How do pandemics end? History suggests diseases fade but are almost never truly gone
Instead of looking forward, we should be consulting the past.
21 October, 2020
Andrew Redington/Getty Images
When will the pandemic end? All these months in, with over 37 million COVID-19 cases and more than 1 million deaths globally, you may be wondering, with increasing exasperation, how long this will continue.
<p>Since the beginning of the pandemic, epidemiologists and public health specialists have <a href="https://doi.org/10.1038/s41591-020-0883-7">been using</a> <a href="https://doi.org/10.1001/jama.2020.6585" target="_blank">mathematical</a> <a href="https://doi.org/10.1073/pnas.2006520117" target="_blank">models</a> to forecast the future in an effort to curb the coronvirus's spread. But infectious disease modeling is tricky. Epidemiologists warn that “<a href="https://doi.org/10.1038/d41586-020-01003-6" target="_blank">[m]odels are not crystal balls</a>," and even sophisticated versions, like those that <a href="https://doi.org/10.1101/2020.08.19.20177493" target="_blank">combine forecasts</a> or <a href="https://covid19-projections.com/" target="_blank">use machine learning</a>, can't necessarily reveal when the pandemic will end or <a href="https://covid19.healthdata.org/united-states-of-america?view=total-deaths&tab=trend" target="_blank">how many people will die</a>.</p><p>As a <a href="https://sc.edu/study/colleges_schools/artsandsciences/history/our_people/directory/nukhet.php" target="_blank">historian who studies disease and public health</a>, I suggest that instead of looking forward for clues, you can look back to see what brought past outbreaks to a close – or didn't.</p>
<h2>Where we are now in the course of the pandemic</h2><p>In the early days of the pandemic, many people hoped the coronavirus would simply fade away. Some argued that it would <a href="https://www.npr.org/2020/04/21/837348551/timeline-what-trump-has-said-and-done-about-the-coronavirus" target="_blank" rel="noopener noreferrer">disappear on its own</a> <a href="https://theconversation.com/coronavirus-may-wane-this-summer-but-dont-count-on-any-seasonal-variation-to-end-the-pandemic-136218" target="_blank" rel="noopener noreferrer">with the summer heat</a>. Others claimed that <a href="https://www.theatlantic.com/health/archive/2020/03/coronavirus-pandemic-herd-immunity-uk-boris-johnson/608065/" target="_blank" rel="noopener noreferrer">herd immunity</a> would kick in once enough people had been infected. But none of that has happened.</p><p>A combination of public health efforts to contain and mitigate the pandemic – from rigorous testing and contact tracing to social distancing and wearing masks – <a href="https://www.endcoronavirus.org/countries" target="_blank" rel="noopener noreferrer">have been proven to help</a>. Given that the virus has <a href="https://www.aljazeera.com/news/2020/09/14/which-countries-have-not-reported-any-coronavirus-cases/" target="_blank" rel="noopener noreferrer">spread almost everywhere in the world</a>, though, such measures alone can't bring the pandemic to an end. All eyes are now turned to <a href="https://time.com/5887199/coronavirus-vaccine-race/" target="_blank" rel="noopener noreferrer">vaccine development</a>, which is being pursued at unprecedented speed.</p><p>Yet experts tell us that even with a successful vaccine and effective treatment, <a href="https://www.theatlantic.com/health/archive/2020/08/coronavirus-will-never-go-away/614860/" target="_blank" rel="noopener noreferrer">COVID-19 may never go away</a>. Even if the pandemic is curbed in one part of the world, it will likely continue in other places, causing infections elsewhere. And even if it is no longer an immediate pandemic-level threat, the coronavirus will likely become endemic – meaning slow, sustained transmission will persist. The coronavirus will continue to cause smaller outbreaks, much like seasonal flu.</p><p>The history of pandemics is full of such frustrating examples.</p>
<h2>Once they emerge, diseases rarely leave</h2><p>Whether bacterial, viral or parasitic, virtually every disease pathogen that has affected people over the last several thousand years is still with us, because it is nearly impossible to fully eradicate them.</p><p>The only disease that has been <a href="https://www.cdc.gov/smallpox/history/history.html" target="_blank" rel="noopener noreferrer">eradicated through vaccination is smallpox</a>. <a href="https://theconversation.com/a-massive-public-health-effort-eradicated-smallpox-but-scientists-are-still-studying-the-deadly-virus-139468" target="_blank" rel="noopener noreferrer">Mass vaccination campaigns</a> led by the World Health Organization in the 1960s and 1970s were successful, and in 1980, smallpox was declared the first – and still, the only – human disease to be fully eradicated.</p><p>So success stories like smallpox are exceptional. It is rather the rule that diseases come to stay.</p><p>Take, for example, pathogens like <a href="https://www.sciencedaily.com/releases/2010/06/100617120718.htm" target="_blank" rel="noopener noreferrer">malaria</a>. Transmitted via parasite, it's almost as old as humanity and still exacts a heavy disease burden today: There were about <a href="https://www.who.int/news-room/fact-sheets/detail/malaria" target="_blank" rel="noopener noreferrer">228 million malaria cases and 405,000 deaths</a> worldwide in 2018. Since 1955, global programs to eradicate malaria, assisted by the use of DDT and chloroquine, brought some success, but the disease is <a href="https://www.who.int/malaria/media/world-malaria-report-2018/en/" target="_blank" rel="noopener noreferrer">still endemic in many countries of the Global South</a>.</p><p>Similarly, diseases such as <a href="https://www.who.int/news-room/fact-sheets/detail/tuberculosis" target="_blank" rel="noopener noreferrer">tuberculosis</a>, <a href="https://doi.org/10.1126/science/1109759" target="_blank" rel="noopener noreferrer">leprosy</a> and <a href="https://doi.org/10.1126/science.368.6497.1324-o" target="_blank" rel="noopener noreferrer">measles</a> have been with us for several millennia. And despite all efforts, <a href="https://ourworldindata.org/eradication-of-diseases" target="_blank" rel="noopener noreferrer">immediate eradication is still not in sight</a>.</p><p>Add to this mix relatively younger pathogens, such as <a href="https://www.nature.com/articles/d42859-018-00008-6" target="_blank" rel="noopener noreferrer">HIV</a> and <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease" target="_blank" rel="noopener noreferrer">Ebola virus</a>, along with <a href="https://www.who.int/health-topics/influenza-avian-and-other-zoonotic#tab=tab_1" target="_blank" rel="noopener noreferrer">influenza</a> and <a href="https://www.niaid.nih.gov/diseases-conditions/coronaviruses" target="_blank" rel="noopener noreferrer">coronaviruses</a> including <a href="https://www.who.int/ith/diseases/sars/en/" target="_blank" rel="noopener noreferrer">SARS</a>, <a href="https://www.who.int/news-room/q-a-detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)" target="_blank" rel="noopener noreferrer">MERS</a> and <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses" target="_blank" rel="noopener noreferrer">SARS-CoV-2 that causes COVID-19</a>, and the overall epidemiological picture becomes clear. Research on the <a href="https://doi.org/10.1016/B978-012373944-5.00185-1" target="_blank" rel="noopener noreferrer">global burden of disease</a> finds that annual mortality caused by infectious diseases – most of which occurs in the developing world – is nearly one-third of all deaths globally.</p><p>Today, in an age of global air travel, climate change and ecological disturbances, we are constantly exposed to the threat of <a href="https://wwwnc.cdc.gov/eid/about" target="_blank" rel="noopener noreferrer">emerging infectious diseases</a> while continuing to suffer from much older diseases that remain alive and well.</p><p>Once added to the repertoire of pathogens that affect human societies, most infectious diseases are here to stay.</p>
<h2>Plague caused past pandemics – and still pops up</h2><p>Even infections that now have effective vaccines and treatments continue to take lives. Perhaps no disease can help illustrate this point better than <a href="https://www.visualcapitalist.com/history-of-pandemics-deadliest/" target="_blank" rel="noopener noreferrer">plague, the single most deadly</a> infectious disease in human history. Its name continues to be synonymous with horror even today.</p><p><a href="https://www.who.int/health-topics/plague#tab=tab_1" target="_blank" rel="noopener noreferrer">Plague</a> is caused by the bacterium <em>Yersinia pestis</em>. There have been countless local outbreaks and at least three documented plague pandemics over the last 5,000 years, killing hundreds of millions of people. The most notorious of all pandemics was <a href="https://www.livescience.com/what-was-the-black-death.html" target="_blank" rel="noopener noreferrer">the Black Death</a> of the mid-14th century.</p><p>Yet <a href="https://scholarworks.wmich.edu/medieval_globe/1/" target="_blank" rel="noopener noreferrer">the Black Death</a> was far from being an isolated outburst. Plague returned every decade or even more frequently, each time hitting already weakened societies and taking its toll during <a href="https://doi.org/10.1017/npt.2020.27" target="_blank" rel="noopener noreferrer">at least six centuries</a>. Even before the <a href="https://doi.org/10.1136/bmj.39097.611806.DB" target="_blank" rel="noopener noreferrer">sanitary revolution</a> of the 19th century, each outbreak gradually died down over the course of months and sometimes years as a result of changes in temperature, humidity and the availability of hosts, vectors and a sufficient number of susceptible individuals.</p><p>Some societies recovered relatively quickly from their losses caused by the Black Death. Others never did. For example, medieval <a href="https://utpress.utexas.edu/books/borbla" target="_blank" rel="noopener noreferrer">Egypt could not fully recover</a> from the lingering effects of the pandemic, which particularly devastated its agricultural sector. The cumulative effects of declining populations became impossible to recoup. It led to the gradual decline of the Mamluk Sultanate and its conquest by the Ottomans within less than two centuries.</p><p>That very same state-wrecking plague bacterium remains with us <a href="https://www.cnn.com/2020/08/08/us/second-plague-death-new-mexico-man/index.html" target="_blank" rel="noopener noreferrer">even today</a>, a reminder of the very long persistence and resilience of pathogens.</p><p>Hopefully COVID-19 will not persist for millennia. But until there's a successful vaccine, and likely even after, no one is safe. Politics here are crucial: When vaccination programs are weakened, infections can come roaring back. Just look at <a href="https://www.cdc.gov/media/releases/2019/s0424-highest-measles-cases-since-elimination.html" target="_blank" rel="noopener noreferrer">measles</a> and <a href="https://www.nytimes.com/2019/07/15/health/polio-pakistan-afghanistan.html" target="_blank" rel="noopener noreferrer">polio</a>, which resurge as soon as vaccination efforts falter.</p><p>Given such historical and contemporary precedents, humanity can only hope that the coronavirus that causes COVID-19 will prove to be a tractable and eradicable pathogen. But the history of pandemics teaches us to expect otherwise.<img src="https://counter.theconversation.com/content/146066/count.gif?distributor=republish-lightbox-basic" alt="The Conversation"></p><p><a href="https://theconversation.com/profiles/nukhet-varlik-1155360" target="_blank">Nükhet Varlik</a>, Associate Professor of History, <em><a href="https://theconversation.com/institutions/university-of-south-carolina-1755" target="_blank" rel="noopener noreferrer">University of South Carolina</a></em></p><p>This article is republished from <a href="https://theconversation.com/" target="_blank" rel="noopener noreferrer">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066" target="_blank" rel="noopener noreferrer">original article</a>.</p>
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Quarantine rule breakers in 17th-century Italy partied all night – and some clergy condemned the feasting
17th-century outbreaks of plague in Italy reveal both tensions between religious and public health authorities.
27 September, 2020
Hulton Archive/Getty Images
Since the beginning of the COVID-19 pandemic, conflicts between religious freedom and public health regulations have been playing out in courts around the world.
<p>Churches from California to Maine have flouted public health orders by convening in person, indoors, unmasked and accompanied by choirs. When an underground church in South Korea seeded one of the country's largest outbreaks in February, the <a href="https://www.bbc.com/news/world-asia-53803011" target="_blank">government responded</a> by arresting its leader for obstructing contact tracers and violating public health regulations. </p><p>I am a <a href="https://press.uchicago.edu/ucp/books/book/chicago/F/bo60921208.html" target="_blank">historian of science and religion in the Renaissance</a>, and what strikes me as remarkable about the current moment is not that some religious communities are defying public health measures, but that so many religious institutions and individuals are piously working to implement them.</p><p><a href="https://books.google.com/books/about/Cristofano_and_the_Plague.html?id=iAjbAAAAMAAJ%20pp.79-80" target="_blank">Historical accounts</a> from 17th-century outbreaks of plague in Italy reveal both tensions between religious and public health authorities and also examples for collaboration. </p>
<h2>Sites of conflict</h2><p>In the summer of 1630, <a href="https://books.google.com/books/about/Cristofano_and_the_Plague.html?id=iAjbAAAAMAAJ" target="_blank" rel="noopener noreferrer">a plague epidemic packed</a> the plague hospitals known as "lazaretti" with over 15,000 people in Milan. Smaller towns also faced outbreaks that taxed their community resources.</p><p>In the <a href="https://books.google.com/books/about/Cristofano_and_the_Plague.html?id=iAjbAAAAMAAJ" target="_blank" rel="noopener noreferrer">Tuscan town of Prato</a>, public health officials were beginning to doubt the wisdom of treating plague patients at the "lazaretto" located within the city walls. They feared a risk of further infection if the healthy were in such close proximity to the sick.</p><p>The city officials <a href="https://books.google.com/books/about/Cristofano_and_the_Plague.html?id=iAjbAAAAMAAJ" target="_blank" rel="noopener noreferrer">needed to identify an alternative location</a> that was far enough to keep the city safe, but close enough that they could conveniently move the sick patients. They determined that the Convent of St. Anne, located a couple of kilometers outside town, <a href="https://books.google.com/books/about/Cristofano_and_the_Plague.html?id=iAjbAAAAMAAJ" target="_blank" rel="noopener noreferrer">should serve as the lazaretto and requisitioned it</a>.</p><p>The seizure of church property by the nominally secular powers of the Tuscan grand duke infuriated the friars of St. Anne. They petitioned Grand Duke Ferdinando II de' Medici to <a href="https://books.google.com/books/about/Cristofano_and_the_Plague.html?id=iAjbAAAAMAAJ" target="_blank" rel="noopener noreferrer">overturn the act</a>, but he ignored their objections.</p><p>This was not because the grand duke was persecuting Catholics – he ruled a Catholic state, and two of his brothers became cardinals. However, during this outbreak of plague, it appeared that the grand duke deemed such emergency measures to be a necessity.</p>
<h2>Limits to jurisdiction</h2><p>However, the grand duke's jurisdiction did have limits. In late-Renaissance cities, civil authorities <a href="https://books.google.com/books/about/Faith_Reason_and_the_Plague_in_Seventeen.html?id=aqOrYdo8xnUC" target="_blank" rel="noopener noreferrer">could punish citizens</a> for public health infractions, but they did not have direct authority over the clergy.</p><p>When a priest in Florence broke quarantine by staying out late at night drinking and playing guitar with family members, the <a href="https://yalebooks.yale.edu/book/9780300196344/florence-under-siege" target="_blank" rel="noopener noreferrer">health board punished his sisters</a> but not him.</p><p>To discipline priests who broke public health laws, civil authorities had to petition local church officials, like bishops, to intervene. For example, as the plague spread in the Tuscan city of Pistoia in September 1630, public health officers <a href="https://uwpress.wisc.edu/books/0907.htm" target="_blank" rel="noopener noreferrer">resolved to broach with the archbishop</a> the possibility of emptying the fonts of holy water in case they were spreading disease.</p><p>Although no records confirm the outcome, throughout this epidemic the archbishop of Florence <a href="https://yalebooks.yale.edu/book/9780300196344/florence-under-siege" target="_blank" rel="noopener noreferrer">repeatedly reinforced the importance of the policies</a> of secular health commissioners.</p><p>State and religious officials alike were concerned about plague spreading through air, water and wine and curtailed traditional activities to minimize contagion.</p>
<h2>Case of Father Dragoni</h2><p>Much like today, when civil authorities <a href="https://www.sfgate.com/bayarea/article/SF-archbishop-protest-Catholic-march-covid-15584389.php" target="_blank" rel="noopener noreferrer">canceled religious services and ceremonies</a>, local protests ensued.</p><p>During the plague outbreak of 1631 in the small Tuscan town of Monte Lupo, a <a href="https://books.google.com/books/about/Faith_Reason_and_the_Plague_in_Seventeen.html?id=aqOrYdo8xnUC" target="_blank" rel="noopener noreferrer">fight broke out</a> between the guards tasked with preventing gatherings and a group of armed civilians from the surrounding countryside and their parish priest.</p><p>The worshipers insisted on congregating to <a href="https://books.google.com/books/about/Faith_Reason_and_the_Plague_in_Seventeen.html?id=aqOrYdo8xnUC" target="_blank" rel="noopener noreferrer">pray at the crucifix</a> in the local church and threatened to shoot with an arquebus – a long gun used during the Renaissance period – anyone who got in their way.</p><p>The health officer <a href="https://books.google.com/books/about/Faith_Reason_and_the_Plague_in_Seventeen.html?id=aqOrYdo8xnUC" target="_blank" rel="noopener noreferrer">tasked with managing the delicate situation</a> at Monte Lupo was a 60-year-old Dominican friar, Father Giovanni Dragoni, who was both a public health officer and a member of the clergy.</p><p>Father Dragoni was <a href="https://books.google.com/books/about/Faith_Reason_and_the_Plague_in_Seventeen.html?id=aqOrYdo8xnUC%2056" target="_blank" rel="noopener noreferrer">stated to be furious</a> with the parish priest for his disregard for the public health measures. He promptly dispatched a message to the regional health commissioner: "It is necessary to take measures against these agitators of the people. The evidence is serious, and … the reverend parish priest is largely responsible for these uprisings."</p><p>Father Dragoni was unable to prevent the parish priest and congregants from gathering and feasting. He found himself further burdened the next morning with sorting out the events that had followed the procession, when prayer and feasts had turned into late-night drunken parties of revelers who tore down part of the wooden stockade that had been erected to enforce the quarantine.</p><p>When the plague outbreak finally ended and the town reopened, Father Dragoni offered the following report <a href="https://books.google.com/books/about/Faith_Reason_and_the_Plague_in_Seventeen.html?id=aqOrYdo8xnUC" target="_blank" rel="noopener noreferrer">on his own actions</a>: "I have not acted unjustly and have accompanied severity with compassion and charity. … In more than a year that I have held this office, no one has died without sacrament or confession."</p><p>In a period that has been characterized by faith's opposition to science, Father Dragoni demonstrated through his actions that carrying out public health measures and God's sacraments went hand in hand.</p>
<h2>Then and now</h2><p>Four centuries later, there are similar examples of religious resistance to public health measures and striking examples of religious collaboration with public health regulations.</p><p>Although <a href="https://www.bostonglobe.com/2020/08/31/metro/i-want-people-god-enjoy-liberty-pastor-maine-super-spreader-wedding-gives-defiant-indoor-sermon/" target="_blank" rel="noopener noreferrer">there are instances of church leaders</a> rallying congregants against public health measures, there are <a href="https://www.bostonglobe.com/2020/09/12/metro/new-england-evangelical-leaders-maine-sermon-reflects-deepening-rifts-faith-community/?s_campaign=8315" target="_blank" rel="noopener noreferrer">far more examples</a> of people and institutions who, like Father Dragoni, bring together religious devotion and disease control.</p><p>When the coronavirus swept into Italy in February, the patriarch of Venice – the bishop – promptly complied with the government's edict to cancel Masses, eagerly doing his part to <a href="https://www.repubblica.it/cronaca/2020/02/23/news/coronavirus_italia-249329434/" target="_blank">stem the epidemic</a>. And in the Italian churches around Turin that remained open for private prayer, the cisterns of holy water were promptly <a href="https://www.repubblica.it/cronaca/2020/02/23/news/coronavirus_scuole_chiuse_e_niente_carnevale_tutti_i_provvedimenti-249355737/" target="_blank">emptied</a>.</p><p>To be clear, there is a long history of religious resistance to public health measures during disease outbreaks. But cooperation between church and state in attempting to stem the spread of disease has its precedents too.<img src="https://counter.theconversation.com/content/146473/count.gif?distributor=republish-lightbox-basic" alt="The Conversation"></p><p><a href="https://theconversation.com/profiles/hannah-marcus-1156731" target="_blank">Hannah Marcus</a>, Assistant Professor, Department of the History of Science, <em><a href="https://theconversation.com/institutions/harvard-university-1306" target="_blank">Harvard University</a></em></p><p>This article is republished from <a href="https://theconversation.com/" target="_blank">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/quarantine-rule-breakers-in-17th-century-italy-partied-all-night-and-some-clergy-condemned-the-feasting-146473" target="_blank">original article</a>.</p>
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‘Morality pills’ may be the US’s best shot at ending the coronavirus pandemic, according to one ethicist
COVID-19 is a tragedy of the commons.
05 September, 2020
Photo by Adam Nieścioruk on Unsplash
COVID-19 is a collective risk.
<p>It threatens everyone, and we all must cooperate to lower the chance that the coronavirus harms any one individual. Among other things, that means <a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html" target="_blank">keeping safe social distances and wearing masks</a>. But <a href="https://www.pewresearch.org/fact-tank/2020/06/23/most-americans-say-they-regularly-wore-a-mask-in-stores-in-the-past-month-fewer-see-others-doing-it/" target="_blank">many people choose not to do these things</a>, making spread of infection more likely.</p><p>When someone chooses not to follow public health guidelines around the coronavirus, they're defecting from the public good. It's the moral equivalent of the <a href="https://en.wikipedia.org/wiki/Tragedy_of_the_commons#:%7E:text=The%20tragedy%20of%20the%20commons,resource%20through%20their%20collective%20action." target="_blank">tragedy of the commons</a>: If everyone shares the same pasture for their individual flocks, some people are going to graze their animals longer, or let them eat more than their fair share, ruining the commons in the process. Selfish and self-defeating behavior undermines the pursuit of something from which everyone can benefit.</p><p>Democratically enacted enforceable rules – mandating things like mask wearing and social distancing – might work, if defectors could be coerced into adhering to them. But <a href="https://www.aarp.org/health/healthy-living/info-2020/states-mask-mandates-coronavirus.html" target="_blank">not all states have opted to pass them</a> or <a href="https://www.clickondetroit.com/news/local/2020/05/15/several-michigan-sheriffs-say-they-wont-enforce-parts-of-executive-orders/" target="_blank">to enforce the rules</a> that are in place.</p><p><a href="https://scholar.google.com/citations?user=oEHIR14AAAAJ&hl=en&oi=ao" target="_blank">My research in bioethics</a> focuses on questions like how to induce those who are noncooperative to get on board with doing what's best for the public good. To me, it seems the problem of coronavirus defectors could be solved by moral enhancement: like receiving a vaccine to beef up your immune system, people could take a substance to boost their cooperative, pro-social behavior. Could a psychoactive pill be the solution to the pandemic?</p><p>It's a far-out proposal that's <a href="https://slate.com/technology/2017/03/why-we-are-so-alarmed-by-the-idea-of-a-moral-enhancement-pill.html" target="_blank">bound to be controversial</a>, but one I believe is worth at least considering, given the importance of social cooperation in the struggle to get COVID-19 under control.</p>
<h2>Public goods games show scale of the problem</h2><p>Evidence from experimental economics shows that defections are common to situations in which people face collective risks. Economists use <a href="https://en.wikipedia.org/wiki/Public_goods_game#:%7E:text=The%20public%20goods%20game%20is,put%20into%20a%20public%20pot." target="_blank" rel="noopener noreferrer">public goods games</a> to measure how people behave in various scenarios to lower collective risks such as from climate change or a pandemic and to prevent the loss of public and private goods.</p><p>The evidence from these experiments is no cause for optimism. <a href="https://doi.org/10.1073/pnas.0504902103" target="_blank" rel="noopener noreferrer">Usually everyone loses</a> because people won't cooperate. This research suggests it's not surprising people aren't wearing masks or social distancing – lots of people defect from groups when facing a collective risk. By the same token, I'd expect that, as a group, we will fail at addressing the collective risk of COVID-19, because groups usually fail. <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html" target="_blank" rel="noopener noreferrer">For more than 150,000 Americans so far</a>, this has meant losing everything there is to lose.</p><p>But don't abandon all hope. In some of these experiments, the groups win and successfully prevent the losses associated with the collective risk. What makes winning more likely? Things like keeping a running tally of what others are contributing, <a href="https://doi.org/10.1038/s41598-019-50964-w" target="_blank" rel="noopener noreferrer">observing others' behaviors</a>, <a href="https://doi.org/10.1073/pnas.1102493108" target="_blank" rel="noopener noreferrer">communication and coordination</a> before and during play, and <a href="https://doi.org/10.1038/nature13530" target="_blank" rel="noopener noreferrer">democratic implementation of an enforceable rule requiring contributions</a>.</p><p>For those of us in the United States, these conditions are out of reach when it comes to COVID-19. You can't know what others are contributing to the fight against the coronavirus, especially if you socially distance yourself. It's impossible to keep a running tally of what the other 328 million people in the U.S. are doing. And communication and coordination are not feasible outside of your own small group.</p><p>Even if these factors were achievable, they still require the very cooperative behavior that's in short supply. The scale of the pandemic is simply too great for any of this to be possible.</p>
<h2>Promoting cooperation with moral enhancement</h2><p>It seems that the U.S. is not currently equipped to cooperatively lower the risk confronting us. Many are instead pinning their hopes on the rapid development and distribution of an enhancement to the immune system – a vaccine.</p><p>But I believe society may be better off, both in the short term as well as the long, by boosting not the body's ability to fight off disease but the brain's ability to cooperate with others. What if researchers developed and delivered a moral enhancer rather than an immunity enhancer?</p><p>Moral enhancement is the use of substances to make you more moral. The psychoactive substances act on your ability to reason about what the right thing to do is, or your ability to be empathetic or altruistic or cooperative.</p><p>For example, oxytocin, the chemical that, among other things, can induce labor or increase the bond between mother and child, may cause a person to be more empathetic and <a href="https://doi.org/10.1126/science.1189047" target="_blank" rel="noopener noreferrer">altruistic</a>, <a href="https://doi.org/10.1371/journal.pone.0001128" target="_blank" rel="noopener noreferrer">more giving and generous</a>. <a href="https://doi.org/10.1093/ijnp/pyx047" target="_blank" rel="noopener noreferrer">The same goes for psilocybin</a>, the active component of "magic mushrooms." These substances have been shown to <a href="https://doi.org/10.1007/s40732-015-0139-y" target="_blank" rel="noopener noreferrer">lower aggressive behavior in those with antisocial personality disorder</a> and to improve the <a href="https://doi.org/10.1016/j.psyneuen.2017.07.483" target="_blank" rel="noopener noreferrer">ability of sociopaths to recognize emotion in others</a>.</p><p>These substances interact directly with the psychological underpinnings of moral behavior; others that make you more rational could also help. Then, perhaps, the people who choose to go maskless or flout social distancing guidelines would better understand that everyone, including them, is better off when they contribute, and rationalize that the best thing to do is cooperate.</p>
<h2>Moral enhancement as an alternative to vaccines</h2><p>There are of course pitfalls to moral enhancement.</p><p>One is that the science isn't developed enough. For example, while oxytocin may cause some people to be more pro-social, it also <a href="https://doi.org/10.1073/pnas.1015316108" target="_blank" rel="noopener noreferrer">appears to encourage ethnocentrism</a>, and so is probably a bad candidate for a widely distributed moral enhancement. But this doesn't mean that a morality pill is impossible. The solution to the underdeveloped science isn't to quit on it, but to direct resources to related research in neuroscience, psychology or one of the behavioral sciences.</p><p>Another challenge is that the defectors who need moral enhancement are also the least likely to sign up for it. As some have argued, a solution would be to <a href="https://global.oup.com/academic/product/unfit-for-the-future-9780198707929" target="_blank" rel="noopener noreferrer">make moral enhancement compulsory</a> or <a href="https://doi.org/10.1111/bioe.12496" target="_blank" rel="noopener noreferrer">administer it secretly, perhaps via the water supply</a>. These actions require weighing other values. Does the good of covertly dosing the public with a drug that would change people's behavior outweigh individuals' autonomy to choose whether to participate? Does the good associated with wearing a mask outweigh an individual's autonomy to not wear one?</p><p>The scenario in which the government forces an immunity booster upon everyone is plausible. And the military has been <a href="https://www.theatlantic.com/technology/archive/2012/02/more-than-human-the-ethics-of-biologically-enhancing-soldiers/253217/" target="_blank" rel="noopener noreferrer">forcing enhancements like vaccines or "uppers" upon soldiers</a> for a long time. The scenario in which the government forces a morality booster upon everyone is far-fetched. But a strategy like this one could be a way out of this pandemic, a future outbreak or the suffering associated with climate change. That's why we should be thinking of it now.<img src="https://counter.theconversation.com/content/142601/count.gif?distributor=republish-lightbox-basic" alt="The Conversation"></p><p><a href="https://theconversation.com/profiles/parker-crutchfield-775987" target="_blank">Parker Crutchfield</a>, Associate Professor of Medical Ethics, Humanities and Law, <em><a href="https://theconversation.com/institutions/western-michigan-university-2102" target="_blank" rel="noopener noreferrer">Western Michigan University</a></em></p><p>This article is republished from <a href="https://theconversation.com/" target="_blank" rel="noopener noreferrer">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/morality-pills-may-be-the-uss-best-shot-at-ending-the-coronavirus-pandemic-according-to-one-ethicist-142601" target="_blank" rel="noopener noreferrer">original article</a>.</p>
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Not long after the COVID-19 pandemic caused colleges to start teaching remotely, students balked at the idea of paying full tuition for online learning.
<p> It's not hard to understand why. After all, they were not getting the football and basketball games, student clubs, access to labs and the library and the out-of-class conversations that are all part of the typical campus experience.</p><p>Although students who study online will not pay the room, board and activities fees that typically cover nonacademic costs, concern about paying full tuition continues this fall, as many universities opt to <a href="https://www.chronicle.com/article/heres-a-list-of-colleges-plans-for-reopening-in-the-fall/" rel="noopener noreferrer dofollow" target="_blank">continue online instruction</a> in the interest of keeping students, faculty and staff safe from the pandemic.</p><p>Is it right to expect to pay less tuition for online learning? Or are colleges justified in charging the full tuition price when classes – at least <a href="https://www.chronicle.com/article/heres-a-list-of-colleges-plans-for-reopening-in-the-fall/" rel="noopener noreferrer dofollow" target="_blank">at many schools</a> – won't be taking place on campus?</p><p>As a longtime college admissions and enrollment leader – and now as a professor of higher education – I have some insights. One of the most important is that <a href="https://nces.ed.gov/fastfacts/display.asp?id=31" rel="noopener noreferrer dofollow" target="_blank">fewer than one in five</a> families pay the full price for in-person instruction to begin with. They are getting a break through scholarships and need-based grants from the colleges. In other words, most students are already getting a discount.</p>
<h2>Price versus cost</h2><p>In addition, it's important to understand the difference between the price of education and the cost of education. These two things might often be misunderstood because the terms "price" and "cost" are often used interchangeably as though they are the same. But there's a big difference between the two.</p><p>Price is the amount of money charged to a consumer – in this case a student – for a good or service. Cost is the amount of money the provider spends to produce that good or provide that service. Unlike in business, the price colleges charge – that is, tuition – is almost always less than the cost to provide instruction. The difference is covered by taxpayers and grants at public colleges and by endowment earnings, gifts and grants at private colleges.</p><p>In other words, even when their families are paying "full price," Americans are not paying for the full cost of their education.</p><p>However, the cost of instruction during the pandemic has actually <a href="https://www.insidehighered.com/news/survey/covid-19s-forceful-impact-shakes-college-business-officers-confidence" target="_blank" rel="noopener noreferrer dofollow">increased</a> due to the need for new technology platforms, training and online instructional support. Faculty are still teaching and are available to students for extra help and consultation. And because some students and staff will be on campus even if teaching is primarily online, colleges have <a href="https://theconversation.com/going-online-due-to-covid-19-this-fall-could-hurt-colleges-future-138926" target="_blank" rel="noopener noreferrer dofollow">spent millions of dollars</a> updating and maintaining their campuses for COVID-19 safety.</p><p>With the toll of the pandemic bearing down on our nation and its colleges and universities, that may not be something that students and their parents necessarily want to hear. They see that they are being asked to pay "in-person" tuition prices for remote learning and feel like it's a ripoff.</p><p>However, it is important to understand that in expecting colleges to reduce tuition when they are paying more to deliver instruction is to ask colleges to take on an even bigger share of the cost than they already do.</p>
<h2>Financial aid factors</h2><p>Even if schools offered "online discounts," it may not make as big a difference as people think because of the way that financial aid works.</p><p>At four-year public and nonprofit private colleges and universities, <a href="https://nces.ed.gov/fastfacts/display.asp?id=31" target="_blank" rel="noopener noreferrer dofollow">85% of undergraduates</a> receive financial aid. These students not only benefit from a list price that is lower than the cost borne by colleges, but they are getting a further discount in price through financial aid.</p><p>This leads to an important point.</p><p>Financial aid is based on the price charged minus what a family would be expected to pay, based on a federal formula. So, if tuition were lowered, students would get less financial aid and would therefore be expected to pay the same amount of money no matter what the tuition charge.</p><p>As a result, even at the colleges offering an online discount, the students who need that discount the most are going to benefit the least. For example, if tuition is US$40,000 and you are expected to pay $10,000, you might get $30,000 in various forms of aid. If tuition is reduced to $36,000, you are still expected to pay $10,000, and you might get $26,000 in aid.</p><p>The tab for tuition does not generally cover out-of-class experiences such as student activities and residence hall functions. When going remote, colleges will not be charging residence hall, food and activities fees. That means colleges will lose revenue on those things. They will lay off some staff who work with student groups.</p><p>So while charges for room and board and student activities and athletics fees will be eliminated for online-only instruction, tuition pricing will either be untouched or be slightly reduced. But the ability for a college to reduce tuition will depend largely on the school's financial health.</p>
<h2>Price adjustments</h2><p>Even in light of these realities, some schools are still lowering tuition for online learning.</p><p>Although they'd rather not, many colleges with small <a href="https://theconversation.com/how-should-we-measure-the-size-of-a-universitys-endowment-54634" target="_blank" rel="noopener noreferrer dofollow">endowments</a> and limited state aid will lower tuition. These schools typically are not as well known and risk losing students if they do not charge less. They will take in less money per student but expect to recover at least some of the loss with a larger enrollment.</p><p>Some of the wealthiest schools have already reduced tuition at the edges.</p><p>Williams College, a small liberal arts school in Massachusetts, with its $3 billion endowment and 2,000 students, <a href="https://www.chronicle.com/article/colleges-face-a-no-win-dilemma-to-cut-or-not-to-cut-tuition" target="_blank" rel="noopener noreferrer dofollow">cut tuition by 15%</a>. In so doing, its provost <a href="https://www.chronicle.com/article/colleges-face-a-no-win-dilemma-to-cut-or-not-to-cut-tuition" target="_blank" rel="noopener noreferrer dofollow">admitted</a> to being concerned about the pressure this would put on less well-endowed competitors to do the same.</p><p>However, Williams' leaders thought it was the right thing to do for their students.</p><p>Princeton, with a <a href="https://planetprinceton.com/2019/10/11/princeton-universitys-endowment-rose-to-26-1-billion-at-end-of-the-fiscal-year/" target="_blank" rel="noopener noreferrer dofollow">$26 billion</a> endowment, applied a <a href="https://www.chronicle.com/article/colleges-face-a-no-win-dilemma-to-cut-or-not-to-cut-tuition" target="_blank" rel="noopener noreferrer dofollow">10% discount</a> to its full-freight tuition. When a college has the resources, this is certainly easier to do.</p><p>Just below these institutions are schools that are well known but not as wealthy. They will not likely lose students because of tuition pricing but cannot afford to offer online discounts.</p><p>Dickinson College, a liberal arts school in Pennsylvania, where I served as vice president from 1999-2009; Smith College, also in Massachusetts; and Carnegie Mellon University, in Pittsburgh, are examples of institutions not offering online discounts.</p><p>Dickinson College president <a href="https://www.dickinson.edu/info/20043/about/4030/dickinson_college_updates_on_fall_2020/5" target="_blank" rel="noopener noreferrer dofollow">Margee Ensign sought to reassure</a> students that the online fall semester will "feature the same expert faculty and the same small class sizes," and will also "maintain rigor" and "close student-faculty relationships."</p>
<h2>Skepticism and potential benefit</h2><p>
Predictably, <a href="https://www.insidehighered.com/views/2020/07/28/four-key-things-students-say-they-want-college-fall-opinion" target="_blank" rel="noopener noreferrer dofollow">many students are not convinced</a> that online instruction will be of the same quality as in-person. Plus, many students are understandably upset because they did not expect to spend their college days doing remote learning.
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But there is a potential long-term benefit.
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The COVID-19 pandemic has forced higher education leaders to control costs by changing priorities and eliminating nonessential spending in ways that they didn't have to think as much about doing before. As a result, perhaps tuition increases will moderate in the short term, and stay more affordable in the future. After all of the stress and pain caused by the pandemic, this may be one positive change.
</p><p>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/should-students-get-a-discount-if-they-wont-be-on-campus-because-of-covid-19-144031">original article</a>.</p>
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Does your homemade mask work?
Despite unregulated face coverings being highly variable, they do, on average, reduce the spread of the virus.
15 August, 2020
Ming Yeung / Getty Images
If a surgeon arrived at the operating theatre wearing a mask they had made that morning from a tea towel, they would probably be sacked.
<p> This is because the equipment used for important tasks, such as surgery, must be tested and certified to ensure compliance with specific standards.
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But anyone can design and make a face covering to meet new public health requirements for using <a href="https://www.gov.uk/government/publications/face-coverings-when-to-wear-one-and-how-to-make-your-own/face-coverings-when-to-wear-one-and-how-to-make-your-own#when-to-wear-a-face-covering" rel="noopener noreferrer dofollow" target="_blank">public transport or going to the shops</a>.
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Indeed, arguments about the quality and standard of face coverings underlie recent controversies and explain why many people think they are not effective for protecting against COVID-19. Even the language distinguishes between face masks (which are normally considered as being built to a certain standard) and face coverings that can be almost anything else.
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Perhaps the main problem is that, while we know that well-designed face masks have been <a href="https://theconversation.com/coronavirus-wearing-a-cloth-face-mask-is-less-about-science-and-more-about-solidarity-138461" rel="noopener noreferrer dofollow" target="_blank">used effectively for many years</a> as personal protective equipment (PPE), during the COVID-19 outbreak <a href="https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/managing-shortages-in-personal-protective-equipment-ppe" rel="noopener noreferrer dofollow" target="_blank">shortages of PPE</a> have made it impractical for the entire population to wear regulated masks and be trained to use them effectively.
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<p>As a result, the argument <a href="https://theconversation.com/does-your-face-mask-protect-you-or-other-people-142612" target="_blank">has moved away</a> from wearing face masks for personal protection and towards wearing "face coverings" for public protection. The idea is that despite unregulated face coverings being highly variable, they do, on average, reduce the spread of virus perhaps in a similar way as covering your mouth when you cough.</p><p>But given the wide variety of unregulated face coverings that people are now wearing, how do we know which is most effective?</p><p>The first thing is to understand what we mean by effective. Given that coronavirus particles are about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045880/" target="_blank">0.08 micrometres</a> and the weaves within a typical cloth face covering have gaps about 1,000 times bigger (between 1 and 0.1 millimetres), "effectiveness" does not mean reliably trapping the virus. Instead, much like covering our mouths when we cough, the aim of wearing cloth coverings is to reduce the distance that your breath spreads away from your body.</p><p>The idea is that if you do have COVID-19, depositing any virus you may breathe out on either yourself or nearby (within one metre) is much better than blowing it all over other people or surfaces.</p><p>So an effective face covering is not meant to stop the wearer from catching the virus. Although from a personal perspective we might want to protect ourselves, to do so we should be wearing specially designed PPE such as FFP2 (also known as N95) masks. But, as mentioned, by doing so we risk creating mask shortages and potentially <a href="https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide" target="_blank" rel="noopener noreferrer dofollow">putting healthcare workers at risk</a>.</p><p>Instead, if you want to avoid catching the virus yourself, the most effective things to do are avoid crowded places <a href="https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/guidance-for-households-with-grandparents-parents-and-children-living-together-where-someone-is-at-increased-risk-or-has-symptoms-of-coronavirus-cov#why-staying-at-home-is-very-important" target="_blank" rel="noopener noreferrer dofollow">by ideally staying at home</a>, don't touch your face, and wash your hands often.</p>
<h2>Two simple tests</h2><p>If effectiveness for face coverings means preventing our breath travelling too far away from our bodies, how would we go about comparing different designs or materials?</p><p>Perhaps the easiest way, as demonstrated by several increasingly shared pictures or videos on social media, is to find someone who "vapes" and film them breathing out the vapour while wearing a face covering. One glance at such a picture dispels any suggestion that these face coverings stop your breath escaping.</p><p>Instead, these pictures show that your breath is directed over the top of your head, down onto your chest, and behind you. The breath is also turbulent, meaning that although it does spread out, it doesn't go far.</p><p>In comparison, if you look at a picture of <a href="https://www.ed.ac.uk/covid-19-response/latest-news/face-coverings-covid-19-transmission-risk" target="_blank" rel="noopener noreferrer dofollow">someone not wearing a face covering</a>, you will see that the exhalation goes mostly forward and down, but a significantly further distance than with the face covering.</p>
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Such a test is probably ideal for examining different designs and fits. Do coverings that loop around the ears work better than scarves? How far under your chin does a covering need to go? What is the best nose fitting? How do face shields compare to face masks? These are all questions that could be answered using this method.
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But, in conducting this experiment, we should appreciate that "vaping" particles are about <a href="https://pubs.acs.org/doi/abs/10.1021/acs.chemrestox.9b00243" target="_blank">0.1 to 3 micrometres</a> – significantly bigger than the virus. While it is probably fair to assume that the smaller virus particles will travel in roughly the same directions as the vaping particles, there is also the chance that they may still go straight forward through the face covering.
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To get an idea of how much this might happen, a simple test involving trying to blow out a candle directly in front of the wearer could be tried. Initially, the distance coupled with the strength of exhalation could be investigated, but then face coverings made from different materials and critically with different numbers of layers could be tried. The design of face covering that made it hardest to divert the candle flame will probably provide the best barrier for projecting the virus forward and through the face covering.
</p><iframe width="560" height="315" src="https://www.youtube.com/embed/pKk9GFur4Hc" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen=""></iframe><p>
Without any more sophisticated equipment, it would be difficult to conduct any further simple experiments at home. However, combining the above two tests would provide wearers with a good idea about which of their face coverings would work the best if the aim was to avoid breathing potential infection over other people.
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This article is republished from <a href="https://theconversation.com/" target="_blank" rel="noopener noreferrer dofollow">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/does-your-homemade-mask-work-142675" target="_blank" rel="noopener noreferrer dofollow">original article</a>.
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