Tag: <span>Pandemic</span>

Pandemic: The End of the Beginning

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When people in the US think of World War II, they think of Pearl Harbor, or Normandy or Hiroshima. What most people don’t realize is that the war had been already going on for two years when Pearl Harbor happened. During that time, the UK stood alone against Germany, and the situation looked grim. Even once the US had entered the war things still mostly went badly for them. They were just barely holding their own in North Africa against Rommel, and on the other side of the world there was the disastrous fall of Singapore. But finally nearly a year after the US had entered the war, and three years after it had started, the British finally got their first decisive win at the 2nd Battle of El Alamein. (AL-a-main)

Shortly after this victory Churchill was giving a speech, and in reference to this battle and the turning point it represented he said:

Now this is not the end. It is not even the beginning of the end. but it is, perhaps, the end of the beginning.

I bring this quote up because it feels like a decent description of where we are with COVID. It is not the end, or even the beginning of the end, but I think once the omicron surge passes that it will, perhaps, be the end of the beginning. As a consequence I thought it might be time to do a post about the beginning of the pandemic, both because I think we’re at the end of that beginning, but also because it’s an opportunity bring together some insights about the pandemic I recently gleaned from three books:

Nightmare Scenario by: Yasmeen Abutaleb and Damian Paletta

Premonition by: Michael Lewis

Viral by: Matt Ridley and Alina Chan

But first, before I forget, back on the 8th I made a prediction about when omicron would peak. I said that it would peak on the 15th, at around 2,500 new daily cases per million people. So how’d I do? 

It did in fact peak on the 15th at 2,409 cases per million. How’s that for an accurate prediction? 

Hopefully now that I’ve verified my expertise you’re ready to listen to me on all the other things I have to say about COVID. Speaking of other things, I obviously can’t cover everything from three books, or even everything I think is important and interesting. Instead I’ve picked five subjects where I think I have something important and interesting to add. Let’s get started with:

I- Schools

With the latest surge there was a lot of pushback from teachers unions, and even students on the fact that schools were not closing this time around. But it wasn’t just right wing governors that refused to close schools, Biden and democratic politicians were also emphatic that schools should remain open. 

For my own part I think going back to remote learning for a week during the very peak of omicron (which, as you may remember, I called) is fine, particularly if it’s a staffing issue rather than overactive risk management. The big question we’re grappling with now is not whether we should continue doing it, but whether we should have ever done it. Increasingly the answer seems to be that, outside of those first few weeks when information was scarce, it was always a mistake, and a huge mistake at that.

Recently shots were fired on this subject by Nate Silver, the noted statistician, who tweeted:

Suppose you think that school closures were a disastrous, invasion-of-Iraq magnitude (or perhaps greater) policy decision. Shouldn’t that merit some further reflection?

He later clarified that this was not merely a hypothetical, he did in fact think it was a mistake on the magnitude of invading Iraq. As you can imagine responses were all over the map, but I think Jonathan Haidt’s summation of the situation was on the money:

It is now indisputable, and almost undisputed, that the year and a quarter of virtual school imposed devastating consequences on the students who endured it. Studies have found that virtual school left students nearly half a year behind pace… learning loss falling disproportionately on low-income, Latino, and Black students…a million students functionally dropped out of school…caused a mental health “state of emergency,” according to the American Academy of Pediatrics. The damage…will be irrecoverable.

 

It is nearly as clear that these measures did little to contain the pandemic… 

 

By the tail end of spring 2020, it was becoming reasonably clear both that remote education was failing badly and that schools could be reopened safely.

 

What happened next was truly disturbing: The left by and large rejected this evidence. Progressives were instead carried along by two predominant impulses. One was a zero-COVID policy that refused to weigh the trade-off of any measure that could even plausibly claim to suppress the pandemic. The other was deference to teachers unions…

 

It is always easier to diagnose these pathologies when they are taking place on the other side. You’ve probably seen the raft of papers showing how vaccine uptake correlates with Democratic voting and COVID deaths correlate with Republican voting. Perhaps you have marveled at the spectacle of Republican elites actively harming their own audience. But the same thing Fox News hosts were doing to their elderly supporters, progressive activists were doing to their side’s young ones.

For me it mostly boils down to that last bit. If we’re faced with the horrible task of apportioning harm, and unfortunately we are. Then it seems logical to not apportion a greater share of it to the young. And not only is it logical, but viscerally I, and I think most people, recoil from the idea of sacrificing the boundless potential of the young for the limited potential of the old. (Which is harsh to say but ultimately true.)

So how did we end up doing just that?

Here’s where I can add something to the discussion, to do that I need to take you back to 2005. President Bush had just read The Great Influenza by John M. Barry about the Spanish Flu and decided the government needed to pursue pandemic preparedness. This was the first big effort taken by the federal government and they had to develop a lot of stuff from scratch. One of the things they lacked was a good model. The Premonition has a whole cute story about how the best model was developed by a child for a science fair project, which only starts to make sense when you realize her dad worked at Sandia National Labs. I don’t have the space to go into that story, the key point is once they started messing with this model they realized that they could significantly reduce transmission through non-pharmaceutical measures. This was the birth of social distancing. And if distance mattered for transmission, then the first places the model said you needed to shut down were schools. Nobody gets packed in tighter than school children.

I’m not sure how much this model drove school closures in the early days of the pandemic. I assume it had to have had some impact, but I don’t remember it ever getting mentioned. And of course even if the model was used to make this decision, it should have been updated as more information came in. Which is to say even if the model was used to justify closing schools I don’t think it could be used to justify keeping them closed.

As one final point as long as we’re on the subject of what sort of things were recommended in the years before the pandemic. When the group President Bush put together went to the CDC and recommended closing down things as per the model the CDC pushed back and said it would never work, people wouldn’t tolerate it. And to a certain extent that’s exactly what we’re seeing. Also the period the group recommended for shutting things down was relatively short. Which is also something we haven’t exactly done (particularly with schools).

II- Republicans vs. Democrats

I’m already a third of the way through the expected length of this post and I’ve only covered 1 of the 5 items on my list. I guess I’ll need to exercise more brevity going forward.

Like so many things COVID became a tribal issue with the blue tribe on the left and the red tribe on the right. And members of each tribe want to know that their tribe was the righteous one, while the other tribe was the wicked one.

Nightmare Scenario was written with the goal of proving that the Republicans, and particularly Trump were the wicked ones. Having also read Premonition as well as countless blog posts and tweets, I think this fixation blinded the authors of Scenario to the even greater failings of the FDA and CDC, institutions which are supposed to be the ones preparing for and dealing with emergencies like this. Which is to say while it would have been nice to have a President who’s great at handling a global pandemic, it shouldn’t be too surprising when we don’t. The president has countless jobs, the CDC only has a couple and the most important of those is handling a global pandemic, and on this count they were abject failures.

This discussion of tribalism and the CDC takes us to the story of Charity Dean, one of the three stars of The Premonition. In the years leading up to the pandemic, Charity was a public health official, a very talented and dedicated one, exactly the kind of person you wanted in charge during a pandemic. The book relates numerous stories about her, but two are germane here.

First, in the months immediately before the pandemic Charity had risen to be the number two  person in the state of California for public health, and when the top position, Director of the California Department of Public Health, opened up in 2019, Charity assumed she would be appointed. She was not, and she discovered later that as a white woman with blond hair she wasn’t even in the running, despite being the number two person. Instead Dr. Sonia Angell was given the job. Her primary qualification appeared to be the fact that she was Latina. In other words it was an affirmative action hire. Had it been a successful example of affirmative action, raising someone with the necessary skills who had previously been overlooked, then we wouldn’t be talking about Dr. Angell, but that was not the case. Lewis described her as being “monstrously incompetent”, so much so that she ended up abruptly resigning in August of 2020.

Republican ideology gave us Trump, and he obviously made some big mistakes (more on that later) but the presidency is not our primary line of defense. The public health bureaucracy is, and Democratic ideology undermined that, and not merely in the case of Dr. Angell. I think one of the biggest hits the public health authorities took was when they backpedaled all their guidance on gatherings when people started to protest in the wake of George Floyd’s murder.

The second reason I wanted to bring up Charity Dean was to highlight her views on the CDC, since you might need further convincing. Lewis describes how Dean, through her connection with other characters in the book, was finally given the opportunity to put together a plan for how to deal with the pandemic. Someone, in an effort to help, added a small role for the CDC in her plan. Charity wrote back:

No…The single most important part of this plan is IT IS NOT RUN BY THE CDC… The entity/agency/figurehead leading this must be a Churchill not a Chamberlain.”

III- The FDA and CDC

So what made the FDA and CDC so bad? What did they do that they shouldn’t have and what should they have done that they didn’t? 

To explain that I’ll first need to take you on a brief aside. Back in 2014 Scott Alexander of Slate Star Codex decided to take on the effects of marijuana legalization, in a post titled, Marijuana Much More Than You Wanted to Know. As is usual with his “Much More Than You Wanted to Know” posts he went really deep, looking at the issue from every angle you could imagine. But despite pot affecting everything from IQ to organized crime, one consideration overwhelmed everything else: traffic fatalities. Does pot increase the number of traffic fatalities because more people drive under the influence? Or does it decrease the number of traffic fatalities because people substitute pot for alcohol and while driving under the influence of pot is bad, it’s vastly better than driving drunk? In the final analysis death is so bad, and traffic fatalities are such a big cause of death that even changing it by a tiny percentage one way or the other overwhelms every other consequence the legalization of marijuana has on society.

This is the position the FDA and CDC were in. They probably did a lot of things right. There are probably many criticisms which are unjustified. But in the final analysis the consequences of the few bad things they did were so bad they overwhelmed all the rest.

The reason these things were so bad is that when you’re talking about exponential growth, what happens at the very beginning of that curve has a far more dramatic impact than anything that happens later on, after the curve is established. I’ve seen evidence that they did lots of things wrong at pivotal points where speed was essential, but here are the two biggest examples in my opinion, one from each agency:

For the CDC it was obviously creating the initial test. If you haven’t heard this story Buzzfeed actually has a great investigative piece on it. But basically they refused to rely on tests that had already been created in other countries, they refused to let private companies market tests they had developed, the supply of their test was horribly limited and to top it all off it didn’t work! Certainly even with good testing there was no way for the US to avoid the pandemic, but we seeded it far more deeply and more broadly than necessary because in the very earliest days we couldn’t test for it.

For the FDA it was the vaccine, and in some respects this is less forgivable. The CDC might plausibly claim that, early on, it wasn’t really clear how important the test was going to be, the FDA had no such excuse when it came to the vaccine, everyone knew exactly how important it was. And yet the FDA’s Vaccine Advisory Committee seemed almost leisurely in their approval approach. The vaccine was ready for approval by November 20th, but they didn’t meet until December 10th, nearly three weeks later. What possible reason could there be for not meeting on November 21st or the evening of November 20th? 

As I said, I think these are the biggest mistakes, but they are by no means the only mistakes made by the FDA and CDC. In fact when it comes to the vaccines there may be an even bigger scandal, but for discussing that, let’s turn to: 

IV- Trump and the Vaccine

The same thing I said about the CDC and the FDA could be applied in reverse to Trump, and his team. However many mistakes they may have made, in the final analysis, the speed of vaccine development was going to be the measurement that mattered the most. And in this respect everyone basically agrees that Operation Warp Speed did an amazing job. The obvious objection for those not inclined to give Trump any credit is that he played only a very small part in the operation. That’s a fair point, but in considering it we should remember what Kennedy said after the Bay of Pigs, “Victory has 100 fathers while defeat is an orphan.” Lots of people now want to take credit for starting or managing or having the idea for Operation Warp Speed, but if it had failed everyone would have blamed Trump. This being the case, should he not therefore get some of the credit?

Even Nightmare Scenario which was written specifically to savage Trump, admitted that this sort of “hail mary” approach was something the Trump administration was actually pretty good at. The book’s chief criticism of such efforts was not that they were ineffective, but rather that by routing around the normal procurement process, such efforts wasted money. This complaint about the government wasting money made me laugh, a lot.  Other more serious criticisms include duplication and a lack of focus, and there was certainly a lot of that, but in the end we got the vaccine months and months sooner than anyone thought possible. Though we could have gotten it even sooner and therein lies the potential scandal. 

There’s lots of evidence of people working to move the announcement of a successful vaccine from October to November, enough that the fact of it happening really isn’t in question, what’s in question is why?

The most benign explanation is these people were worried about anti-vaxxers and vaccine hesitancy, and they wanted to make sure the safety data was ironclad. 

However, lots of people (including the aforementioned Nate Silver) find the timing to be very suspicious. The fact that moving it from October to November happened to move it from before the election to after the election makes it look like it was largely motivated by a chance to hurt Trump’s reelection efforts.

Other people don’t care about the motivation, they just think that it was a bad trade off, that the delay was never going to have that much of an impact on vaccine hesitancy and anti-vaxxers, but it was always going to have a huge effect on the number of people who died. Who cares what the motivation was, the decision to delay ended up killing thousands of people.

The problem with much of the discussion is that it ends up being broken into a binary. Either it was totally reasonable for the FDA to wait 60 days to see about side effects or it was monstrous and politically motivated. And what’s lacking in both the current discussion and the toolkit of bureaucratic capabilities is any capacity for nuance. Could we have authorized it for high risk old people in October? People who felt that the protection from not dying was worth the potential that there might be unknown side effects?

V- The True Beginnings of the Pandemic 

Here we arrive at the ultimate example of the “traffic fatality effect”. Despite everything that has been said so far, when it comes to the pandemic all other considerations are secondary to the question of where the virus came from, because if it didn’t happen in the first place every other issue is moot. Thus far I have mostly drawn from The Premonition and Nightmare Scenario. This section is going to draw almost entirely from Viral. With a few other quotes here and there. Speaking of which, here’s Matthew Yglesias to start us off with a quote saying essentially the same thing:

I’m not saying it was definitely a lab leak. I’m saying that answering that question is one of the most important tasks of the post-mortem, and anyone who says it definitely wasn’t a lab leak is not trying to answer it they’re engaged in the culture war.

Before we get to a discussion of the actual evidence, this is a perfect example of what I talk about over and over again in this space. You might think that in a situation where something only has a 5% chance of happening that you should act as if it won’t or if it didn’t. But my argument has always been if the consequences of it happening are bad enough, you should act as if it will or that it did. Applying this the lab leak hypothesis they should have never been conducting coronavirus research in a biosafety level 2 lab (4 is the highest) and going forward we should probably stop such research all together, certainly anything that involves gain of function. But that’s precisely what we’re NOT doing. To quote from Yglesias again:

By contrast, on something like Covid-19’s origins, we’ve had a decent amount of coverage of the lab leak controversy but essentially no coverage of what is being done to prevent future lab leaks (basically nothing) or to prevent future zoonotic crossover events (again, nothing). But the reason these are our two contenders is that as far as we know, these are the routes through which new viruses emerge…either way, we’re not doing anything to counter either route for transmission, and that (shocking! alarming! insane!) fact gets way less attention than the latest round of “who’s yelling at whom about masks?”

We should be taking all of these measures even if the chance is only 5%, but having read Viral I would argue that the chance is far higher than 5%. In fact it might be the inverse of that, I might put the odds at 95% lab leak, 5% zoonotic origin. I’m sure you’re interested in the evidence backing up that assertion. As this post is already running long I’m going to steal Scott Aaronson’s list, and briefly offer my own commentary. And if you’re interested in going deeper you should read his whole review. But this is his list of things Viral proved beyond reasonable doubt, a list I entirely agree with:

Virologists, including at Shi Zhengli’s group at Wuhan Institute of Virology (WIV) and at Peter Daszak’s EcoHealth Alliance, were engaged in unbelievably risky work. 

This gets to the point I was making previously. We were already taking risks we shouldn’t have been. Lab leaks happen all the time, and rather than focusing on the huge negative black swan of potentially creating and releasing a viral pandemic, they were focused on the small gains of having a better viral database. The claim was it would help us fight future pandemics, but:

Even if it didn’t cause the pandemic, the massive effort to collect and enhance bat coronaviruses now appears to have been of dubious value. It did not lead to… useful treatments, vaccines, or mitigation measures, all of which came from other sources.

Another point I make all the time, the benefits of technology are almost always oversold while the potential harms are generally entirely invisible. Particularly once we have done all the obviously beneficial things (modern sanitation) and we’re moving on to things of more dubious value (harvesting exotic viruses and studying them).

There are multiple routes by which SARS-CoV2, or its progenitor, could’ve made its way, otherwise undetected, from the remote bat caves of Yunnan province or some other southern location to the city of Wuhan a thousand miles away, as it has to do in any plausible origin theory. Having said that, the regular Yunnan→Wuhan traffic in scientific samples of precisely these kinds of viruses, sustained over a decade, does stand out a bit! On the infamous coincidence of the pandemic starting practically next door to the world’s center for studying SARS-like coronaviruses, rather than near where the horseshoe bats live in the wild, Chan and Ridley memorably quote Humphrey Bogart’s line from Casablanca: “Of all the gin joints in all the towns in all the world, she walks into mine.”

I had to quote this point in full. It really elegantly encapsulates the whole argument. And what about the wet market?

The seafood market was probably “just” an early superspreader site, rather than the site of the original spillover event. No bats or pangolins at all, and relatively few mammals of any kind, appear to have been sold at that market, and no sign of SARS-CoV2 was ever found in any of the animals despite searching.

My sense is that those who hold on to the zoonotic origin idea, imagine that the wet market was this crazy lawless area where anything could have happened. Actually it was closely monitored, and because of other diseases they were carefully tracking what was sold and when, and as Aaronsson says, none of the potential carriers were even sold at that market.

Most remarkably, Shi and Daszak have increasingly stonewalled, refusing to answer 100% reasonable questions from fellow virologists… They’ve refused to make available a key database of all the viruses WIV had collected, which WIV inexplicably took offline in September 2019. 

If that database had been taken offline in November of 2019, this would be the smoking gun, but even September seems very, very strange. But of course the most inexplicable thing is why it has never been made available since the pandemic started. The whole point of the database was to assist people in fighting pandemics, and when an actual pandemic comes along it’s permanently made unavailable. The list of other strange oversights and evasions is nearly as baffling. And of course on top of it all:

The Chinese regime has been every bit as obstructionist as you might expect: destroying samples, blocking credible investigations, censoring researchers, and preventing journalists from accessing the Mojiang mine.

Sometimes people imagine coverups where there probably aren’t any. Or there is a coverup, but they’re covering for something different than what you imagine. Consequently I try to be somewhat skeptical when an organization or a person is accused of acting in bad faith. The world is complicated, and incompetence is ubiquitious, but for this particular issue there are so many obvious good faiths steps would could be taken but haven’t been:

  • WIV could restore access to the database.
  • China could allow an international team to investigate the cave.
  • Daszak could confirm and explain facts that are already out there.
  • They could stop any remotely dangerous viral research now that it’s been shown that it may have caused significant harm, and it didn’t provide any significant help.

Of course this lack of good faith engagement illustrates the entire problem, not just with finding the actual source of the pandemic, but with everything about the pandemic, and indeed everything about the modern world. We have turned everything into tribal warfare, and the only thing that’s important is that our tribe wins.


Speaking of fracturing into tribes, sometimes I feel like Treebeard, from the Lord of the Rings, when he was asked by Pippin whose side he was on, “Side? I am on nobody’s side, because nobody is on my side…” If you’d like to be on my side with things like the pandemic, and the fragility of modernity more broadly. Consider donating


The 8 Books I Finished in November (And the One Series I Decided Not to Finish)

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  1. The Deep Places: A Memoir of Illness and Discovery by: Ross Douthat
  2. Nightmare Scenario: Inside the Trump Administration’s Response to the Pandemic That Changed History by: Yasmeen Abutaleb and Damien Paletta
  3. The Premonition: A Pandemic Story by: Michael Lewis
  4. Morning Star by: Pierce Brown
  5. Star Trek: The City on the Edge of Forever Teleplay by: Harlan Ellison
  6. The Economics of Violence by: Gary M. M. Shiffman
  7. The Hobbit, or There and Back Again by: J. R. R. Tolkien
  8. Chorazin: (The Weird of Hali #1) by: John Michael Greer
  9. The Great Game: The Struggle for Empire in Central Asia by: Peter Hopkirk

I’ve always been a big fan of November. I’m a big fan of fall in general, and November has the start of the holidays going for it as well. Along the way, at some point in the month, one nearly always gets a spell of Indian summer, where the temperature is perfect and the leaves are still pretty. 

It was particularly nice to be somewhat back to normal in terms of family gatherings. Last Thanksgiving our big family gathering was cancelled and so I took my immediate family to a restaurant. (I’m not saying that option was necessarily safer, it’s just the option we took.) 

Writing wise I’m trying to prioritize working on my book as the first writing I do every day, which made the essays drag out a little bit, so I’m still trying to strike a balance there. But hopefully I’m dialing it in. 

Finally, since by the next time this section rolls around it will already have passed. I guess this is the time to wish everyone a Merry Christmas and a Happy New Year!


I- Eschatological Reviews

The Deep Places: A Memoir of Illness and Discovery 

by: Ross Douthat

224 Pages

Briefly, what was this book about?

Epistemology in an age of unlimited information and experimentation. 

I suppose, if you want to split hairs, the story of Douthat’s battle with chronic lyme disease (CLD) also features prominently, but mostly it’s about epistemology.

Who should read this book?

It’s possible that over the two and a half years I’ve been publishing my reviews, that I have been too liberal with my “everyone” designation. As in:

“Who should read this book?”

“Everyone.”

I will be more parsimonious going forward, because I want “everyone” to mean something. Particularly now, because I really do think that everyone should read this book.

General Thoughts

After that intro the first question you might have is “Why?” “Why should everyone read this book?” Well to begin with Douthat is a great writer, and even Freddie deBoer, who was critical of the book, acknowledges that:

The Deep Places tasks us with becoming intimately familiar with Douthat’s body and mind, and succeeds in that way that is unique to reading. The book depends on that willingness to inhabit Douthat’s life, including its most private spaces, a profound change of pace even from his memoiristic first book. If he had failed to draw his readers in, if he hadn’t successfully opened up his self to be picked over by strangers, the book would have failed completely. At that first prerequisite task he’s succeeded, to the degree that it’s hard for me to imagine someone reading this book and not wanting desperately to alleviate Douthat’s pain. This is all the more impressive given the degree of difficult[y] here; it’s a book that requires a leap of faith. The size of that leap will depend on your priors.

If even someone critical of the book describes it as immersive and impressive, then hopefully you can start to see why I’m saying that everyone should read it. But it’s that last part, the “leap of faith”, the part that deBoer takes issue with, which is where the book goes from immersive and impressive to important

As you may, or may not have already guessed, it’s in the existence of CLD where deBoer and much of the medical world argue that faith is required. Faith, because there’s no proof. Or as Wikipedia says:

Chronic Lyme disease is the name used by some people with “a broad array of illnesses or symptom complexes for which there is no reproducible or convincing scientific evidence of any relationship to Borrelia burgdorferi infection” to describe their condition and their beliefs about its cause. Both the label and the belief that these people’s symptoms are caused by this particular infection are generally rejected by medical professionals, and the promotion of chronic Lyme disease is an example of health fraud… 

Despite numerous studies, there is no evidence that symptoms associated with CLD are caused by any persistent infection…

A number of alternative health products are promoted for chronic Lyme disease, of which possibly the most controversial and harmful is long-term antibiotic therapy, particularly intravenous antibiotics. Recognised authorities advise against long-term antibiotic treatment for Lyme disease, even where some symptoms persist post-treatment. Following disciplinary proceedings by state medical licensing boards in the United States, a subculture of “Lyme literate” physicians has successfully lobbied for specific legal protections, exempting them from the standard of care and Infectious Diseases Society of America treatment guidelines. Such legislation has been criticised as an example of “legislative alchemy”, the process whereby pseudomedicine is legislated into practice.

In the book Douthat argues against all of that. That he did have CLD and it was because he was still infected. That the studies are wrong, and that it was only after massive experimentation with antibiotics, intravenous and otherwise, that he finally started feeling better. And all of this was only possible because of the existence of “Lyme literate” physicians. 

(I’m not sure if Douthat still thinks he’s infected, or if he thinks his CLD has moved on to being “post-treatment Lyme disease syndrome”.)

So who do we believe, the “recognized authorities” or Douthat? Well even Douthat initially wanted to believe the “recognized authorities” and that’s part of what makes the book so compelling. The way it demonstrates the journey of someone who desperately wants to believe the recognized authorities, but the longer things go the worse their advice gets and the more attractive the fringe becomes.

He starts off in the exact opposite position as someone who actively rejects fringe thinking and really wants to “follow the science”. So when the doctors in DC tell him he doesn’t have Lyme disease, he believes them, and really tries to come to terms with a world where his bizarre array of incredibly serious symptoms are all just psychological. But treating it from this angle is singularly ineffective, and things continue to get worse. But then, he moves to the Northeast where Lyme disease is endemic, even “by the book” doctors tell him, “Oh, you obviously have Lyme disease.” At this point should he follow the DC science or the Northeastern science? Presumably the latter because they have more data, right? Does this trend continue towards believing people on the internet who’ve actually cured CLD? No? Why not? Where do we draw the line?

Answering this question of how to conduct science when you’re the subject, is the entire point of the book, and why I think it’s a book about epistemology. Douthat’s process is important enough and interesting enough that I’m going to include a very long quote from the man himself.

The first, an infectious disease specialist in New York City, had an avuncular, reassuring manner. Yes, he said, I probably had Lyme — my symptoms fit, the blood tests missed lots of cases, he saw people like me all the time. But no, I didn’t need to worry that much about the disastrous chronic cases I was now reading about on the internet. Yes, some Lyme cases took more than a few weeks to clear, and he usually prescribed antibiotics for a little longer than the official guidelines. But that would be enough, he promised: I would be much, much better by the holidays, and well within a year.

The second doctor had a wood-paneled office one town over from our new Connecticut house, more like a den than a clinic, and books and pamphlets littering the waiting room, each seeming to offer a different theory on how one might treat an entrenched case of Lyme. He talked to me for 90 minutes, took copious notes, asked a thousand questions, and informed me that chronic Lyme was an epidemic, wildly underdiagnosed and totally mistreated. Could he get me better? Probably, but I was obviously very sick, and it would take a while. Most of his patients took high doses of antibiotics for around a year; I might need more; some needed years and years of treatment.

The first doctor reassured me; the second doctor frightened me. So I chose to believe the first one, to trust his version of the science, and for months I followed his prescriptions — while also seeing doctors who told me that even his approach was too aggressive, that if I had Lyme disease at one point I no longer did, and that I should stop the antibiotics altogether and wait for my body to recover on its own.

But the body’s experiences are their own form of empirical reality, and as a patient you can’t follow a scientific theory that doesn’t succeed in practice. And in the end the reassuring doctor’s theories didn’t work — I didn’t get better on his steady dose of antibiotics, the constant pain didn’t go away — while the advice to go off antibiotics entirely led to disasters, where I stopped the drugs and disintegrated quickly.

So I went back to the doctor who frightened me, feeling that otherwise I could be sick forever, sick until I died. And the rest of the story unfolded, over a very long period of time, roughly as the dissenting faction of Lyme doctors would have predicted.

…after about a year of trying different combinations of antibiotics and extremely high doses, I finally found a cocktail that first made my symptoms more predictable, and then enabled me to begin slowly gaining ground, month upon month and year upon year — in a process that has taken me from almost-constant pain to something approaching normal life and health.

So that dissenting doctor — and others like him, and many researchers doing work on Lyme disease treatments outside the official line — saved my life. But I also saved my own life, because I was the only one who could actually tell what treatments made a difference.

So what is one to make of all this? DeBoer reads the whole book (which is full of much more stuff than could be included in the quote) and ends his review by pointing out the ways in which the book “triumphs”, but then immediately follows that declaration with this final paragraph:

But I still don’t believe in chronic Lyme. And I wish I could say I was sorry.

I ended up reading deBoer’s review before I read the actual book, and after reading the actual book I was stunned by this assertion. And it raises a host of questions in my mind:

  • When he says he doesn’t believe, what’s his certainty level? 51%? 100%? Did reading the book move the needle at all? If so, by how much?
  • How does deBoer feel about other diseases on the fringes? Does he just have a beef with CLD? What about chronic fatigue syndrome (CFS)? How does he feel about people who think CLD may be misdiagnosed CFS? 
  • How much of his dismissal is tied into Douthat’s Catholicism? Which is to say his belief in other non-scientific phenomena? (I’ll have just a little bit more to say about this in the religious section at the end.)
  • Finally, and most importantly, what does deBoer imagine he would do if he were in Douthat’s shoes? If he had the same symptoms and those symptoms all responded in the same way to the same things? Would he still not believe in CLD? Or does he imagine that it couldn’t happen to him? (Perhaps because of the aforementioned religiosity?)

The problem with that, is it’s already happening to all of us. Which takes me to:

Eschatological Implications

I don’t have the space to go into why it happened, and in any case I’ve touched on those subjects elsewhere—the history of the internet, and conspiracy theories and the various ideological camps, each seemingly possessed of their own fringe ideas. But somehow we’ve all ended up suffering from the same epistemological chaos as Douthat. Most (though not all) are fortunate enough that it doesn’t affect their health and doesn’t leave them in constant pain. For most people it’s ideological and evidentiary chaos. A million voices screaming at them all the time that this thing is important, no this other thing is important. With very little way to make sense of it except by doing their own crude experiments, following their gut, and choosing which flavor of the fringe they find most palatable.

Yes, there are still authorities, but beyond the obvious fact that their authority has been diminishing for years, it’s also much harder to be an authority, as knowledge, opinions and innuendo have proliferated, seemingly exponentially. And so, like Douthat we are left to construct our own authority on those issues we care most deeply about. In this effort, it’s clear that we’re not all that good at it, but that also it doesn’t take much to be better than the experts. Or, to put it another way, is there really any greater authority on Douthat’s condition than Douthat? Before the internet, sure? Afterwards, no way.

I don’t know what this atomization of authority means for the future of our society. But I do know that it’s happening, and that Douthat’s is the best book I’ve seen for describing what that atomization feels like from the inside.


II- Capsule Reviews

Nightmare Scenario: Inside the Trump Administration’s Response to the Pandemic That Changed History 

by: Yasmeen Abutaleb and Damien Paletta

496 Pages

Briefly, what is this book about?

The Trump administration’s handling of the COVID-19 pandemic.

Who should read this book?

I read two books about the pandemic last month. Of those two I would recommend reading Michael Lewis’ (see my next review) before reading this one. But if you have already decided that Trump is THE bad guy and you just want that decision to be confirmed, you will probably really enjoy this book.

General Thoughts

It is my eventual intention to take this book and the next book, plus a third book which I have yet to read and pull all of them together into a post mortem on the initial handling of the pandemic, along with what I believe are some long term lessons we should take from things.

Until that point, the key thing to know about this book is that it’s not a book about the pandemic, it’s a book about what Trump did during the pandemic. As an example of what I mean, when the book gets to the point in the narrative when BLM protests erupt in the wake of George Floyd’s killing the authors spend three pages talking about Trumps march to St. John’s Church and only a paragraph discussing whether the large gatherings might contribute to the spread of the virus. The former had nothing to do with the pandemic while the latter represented one of the biggest questions of the whole period. 

Not only is the book focused on Trump, it has clearly taken sides as well. The very first thing it does is introduce Trump as the bad guy while introducing Fauci as the good guy. 

Despite what I feel are its evident biases, I do think that the insider account of how the pandemic was handled at the highest levels is very interesting and useful, but unfortunately the biases mean that it’s also very narrow.


The Premonition: A Pandemic Story 

by: Michael Lewis

320 Pages

Briefly, what is this book about?

Modern attempts to prepare for pandemics going back to George W. Bush, and how this preparation played out when we actually had a pandemic. 

Who should read this book?

At this point I’ve only read one other book about that pandemic, which is not surprising, the story is still ongoing. But out of those two I would definitely recommend this one. But it’s also entirely possible that the real definitive work is yet to be published. 

General Thoughts

Lewis is a great writer, and this is a very enjoyable book. As I already said I’m going to wait to really dig into it in a separate post. But I guess it’s worth comparing this book to the previous book. In this book the Trump administration is something of a villain, but it’s not the villain, nor is it all directed at Trump either. Also one gets the impression from Lewis’ book that there were a lot of moving parts, and that it’s really difficult to isolate which ones could have saved us and which ones really hurt us. Which is to say Lewis’ is definitely the more nuanced of the two.

Perhaps the best way to compare the two books, though certainly not 100% accurate, is that Lewis is promoting the Mistake Theory version of the story. While Abutaleb and Paletta seem to be promoting more of the Conflict Theory version.


Morning Star

by: Pierce Brown

544 Pages

Briefly, what is this book about?

The concluding events of the initial Red Rising trilogy, where the Gold’s finally get what’s coming to them, or something, I got about 20% of the way through it and couldn’t stomach it anymore.

Who should read this book?

After reading book 2 of the series I decided that it was a combination of Dune, Game of Thrones and the Hunger Games, but bloodier and more duplicitous than all of them. If that sounds appealing maybe you should read this book. For myself I can’t recommend the series and I probably can’t even recommend just reading the first book.

General Thoughts

Imagine if someone experienced the Red Wedding from Game of Thrones and said, “I’m going to write a book that is nothing but Red Weddings!” That’s how book 3 felt to me. Before abandoning it, I decided to read the plot summary on Wikipedia, I was not wrong. 


Star Trek: The City on the Edge of Forever

Originally by: Harlan Ellison

Adapted by: Scott & David Tipton

128 Pages

Briefly, what is this book about?

A graphic novelization of Harlan Ellison’s original script for “The City on the Edge of Forever”. One of the best regarded of the episodes from Star Trek’s original series.

Who should read this book?

If you like Harlan Ellison, Star Trek, or graphic novels, you will probably enjoy this book.

General Thoughts

Wikipedia asserts that “The City on the Edge of Forever” is frequently named as the best Star Trek episode of the entire Star Trek franchise. Harlan Ellison always maintained that they butchered his original script and that what you saw was just a pale imitation of the majesty of the original. Having heard this accusation for years, when I saw that there was a graphic novelization of his original I bought it immediately, so that I could finally decide for myself. 

It was great, and thoroughly enjoyable, but having read it I would say Ellison oversold things, and was probably insufficiently appreciative of what they had managed to do with the actual episode. But if you’re familiar at all with Ellison that probably won’t surprise you. Still the man could write.


The Economics of Violence

by: Gary M. M. Shiffman

244 Pages

Briefly, what was this book about?

That the conventional wisdom that cartel violence is different from mob violence, is different from terrorism, is wrong. That really all violence can be explained using economic incentives. 

Who should read this book?

Previously we had an “everybody”? Well this one is “nobody”. Shiffman is so taken by his one idea, that he pushes it past the point of utility into being less useful than the idea he’s trying to replace. Plus he spends way too much time getting into the minutia with his various examples.

General Thoughts

Answering the question of, “Why should everyone read this book?” is difficult. For this one I have to answer the opposite question, which of course is far easier. Given how many books are out there, to a first approximation the vast majority of books are read by nobody. Why should this book be any different? I suppose the next question is, if the book shouldn’t be read, is there a point in reviewing it either? Particularly as one of the highly selective reviews of the world renowned We Are Not Saved blog?

Perhaps not, but given that I read it for a book club I ended up with some fairly extensive notes, and it would be a shame to let all that go to waste.

Shiffman’s one big idea is to note the similarities between the actions of violent organizations and the actions of normal businesses. Pointing out how both are responding to market forces and financial incentives. This is useful and interesting, but Shiffman is so taken by the idea that he tries to squeeze everything into that framework. I think this could have been a far more useful book if he had also used this model to draw a contrast between violent organizations and businesses. A couple of examples:

First, I have a friend who feels that a disproportionate number of people at the highest levels of business and government are psychopaths. If you also believe that, and also believe Shiffman, then it’s not surprising that you would also find psychopaths at the head of violent organizations. But clearly rising to be the head of the Medellín Cartel, or the Lord’s Resistance Army, or Al Qaeda selects for psychopathy to a far greater degree than being the head of a Fortune 500 company. And I would be inclined to argue that it is this quality that is more predictive of success in a violent organization than being a savvy businessman. Shiffman talks about sadism, but dismisses it as being only a tiny part of the story. I would argue that it’s one of the key differentiators between a normal business and a violent organization. But since Shiffman’s project is to minimize these differences, he also minimizes its role.

Second, Shiffman talks extensively about how important ties of family and ideology are to the cohesion and success of violent organizations. That: 

People face scarcity, and so have almost constant need for others: need to know the “us” and the “them” so we know who to look out for and who will look out for us when matters of survival and growth arise. Issues such as “radical Islam” matter only in the way that branding and marketing matter for a firm.

But family and ideology generally aren’t that big of a deal in a normal business, and comparing “radical Islam” to branding and marketing, is a gross exaggeration of the power of marketing and a gross understatement of the appeal of radical Islam. 

In both of these cases leaning into the contrast between the two would have been more informative than what Shiffman did, which was to lean into the similarities.

Yes, there are similarities between violent organizations and business, but this is neither as groundbreaking nor as widespread an insight as Shiffman thinks.


The Hobbit, or There and Back Again 

by: J. R. R. Tolkien

320 Pages

Briefly, what was this book about?

I assume everyone knows what this book is about.

Who should read to this book?

Actually, as with the majority of the books, though I’m coy about it, I listened to this book. Specifically I wanted to listen to The Hobbit as narrated by Andy Serkis (the guy who did the voice and motion capture for Gollum in the movies.)

General Thoughts

The book is even better than I remembered. And I remembered it as being very good. Serkis’ narration was also a delight, as expected. If you need some “comfort” listening over the holidays, it would be hard to do better than this.


Chorazin: (The Weird of Hali #3) 

by: John Michael Greer

255 Pages

Briefly, what was this book about?

It’s the next book in the “What if the elder gods were the good guys?” series.

Who should read this book?

If for some reason you’ve started this series (perhaps on my recommendation) then there’s nothing in this book that should make you stop.

General Thoughts

This book spent a fair amount of time on world building, which was nice, though that did make the first part drag a little bit. But I thought the action and reveal at the end were satisfying enough to make up for it. As I have said in my past reviews, the chief appeal of this series is its premise. If the premise sounds appealing to you then you’ll probably like the book. If you have no idea what an elder god is, and the name Cthulhu means nothing to you then I would avoid these books.


The Great Game: The Struggle for Empire in Central Asia 

by: Peter Hopkirk

564 Pages

Briefly, what was this book about?

The Central Asian rivalry between the United Kingdom and Russia which played out during the 19th Century.

Who should read this book?

If you like good history, then you’ll appreciate this book. Though make sure to read it with a map handy because you won’t have heard of most of the places where the action takes place.

General Thoughts

In some of my previous posts on Afghanistan I mentioned Mohammad Najibullah, the last president of Afghanistan while it was controlled/supported by the Soviets. In between Najibullah’s capture by the mujahideen and his execution by the Taliban he spent his time translating this book into Pashtun so that the Afghans could better understand how they got to where they are. To the best of my understanding the translation was unfinished when he died. But I can see why he undertook the project, if I hadn’t read about the history of things I’m not sure I would have believed it myself. 

The book is worth reading just for the story of the First Anglo-Afghan War, or as the British call it the Disaster in Afghanistan. Take the biggest military fiasco you can imagine, multiply it by 10 and then imagine the most cinematic ending possible, and that’s the story. Essentially of the 16,500 British citizens, soldiers and camp followers who started the retreat from Kabul, only one nearly dead assistant surgeon made it to safety.

I’m something of a collector of horrible, preventable tragedies and this is one of the most terrible ones I’ve encountered. It makes me wonder if anyone associated with the recent withdrawal from Afghanistan had read this book, because beyond all of the interesting historical events, the book is obviously still relevant today. Up until a few months ago we were still fighting over Afghanistan. We’re still trying to figure out what to do in Central Asia. And we’re still suffering massive, preventable tragedies.

III- Religious Observation

The Deep Places: A Memoir of Illness and Discovery 

Before leaving the book entirely I wanted to briefly include a comment about Douthat’s religion. Obviously Douthat’s faith is a big part of who he is and how he went about recovering. And there was one story in particular which really struck me, because Douthat describes an interaction with God which is almost an exact parallel to some of my own experiences with God:

On the last morning, I was up early as always and I carried my son, now six months old and heavy, down the long, low-tide strip of sand. The pain was mostly in one shoulder, though I knew it would be somewhere else soon enough. There was a spot where the sand gave way to barnacled rocks bewigged with seaweed, where the tide met the stones; sometimes in her youth, my mother had found sand dollars there. I had never found one in decades of looking, and over time it had become a game I played – If I find one today, it means that God exists. If I find one today, it means that the girl I have a crush on has a crush on me. If I find one today, it means I’ll get into the college I want. If I find one today, it means…

Inevitably, I had been playing the game all that vacation week, casually glancing in the shallows as I waded with my kids.

If I find one it means I will get better.

If I find one it means I will get better.

If I find one it means I will get better.

On that last day, though, I was in too much pain to play. I held my son in my right arm, watching the seagulls sweep above, feeling the fire spread down my left arm and side. At a certain point, the combination of beauty and agony broke me, and I began to sob there, on the empty sandbar beside the flat, blue bay, while my son cooed curiously, and from somewhere in the depths I came out with a desperate, rasping croak.

“Help me, God. Why won’t you help me?”

My eyes dropped to the water. There between my feet, as tiny as a nickel and as pale as a wedding dress, was the only sand dollar I have ever found.


I don’t think that everyone should read my blog, but neither do I think nobody should read it either. Rather I think you should read it if you think the next 20 years are going to be particularly difficult to navigate. And you should donate to it if you think I might in some sense be helping to navigate it better. 


Eschatologist #11: Black Swans

If you prefer to listen rather than read, this blog is available as a podcast here. Or if you want to listen to just this post:

Or download the MP3


February 2020, the last month of normalcy, probably feels like a long time ago. I spent the last week of it in New York City. Which was already ground zero for the pandemic—though no one knew that yet. I was there to attend the Real World Risk Institute. A week-long course put on by Nassim Taleb, who’s best known as the author of The Black Swan. The coincidence of learning more about black swans while a very large one was already in process is not lost on me.

(Curiously enough, this is not the first time I was in New York right before a black swan. I also happened to be there a couple of weeks before 9/11.)

Before we go any further, for any who might be unfamiliar with the term, a black swan is an unpredictable, rare event with extreme consequences. And, one of the things I was surprised to learn while at the institute is that Taleb, despite inventing the term, has grown to dislike it. There are a couple of reasons for this. First people apply it to things which aren’t really black swans, to things which can be foreseen. The pandemic is actually a pretty good example of this. Experts had been warning about the inevitability of one for decades. We had one in 1918, and beyond that several recent near misses with SARS, MERS, and Ebola. And that was just in the last couple of decades. If all this is the case, why am I still calling it a black swan?

First off, even if the danger of a pandemic was fairly well known, the second order effects have given us a whole flock of black swans. Things like supply chain shocks, teleworking, housing craziness, inflation, labor shortages, and widespread civil unrest, to name just a few. This is the primary reason, but on top of that I think Taleb is being a little bit dogmatic with this objection. (I.e. it’s hard to think of what phrase other than “black swan” better describes the pandemic.)

However, when it comes to his second objection I am entirely in agreement with him. People use the term as an excuse. “It was a black swan. How could we possibly have prepared?!?” And herein lies the problem, and the culmination of everything I’ve been saying since the beginning, but particularly over the last four months.

Accordingly saying “How could we possibly have prepared?” is not only a massive abdication of responsibility, it’s also an equally massive misunderstanding of the moment. Because preparedness has no meaning if it’s not directed towards preparing for black swans. There is nothing else worth preparing for.

You may be wondering, particularly if black swans are unpredictable, how is one supposed to do that? The answer is less fragility, and ideally antifragility, but a full exploration of what that means will have to wait for another time. Though I’ve already touched on how religion helps create both of these at the level of individuals and families. But what about levels above that? 

This is where I am the most concerned. And where the excuse, “It was a black swan! Nothing could be done!” has caused the greatest damage. In a society driven by markets, corporations have great ability to both help and harm by the risks they take. We’re seeing some of these harms right now. We saw even more during the 2007-2008 financial crisis. When these harms occur, it’s becoming more common to use this excuse. That it could not be foreseen. It could not be prevented.

If corporations suffered the effects of their lack of foresight that would be one thing. But increasingly governments provide a backstop against such calamities. In the process they absorb at least some of the risk. Making the government itself more susceptible to future, bigger black swans. And if that happens, we have no backstop.

Someday a black swan will either end the world, or save it. Let’s hope it’s the latter.


One thing you might not realize is that donations happen to also be black swans. They’re rare (but becoming more common) and enormously consequential. If you want to feel what it’s like to have that sort of power, consider trying it out.