout the week leading right up to the moment the French went into full lockdown yesterday morning.

And of course we’re still seeing it in the USA now.

How well does this approach work?

Let’s check a first-hand report from a doctor in Bergamo, a city in Northern Italy:

The results of the swabs now come one after the other: positive, positive, positive. Suddenly the emergency room is collapsing. Emergency provisions are issued: help is needed in the emergency room.

…

Exams, radiology always with the same sentence: bilateral interstitial pneumonia. All to be hospitalized. Someone already to intubate goes to intensive care. For others, however, it is late. Intensive care becomes saturated, and where intensive care ends, more are created.

…

And every reorganization of beds, wards, staff, work shifts and tasks is constantly reviewed day after day to try to give everything and even more. Those wards that previously looked like ghosts are now saturated, ready to try to give their best for the sick, but exhausted. The staff is exhausted. I saw fatigue on faces that didn’t know what it was despite the already grueling workloads they had. I have seen people still stop beyond the times they used to stop already, for overtime that was now habitual. I saw solidarity from all of us, who never failed to go to our internist colleagues to ask “what can I do for you now?” or “leave alone that shelter that I think of it.” Doctors who move beds and transfer patients, nurses with tears in their eyes because we are unable to save everyone and the vital signs of several patients at the same time reveal an already marked destiny. There are no more shifts, schedules.

…

Social life is suspended for us. I have been separated for a few months, and I assure you that I always have everything possible to constantly see my son even on disassembly days at night, without sleeping and postponing sleep until when I am without him, but for almost 2 weeks I have voluntarily seen neither my son nor my family members for fear of infecting them and in turn, infect an elderly grandmother or relatives with other health problems. I’m happy with some photos of my son that I regard between tears and a few video calls. So be patient too, you can’t go to the theater, museums or gym. Try to have mercy on that myriad of older people you could exterminate. It is not your fault, I know, but of those who put it in your head that you are exaggerating and even this testimony may seem like an exaggeration for those who are far from the epidemic, but please, listen to us, try to leave the house only for the essential things. Do not go en masse to stock up in supermarkets: it is the worst thing because you concentrate and the risk of contacts with infected people who do not know they are higher.

…

Oh yes, thanks to the shortage of certain devices, I and many other colleagues are certainly exposed despite all the means of protection we have. Some of us have already become infected despite the protocols. Some infected colleagues in turn have infected family members and some of their family members already struggle between life and death. We are where your fears could make you stay away. Try to make sure you stay away.

Source: Corriere della Sera (translated from Italian)

That was from March 7, when the death toll in Italy was 230. Fast forward just 11 days to today, and now there are about 3000 dead – 475 of them just in the past 24 hours. In that same time they went from about 5800 reported infections to about 36,000 now. And this is still speeding up.

Soon this will be the situation in Southern Italy too. France and Spain are quickly following suit. More countries are following just days behind.

Of the nearly 36,000 reported infections in Italy, more than 2600 are medical personnel. A number of doctors have already died from this virus while trying to save other people’s lives.

This is a glimpse of what we’re about to see in the USA shortly. Very likely by the end of the month, we can expect hundreds if not thousands of medical personnel to get infected as well, even as they work to exhaustion trying to treat people. And that will still just be the tip of the iceberg with so much more to follow. We are nowhere near the peak yet. In fact, we’re not at Base Camp yet. (Incidentally, Mount Everest is closed too.)

A full lockdown in the USA is inevitable – I’d say almost a certainty before month’s end at the rate things are going. The sooner we reach that point, the better. All 50 states have infected people now, with West Virginia being the last holdout to join.

Each day we’re seeing different cities and states making bigger and bigger sacrifices while the virus makes even bigger gains. We’re progressively locking down, and as fast as it seems, we should actually be moving even faster.

Yesterday night the Governor of Nevada announced the closing of all casinos, hotels, bars, and more statewide, joining schools which were shuttered on Monday. The Las Vegas Strip has gone dark. And yet as extreme as this seems, especially for a city that runs on 42 million tourists per year, it’s still just another intermediate step among more to be taken.

When a full lockdown does happen, and it will, it will likely endure for at least two months, and realistically we may be looking at well into the summer or beyond.

Some are projecting as long as 18 months of this kind of disruption (which may involve full and partial lockdowns), as there may be multiple waves of the virus.

When you see businesses announce they’re shutting down for 2-3 weeks, don’t believe that for a second. As I noted in Sunday’s post: This Will Not Be Over Quickly. When I wrote that post, the U.S. death total from the virus was 63 with 3300 reported infections. Three days later we’re at 8300+ infections and 133 deaths, so both numbers have more than doubled. And this is going to speed up significantly in the days and weeks ahead.

Meanwhile many people are still going out partying and gathering in large groups, such as was reported at the Clearwater Beach in Florida yesterday. Under the current circumstances and given what we see happening elsewhere, this behavior means more painful deaths for many more people, including the deaths of doctors and nurses trying to save lives. Not shutting down sizable human gatherings is ludicrous at this point. The sooner we take action, the more lives will be saved.

Let’s return to our Star Trek episode to see how Data eventually convinces the colonists to leave for their own good.

After his other attempts to convince the colonists to leave fail, Data goes to the colony’s pumping station for their aqueduct, which is the colony’s only source of water. He pulls out his phaser, first using the stun setting and then using a higher setting after he says his first line in this scene.

(The elders are on a raised platform to the side, and four security guards are in front of the pool. Data fires at them)

DATA: Stop. That was the stun setting. This is not.

(There’s a big bang, then energy is seen racing up the pipeline to the mountain)

DATA: I can reduce this pumping station to a pile of debris, but I trust my point is clear. I am one android with a single weapon. There are hundreds of Sheliak on the way and their weapons are far more powerful. They may not offer you a target. They can obliterate you from orbit. You will die never having seen the faces of your killers. The choice is yours.

KENTOR: There are other places, other challenges.

(The security guards recover from their stuns)

GOSHEVEN: I really was willing to stay here and die for this.

DATA: I know that. This is just a thing, and things can be replaced. Lives cannot.

That approach worked. The colonists, including Gosheven, finally agreed to evacuate. So they lived.

Data is an android programmed for politeness and manners. He’s one of the kindest and gentlest characters on the show. He’s willing to accept and befriend everyone as they are, like an android version of Mister Rogers.

And of course Data is very rational, so he starts by greeting the colonists warmly and offering them a rational explanation about what’s happening and why they need to evacuate – a sensible place to begin.

When that doesn’t work, he appeals to their emotions since he knows something about human psychology too.

And when that doesn’t work, he pulls out his weapon but still uses the stun setting initially. Now having good reason to conclude that this too will be insufficient, he quickly bumps it to a higher setting and demonstrates at that level as well. And then he immediately threatens to bump it higher still, to a setting which would effectively destroy something the colonists have been trying to protect. Fortunately he doesn’t seriously hurt anyone, but he does keep escalating until he finally succeeds. Moreover, he accelerates the pacing of his escalations to match the increasing urgency of the situation.

This is a rational approach, isn’t it? For a mission that’s important enough, keep escalating until you succeed, even if you must stretch your character to do so. Data had to stretch his character to succeed in his mission, yet he was able to do so while still honoring his rational core.

And we must continue to do the same. When the stun setting is ineffective, ratchet up your efforts more to help get people off the streets and to stay the fuck home.

Is it rational to continue using the stun setting if it isn’t working quickly enough?

Is it rational to avoid stretching our characters due to fear of criticism or social pushback, knowing by sticking to our comfort zones and refusing to go any higher, we sentence more people to death – including more medical personnel who will soon give their lives trying to save others?

Or is it rational to ratchet up our actions towards the stun setting and beyond until we achieve what’s needed?

If you’ve been trying to help people behave more rationally during this time, yet they’re still behaving irrationally, ratchet up your efforts and attitude, just as Data had to do to accomplish his mission.

This isn’t the time to get stuck at your personal stun setting. This is the time to do what it takes to save more lives and reduce suffering because the actions you take now can and will make a difference.

And lastly…

CLOSE THE BEACH, YOU FUCKING IDIOTS!!!

#closethebeachyoufuckingidiots

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Simple Stretches You Should Be Doing While Working From Home

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Here’s The Difference Between Coronavirus And Covid-19

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Why Am I So Tired After A Big Sleep? A Quick Guide

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To My Influencer and Marketer Friends

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This is not remotely a “business as usual” situation. Please open your eyes to what’s happening. But more importantly, please open your heart to what’s about to happen.

This isn’t a time to be working on your launches. This isn’t a time to work on your campaigns. The focus on business needs to be put on hold right now.

We all have something much more important to work on right now. We have the leverage to greatly reduce a tremendous amount of suffering and loss of life that’s about to unfold. That this will happen is unfortunately inevitable, but we can absolutely have a meaningful impact in reducing it.

And if there are any marketing and influencing challenges that are worth the committed application of the very best of our skills, this is such a challenge.

The seriousness of our collective situation is going to intensify in the coming weeks – way more dramatically than it already has.

By the end of the month, many more hospitals across Europe and the USA will be where Northern Italy is – overwhelmed and with doctors and nurses dying from the disease too. Hospitals in the USA are already preparing for this by adding tents in parking lots. It’s a race against time, and we have much less time than most people realize. Seattle is already showing us a glimpse of what will soon hit many other cities.

This won’t simply blow over in a couple of weeks. We’re talking months, including the inevitability of 2+ months of full lockdown, which will almost certainly begin by the end of this month.

The best thing you can do now is share the critical importance of social distancing to reduce the spread of the disease, which has a long, silent incubation period. If you do that, you can save a lot of lives.

What if your launches and products are beneficial to people? Of course they are. But consider the opportunity cost of what you could be doing right now instead if you shift your focus into life-saving mode.

I can certainly claim that my work benefits people too, and it surely does, but I think I can be of greater service right now if I respond to the tremendous opportunity of taking direct action to help lower the disease progression in whatever way I can.

One way where I may be able to exert some leverage is to invite more people to join me in helping to get the word out about just how critical it is for all of us to shift gears right now. I’ve already been doing this behind the scenes for days, starting around February 26th. And that’s having some impact. But we still need to do more.

Every day that you work on your usual business instead of promoting the critical importance of social distancing is another day you could have saved lives and reduced suffering. Every day you delay is a missed opportunity for you to truly step up, not merely with personal ambition but with caring, compassion, and courage as well.

This is an extraordinary time for you to take your best expression of ambition and get it aligned with your best expression of caring. This is an invitation for us to collectively change the world in a way that really matters to a lot of people, especially those who will be hit hardest by this disease in the weeks and months ahead.

Where else are you going to encounter such an extraordinary opportunity to do the most meaningful work of your life?

Don’t worry about perfection. Speed of messaging is way more important than elegance right now. Just get the word out as fast as you can. Even if all you do is tell people to stay the fuck home or share the hashtag #staythefuckhome, that will help. Just start with one Tweet. Please.

Don’t worry about being judged or criticized for being an alarmist. By the end of the month, it will be obvious that you did the right thing. You’ll probably wish you’d acted sooner and more powerfully. I already feel that way now.

Please put normal business on hold. Please use your marketing and influencing skills to save lives right now. Every day counts.

It doesn’t matter how big your reach is. Even if you’re just starting a new YouTube channel and only have a few viewers, please get the word out. That’s just as honorable a deed as for those who may reach millions.

Once we’re on full lockdown and people are no longer still going out risking other people’s lives, then maybe it will be an okay time to think about business again. But there’s a good chance your priorities will shift too as the body count continues to rise. Will you still care about business in the same way when people you know start having breathing difficulties, and they’re scared to go to an overcrowded nearby hospital with an exhausted staff and no more beds or ventilators available?

It hurts my heart to see marketer friends brainstorming and pondering the money-making opportunities that may come from everyone being stuck at home, salivating over that captive audience. I can understand that mindset, but I can’t pretend it’s okay. I realize that I must personally do something about that… and encourage others to help us change course as well.

At this time it’s just not okay to be blogging and emailing and tweeting and advertising as if we’re still in business as usual. It’s downright wicked to do such things right now because you’re encouraging others to engage in denial about what’s happening. We need to do the opposite of that. We absolutely must be sounding the alarm to wake more people up to what’s happening. We must do our best to turn the ship of ignorance and denial towards saving lives and reducing suffering.

Years from now when you look back on these days, do you really think you’ll reflect upon how brilliant you were for capturing those extra sales while people were getting sick and dying? Will you feel proud of yourself for your pandemic launches and marketing campaigns?

If you promote stuff that comforts people, that’s great – but save it for later once we’re all under lockdown. Our priorities right now should be to get people to stop silently spreading the disease and to push towards full lockdown to the extent that we can influence that too.

It’s your business and your decision of course. Just please take a peak into your heart and see what it wants to do about this situation. If your current business activities still feel very aligned and if what I’m sharing here doesn’t change anything for you, that’s fine. You have nothing to defend.

While I normally feel very aligned with my business and it’s very flexible anyway, I’m stretching it to go where it needs to go right now in order to push it to be of more service than usual. I’m not willing to be haunted for the rest of my life by the knowledge that I could have tried harder to save lives and reduce suffering – and didn’t. Are you willing to go that route?

This is one of the most extreme times you’ll ever live through. Who do you want to be in this situation? A decade from now, how will you wish you’d responded?

For Everyone

If you see anyone doing “business as usual” posts, videos, promotions, launches, and ads that don’t seem to be helping with the current situation, please actively encourage – no, implore – them to stop immediately and shift gears to save lives and reduce suffering.

Immediately reply to their emails as soon as you receive them. Comment on their posts, videos, and ads right away. Call them out on their Facebook Lives and webinars. Tell them to please focus on saving lives instead of trying to do anything less important right now. Be gentle but please be firm too. And be brave.

Please don’t shame anyone. Please invite them to step up to serve a greater need.

Realize that if you can influence even one more marketer or influencer to help spread the word about practicing social distancing just one day earlier than they otherwise would, you’re saving lives too. You do that, and you’re my hero.

Here are some further resources to help, both for your own education and for further re-sharing:

  • Coronavirus stats – This page shows frequently updated virus stats for all countries, so you can see at a glance what’s happening. Also follow some of the links for deeper stats and data.
  • Stay the Fuck Home – This is a good page for referring people. It shows simple actions to be taken immediately and handle multiple translations for different languages.
  • Coronavirus: Why You Must Act Now – Tomas Pueyo’s powerfully persuasive piece with lots of math-based reasoning, charts, and graphs (more than 28M views in the past week). I’ve been sharing this one a lot and feel grateful for Tomas’ efforts.
  • Jason Warner’s Facebook post – A solid math-based post to help persuade people of the importance of changing behaviors immediately. Please reshare this on Facebook. I did, as did 119K other people so far.
  • Messages from Italy – This is a short YouTube video of Italians under lockdown sharing what they wished they’d known 10 days earlier.

Note that my blog posts are uncopyrighted and donated to the public domain. So you’re free to republish, translate, or modify them… no need to ask. Just get the word out that we need to change our behaviors immediately to save lives and reduce suffering.

Please care.

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This Will Not Be Over Quickly

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Italy provides a glimpse of what’s coming soon to the rest of Europe, the USA, and other parts of the world.

Here’s what’s happening in the Italian city of Parma:

The intensive care units are now all full. Hospital wards are spilling out into corridors, tents, car parks, gardens and commercial warehouses. We are hearing words – like “triage” – which are usually associated with warfare. Medics and nurses are having to make decisions on which patients to prioritise. Some doctors have died, and others have compared the numbers of admissions to dealing with “an earthquake every day”.

Source: The Guardian (Mar 15)

There are also reports of prison riots breaking out, including prisoners escaping and several prisoners being killed.

From that same piece:

What’s intriguing is that all the adjectives you might normally use to describe Italy (sociable, excitable, chaotic, undisciplined, polemical, fun and – despite all its troubles – somehow optimistic) have become redundant. It feels completely the opposite: isolated, calm, orderly, obedient, cowed, dour and pessimistic. It’s as if the country has suddenly discovered a different, maybe deeper, side. It’s a sterner, more serious place.

Meanwhile in Las Vegas:

Buffets are closing, nightclubs and day clubs are shuttering, conventions are cancelling and putting people out of jobs and resorts are using thermal cameras to screen guests for fevers – a symptom of the coronavirus causing grocery store calamity and self-imposed isolation across the globe.

Yet thousands of people are walking up and down the Las Vegas Strip.

They pick through Sin City t-shirts at Planet Hollywood. They pack the buffet at Bally’s, one of the few left open. They stand elbow-to-elbow at crosswalks.

They lean over the edge at the Fountains of Bellagio and wait for the music to begin.

Sitting near the food court in Planet Hollywood’s Miracle Mile Shops is 41-year-old Burt Harshman, a hulking construction worker from Kansas.

He’s been in town since Tuesday for CONEXPO-CON/AGG 2020 – one of the conventions that went on as planned despite coronavirus concerns.

“I think it’s stupid,” Harshman said of coronavirus fallout. “All of it.”

To his left is another construction guy named Mitch Evans, a 31-year-old worker also in town for the convention.

“You know how much money Las Vegas is losing because people are freaking out?” Evans asked.

“The whole country’s losing money,” Harshman said. “If we’re not tough enough to deal with a bug, society has gotten to be a bunch of pansies.”

Source: USA Today (Mar 14)

This week some of those people who were “partying through the apocalypse” on the Vegas Strip will start showing flu-like symptoms. Some will take the illness back home with them and infect more people. And more people will die as a result in the weeks and months ahead.

We know that the coronavirus is already on the Vegas Strip, as multiple infections have already been detected there, including among employees who’ve been working there.

Despite multiple calls not to do so, including from local unions, the Clark County School District still intends to keep all Vegas public schools open for classes as usual on Monday. That’s a mistake that will cost lives. Do not open the schools.

Of the 83,083 people worldwide who have “completed” their coronavirus infections so far, 6,485 (7.9%) completed it by dying rather than recovering. By the time you’re reading this, those numbers will have gone up.

The attitude that many Americans still exude is the same kind of attitude that Italians initially had when the virus outbreak began there. This attitude isn’t far removed from the attitude of the construction workers visiting Las Vegas.

This attitude isn’t courage or bravado. It isn’t optimism. It’s irrationality.

How well does irrationality work with a pandemic? It doesn’t.

The Italians know this all too well, and they’re trying to warn the rest of the world not to react as they initially did because each day that they delayed is now costing them more lives and more time under lockdown.

Yesterday 175 people died from the virus in Italy. Today their death toll is more than double that – 368 so far. More than 1800 people have died there in the past 3 weeks. And this will keep going up and up and up for a while longer.

So far we have over 3300 known cases in the USA, and we’re still severely under-testing. Italy added more than this many new cases (about 3600) just in the past 24 hours. It won’t be long before the USA is reporting that many new cases daily, and then we’ll blow right past that.

So far only 63 people have died from this virus in the USA. That seems like hardly anything, right? But it’s the exponential growth rate that we need to pay attention to. Two weeks ago (on March 1st), Italy had reported only 34 coronavirus deaths.

The U.S. population is about 5.5 times that of Italy. But in terms of the quality of our medical system, we actually lag behind theirs, so we’re even less prepared for this than they are.

The U.S. federal response to this virus has been underwhelming to say the least. More governors and mayors are expressing major frustration with federal agencies to get their acts together. The governor of my home state called the situation “infuriating.”

Here’s the current result of the recent travel restrictions from Europe and what the Mayor of Chicago thinks of it:


Soon the U.S. death toll will be in the hundreds, then the thousands, then the tens of thousands, and then the hundreds of thousands. The sooner we change our tune and listen to what Italy, China, and other parts of the world are trying to warn us about, the fewer casualties we’ll have at the tail end, and the less time we’ll all need to be in lockdown.

The USA is gradually figuring this out, albeit slowly. Those states and cities that are further along the infection curve are figuring this out sooner. New York City is already considering a lockdown.

If you encounter anyone who’s still saying that this is “just the flu” or “media hype” or any other B.S. like that, do what you can to educate them and persuade them to stretch towards rational behavior. Also do what you can to block or derail them from spreading further irrationality and getting more people killed. You’ll be saving lives.

Invest your energy where you can help turn the ship from incompetence to rationality as best you can. This is a situation where we must lean into action. Remind yourself that even if you get a bit of social blowback, you could actually be saving many lives by taking action even a few hours sooner.

This will not be over quickly. That’s the reality we must accept.

When we do go into lockdown, the time there will likely be measured in months. It’s unrealistic to assume that we’ll be through this in a couple of weeks and that things will be back to normal within a month. This situation will get way more serious for many weeks before it starts getting better. We need to surrender to spending this entire Spring very differently.

In the meantime do your part to get the word out that people need to Stay the Fuck Home.

Update: A few hours after I posted this, the Governor of Nevada announced that all schools are closed. Same goes for New York City. We’re making progress, but we need to go even faster.

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We Need to Align With What’s Coming Next

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We’ve seen a lot of changes in the world this week due to the coronavirus situation. I think what many people don’t yet realize is that the rate of change isn’t going to be linear. It’s going to accelerate.

Despite all the changes you’ve seen this week, next week’s changes will be bigger still… and the changes coming the week after that will be even bigger. So if your head is spinning now, it will spin twice as hard next week.

In the USA I see people making some adaptations, but they seem to be mentally making minimalist ones. By this I mean that they’re taking in what has occurred thus far, and they’re doing their best to make sense of it based on the events of the past few days. That isn’t going to be enough of an adaptation though. The mental models you’re most likely forming now will break within a week as the pace of change accelerates. You’re going to have to start thinking in terms of the bigger leaps that are coming.

This week in the USA we’ve seen lots of events being canceled. Disney’s parks are closed. Apple closed its U.S. stores. Other businesses will soon follow suit – in fact, most of them will. They just don’t realize it yet. If you’re still showing up at a job today, you probably won’t be by the end of the month.

The new fitness center that I joined in February sent an email earlier today, noting a reduced schedule starting on Monday as well as enhanced sanitization procedures between classes. This is a adaptation based on what’s already happened up to this point, but it’s not aligned with what’s about to happen next. I expect they’ll be closed by the end of the month, and I don’t think they see this yet.

I got a similar impression when I talked to my local guitar store to put my in-person lessons on hold till further notice. I told the employee that I talked to that I doubt the store will still be open two weeks from now. I don’t think he believed me.

These responses are understandable. People are basing their predictions on what they’ve just recently processed. They’re looking at what they see locally. But that isn’t where we should be looking to predict what the rest of this month will be like.

To date there are only 21 reported cases of coronavirus in the whole state of Nevada and zero deaths. The progression over the past several days has been something like 0, 1, 2, 4, 7, 11, 17, 21. It still looks small. But soon we’ll be in the hundreds, the thousands, and then the tens of thousands of infections. And unfortunately the deaths will follow.

The Mayor of Las Vegas has been furious at the media, as if it’s their fault for sabotaging the city, which of course depends heavily on tourism. She’s in an untenable position though, her job being akin to that of Baron Harkonnen in Dune – to keep the spice flowing at all costs. She must be under enormous pressure right now, and it’s only going to get worse for her in the days and weeks ahead.

The Vegas Strip is gradually becoming a ghost town, with so many events being canceled. Hotels are trying to adapt to what they think is the new and temporary reality. They’re closing buffets, restaurants, clubs, sports books, and shows… and offering major discounts for people still willing to book hotel rooms.

Given its huge reliance on tourism, Vegas is going to be hit way harder than most U.S. cities economically. People who work at the hotels and with the conventions can’t simply do their jobs from home, and now their work is drying up anyway. The layoffs on the Vegas Strip have already begun. The local economy is sure to crash and crash hard. That is inevitable at this point.

And yet the casinos are still trying to adapt. But by the end of the month, those adaptations aren’t really going to matter because the situation will be way beyond what it is now. They aren’t really going to have much choice other than surrendering to what’s unfolding.

As much as the stock market has been roller coastering this week, I expect it’s going to crash harder still, significantly lower than the lowest we’ve seen this week. You know who else thinks so? Michael Burry. You may remember him as the savvy hedge fund manager played by Christian Bale in the movie The Big Short – the guy who bet that the housing market would tank. He admits to presently wagering substantially against market indexes due to the unfolding coronavirus situation. Also consider that he’s not only an investor; he’s also a medical doctor. Although he doesn’t practice medicine, he’s kept his medical license active. He doesn’t believe that the “buy the dip” mentality (which causes rebounds) will endure what’s coming. I’m not invested in the stock market at all right now, but based on what I’m seeing, I think it’s going to be downhill for stocks even more.

Even people who are betting on Amazon Prime to pick up the slack should note that some are predicting that this service will come under heavy strain as more Amazon employees get sick and supply chains are further disrupted – and that it may not be as reliable as people expect. It still relies heavily on a large human workforce.

What about Netflix? Well, maybe that’s great for streaming from home, but also note that the company just announced that they’re halting production on all movies and series.

This situation affects us all. While many people are focusing on the economic fallout, we ought to look to saving lives first, especially since this is actionable at the individual level right now.

I know of one private school in Las Vegas that voluntarily closed this week, but the public schools here announced that they intend to remain open on Monday. Keeping the schools open will enable the infection to spread faster, and more deaths will result. It’s a big mistake.

To get a sense of what’s coming to the USA, we shouldn’t be looking around locally. We should be looking to parts of Europe that are a couple weeks ahead of us. Italy now has 21K+ reported cases and 1441 deaths, and the entire country has been on lockdown since Monday. Spain and France just announced that they’re following suit. And Ireland, Denmark, and the Netherlands are locked down as well.

The lockdowns are slightly different for each country, but they essentially mean that people must stay in their homes except for essential outings to get food or medicine. So grocery stores and pharmacies remain open, but schools, universities, hotels, retail stores, restaurants, bars, and non-essential businesses are shuttered.

Why is this being done at all? It’s to slow the rate of new infections.

The USA is lagging behind. Lockdowns seem extreme here still. I understand that impression. We must advance the story in our minds and hearts now though, not a week or two from now. Every day of delay means more infections and more deaths.

The main risk we face is that hospitals become overwhelmed by an increasingly rapid influx of new patients. That’s already happened in Northern Italy. Doctors there have to triage patients because there are too many critical ones to attend to. Meanwhile medical personnel themselves are getting sick too, even as they’re working to exhaustion to save lives. A few days ago, the President of the Medical Guild of Varese (a city in Northern Italy) died from respiratory failure due to coronavirus infection. More deaths of medical personnel will follow, which further strains an overstrained system.

Spain, France, Germany, and other parts of Europe are all about to enter similar phases, and the USA and UK won’t be far behind.

Some claim that the media are blowing this whole situation out of proportion. I think the opposite is true. As serious as this is now, it’s about to get a whole lot more serious. What you’re seeing reported in the media now will seem pretty tame a few weeks from now, and you may look back and wish they’d been louder and stronger in their voices.

We can’t just look at our local present realities to predict what’s coming. We must broaden our perspectives to pay attention to what’s happening elsewhere. And then we must continue to project forward still, not linearly but exponentially. I know this doesn’t come naturally. That doesn’t exempt us from the responsibility. Enough people are smart enough and observant enough to see what’s coming. We must sound the alarm, even at risk of being treated like Cassandra. This is too important not to do so.

The infections in many places are doubling roughly every week. In the beginning that seems small. It’s not a big deal to go from 10 to 20. It’s really going to look like a big deal when we’re going from 100K to 200K or from 1M to 2M in a week. We’re about to tax our medical system like never before.

It’s true that getting infected won’t be a big deal for most people health-wise. But this virus is way more deadly than the flu.

Of the 80K coronavirus cases that have ended so far, meaning that the people are no longer showing signs of infection, 93% concluded in recovery, and 7% concluded in death. And there are still 76K open cases that we know of… and still increasing rapidly each day.

But of course due to rampant under-testing, especially in the USA, the actual numbers are much higher, and they’re going to go much higher still. Many people are infected but aren’t symptomatic yet. Meanwhile they’re infecting others.

For people under 40, the mortality rate is about 0.2% (and virtually nil for children under 10). For people in their 40s like Rachelle and me, it’s double that (0.4%). For people in their 60s it’s 3.6%. For those in their 70s it’s 8%. And for those in the 80s or older, it’s 14.8%. So it’s a lot more dangerous for older people. It’s also significantly more dangerous for men than for women.

But these numbers depend heavily on whether people have access to good medical care. The risks go up substantially when hospitals get overloaded.

About 1 in 5 people who get infected will need to go to the hospital, and about 1 in 20 will need intensive care. On average, those who will die are averaging about 17 days from infection to death. Respiratory failure isn’t a pleasant way to go out (much like drowning).

The average person will infect 2.5 other people, and those people will infect more. So this isn’t just about you and your health and your personal risks. If you get infected, you’ll likely recover, and the experience will be much like having the flu, but there’s a good chance you’ll pass on the infection to other people, eventually contributing to a chain that sends people to the hospital and ends some people’s lives. Do you want to be responsible for that?

What we can do now is to take action to prevent becoming part of those chains. It’s too late to stop or fully prevent what’s coming because the infections have spread too far already, so there’s a sense of inevitability to what’s about to happen next. But we can still take personal action to slow it down. And we must in good conscience do that, starting immediately.

This means not going out unnecessarily and keeping in-person interactions to a minimum. As much as we may resist social distancing, we’ve got to do it, even before we feel it’s necessary. If it feels like you’re being too extreme, your timing is actually reasonable. The time to change your behavior is this very hour.

I know this isn’t pleasant, but get the picture in your mind of someone going through respiratory failure in a packed hospital hallway lined with critical patients who can’t get into the ICU. Imagine someone’s grandmother or grandfather painfully gasping for air, panicking and unable to even call for help as their lungs strain against the inevitable. No one is available to attend to them. No respirators are available. They’ve been triaged by an exhausted doctor or nurse, who’s also coughing while trying to save other people. Connect the dots between your actions and these consequences. Don’t languish in pretending.

If you don’t immediately remove yourself from this causal chain, you’re not just going to give some people the sniffles or a fever. You’re potentially going to snuff out some lives in a most painful way. You’ll be contributing to some serious misery.

Is this an over-the-top visualization? Is this extreme? No, this is what people are really dealing with in Italy right now. In Iran bodies are being dumped into mass graves visible from space. I wish this were a bad movie. But this is real. And we need to connect the dots between our actions and what we could very realistically cause and contribute to.

So many of us have been in denial of the causal chains of how our actions affect other lives. And here’s a huge wake-up call screaming at us to finally connect those dots.

Do you care? Does any of this make it through the objections of your mind?

I’m not willing to risk being the cause of someone else being unable to breathe. The very thought of that makes my own lungs tighten up, and I feel like I can barely breathe myself. Justifying some extra workouts at the fitness studio or squeezing in one more guitar lesson just isn’t rational. I cannot risk adding more bodies to those hospital hallways.

Rachelle and I are voluntarily isolating ourselves and have been doing so for several days already. We stopped going to the local fitness center earlier this week, and I canceled all in-person guitar lessons till further notice (my last lesson was a week ago). We canceled an in-person meetup with an out-of-town friend that we wanted to see this week as well. We’ll do our best to practice social distancing for as long as necessary.

I encourage and implore you to join us if COVID-19 has reached your city too, even if it seems extreme or early to take such actions.

Every day you continue going out is another day you could contribute to the chain of someone’s life being snuffed out early and most painfully. Regardless of what your local government is doing, we need to do what we can as individuals to slow this down.

The second thing you can do is to invite and encourage others to join you. I realize that many people will reject the idea and it may cause you some social strain to do this, but even if you only influence one extra person to take this step a day early, that can make a meaningful difference. Rachelle and I are doing this because other people made the effort to express the importance of this step, and for that I’m grateful.

It will be a challenge to get through this. It’s going to be a very different year than you were likely expecting. But this is what life is offering as our challenge for now. Think carefully about how you’d like to express your character during these difficult times, as you’re going to carry the memories of those decisions for the rest of your days.

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‘It’s Robbed Me Of A Wonderful Time’: We’re Heavily Pregnant In The Coronavirus Pandemic

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