health

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Wear a mask – or burn it?

Public mask burning in Florida

In the US this week the CDC (Centers for Disease Control) issued new guidelines for wearing masks, advising even fully vaccinated individuals to wear them indoors in public settings, especially in counties with high numbers of coronavirus infections (currently the majority of US counties). This has led to some areas and cities to announce new guidance for schools and businesses. Some schools, universities, and companies have announced mandatory vaccinations, with exceptions due to medical or religious considerations.

In other areas, public opinion is moving in the opposite direction, with large numbers of people refusing to be vaccinated or to wear a mask. In fact, in some cities, masks have been publicly burned, in an act of defiance, with demonstrators objecting to what they see as government overreach and a loss of personal freedom. Governor DeSantis of Florida has been vocal in his opposition, announcing that he has no intention of issuing a mask mandate, refusing to “muzzle” his own son and other Florida children.

Others object to changing positions on virus prevention measures from the CDC. In fact, media and medical critics have not been kind in their comments on the CDC policy shifts. However, the changes in guidance are not capricious, but rather a result of changing conditions. The delta variant, much more easily transmittable, has dramatically changed the nature of the “war” against the virus, according to the CDC. Hence the changes in guidance. Wouldn’t we want public health measures to be in tune with public health dangers? On the other hand, politicians like DeSantis or Governor Abbott of Texas have little interest in science and don’t accept expert guidance. For them, political positioning seems to be paramount.

The burning of masks meant as a symbolic gesture of individual freedom of choice is actually a symbol of willful ignorance and denial of science. And also of a lack of care for one’s fellow human beings; not wearing a mask not only puts the individual in danger, but fellow citizens as well. Mask wearing has long been common in Asian countries, where it has been seen not only as a protective measure for the individual but as a sign of solidarity with others.

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What we need now? Cultural responses

Sports and the pandemic

This weekend in Virginia, high school sports matches will be able to be held in almost “normal” conditions, with large numbers of spectators. Our Governor has loosened rules for in-person gatherings, as more residents of the Commonwealth have gotten vaccinated, and the virus infection rate has fallen. That the Governor made a point of allowing larger gatherings right now – when league championships are being determined – is a sign of the important cultural role played by sports in schools and society in general in the US. Friday nights in the fall in many US states, the place to be is the local high school (American) football game.

Other countries have other priorities, often culturally determined. India has experienced severe upticks in viral spread following many Indians congregating together for religious festivals. One of the difficult issues in India, as elsewhere, has been whether to be impose lockdowns country-wide or allow individual regions to make the rules based on local conditions. Federalism has been a tricky topic in countries like Germany or the USA, where traditionally individual states have control over public health measures.

The cultural issues are not just related to national cultures, but also to generational groupings. For young people, not being able to get together is not just related to losing entertainment venues, but also to the greater importance of socialization for that age group. It has been interesting to follow this past year, just which institutions and services are seen as important, depending on individual and group characteristics. That doesn’t reference just those deemed of “essential” importance (health care workers, grocery store clerks, etc.), but rather those services individuals are used to having available: gyms, hairdressers, church services, arts events. Which are truly essential, many have experienced firsthand, finding ways to exercise at home, cut ones own hair, etc.

The fascinating question is this: what will represent temporary changes and which are long-term? It seems lasting effects might be changes in greeting rituals and more remote working opportunities. Uncertain from my perspective is whether masks will become a new normal in countries other than those, for example in Asia, where masks have been widely used for some years. I think many folks assume that this pandemic is a once in a generation event; I’m skeptical on that; it seems inevitable that we will see more viruses appear. That may bring more culturally determined differences.

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Germany: What once were virtues are now vices?

Chancellor Merkel

With apologies to the Doobie Brothers for the title (dates me badly, I know), there has been considerable press lately, in Germany itself, and elsewhere about the intriguing turn-around in the country’s fight against the COVID-19 pandemic. In the early days, Germany’s success fighting the disease and persuading Germans to follow mitigation measures was hailed widely, especially when compared to the lackluster and ineffective efforts in the US. The explanation frequently given: Germans’ reputed respect for authority and obedience to rules. Chancellor Merkel was given credit for clarity and consistency of messaging, with her science background considered a major plus. The German government was seen as acting with the Gründlichkeit often seen as characteristic of Germans, i.e., thoroughness/rigor and a need to understand and consider all aspects of an issue.

But now, as a headline in the Guardian recently put it, that positive trait seems to be a liability: “Heroes to zeros: how German perfectionism wrecked its Covid vaccine drive. The same thoroughness that made Angela Merkel’s government a pandemic role model is now holding it back.” Gründlichkeit brings with it the need to know the truth, to get to the bottom of things, before making decisions. That aligns with Merkel’s well-known penchant for caution and deliberation before acting. While the US went ahead and ordered millions of doses of COVID-19 vaccines without knowing at the time whether any of those vaccines would actually work, Germany held back, wanting to see what the clinical trials would reveal. In fact, it wasn’t just Germany’s decision, but the joint decision of the European Union, of which Germany is a leading voice. The German authorities set up central vaccination sites with great organizational efficiency, only to discover that they went largely unused, because no vaccines were available. Now that vaccines are becoming available, the mixed messaging about the most widely available vaccine in Europe, AstraZeneca, has led many Germans to be wary. First that vaccine was for those under 65, then it was pulled entirely (fears over blood clots), then yesterday it was announced it would be available again, but this time for those over 65.

A substantial part of the problem in Germany is federalism, which, as in the US, has resulted in different Covid strategies in each German state, made more complicated by the fact that it is an election year and several state prime ministers are jockeying for position to replace Merkel. Meanwhile, Merkel issued this statement recently: “Wir wollen, dass die sprichwörtliche und im übrigen auch bewährte deutsche Gründlichkeit um mehr deutsche Flexibilität ergänzt wird” [We are going to supplement the proverbial and well-established German Gründlichkeit with more German flexibility.] Part of that newly-discovered “German flexibility” apparently will be something many have called for, namely allowing family doctors to administer the vaccine.

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Our plague year

Scene from the 1918 pandemic

Few of us are likely to regret the passing of the plague year 2020 (see the comprehensive New Yorker piece on the catastrophic handling of the COVID-19 virus in the US). Just a few thoughts here on the last day of the year on what has changed in our lives.

1) Human lives
My grandmother died in the 1918 “Spanish flu”. That had a profound effect on my father’s life, growing up without a mother, forming habits, tastes, personality traits that surely would have been different had his mother not died. I’m sure it contributed to my grandfather being taciturn and withdrawn. My Dad had trouble expressing emotion, as did many men of his generation, and was rather coarse in his habits (eating, for example) and abrupt in his dealings with others. No one can tell if having had a mother would have made a difference, but it seems like it could have. In turn, I see many aspects of my father mirrored in my own personality, and likely passed on to my children, and now, quite possibly to my grandchildren.

One death and many ripple effects. In the US we are approaching 350, 000 dead from the virus, many more world-wide. Unbelievable real-life repercussions on lives and families everywhere. Grieving now and long, long-term effects.

2) Cultural practices
For friends and families losing loved ones: So sad not to be able to say good-bye in normal and meaningful ways and to engage in rituals that can be tremendously meaningful to many. It seems likely that end of life practices will slowly come back, but for other culture-related practices changes may be longer-lasting.

Handshakes, hugs, standing close to others: They have disappeared this year. Will they come back or is physical distancing of one kind or another here to stay? Will it be different depending on the culture? In some parts of the world, the adjustment may not be a big deal, but if you’re used to cheek kissing as a normal greeting ritual, that’s a big change. Elbow bumps don’t seem like a satisfactory replacement.

Work cultures seem certain to have changed. Many more folks likely to continue to work remotely. That in turn brings changes to everyday lives, more time at home, more options for cooking, gardening, other homebody activities, maybe more pets?

Changes in education are equally profound. Distance learning is not likely to go away. But just as in employment opportunities, this trend will not affect us all equally. The divide between those with white collar jobs, able to work from home, and those in the service sectors, exposed to the virus, has led in the US to disproportionally high number of black and brown infected and dead Americans. Similarly, well-off parents can afford the better computing set-up and higher-speed Internet crucial to effective online learning. Those are some of the many ways the virus has brought into sharper contrast the stark inequalities in US society.

3) Trust in science (and in each other)
Another dividing line in the US (and elsewhere) has been the extent to which individuals have changed their public behavior to protect themselves and others from the spread of the virus. That has exposed the extent to which many people deny the findings of science and medicine (i.e., masks work) and show blind faith in voices of leaders and media figures, with no science expertise, but with plentiful political goals. Those skeptical of science, or even of the reality of the virus, have shown that they are not reachable through objective, factual information. Their beliefs in areas related to the virus have become part and parcel of their identities, of their personal life histories, and thus are nearly impossible to dislodge by logic or by any other means.

Sad to say, it seems unlikely that 2021 will bring meaningful change in that area.

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Face masks vs. MAGA hats

Anti-mask sign in Illinois store

One might expect that in a pandemic, a public consensus would arise on how people should protect themselves and others from catching the disease. However, in the US, the spread of COVID-19 has led to very different behaviors, that are divided along political lines. That is translating currently into different camps regarding the need to wear face masks in public. Rather than considering the practical health benefits, some refuse to wear a mask as a signal of solidarity with President Trump and his call for the country to open back up. This has turned into a face mask becoming a partisan symbol, as described in US News:

While not yet as loaded as a “Make America Great Again” hat, the mask is increasingly a visual shorthand for the debate pitting those willing to follow health officials’ guidance and cover their faces against those who feel it violates their freedom or buys into a threat they think is overblown.

That resistance to masks has been stoked by President Trump. Rather than wearing a mask to model desired behavior among the public, he didn’t wear a mask during an appearance at a facility making them. Vice President did the same when visiting the Mayo Clinic.

Vice President Pence without a mask

Wearing a mask, on the other hand, can be seen as an endorsement of the advice of medical personnel and public health officials, namely that wearing a mask protects oneself as well as those around us. In that way it is also signaling social solidarity. Not wearing a mask might be seen as a sign of selfishness – or, from others’ perspective, as an assertion of individual freedom.

In the US, this is a radical change from popular opinion on mask-wearing before the pandemic. While wearing a face mask has long been common practice in many East Asian countries, that has not been the case in the US. Indeed, wearing a mask was often seen negatively; as reported in National Geographic, “masks signaled ‘disease,’ as if the wearer had something to hide”. Not being able to see someone’s face automatically made them suspicious. We are used to reading faces as a way to evaluate others’ actions, attitudes or intentions, so not being able to see facial expressions can be disturbing in a culture not used to seeing face masks. The article points out that people may use other non-verbal cues to make up for the absence of facial expressions, such as excessive, energetic waving or extra-explicit friendly language. It may be that as more US Americans don masks, behaviors will adjust. For now, however, there remains a strongly political symbolism to face masks.

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Measles and Willful Ignorance

Child with measles, a potentially life-threatening disease

Child with measles, a potentially life-threatening disease

The super bowl will be played tomorrow and there is some concern that with so many people in one place, there is danger that the recent measles outbreak may lead to cases from those attending the game, particularly as there have been cases reported in Arizona. But wait, wasn’t measles declared eliminated in the U.S.? Yes, it was, back in 2000. The problem is not that the vaccine has stopped working; it’s that there are a substantial number of parents – especially in California – who refuse to have their children vaccinated. It’s bad enough that this endangers the children of these parents, but it also endangers others, particularly infants who are too young to be vaccinated, pregnant women, or people with immune problems that prevent them from being vaccinated. There was a story recently on NPR about such a child, recovering from leukemia, whose father it asking that the school in Marin County, California, his son attends bar students from attending who have not been vaccinated.

Why are the parents refusing to have their children vaccinated? Because they have bought in to the anti-vaccine movement which claims a link between vaccination and autism. This idea comes from an article by Andrew Wakefield published in the medical journal The Lancet in 1998. The article has long since been discredited and Wakefield, based on evidence that the study was fraudulent and that Wakefield had a financial conflict of interest, has been bared from practicing medicine in Britain. All the available scientific evidence indicates that there is no link between vaccinations and autism. That evidence has not been enough to convince doubters, which include some politicians (Michele Bachmann) and TV personalities (Jenny McCarthy). In addition to citing the junk science represented by Wakefield, such voices also talk about parental rights. However, individual rights have to be seen within the context of social responsibility – no one has absolute rights to take actions that endanger others.

This phenomenon is one more case of willful ignorance, the refusal to accept evidence-based science. We continue to see this among evolution deniers and those who don’t believe in global warming. A recent survey by the Pew Research Center indicates how large the gulf is between the views of scientists in the U.S. and non-scientists across a wide range of issues. The results confirm the importance of encouraging more attention in our schools to critical thinking and the process of scientific enquiry.

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Coffee not soda

gulpArticle in today’s Wall Street Journal on the decline in consumption in the US of carbonated soda drinks, worrying companies like Coca Cola and Pepsi. Young Americans are increasingly drinking water, energy drinks and coffee. It’s of course not just a question of taste, but increasingly of health. Americans are becoming more conscious of the importance of a healthy diet and increasingly aware of how much the consumption of soft drinks is a factor in the obesity epidemic in the US.  High profile actions like the recent initiative from New York mayor Bloomberg’s to ban the sale of large sodas at restaurants and movie theaters help to spread the message.  The soda companies have been fighting back; Coke has a recent ad encouraging Americans to fight obesity, which has been received with considerable sardonic criticism.  Drinking soft drinks – and lots of them – has been culturally entrenched in the US for decades.  Tourists from abroad are often amazed by the size of American soft drinks (like 7-11’s Big Gulp) – the small size here is often equivalent to the largest size available in many other countries.  When I was hiking with my son in the Black Forest, he complained about the fact that my (standard size) beer was half a liter but his (standard size) soda was .3 or even .2 liter.  And no free refills! It must be that the move away from soft drinks is part of a communist conspiracy (probably from our Socialist president!) to undermine American culture, just like the sneaky move years ago to fluoridate our water (see Dr, Strangelove for the truth!).

Of course, it’s not necessarily the case that Americans are turning away from soda to something healthier.  Young Americans in particular are getting ever larger doses of caffeine.  A story recently on NPR discusses the trend on American campuses for students to drink more and more coffee, as well as caffeinated energy drinks. Besides the high cost on the wallet of this trend, the cost in terms of health is high as well.  High caffeine consumption interferes with getting a good night’s sleep.  This can have negative consequences in terms of academics.  A researcher cited in the study comments that high caffeine has been linked to decresed REM sleep, which is important for memory consolidation and learning.  Of course, that’s part of the conspiracy as well – trying to get us to dump our soft drinks and switch to drinks that make us dumber!

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Exercise & Politics

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Student during a yoga class at elementary school in Encinitas, Calif (NY Times)

A recent article in the NY Times discusses the protests by some parents in a California school district where first graders are having 30-minute yoga classes.  This would seem to be a beneficial program for small children, doing something positive in the area of physical education, just as art and music classes do, as well as foreign language classes. In the age of strictly controlled and standardized curricula, it’s refreshing to see something creative happening, even if on a small scale. According to the article, the yoga sessions have a noticeably calming effect on the 6- and 7-year olds.  So what’s the reason for the protests?  Religious indoctrination, specifically the protesters “were concerned that the exercises might nudge their children closer to ancient Hindu beliefs”.  This need to protect children from knowledge has had the unfortunate result in American schools of discouraging teaching about world religions, with a by-product being a wide-spread lack of knowledge about Islam (as well as of other non-Christian religions). In the absence of knowledge, stereotypes replace reality.

The intersection of religion, physical exercise, and politics has had some interesting case histories.  Recently, the Falun Gong spiritual movement in China, combining slow-moving exercises with meditation and a basic moral philosophy, after gaining widespread popularity in the 1990’s, was suppressed by the Chinese government, fearful that such a large movement could threaten state control.  In 19th-century Germany, Friedrich “Turnvater” Jahn (Father of Gymnastics Jahn), who had studied theology, wanted to encourage greater physical fitness among the Prussian youth, after seeing the humiliation of Germany’s defeat by Napoleon.  What started out as gymnastics (he invented the parallel bars, the balance beam, horizontal bar, and the vaulting horse) turned nationalistic and was seen as a threat by the authorities, leading to his arrest.

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Non-freedom fries

Chip Butty – not at the Olympics!

Big bucks win over cultural preferences. There’s a ruckus in England over food at the 2012 Olympics, specifically the well-beloved Chips (French Fries). Seems that McDonald’s as an official sponsor has exclusive rights to sell fries at the Olympics. Only approved exception is fish and chips, no luck if you feel like sausage and chips, egg and chips, lasagna and chips, steak and chips or even the famous chip sandwich (Chip Butty, popular in York). Part of the problem is that the skinny McD’s fries are not the style the Brits like – they prefer fat and greasy.

Reminds me of the uproar in Germany at the 2006 World Cup when originally only Budweiser (an official sponsor) was allowed to be served at the games being played in Germany, quite a slap in the face to German beer drinkers. There is actually an excellent Budweiser beer, however it’s not the Anheuser-Busch brew but rather the original Budweiser from Budvar, in the Czech Republic. Unfortunately for beer drinkers, the relationship between the FIFA, which puts on the World Cup, and Anheuser-Busch InBev recently was extended to 2022. It remains to be seen, however, if beer will even be served at the 2014 championship in Brazil, since beer at soccer stadiums there has been banned since 2003 (too much alcohol-fueled violence). Same ban applies in Russia, the sponsor for 2018.

Side note:  There will be a new world’s largest McDonald’s for the London Olympics, taking over from the McDonald’s in Pushkin Square,  Moscow.  I visited that McD’s a couple of years ago – quite an operation there.  I went to have an American breakfast – which I have to say I enjoyed immensely, as a break from Russian food.  I have to admit as well that I have also visited the second busiest McD’s world-wide – at the Karlstor in Munich.  I enjoyed the chance to have a beer with my “Royale with Cheese”.

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Are French women worried about getting fat?

Interesting article in the New York Times on efforts by a weight-loss company (Jenny Craig) to see their products and services in France, a cuture not big on pre-packaged cooked foods, especially if they come from a company associated with the home of the Big Mac: “Selling an American-style weight-loss program to France would seem an absurd business proposition: from a French point of view, Americans might appear better equipped to give pointers on how to gain weight than how to lose it. The obesity rate in the United States is around 35 percent, compared with 14.5 percent in France.” But the obesity rate has been rising in France lately as well, although not nearly at the rate of the US.

The article points out that the many people in France believe that the traditional French food and eating culture is the answer to obesity.  Valérie Bignon, the director of corporate communications for Nestlé France comments:  “The solution to America’s weight problem lies in what I call the French food model, a model that is very social, as opposed to the individualist approach of the Americans.”  She points to the importance of placing high value on everyone getting together at the same time, eating the same thing, and making meals into a social event, thus discouraging between-meal snacking.  She is down not only on American fast food but also on self-serve restaurants (le Self)  – which move away from the “French food model”.  I have to admit that when I was a student in France, I often ate at self-serve restaurants – they were cheap.