The Great Coronavirus Contact-Tracing Race

It starts with a phone call. You may have been in contact with someone who has coronavirus, a kind-sounding voice tells you: You should self-isolate and get tested for Covid-19, if possible. The caller is careful not to reveal the identity of the infected individual you’ve crossed paths with; if they’re good at their job, they’re sensitive both to your fears and the others’ privacy.

The voice on the line is a contact tracer — a person trained to track down and notify all the people who might have been exposed to coronavirus by someone who’s known to have the infection.

Contact tracing is being pursued as a key part of the global effort to target Covid-19 hot spots, slow the spread of infection, and reopen local economies. Most experts agree that to truly halt the disease, it will take far more widespread testing and, ultimately, an effective vaccine. But by carefully following the movement patterns of the human disease vectors that carry it, jurisdictions hope to be able to target their lockdown measures at individuals who are most at risk, allowing a semblance of normal public life to resume.

To safely reopen, the U.S. might need to train and deploy at least 100,000 contact tracers. But some hope that this laborious process could be at least partially automated. Tech companies are jockeying to introduce infection alert systems, which use phone data to do some of the legwork of tracking recent contacts. Apple and Google have teamed up to develop a tool that uses Bluetooth to identify which other devices (and the people who own them) you come close to each day; if someone gets sick, anonymous signals go out to the people that had entered their orbit, urging them to quarantine or stay home.

Outside the U.S., such tracing technology is already in the field. South Korea’s much-talked-about coronavirus control regime leans heavily on the smartphones that 95% of residents carry; authorities can piece together and share anonymized routes of potential carriers using location data, credit card records, and security tapes. The U.K.’s National Health Service is introducing a Bluetooth tracking app akin to Apple and Google’s; since it became available to the 800,000 residents of the Isle of Wight last week, in April that only about half of the tracers’ subjects pick up the phone, Ryan told me she’s surprised at how receptive people have been to her cold-calls.

“Everyone has been super willing to talk and answer questions about like, whether they had diarrhea or not,” she said. “People also seemed to be pretty willing to help out, because [they know that] part of the reason we’re collecting info on symptoms is to help better understand how it presents in different people.”

There’s no app for this

The interpersonal skills required to build this relationship is one reason why public health experts are skeptical about using technology to replace manual tracers.

“The human element of contacting someone on the phone, gaining their trust, having them view you as an ally, and accepting your recommendation to self-quarantine and share who they’ve had contact with is very important and somewhat of an art,” said Waters. “I’m not sure a tech-based solution could replicate that.”

Early in the coronavirus outbreak, Singapore’s contract tracing efforts were singled out for praise by the World Health Organization. The city-state of nearly 6 million acted aggressively to contain the virus, supplementing its vast network of human tracers with a tracing app, TraceTogether. But since its March launch, only a fifth of its residents has downloaded it, and Singapore has more recently experienced a surge in cases. New outbreaks have been sourced to dormitories where migrant workers lived, where Welty says it’s unlikely such an app would have helped; Singapore’s human army stepped in instead.

Oxford University researchers suggest that a minimum 60% adoption rate is necessary for a tracing system to be effective. Of all the countries using technology as a tracing supplement, MIT Techology Review found that Iceland’s app has the highest adoption rate, at 38%. For the country of 364,000 people, which has largely managed to flatten its curve, the app “wasn’t a game changer,” an official overseeing tracing efforts told MIT.

Jason Bey, the product lead for Singapore’s TraceTogether app, put it even more simply in a Medium post: “If you ask me whether any Bluetooth contact tracing system deployed or under development, anywhere in the world, is ready to replace manual contact tracing, I will say without qualification that the answer is, No.”

The prospects of a tech fix may be even dimmer in the U.S., where  privacy concerns are more widespread. Based on polling by the Washington Post and the University of Maryland, many Americans don’t trust tech companies with their public health information, despite assurances from the companies that they won’t save location data or store it in a centralized location. Three in five respondents reported being “unable or unwilling” to use such a system, and most expressed a greater trust in public health departments than Big Tech. Of people who owned smartphones, only 41% said they’d be willing to download the app.

That hasn’t stopped the emerging patchwork of coronavirus-tracing apps that are appearing at the local and state level, BuzzFeed News reported, which could introduce new incompatibilities between health departments and further scuttle any sort of coordinated national response.

Adding to the challenge, many communities especially vulnerable to the virus in the U.S. — migrant workers, people experiencing homelessness, and undocumented immigrants — do not have access to an internet-connected device, says Welty. They also might have more reason to hesitate before sharing movement patterns with an entity that they fear could pass them along to the government.

Even if an app was capable of locating potential contacts and asking the same series of automated questions, certain subtleties can’t be replicated, as when Welty carefully probes her subjects to try and determine when the contact happened. And a human tracer can also provide additional public health information, she says. For example, if a subject is told to stay inside but responds that they have to keep working to provide for their family, Welty submits their name and address to the city, which sends them food, cleaning supplies, or even diapers.

“We really need to be able to provide the services they need to isolate,” she says. Acts of support like this can help build trust among whole neighborhoods, like the communities of Latino San Franciscans Welty works with, who are testing positive at far higher rates than white residents.

“People also need guidance about where to get resources, how to communicate with their employers; some people fear loss of income or job,” said Dr. Emily S. Gurley, an infectious disease epidemiologist at the Center for Global Health at the Bloomberg School, in a press conference. “At the end of the day, this endeavor is about helping people in a difficult and scary time.”

But technology can be an effective ally in the Covid-19 battle. For those willing and digitally able to opt in, apps can be used by patients to record the results of daily temperature checks, or alert public health departments of their need for services, Braunstein said. And tracers like Ryan could use the assist when hunting down cold leads. Most of the people she’d contacted during recent shifts had been tested three weeks prior, which made remembering and finding the people they’d seen while developing symptoms much harder. One woman’s office used internal CCTV footage to help retrace her steps as soon as they knew she tested positive, Ryan said. By the time Ryan called, the brunt of the tracing work had already been done.

A lot has changed since the Ebola outbreak of 2014, when contact tracers in west Africa sat in centralized call centers or went door-to-door to find subjects. Today, technology can continue to push the craft forward, even without tying your health data to your GPS coordinates. “There are many ways that tech can support the public health function: It can help them be faster, it can help them organize data, it can help cases and contacts respond in a quick way about their signs and symptoms,” said Gurley. “Technology can be a support all along the way. But it never supplants the public health function.”

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Who Will Ride Transit After Coronavirus?

In 1918, streetcars were the top urban transportation mode in the United States. And they were packed: Americans made about 140 trips per capita, about 15 billion trips total, that year.

Then came the Spanish flu. As influenza ripped through cities, crowded systems were forced to make health-centric changes, including requiring masks on passengers, limiting streetcar capacity, and staggering commute hours to keep riders distanced. Some vehicles were briefly decommissioned due to a shortage of operators. Still, the popularity of mass transit did not suffer dramatically in the succeeding years — at least not until the Great Depression put a quarter of the country out of work and, later, when the private automobile began to displace it.

What about today? Coronavirus has walloped bus and rail networks. The top transit systems in the U.S. have seen 70% to 90% ridership losses as commuters have been laid off, worked from home, or opted for other means of travel since March. With few passengers, daunting finances, sick operators, and a heightened imperative to sanitize, agencies have dramatically scaled back service. San Francisco’s Municipal Transit Agency has ceased rail operations and eliminated nearly 70% of its bus network. In Washington, D.C., buses are serving just 26 “lifeline” routes and Metro trains are running on Saturday schedules. The New York subway has stopped running 24 hours a day for the first time in 115 years.

Transit’s current situation is partly a reflection of the overall travel freeze on driving, flying, and all other modes during stay-at-home orders in major cities. But when lockdowns ease, there are reasons that transit commuters in particular may not return in force.

First, bus and rail ridership tends to be more sensitive to  economic changes than other modes, and the financial effects of coronavirus are poised to stretch long into the future, said Brian Taylor, an urban planning professor and director of the Institute of Transportation Studies at the University of California, Los Angeles.

Second, some proportion of would-be passengers are likely to continue to work remotely, while others may change their commute patterns to driving or biking. “We know that people will be scared to use public transportation from a health perspective,” said Ahmed El-Geneidy, a professor of urban planning at McGill University who has studied transit ridership. Based on what’s happening in China, a post-pandemic car sales boom may be in the offing.  

Third, assuming rider demand and revenue remain low, transit agencies may have to keep service cuts even after lockdowns lift, despite the fact that more vehicles, not fewer, are needed to allow for social distancing. Academic literature shows that such cuts themselves can be rider-deterrents. “There’s an elasticity that shows if you cut service by 10%, you can generally expect ridership goes down 3-6%,” said Greg Erhardt, a civil engineering professor at the University of Kentucky who specializes in travel behavior and transportation planning.

A final and pernicious factor is that 2020 was primed to be the sixth consecutive year of what Taylor calls a “disturbing trend”: U.S. transit ridership has been in decline since 2014, even as transit agencies have added service on the whole. Much of that new service has come in light-rail extensions and some bus-rapid transit lines usually designed to attract “discretionary riders,” or people who can afford to choose between driving and transit, and often financed through sales tax measures.

Explanations for ridership’s downward slide during these years abound. Cheap gas and easy credit for auto loans increased the appeal of car use, while service quality deteriorated on the older parts of transit systems. Ride-hailing services like Uber and Lyft emerged, and a housing affordability crisis pushed many people outside the range of reliable transit.  

In Southern California, Taylor and his colleagues have found that the largest drops in ridership have come from groups that were traditionally the heaviest, most economically dependent users of transit. Lower-income immigrants in particular have abandoned buses as car ownership among those communities has increased. While the share of discretionary riders has increased slightly, thanks to increased investment into rail and rapid bus service geared toward more affluent commuters, “their added trips are still overwhelmed by lost trips from others,” Taylor said.

Who will ride in the wake of coronavirus? Passengers will inevitably return in dense cities with extensive systems, such as New York City, Washington, D.C., and San Francisco, where transit is critical for thriving urban economies to function, Taylor said. But the best indication of the future face of transit may be the people on board right now. And there are still a lot of them: By the end of March, New York City subway ridership cratered to 10% of its usual five million weekday trips, but that still meant it was providing more than 500,000 trips. The 65% ridership drop on L.A.’s Metro buses, reported in mid-April, still equates to 500,000 daily boardings.

It isn’t clear how many of these trips were made by essential workers, but analyses based on census data show that more than 30% of normal transit riders have jobs that have been deemed pandemic-critical. Individuals riding to work right now are also less likely to have the option to drive, and they are more likely to be people of color, as evidenced in photos of crowded subways and buses that have sparked online outrage in recent weeks. Transit, an urban mobility navigation app, has found that 68% of the people using it to plan bus and metro trips right now are women, most of them black and Latinx.

There is one grim new potential reservoir of future transit riders, Taylor said: lower-income households that have bought vehicles in the last few years. Their car-owning status could be vulnerable to an economic downturn.

These circumstances point to a potential shift in the way transit is used, viewed, and potentially funded, experts said. Traditionally, a successful transit system is one with a lot of riders, with packed buses and cars and a large share of revenue derived from passenger fares. But in a world where social distancing means life or death, and a 40-foot bus has an eight-passenger capacity limit, emphasizing ridership and fare recovery as the metrics of success may no longer make sense. Yet the nurses, orderlies, grocery store workers and pharmacists boarding today are proof that transit itself is a critical social institution. “Transit agencies should be switching their brains to serving those riders,” said El-Geneidy. “We have to accept that public transport is an essential service. We can’t think about it as a for-profit organization that can make money from ridership.”

That could create a stronger demand for federal funding for transit, instead of local agencies continuing rely on fares and tax measures tied to projects like light-rail expansions sold to affluent voters with the promise of congestion relief. For Taylor, that may mean something like a reality check for transit-boosters.

“For many years we have a lot of aspirations for transit: We want it to beat traffic, fight climate change, and revitalize communities,” he said. “But the two things it has demonstrably done in last half century is provide mobility for those without — whether that’s due to age, income, or disability — and allow highly agglomerated places function. My educated guess is that we will see the rise of transit as a social service.”

If that sounds like giving up on transit, look to the cities that are using the crisis as a moment to revamp their systems with social equity as a priority. El-Geneidy and Erhardt both pointed to San Francisco as a leader, where the SFMTA redesigned bus service virtually overnight in early April to focus on just a few dozen routes mostly serving commutes into the city’s downtown core and major hospitals. About 100,000 people are still riding every day.

Jeffrey Tumlin, the executive director of the SFMTA, acknowledged that not all of the 100-plus routes lost to coronavirus are necessarily going to return. But he strikes an optimistic tone: He believes that a transit network that focuses more narrowly on frequent, more reliable service along fewer routes may serve the city better in the end. While the streets are still empty, the SFMTA hopes to rethink its approach to transportation writ large. Facing a sharp rise in vehicle traffic and fatalities, and seeking to slash carbon emissions, the city had already moved to ban private vehicles on its central downtown corridor, and has spent the past year studying congestion pricing.

With little vehicle traffic, “we’re in an extraordinary period of time to rethink how we manage our streets,” Tumlin said in an interview in April. “We have to set the city up not only for a stronger recovery, but also for a more urban, humane economy.”

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Your Coronavirus Housing Questions, Answered

A month ago, the worst fears of a coronavirus housing apocalypse were coming into view: According to the National Multifamily Housing Council, 31% of renters living in 11.5 million apartment units in the U.S. were late on the rent on April 5. That figure didn’t include the tens of millions of renters who live in single-family homes and other housing situations.

But by hook or by crook, millions of American renters made it through April. By April 26, the share of apartment tenants who were late with the rent had fallen to 8% — enough to put the month just a few percentage points behind rent collection in March (95%) or April 2019 (96%).

Now comes May, and the national unemployment rate has surged, reaching as high as 22%. To make sense of how deep the coronavirus housing crisis really runs and what might happen this month, CityLab asked readers to submit their most pressing questions about keeping a roof over their heads. Tenants and landlords alike sent in their thoughts and concerns. Some of these questions with answers follow (in condensed form).

Q: Are renters going on strike?

A: Yes. The national #CancelRent movement that took shape before May Day may be the largest rent strike in decades. Tenant organizers drummed up support for actions in Los Angeles, Philadelphia, New York, and other cities.

We Strike Together, a joint partnership by a number of social justice organizations, counts more than 190,000 rent and mortgage strikes. In New York alone, the Upstate/Downstate Housing Alliance garnered more than 14,000 commitments to not pay the rent or mortgage, including some 57 apartment buildings.

Q: How many people paid rent for May?

A: There’s no way of knowing yet. If April was any indication, there won’t be a true answer for a while.

Last month, people reached deep into savings or paid with credit cards. Some out-of-work tenants began receiving unemployment benefits; others are still on hold. Some people are now getting state-level benefits but not the $600 federal boost. Millions are waiting for their federal stimulus checks to arrive, but this is only a one-time payment — and $1,200 doesn’t even cover the average rent for a two-bedroom apartment anywhere in the country.

With so many people struggling, landlords may not be in a hurry to evict their tenants, according to Flora Arabo, national senior director for state and local policy at the nonprofit Enterprise Community Partners. They may be willing to work with renters on partial rent or repayment plans in order to keep some income flowing.

“Most housing providers don’t want to have to evict tenants,” Arabo says. “They want steady tenants who pay. For most providers, it’s a last-resort option. If there is a massive wave of evictions, that’s not good for the property owners either.”

Q: Can renters be evicted during the pandemic?

A: The answer depends on a couple of things: where renters live and what kind of mortgage their landlord has.

States are all over the map on coronavirus tenant protections. Six states have taken no action (or next-to-no action) during the pandemic: Arkansas, Idaho, Wyoming, North Dakota and South Dakota. None of those states has passed any kind of statewide order to prevent evictions or foreclosures during the pandemic.

(Marie Patino)

Other states have done only the bare minimum in terms of tamping down coronavirus evictions. In Oklahoma and Georgia, for example, the states have extended deadlines for eviction proceedings. Those states are still conducting court hearings, but in most states — even those with limited tenant protections, such as Louisiana and Virginia — the courts are closed.

Princeton University’s Eviction Lab  has produced a helpful scorecard for each state based on their Covid-19 housing policies. On a five-point scale, Massachusetts earns a 4.15, the highest score in the land; Georgia merits a whopping 0.08 (still better than some others). The National Consumer Law Project also offers detailed guides on eviction moratoriums for each state.

Some cities have produced even stronger rules about evictions and foreclosures. There’s no central database for where cities stand yet. But any city that is willing and able to pass tougher regulations on landlords is likely to have a tenant advocate or another office that can provide more information.

In April, a national bill to cancel and forgive all rent and mortgage payments for the duration of the crisis was introduced by Minnesota Representative Ilhan Omar. For now, though, renters still owe the rent, no matter where they live.

Q: Does the landlord’s mortgage affect whether renters can be evicted? And how can renters get that information?

A: Renters who live in a property backed by the federal government cannot be evicted for the time being. This eviction moratorium applies to a vast web of mortgages financed, insured or securitized by federal agencies (such as Fannie Mae and Freddie Mac) as well as homes subsidized through federal aid programs (like Section 8).

For tenants in apartment buildings, there are a few tools available to figure out whether the eviction moratorium applies where they live. On May 4, Fannie Mae and Freddie Mac both launched look-up tools: Renters can enter their building name and address to find out whether the property is federally backed. The National Low Income Housing Coalition put out a similar tool in April.

However, these tools won’t help the tens of millions of renters who live in single-family homes. The Federal Housing Finance Agency is working on that tool, but for now, renters in single-family homes, condos, and small apartment buildings will need to talk to their landlords to find out whether their units are covered by the eviction moratorium laid out by the CARES Act.

Q: What happens if my lease ends while shelter-in-place orders are in effect? What about renters who don’t have written leases?

A: Under normal circumstances, the lease itself describes what happens when the lease ends, whether it expires, renews for a certain term or converts to a month-to-month agreement. State laws outline default procedures for circumstances when the lease isn’t specific. A stay-at-home order would not block a lease from expiring or renewing. But a federal, state, or local eviction moratorium would stop a landlord from removing a tenant or a leaseholder from kicking out a subletter.

“Even if a tenant’s lease has expired and the person hasn’t moved out, the landlord is required to take the tenant to court and cannot lawfully resort to ‘self help’ such as changing locks or disconnecting utility service,” says Eric Dunn, director of litigation for the National Housing Law Project. “It’s kind of a legal twilight zone where the tenant may not have the ‘right’ to possession of the premises, but does have the right not to be evicted except through judicial means.”

So it comes down to the eviction moratorium. Under the CARES Act, landlords have to give tenants a 30-day notice to evict after the moratorium expires. Many of the state and local moratoriums don’t have this buffer, so tenants without a lease could be out as soon as the order expires.

Landlords may not be in any hurry to see their tenants out the door. In fact, the opposite might be true: Landlords (or lease-holders) may ask tenants (or subletters) to sign full-year leases right away in order to guarantee the rent.

Q: Is there any sort of housing assistance to help out with the cost of rent during Covid-19?

A: In some places, yes. For example, in Massachusetts, a program called Rental Assistance for Families in Transition provides up to $4,000 for households in distress, and the state added $5 million in funding for households affected by Covid-19. In Dallas, more than 16,000 people flocked to apply for rent and mortgage assistance on Monday, the day the city opened its program.

Housing experts are calling on Congress and federal agencies to do a lot more to make aid for renters available everywhere.

Q: Due to the pandemic, some renters can’t use building amenities like gyms, lounges, courtyards, and roof decks. Can renters ask for partial coronavirus rent abatement?

A: Maybe! But before you ask, you might want to remember that many landlords report spending more on maintenance costs, hiring cleaners ‘round the clock to scrub mail rooms and common spaces. Rent abatements are subject to normal lease rules. Rent increases are frozen in a few cities and states for now.

Q: What can landlords do if their tenants can’t pay the rent? What  about homeowners who can’t pay their mortgage?

A: More than 3.8 million homeowners are now in mortgage forbearance plans — which is more than 7 percent of all mortgage holders.

Homeowners and landlords with federally backed mortgages may be able to defer their mortgage payments for up to a year, with no added interest, late fees, or penalties. The National Consumer Law Center has assembled a guide for property owners to determine whether their homes or buildings are federally backed or insured.

The federal government is offering the best possible terms for mortgage forbearance. Banks are offering their own forbearance plans, however, often with terms that are less beneficial for borrowers.

Hello Lender, a tool for mortgage borrowers experiencing financial distress, auto-generates a letter to lenders to declare the homeowner’s participation in the federal forbearance program. The free tool — a product by Six Fifty, the technology arm of the law firm Wilson Sonsini — works a little bit like TurboTax. Borrowers enter their information, and the tool spits out a letter with all the qualifying information.

Q: How can renters get their landlords to work with them on the rent? What if the property owner is a corporation or real estate investment trust?

A: Six Fifty offers another tool, Hello Landlord, for renters to issue notices to landlords that outline tenant rights under state law and the CARES Act. Written notice might be the best approach to take for renters living in large multifamily buildings owned by a corporate landlord.

Nobody knows what happens when eviction moratoriums expire. When the $600-a-week federal expansion to unemployment benefits expires in August, it could trigger a massive wave of delinquencies for out-of-work renters and borrowers. At the same time, a wave of evictions could be followed by a glut of rental vacancies, which doesn’t serve landlords’ interests.

Short of sweeping rent strikes, many housing experts encourage renters to call their landlords, explain their situation, and see what they can work out. “Renters are responsible people,” Arabo says. “They want to pay their rent. They don’t want to lose their housing.”

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Fighting Coronavirus With a Very Canadian Resource: Ice Rinks

For now, Canada has far fewer coronavirus cases than most major countries, most notably its neighbor to the south. But that hasn’t stopped experts in building design, manufacturing and construction from working on a Plan B just in case, and it’s a very Canadian solution: Replace freezing indoor temperatures, ice skates and hockey sticks with hospital beds, vinyl flooring and sanitizing stations.

Kenny Smith, managing principal of engineering firm Integral Group, assembled a group of industry experts to create a plan to repurpose existing medium-sized ice arenas for health-care needs.  Across Toronto, Vancouver and Montreal, there are about 97 municipally owned indoor rinks, according to the cities’ website listings. Based on the design, each rink would have the capacity to accommodate about 90 to 100 beds and could be converted in phases within one to two weeks if and when health-care response teams require them.

The move would follow similarly creative repurposing in countries that have faced on onslaught of Covid-19 patients. France, for example, converted a high-speed train into a mobile hospital. Some U.S. states have set up dozens of modular treatment units in parking lots and turned recreational vehicles into temporary housing. Singapore and Dubai have taken a more lavish approach and are keeping quarantine patients in 5-star hotels.

So far in Canada, hospitals across the country have already freed up beds by postponing non-emergency surgeries. As a result, some provinces have more open beds than they did pre-pandemic. Ontario, Canada’s most populous province, had more than 1,900 critical care beds available as of April 29, according to the Ontario Ministry of Health. The average hospital occupancy rate was 75% in Ontario, compared with 96.2% before Covid-19 measures. That’s because a predicted surge didn’t materialize after Canada imposed a nationwide lockdown. As of May 3, Canada had 59,474 confirmed cases and 3,682 deaths. Positive cases rose 27% from the previous week, compared with 35% the week before.

A Zamboni entrance becomes an ambulance drop off in the plan to repurpose Canada’s ice rinks. (Courtesy of Kenny Smith)

After settling into the “new normal” of working from home, Integral’s Smith started thinking about how his industry could make a difference to fight the virus. He said he received an overwhelmingly positive response after posting a message on LinkedIn asking for proactive ways to ease the strains on Canada’s health-care system by repurposing existing buildings.

“Everyone wanted to help,” said Smith, whose wife is a nurse. “A lot of people were simply looking for an applicable platform that they could lend their help to. These were individual responses that represented companies. That’s a very important distinction. This was not a response by a set of companies.”

The group decided ice rinks was the best option — not only from a Canadian-identity perspective, but also as a cost-effective and locally abundant building prototype. They also wanted to give governments and health-care providers flexible options based on their needs, instead of larger facilities with thousands of beds like the ones built in Wuhan, China, where the outbreak originated.

Smith says his group’s proposal is also flexible enough for other countries to replicate and apply to other types of buildings. Health Infrastructure in New South Wales, Australia, is examining the plan, he said.

A possible design for hospital beds on top of an ice rink. (Courtesy of Kenny Smith)

For Canada, ice rinks make the most sense given how the arenas are typically structured, Smith said. Most rinks have five consistent doorways: the main entrance, Zamboni entrance, mechanical room entrance and two fire exits. These would be used to create safe circulation for patients, health-care professionals and supplies. The main ice rink area would be used as the patient treatment facility, after the floor is covered with a rolled vinyl material and welded seams overlaid with plywood substrate. This protects the floors from puncturing the cooling coils on the rink surface and also ensures cleaning and infection control procedures can be observed. A rink would hold 90 to 100 beds within pre-fabricated modular pods. Each pod will have three hard partitions, a ceiling and a curtained entryway.

The design also includes specific areas to address Covid-19 requirements — hand-washing and sanitizing stations, phone and video booths for clinical staff use, visiting areas from behind a glass and multiple nursing stations.

The group is continuing to talk with the Canadian government and emergency response units at some Canadian hospitals, but Smith is hoping for the best-case scenario: never having to put the plan into action.

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Coronavirus Data in the U.S. Is Terrible, and Here’s Why

Every day now comes with a new set of coronavirus data: numbers for positive tests, negative tests, deaths, patients hospitalized, ventilator shortfalls and hospital beds occupied. And, more rarely, the racial and ethnic breakdown of those who have tested positive, and those who have died.

These numbers enable epidemiologists, officials, journalists and the public around the world to track the evolution of Covid-19 in almost real time, making it the first “data-driven pandemic.” There’s a lot at stake in these numbers, and there’s a major problem: The data on which we are basing decisions is imperfect and incomplete.

For health departments, it can be challenging to stay on top of the numbers. This is especially true in the U.S., which lacks shared standards for Covid-19 data across states and counties. In Sedgwick County, Kansas, home to more than 500,000 inhabitants, the health department had to hire more staff to deal with case investigations into people who have tested positive for Covid-19.  

“This is the most data we’ve collected, and not only about cases but all the surrounding data,” said Christine Steward, health protection director for the Sedgwick County Department of Health. “There’s more of a request for it. There’s a need for a lot more people to know about it.”

The trouble with testing

Across the U.S., testing strategies vary widely, skewing and complicating the stats for confirmed positive Covid-19 cases. As The Markup recently reported, an elderly person with a fever can easily get tested in Utah, but is less prioritized than hospitalized patients and health care workers exhibiting symptoms in Wisconsin.

U.S. test results offer more of a “window to the past” rather than an assessment of the present situation. On February 29, the Food and Drug Administration loosened the regulations on the development of Covid-19 tests, effectively allowing labs other than those of the Centers for Disease Control and Prevention to use their own tests if they had been granted an authorization by the FDA. Before this date, all tests had to be conducted by the CDC for a case to be counted as a “confirmed positive” case of Covid-19. There is a lag between the moment someone gets tested and her results appearing in official statistics. This lag was even more important before February 29 because it hampered states’ ability to react quickly to the crisis.

By April 22, the FDA had granted over 40 Exceptional Use Authorizations (EUA) for test kits, and hundreds of test developers had asked for an urgent authorization from the FDA to develop their own version. In the meantime, the FDA has also had to crack down on dozens of fraudulent coronavirus “treatments” and “cures” popping up every day. The agency’s word of warning: “If it’s too good to be true, it probably is.”

“Before March 10, we could handle about 20 tests a day,” said David Pride, an infectious disease specialist at UC San Diego Health. “Demand was so great that we put a lot of restrictions on testing, from patients’ symptoms to risk factors.” After the lab developed its own test, its capacity went up to processing 1,000 samples a day.

In addition, with any test there is a risk of “false negatives” —  someone testing negative for Covid-19 when she is in fact sick. This can happen if medical staff mishandle swabs, which may have to do with the way the test is administered.

No reporting standards

Once there is a test result, the process of transmitting data to make that test part of the official stats isn’t always an easy one. Coronavirus is categorized as an infectious disease, meaning that all labs have to report the result of positive tests directly to their state health department. But negative tests do not always have to be counted — that depends on the state’s legislation — and most states did not report this number months into the epidemic.

“Many states started to bring in other types of testing: largely commercial, but also hospitals, universities, et cetera,” said Alexis Madrigal, staff writer at The Atlantic and founder of the COVID Tracking Project, which manually tracks Covid-19 numbers in the U.S. “For a time, not every single test result was recorded, and primarily what we were missing were negative tests results. Positives, you have to report. But not everyone’s reporting negatives.”

States now report negative tests either as their own metric, or report the total number of tests conducted, meaning that negatives are then calculated by the COVID Tracking Project as total cases minus positive cases.

All in all, information made available by state health departments has been more timely and complete than information coming from the CDC, especially from a testing perspective, for which the CDC only offers a national aggregate not counting private labs. However, there is no overall standard when it comes to the information that has to be made public at the state level, which has led to a large variation in data quality across the country.

The timeliness of the data is tricky: Fewer deaths are reported on weekends, leading to a lag in the data, which can be problematic for analysis purposes.

The COVID Tracking Project has assembled what the “ideal” Covid-19 dataset should look like. It includes the number of total tests conducted (including commercial tests), the number of people hospitalized (in cumulative and daily increments), the number of people in the ICU, and the race and ethnicity information of every case and death. Few states check all the boxes, but the situation is improving.

“They are trying to get that data available, I really believe that,” Madrigal said. “For us, it’s just a number in a cell, for them, it’s a whole process that has to be run every day, and I have a lot of respect for how difficult that is.”

The accuracy of race and ethnicity information for cases and deaths is currently a problem, even though an increasing number of states are reporting these demographics. These numbers are essential to assess the impact of the pandemic on populations that tend to be socio-economically vulnerable. According to the COVID Tracking Project, 43 states were reporting racial data for positive Covid-19 cases as of April 27, but only 34 had this information for deaths linked to the disease, and just 28 included information about the ethnicity of Covid-19 victims.

Even among the states that do report, the quality of the information varies enormously. The Minnesota Department of Health has one of the most complete datasets, with 84% of its case reports including race and ethnicity information. In Texas, where this metric was only recently added, less than 20% of case reports include race and ethnicity, according to the Texas Department of Health.

Sluggish data transmission

There are several reasons for this missing information. Sometimes, the data is simply missing from records. Race and ethnicity is reported after a case investigation, which is often conducted by local departments of health once a case has been flagged as positive by a state department of health.

The transmission of data from health care providers to public health institutions also can be problematic. Even though electronic health records are now widely adopted, there are major disparities across the country when it comes to the resources a health department has access to in terms of data modernization, according to Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists (CSTE).

“Because public health has been so inconsistently funded over time, we have not been able to fund states in a consistent way so that there is a level playing field,” Hamilton said. The organization successfully petitioned for funding in 2019, but the task to modernize the data pipelines of the U.S. health care system is immense. And, Hamilton said, modernization isn’t a one-time feat: Funding needs to be regular to keep the infrastructure up to date.

“There are a lot of cases getting reported but it’s being reported in ways that are incomplete, or where the data itself is incomplete, and there’s also sluggish reporting,” Hamilton said. “And that delays our public health response, despite wanting to be able to respond. When a report comes in and there’s some large proportion of missing data and information, we’re spending time trying to track down the missing information rather than being able to immediately use that information to affect policy.”

Some health departments are juggling data across multiple programs. In Sedgwick County, for example, Steward wrote in a CSTE study that her employees have to use as many as 85 different software programs, spreadsheets and databases to do their jobs. Even though electronic records are on the rise, a large number of labs across the country still fax their results to state health departments, who then have to sort through them manually. This is a problem when the caseload becomes too large. In Texas, for example, the system can only handle “a queue of 1,000 results that has to be managed by an epidemiologist before the next 1,000 results can be imported into the queue,” a Texas Health Department spokesperson wrote in an email. It currently has 1,500 of its agency workers allocated to its Covid-19 management task force.

Where we go from here

While it’s impossible to readjust the entire country’s data structure amid a pandemic, health departments nationwide can publish more complete metrics, following the advice of the COVID Tracking Project and trying to stick to its checklist.

Some kind of standard as how to present the data to the public would be helpful. Health departments do not all have the resources to put together custom elaborate data visualizations of the Covid-19 pandemic. Most health departments have adopted geographic information system mapping programs from companies like Tableau and Esri — similar to the John Hopkins University dashboard — but there is no standard and no guidance explaining what should be put in place.

This has consequences on the accessibility of the data, too. The Markup has reported that disabled, and especially blind, users are experiencing difficulties in accessing this important information, as screen readers do not easily read the visualizations most states have put in place. In addition, some states are still releasing coronavirus stats as PDF documents — like Massachusetts — making the information difficult to extract for visualizations. Only 13 states offer machine-readable feeds of their data, according to the COVID Tracking Project.  

“Now is the time,” Hamilton said. “Covid-19 moves through the population with intensity, and we need the same level of commitment to move the data with the same speed and intensity, so we can make rapid decisions.”

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The Many Protests of the Coronavirus Pandemic

A seething woman wearing USA gear is leaning out of a pickup truck in Denver, Colorado. She points at her sign — “Land of the Free” — while around her, vehicles blare their horns. Facing the metal mass are a pair of men clad in teal scrubs. They’re serene, blocking the crosswalk with crossed arms.

In San Francisco, a line of cars creeps through downtown, sleeping bags and tents lashed on their roofs. The drivers blare their horns, signs posted on their windows demand “#HotelRoomsNotHospitalBeds” and “Test us now! We need to know!” On the sidewalk, advocates wearing bandanas cheer; photographers leap into the street to capture the traffic.

The two genres of protest could not have been more different in intent. One was convened on April 13 by San Francisco housing advocates to pressure the city to house its large homeless population in vacant hotels before cases of Covid-19 spread within the city’s shelters. The other happened a week later, one of several , noting that it was a vehicle that killed Heather Heyer during 2017’s Unite the Right rally in Charlottesville, Virginia. But conflating all auto-centric uprisings as one brutal force can obscure the disparate danger posed by the protests themselves, as well as the protesters behind them.

Denver’s caravan was just one of many acts of coronavirus resistance in U.S. cities in recent days, led by conservative groups that were egged on by the Koch brothers and organized on Facebook. In Michigan, Confederate flags and rifles poked out of the windows of the vehicles that swarmed the state capitol on April 15. About 150 drivers rallied in Buffalo’s Niagara Square on April 20, calling on New York Governor Andrew Cuomo to reopen the state. Some attendees defy social distancing mandates and gather in person, as several thousand protesters in Madison, Wisconsin, did on Friday. Other foes of stay-home orders have adopted different vehicles to their cause: Anglers in Washington state convened a flotilla of pleasure boats on Sunday to convey their frustrations about Governor Jay Inslee’s ban on recreational fishing during the crisis.

A “Let Us Fish” protest in Lake Washington in Seattle. (David Ryder/Getty Images)

The extensive coverage of these protests has largely overshadowed how unpopular such anti-lockdown sentiments are: Pew Research polling shows that 66% of the country is more afraid of social distancing measures being lifted too quickly than lasting too long, and an AP-NORC Center for Public Affairs Research poll found that only 12% feel sheltering measures “go too far.” As made-for-cable-news theater, however, these rallies are doing their job.

Ironically, the defining photo of the reopen-everything protests could be of those who oppose it: the small counter-protest of masked health-care workers in Denver, quietly reminding the furious drivers that winning their fight could have grave consequences. That scene  — which was captured by freelance photographer Alyson McClaran — evoked past images of asymmetric stand-offs: Ieshia Evans, the Black Lives Matter activist wearing a long dress who stood stoic before a trio of armored police officers in Baton Rouge in 2016, or the lone man who stared down a line of tanks in Tiananmen Square in 1989.

“The power of a protest is not directly related to its size — there are moments where the right people taking the right action …  can make a far more dramatic statement than a much larger action could make,” Kauffman said. “We have a whole set of visual references where what we’re seeing is courage on the part of protesters. It’s changing now, in this era.”

Creative organizing work has been done outside the confines of vehicles, too. On April 19, 2,000 demonstrators gathered in Tel Aviv’s Rabin Square, spacing themselves out into an even grid across the square to maintain six feet of distance. The demonstration was formed both to protest the formation of a new unity government by Benjamin Netanyahu’s Likud with longtime rivals the Blue and White Party, and to challenge new powers the Netanyahu government has granted itself in a bid to fight coronavirus.

Israeli protesters maintained social distance as they gathered in Tel Aviv. (Kobi Wolf/Bloomberg)

The site of a huge crowd maintaining such order during a pandemic — and creating an aesthetically striking shape as they did so — likely did far more to amplify their message than anything on their placards. Still, the act itself was antithetical to the social distancing precautions deemed necessary by governments around the world; six feet of distance isn’t a magical shield, and the crowd risked infection to gather.

Under lockdown, housebound Spaniards have revived the tradition of the Cacerolazo, a protest where demonstrators beat cooking pots on balconies that has frequently been used in the past in countries where police crackdowns have made going out to demonstrate dangerous. As they protest the government’s handling of the pandemic and a corruption scandal in the Spanish royal family, people taking part initially hear just themselves and people on neighboring balconies. It is only when footage of the protests spreads that participants see what they really took part in — a deafening national chorus of discontent amplified across social media. The many videos, knit together, become the true site of the protest.  

Other powerful acts of coronavirus-era resistance, aptly enough, involve emptiness: Workers for companies like Whole Foods and Instacart and Target have held strikes for better pay and stronger protections for their employers. In a crisis where the public health risks have been disproportionately borne by a small group of critical workers, withholding one’s physical presence can speak volumes.

Disaster-appropriate protests from past crises have involved pointedly providing the kinds of emergency aid that governments failed to muster, in order to highlight the gaps. After Hurricane Sandy damaged Rockaway, Queens, for example, the Occupy Wall Street movement switched gears from protesting the 1% to providing disaster relief to the 99%. The change in focus caused a rift, the New York Times reported, with some Occupy members afraid it was abandoning its fight against capitalism for charity. But the support itself was in line with its anti-corporate roots; by “teaching storm victims about conducting sit-ins” and printing “the crisscrossed ‘A’ symbol of anarchism” inside “In Case of Emergency” signs, the flavor of resistance remained.

During the coronavirus crisis, hundreds of mutual aid efforts have emerged in communities across the country, offering food delivery and emergency supplies from local volunteers. Kauffman says the pandemic-born groups aren’t as explicit about their anarcho-communist roots as others have been. “The mutual aid efforts have been extraordinarily powerful, but that dual character that they historically have where they are both an attempt to provide a solution to a problem and a critique of the institutions who allowed the problem to fester, that’s been harder to make visible,” said Kauffman.

Whether these uprisings translate into political leadership change will likely depend on how nimble governments will be in adapting their election processes so people can vote safely, she says.

But rallying groups now, even at a limited capacity, will have dividends later, says Leighton Johnson, another organizer with Stop Solitary CT. He believes the techniques the group is adopting now — lawsuits, car protests, social media blasts, shame campaigns — will help them to come out of lockdown stronger. “It’s teaching people how to campaign virtually, and I think it’s going to … give more ammunition for the fight,” he said. One day after the Coalition on Homelessness’ car rally, San Francisco supervisors passed a landmark emergency ordinance to demand thousands more hotel rooms for people experiencing homelessness. (The struggle continues, as activists press for faster action and San Francisco’s mayor London Breed resists.)

Kauffman is hopeful, too, that the energy will carry through to November and beyond. “It’s too hard to know when social distancing is likely to be relaxed and what that’s likely to look like, but I think the proliferation of experiments that we’ve seen already shows that there are a lot of people who are going to be working hard to innovate in the face of this,” said Kauffman. “The need for protest has only grown.”

Feargus O’Sullivan contributed reporting.

*CORRECTION: An earlier version of this story used an incorrect title for this book.   

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How U.S. Public Transit Can Survive Coronavirus

Public transportation has been in a state of crisis since the coronavirus pandemic began. Ridership in major cities in the U.S., Europe and China is down by 50-90% from pre-crisis levels. Local taxes used to subsidize systems in America, such as sales taxes, have taken a big hit as well. Transit operators are running out of money quickly. While the federal government has allocated $25 billion in emergency aid to help cover operational losses, the next six months will still present an enormous financial challenge to local agencies as they struggle to attract riders back onto buses and subways and continue capital projects.

As urban research scholars specializing in public transit costs, we worry that this dynamic could result in damaging decision-making. Historically, it has been during times of crisis that agencies have deferred maintenance, cut service and canceled expansion projects. It’s these choices, made under extreme duress, that have crippled American transit agencies before.

But there is a way forward. We offer these pathways for saving transit, immediately and into the future.

What to do now

For the duration of the pandemic, agencies need money to continue running service, and to keep operators and passengers safe. Spending priorities need to shift and mimic the best practices used in cities that keep their public spaces clean and their infection rates low. U.S. transit agencies should do all of the following interventions:

  • Hire more cleaners to sanitize vehicles and stations frequently. Alex Garcia, an American urbanist researcher living in Taipei, told us that in the event of an outbreak, that city plans to disinfect all of its stations daily, the equipment that passengers touch every four hours, and trains every two hours if there is even a suspected case traveling by train. Seoul also uses drones to sprinkle disinfectant on hard-to-reach elevated places.
  • Use noninvasive handheld or infrared thermometers to scan all passengers’ temperature — a technique that is very common outside stores and offices in Asian cities and is now being employed to screen transit users in Taipei.
  • Provide front-line workers with masks, gloves, and other protective equipment, especially those tasked with cleaning the system. New York City Transit cleaners have had to work without any PPE, which may have contributed to the elevated death rates among them.
  • Require all passengers to cover their faces, and clearly communicate what is and is not allowed. Reusable cloth masks should be acceptable.
  • Engage in small-scale capital projects to reduce infection spread, such as coating metal poles on trains with copper, which renders viruses inactive. (One Taipei-based food chain has so coated its doorknobs.)
  • For the fast-growing number of operators who have been exposed to the virus already, ensure that they have the job protections and medical care that they require.

On the operations front, agencies should also adjust schedules and consider new kinds of routes and vehicles that serve hospitals, testing centers, industrial clusters and grocery stores rather than office buildings and schools. In San Francisco, the SFMTA dramatically reduced the scope of its network by slashing 72 of 89 routes. Temporary cuts allow transit agencies to focus their workforce and resources into the routes that serve essential workers and medical centers while also maintaining enough service to permit social distancing onboard the bus.

What to plan over the next year

As the economy begins to recover from the pandemic, transit agencies will have to rebuild ridership. This will be a difficult task: Historically, transit ridership and employment have been intertwined. With unemployment skyrocketing, we expect transit ridership to rebound slowly.

To ensure ridership can scale up when service eventually returns to pre-crisis levels, transit agencies and local departments of transportation should develop plans to increase the throughput of transit vehicles on congested streets or antiquated infrastructure. Strategies for doing so include dedicating lanes to buses, giving buses priority at signalized intersections, enacting congestion pricing, implementing parking restrictions, funding capital projects to fix chronic chokepoints and investing in new technologies that enhance transit operations.  

As agencies take a beat to figure out how they will continue to operate service beyond April, this is the perfect time for capital construction teams to consider alternatives that will reduce their construction costs and speed up timelines for future lines. The Beverly Hills City Council recently approved the full closure of a three-block stretch of Wilshire Boulevard to expedite construction on the Purple Line extension, which is projected to shave as much as six months off of the construction schedule. While rushing this work comes with its own set of health risks, if construction can continue in a safe manner, agencies should take advantage of stay-at-home orders and push for more aggressive construction timelines.

The aftermath of the 2008 financial crisis offers a lesson in what transit agencies should not do. Many agencies cut service during the ensuing recession. When we examined the change in service hours for buses in New York between 2008 and 2018, we observed that service hours had been slashed by nearly 20%, even as the unemployment rate fell from 2011-19, a time when bus service should have increased; citywide ridership fell by 22% between the same period. While this is merely a correlation — service was cut, ridership fell — there is evidence of causation in the transportation literature.

That’s why short-term cuts deployed to save transit agencies money during a crisis should not become permanent once the crisis is over. Transit agency after transit agency made this same mistake after 2008 and saw ridership decline year after year, except Seattle, which increased service and experienced ridership gains.

Big, structural change is needed

Finally, in the long run, the federal government should work with states to relax local land-use restrictions and nurture a more beneficial transportation-land-use connection. Transit thrives when it is surrounded by a certain level of population density and mix of land uses; because American cities are largely defined by low-density development, many cities with fairly expansive subway and light-rail networks have flagging ridership. If land-use regulations around train stations allowed a greater mix of mid- and high-rise buildings, they’ll attract higher ridership than if they continue to be flanked by single-family houses (as in much of California) or parking lots (as in many newer American light rail networks).

Transit agencies need the funding they are about to receive, but it will hardly solve all of their problems. For starters, the way the federal government apportions money to transit agencies often comes in the form of competitive grants for capital projects, such as a new light-rail or the extension of a legacy subway network. This $25 billion emergency infusion, however, is exclusively for operational costs, the provision of service. While we hope that Covid-19 is a blip on the radar, this shift in funding priorities is an extremely encouraging development that we hope takes shape in future programs that fund state-of-good-repair maintenance.

As transit agencies struggle to find their footing in an uncertain future with dramatically less revenue from the usual sources, it’s time to rethink how transit agencies operate and are funded. If agencies reassess their priorities and push forward ambitious plans to reorient cities around their systems, with the assistance of the federal government, buses and subways can thrive when the country is ready to return to regular service.

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To Combat Coronavirus, Scientists Are Also Breaking Down Barriers

In a conference room in Washington, D.C., a dozen epidemiologists huddle over a computer monitor. On the screen, a map of self-reported data from test labs around the world shows a lethal strain of avian influenza originating in Asia.

They summon their colleagues — data scientists, economists, and sociologists. What could happen if the pathogen isn’t contained? They build a series of simulations. The U.S. poultry trade will be impacted, as will soybean farmers. Travelers from Asia will need to be monitored; a new vaccine might need to be produced. An alert goes out so that the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services can prepare.

That’s a hypothetical example of what an infectious disease forecasting center, housed inside the U.S. government, might do. Staffed with a crack team of interdisciplinary researchers focused on viruses and their social and economic impacts, it could detect, model, and disseminate critical information to U.S. leaders about how to handle major disease outbreaks much like the coronavirus pandemic we’re experiencing now.

The center, however, doesn’t exist. Caitlyn Rivers, a former epidemiologist with the U.S. Army who is now a senior scholar at the Johns Hopkins Center for Health Security, was among the experts who first discussed the idea during the Obama administration, though it never came to pass. (The forecasting center was a separate idea from the biological defense unit within the National Security Council that the Obama administration set up in 2016, which was folded into another office by President Trump in 2018.) Rivers floated it again in a recent report for the conservative think tank American Enterprise Institute, where she has been working with economists, physicians, and regulatory experts on road maps for reopening parts of the economy now shuttered by the pandemic.

Collaboration between researchers across diverse fields is a critical part of the response to the coronavirus crisis, and it would be key to preparing for them, too. “When there are infectious disease emergencies, there are so many kinds of questions for scientists to answer, and that interdisciplinary focus is so important,” she said.

Although that forecasting center never came to pass, academics and government researchers say that interdisciplinary collaboration is now happening a remarkable level in the face of the urgent coronavirus threat. Across the board, the pandemic triggered an explosion in academic research: A Reuters analysis from early February estimated that at least 153 scientific studies probing the disease were posted or published within the first 50 days since the start of the outbreak in China. Health journals are now fielding three to five times the normal number of submissions. Presented with not only a mysterious disease but also a massive economic, environmental, social, and psychological disruption, many scientists say that they are also reaching across traditional departmental boundaries more before.

“When you have a global problem like this, you get more possibilities to see how our fields are connected to each other,” said Dario Caro, a microbiologist at Denmark’s Aarhus University. He recently co-authored a paper linking the high rate of coronavirus death in Northern Italy to the thick smog and particulate matter in the region’s industrial cities — the first he’d ever published with medical specialists. The colleagues joked that they would coin a name for the new discipline they were pioneering: “immune-environment.” (Unfortunately, it appears the term is already taken by cancer researchers.)

Connecting environmental and social characteristics to medical conditions is nothing new, of course. Curious minds have been doing it since the day John Snow found the contaminated water pump at the heart of London’s 1852 cholera outbreak, and probably earlier than that. Plenty of researchers whose specialty lies at the intersection of science and society pair up with colleagues in other departments all the time.

“For me, it is already the norm,” said Eugenia South, a senior fellow at the University of Pennsylvania’s Perelman School of Medicine who studies the health effects of urban neighborhoods. Past research has found her in partnership with epidemiologists, criminologists, urban planners, health economists, ethnographers, and many other specialists far from the medical school.

Yet it’s common for modern-day academics to be siloed in their work, South said. That’s not necessarily for lack of curiosity: Incentive structures built into academic research funding encourage people to stay in their lanes. A 2016 study published in Nature found that, of 18,476 research proposals submitted to a national academic grant program in Australia over five years, “the higher degree of interdisciplinarity, the lower the probability of being funded.” The more developmental psychologists teamed up with environmental biologists, or the more climatologists teamed up with geospatial scientists, in other words, the less likely they were to win financial support.

“We’re not really supposed to work freely on whatever we want, despite the perception,” said Mauricio Santillana, the director of the Harvard University’s Machine Intelligence Lab and a professor at the medical school. “We have to get grants and create deliverables.”

As a mathematician specializing in big data and computer modeling, Santillana is now in high demand. He’s working with climate scientists to model how temperature changes and other atmospheric conditions work to transmit Covid-19. But he’s also collaborating with economists to look at job losses and other financial impacts across the U.S., and with social scientists to examine how misinformation related to the disease spreads on Twitter, Facebook and other internet media. “I had some contact with people in these areas, but now they’re active research areas for me, too, that were not before,” Santillana said. Grant proposals for several of these interdisciplinary projects are in the works.

Jeffrey Shaman, a professor of environmental health sciences at Columbia University’s Mailman School of Public Health, has observed the same pattern. “The urgency of the situation has compelled many researchers who previously didn’t intersect to reach out to one another to pose novel questions that cross disciplinary boundaries,” he wrote in an email. Etienne Krug, the director of a program at the World Health Organization that oversees noncommunicable diseases and injury prevention, also senses a new aura of openness and curiosity among the research community — “but this is just my own feeling,” he wrote in an email.

Indeed, measuring any trend in interdisciplinary research won’t be possible until we know which proposals ultimately receive grants and funding, said David Lazer, a professor of political science and computer and information science at Northeastern University and one of Santillana’s new collaborators. Like South, partnering with colleagues across other fields is part of Lazer’s normal work. While he believes the practice is surging, many projects are still being formed in home offices and basements where researchers are sheltering, so it’s hard to say for certain.

“Ultimately it’s about the data,” Lazer said. “But I do think that there is a recognition that this is about people solving a problem, not about accomplishing things in their own discipline. And I think that’s the correct priority.”

Interdisciplinary collaboration is happening within scientific research centers of the federal government, if belatedly. Dylan George, the vice president of technical staff at In-Q-Tel, the venture capital arm of the CIA, said that he has seen an unprecedented level of coordination between the Centers for Disease Control and the Department of Health and Human Services to bring in a diversity of outside expertise to inform the government’s response to the pandemic.

Yet George, a former White House adviser and DHHS research manager specializing in biological threats, believes the U.S. ought to fostering more scientific cross-pollination so that it’s better prepared for future pandemics, especially in terms of the country’s technological abilities. Along with Rivers, he was one of the leading experts who devised the idea for the epidemic forecasting center during the Obama administration, which would be similar to the way the National Weather Service monitors the atmosphere, builds weather models, and disseminates predictions.

“If you had a hurricane that was barreling down on Florida, you wouldn’t run out and get a handful of academics to come tell you to set up a model and where to put resources and where to respond,” he said. “We have professionals whose day job it is to do that, and a whole system to enable to do what they do, but we’re not doing that with a pandemic in the same way.”

As an example of the pitfalls of this reactive stance, George pointed to the array of post-facto epidemiological models for coronavirus, employed by leaders in different parts of the country, that point to vastly divergent outcomes. One centralized model, prepared and vetted by a range of dedicated experts, could have helped response teams move faster, he said.

The surge in academic research during the pandemic, interdisciplinary or not, is not without its drawbacks. For one, there seems to be a gender divide in who is able to perform academic labor right now: A number of journal editors have said that that an outsize share of recent paper submissions are coming from men, since women scientists, like women in all fields, appear to be bearing a greater share of childcare and household duties. And though the frenzy in research is producing more papers than ever, observers have warned about the risk of more inaccuracies, whether in vaccine trials or hypotheses about the origins of the new virus.

Yet whether they are in government or academia, scientists ought to be breaking down disciplinary barriers, said Alfred Morabia, a professor of epidemiology at Queens College at the City University of New York and the editor-in-chief of the American Journal of Public Health. “There has long been a schism between the individual-focused approach of the clinician and the population-focused approach of epidemiologists,” he said. “This idea that populations have different qualities than the individuals that compose them, that populations are predictable and comparable — all of those concepts were rarely understood. Now they’re at the center of discussion.”

They’re also converging with patient-focused medical practices, Morabia said, as millions are told to stay at home, wear masks outside, and wash hands to protect the health of others in the community.

These convergences are happening not a moment too soon: From structural racism to economic inequality to climate change, the world’s thorniest problems can only be solved with intersectional thinking, Morabia, South, Shaman, and others said. The stark racial disparity emerging in coronavirus death rates in the U.S. is one example, especially since low-income people of color are also also overexposed to the coming disasters of climate change, Morabia said. The coming challenge of rebuilding communities that are healthy, socially equitable, and sustainable will require a holistic mindset that involves more proverbial walks across campus — after all, doctors and scientists can’t reach vulnerable populations if they don’t understand how these communities think, in the way sociologists, psychologists, or community leaders might.

Yet Morabia struck a hopeful note. After coronavirus, “I think it’s going to happen,” he said. “The public has changed, medicine and public health are more hand in hand than ever, and policy will follow. I’m confident about that.”

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We Can’t Wait Until Coronavirus Is Over to Address Racial Disparities

Recent data from the Centers for Disease Control and Prevention on Covid-19 exposed stark inequalities: Rates of mortality and severe illness are far higher among Americans of color. Politicians, journalists and scholars have been attempting to explain these racial differences by pulling from a wide range of past studies and assumptions. Many of these early suggestions emphasize how Covid-19 is illuminating pre-existing inequality.

Yet, early reporting and existing studies suggest Covid-19 is not simply exposing past inequality. It is also creating it. Like previous crises, such as natural disasters, war, and economic recessions, our response to Covid-19 is exacerbating racial disparities. However, this is not inevitable. Addressing unequal distributions of Covid-19 testing, racial biases in health care, and policy responses to racial segregation now could mitigate how unjust this crisis turns out to be.

Comparing across regions in the U.S. and between countries, it has become abundantly clear that early detection and effective contact tracing are critical for both containing Covid-19 and curtailing its most severe symptoms. This requires widespread, accessible testing — something the United States has yet to implement anywhere. Yet, testing has been even more scarce in communities of color.

Early reporting by NPR has shown that Black Americans have been less likely to receive a Covid-19 test than White Americans even when showing the same symptoms. This has contributed to misdiagnosis and in some cases inaccurate medical advice. These patterns mirror previous research that has repeatedly shown doctors mis- and under-diagnosed Black people’s health conditions leading to further health complications and shorter life expectancy — an occurrence particularly pronounced for Black women whose knowledge about their own bodies is often dismissed, disregarded and misunderstood.

For Covid-19, the lack of testing and misdiagnoses has likely resulted in the virus spreading more rapidly across Black communities, and in individual cases escalating without the proper precautions and treatment. To fully empirically estimate the effect this lack of testing is having on the observed racial inequality, we need more data across all racial groups on who is getting access to proper testing and whether hospitalized Covid-19 patients are receiving improper advice or health care because of initial misdiagnoses. Not to mention, we also need more data from the tests themselves to see who is testing positive and how the virus is affecting various populations.

Beyond testing, initial studies on Covid-19 suggest severe symptoms and mortality are more likely when patients have underlying conditions such as hypertension, obesity, diabetes, asthma or cardiovascular disease. Black and Native Americans are more likely than their White counterparts to have these underlying and chronic conditions because of racial biases in health care, housing markets, employment sectors, educational institutions and the criminal justice system. Government officials and journalists have insinuated that Covid-19 hospitalizations and mortality inequities are a product of the racial gaps in these pre-existing conditions.

Although this is certainly part of the story, it is likely not all of it. The aforementioned lack of Covid-19 testing, lack of access to health care and the quality of health care received could be intensifying the effect underlying conditions have on patients of color with Covid-19. In other words, a White resident with underlying health conditions, who has access to early testing and whose doctors trust their account of their symptoms is more likely to avoid the most severe Covid-19 symptoms compared to a Black or Native American with identical underlying conditions and Covid-19 symptoms.

To fully unpack these various factors we need more data broken down by race about cases, treatments and outcomes. Yet, even without this data, it is clear it is not just pre-existing conditions driving the racial inequality. It is also access to and experiences within the health-care system that are creating the racial inequality.

In addition to underlying conditions, initial analyses by some scholars have explained this inequality as a product of existing occupational and residential segregation: Historical and contemporary labor policies and practices have concentrated workers of color into often below-living-wage employment sectors — many of the same sectors that are disproportionately experiencing heightened exposure to Covid-19 and offer inconsistent or limited sick leave policies. Yet, it goes beyond just class, as middle-class Black workers are disproportionately concentrated in government jobs like mail carriers or bus drivers compared to their White counterparts who are disproportionately employed by private companies.

Likewise, contemporary and historical (im)migration and housing policies have concentrated residents into certain neighborhoods, cities, counties and even regions of the country. This means, even in this time of social distancing, Americans are more likely to interact with people of their same race as they make essential trips to the local grocery store or receive packages on their front porch. Since Covid-19 is highly contagious, living in a community with more cases (for all the aforementioned reasons) means this contagion is likely to spread more quickly within racial groups, as we are witnessing in New York City’s Jackson Heights neighborhood and Louisiana’s Black communities. Just as so-called “Black-on-Black violence” is more a function of racial segregation and proximity than something cultural or biological as is often alleged, so might be Black-on-Black Covid-19 contraction.

Fully illuminating the role occupational and residential segregation are playing in the observed Covid-19 inequities will require significantly more data. Yet, even without this full picture, it is likely occupational and residential segregation combined with racialized practices within workplaces and across regions that are exacerbating the inequities.

Clearly, we need much more information before we can definitively say which mechanisms are contributing to the racial inequality in Covid-19 infections, hospitalizations and deaths. However, using history as a guide and what we know from early reporting, it is clear racial inequities are being created in how we are choosing to respond to this crisis.

To curtail this inequity, we need transparency about who has access to testing, test results, hospitalizations and mortality rates. We also need more data on how employees, residents and patients are interpreting their possible risk and access to healthcare. And we need to use this data to better understand who is getting sick, and why.

Beyond data, we need action steps that explicitly centralize the need for equity in our multifaceted response to this crisis. The federal government must make tests more widely available in communities of color. Health-care workers need to challenge their own racialized biases and ensure patients’ own assessments of their health are being heard. Corporate employers need to think critically about how their policies might directly and indirectly contribute to racial inequality. Federal and local governments need to consider how they can creatively decrease racial inequality through new ways of implementing immediate and long-term responses.

We cannot wait until the crisis is over to examine or address the structural inequalities Covid-19 is exposing. If we do, then these inequalities will only worsen. Prioritizing equity in our responses now is the only way we can begin to create a more equitable tomorrow.

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The Coronavirus Pandemic Makes a Case for Megaregions

As U.S. states move into the next phase of the coronavirus crisis, they may not be getting all the help they want from the federal government, but they won’t be alone. In at least three parts of the country, states have banded together to coordinate changing public health measures and recovery efforts as they consider timelines for lifting lockdowns, knowing that neither the outbreak nor modern-day regional economies adhere to jurisdictional boundaries set long ago.

The foundation of these three multistate compacts — seven Northeast states, from Delaware to Massachusetts; the West Coast including California, Oregon, and Washington; and seven Midwestern states radiating around Chicago — is a once little-known planning framework, known as megaregions, that shows just how much big chunks of the country are interlinked.

The pandemic, it turns out, is exactly the kind of massive but geographically clotted crisis that reveals what Europeans have called “territorial cohesion.” Some parts of the country are taking it slow, while others — such as Georgia, Tennessee, and South Carolina — are moving faster to reopen.

Most may think of three basic levels of government — federal, state, and local — but planners have long recognized that much activity actually occurs at the regional scale, across geographically proximate clusters of settlement. People live in one state and commute to a city in another, or live in the city and travel to a second home many miles away if they can.

The megaregion framework has been useful for all kinds of initiatives, whether protecting wilderness and watersheds that similarly cross political jurisdictions, designing transportation policy including inter-city high-speed rail networks, agreeing on carbon emissions reductions, or building more affordable housing across a larger catchment of labor markets (though that last one is very much a work in progress).

States have been working together in some modest ways for years, forming some 200 cross-border compacts or alliances covering everything from infrastructure to regulatory regimes, says Jonathan Barnett, author of Designing the Megaregion: Meeting Urban Challenges at a New Scale. The better-together arrangements can be found at the National Center for Interstate Compacts, part of the Council of State Governments, which provides technical assistance to keep them working. New reasons to collaborate have been steadily emerging, such as the Missouri-Kansas pact limiting tax subsidies as incentives for business relocation.

And now, others who have studied megaregions say, the approach will be well-suited to coordinating reopenings, or continuing closures, as states manage the next phases of the Covid-19 pandemic. If that’s successful, states may use megaregions to make future improvements in housing, transportation, and the environment.

“It’s clear that actions to manage and recover from the pandemic will require regional action, since the virus doesn’t respect arbitrary political boundaries,” says Robert Yaro, former head of the Regional Plan Association and now a professor at the University of Pennsylvania, who is co-authoring a new book on megaregions to be published by the Lincoln Institute of Land Policy (where I am a senior fellow).

“We can only hope this kind of collaboration will extend to the longer-term steps needed to rebuild the economy — and build the mobility systems and settlement patterns needed to mitigate against future events of this kind,” Yaro says.

The first clue that megaregions might be a useful way of confronting the pandemic emerged as early maps chronicling outbreak patterns mirrored the 11 U.S. megaregions outlined in 2008 by the Regional Plan Association initiative America 2050.

Just as the patterns of contagion mapped mostly along the megaregion categorization, fighting the disease intuitively seemed to require action and coordination across a broader geography than individual cities or states. New York Governor Andrew Cuomo was among the first to propose working together with other states in the Northeast. In the early days of the crisis, there was inter-state tension, as when Rhode Island stopped New Yorkers traveling to summer communities, near the Connecticut border.

In any gradual reopening, it makes all kinds of sense for neighboring states to acknowledge their interconnectedness, says Frederick “Fritz” Steiner, dean of the UPenn Stuart Weitzman School of Design. The closing and reopening of beaches, for example, would benefit from coordination, so there isn’t a patchwork of policies on either side of any state’s borders. Megaregions, which inherently recognize the interconnections in the movement of people emerging from lockdowns, “provide an ideal scale for cooperation in this crisis,” he says.

States in the newly formed alliances have also been sharing protective equipment and other vital supplies. California plans to distribute protective equipment from a ramped-up manufacturing effort throughout the U.S. West, wherever the need is greatest; Montana got more masks from North Dakota than from the national stockpile. Cuomo has proposed a purchasing consortium to avoid a repeat of the “chaos” of 50 states competing for supplies.

It’s important to note that regional interdependency and cooperation does not mean that cities and states don’t need help from the federal government; they clearly do, on such fronts as massive testing and contact-tracing, procuring medical equipment, providing financial relief to people and businesses, keeping beleaguered transit systems financially solvent, and many more pressing needs.

For many it has been gratifying to see how a planning construct could become so useful in this desperate time of need. Planners have been trying to illustrate the advantages of a regional approach for many years, though it has been an uphill battle. Historically, states have often resisted working together — Yaro quips that coordinating efforts of any kind haven’t really been seen since the days of Alexander Hamilton, and even then it was halting. In the 20th century, landscape architect Ian McHarg demonstrated how energy and ecological systems better function across boundaries. For a while, multistate climate pacts, such as the Northeast Regional Greenhouse Gas Initiative, were de rigeur.

Researchers at America 2050 showed that rather than thinking about a national high-speed rail network, it made more sense to focus on more self-contained chunks of the country — Florida, the Pacific Northwest (or Cascadia), Northern and Southern California, the Texas Triangle, and the Boston-to-Washington corridor. The Federal Railroad Administration has also proposed similar networks for the Midwest, Southeast, and Southwest states, roughly corresponding to the America 2050 map.

In the near-term response to the Covid-19 crisis, any megaregion-scale coordination will initially have a focus on nuts-and-bolts logistics. But the real challenge is what comes after that. Can multiple states continue to think regionally while socioeconomic structures, with all of the built-in inequities that the pandemic has revealed, are refashioned into something more resilient?

Looking ahead, megaregions could become the policy vessel for new realities, including more people working remotely, allowing them to spread out across agglomerated labor and housing markets. “It might actually help mitigate the overconcentration of jobs and population in our largest urban regions — and alleviate the extreme congestion and run-up in housing prices that has undercut the livability and functionality of America’s densest urban places,” Yaro says.

The key to that transformation, he says, will be regional transportation networks that shorten travel times across larger landscapes. That means going back to the notion of better multistate commuter and high-speed rail, at the megaregional scale, like the Regional Plan Association’s T-REX proposal for the tri-state region around New York, the Transit Matters vision for expanded transit all around metro Boston, and an envisioned North Atlantic rail network, including a rerouted Acela through Hartford, for the six New England states and downstate New York. The U.K. is advancing similar strategies with its decision to build HS2 and Northern Powerhouse Rail, underpinning a broader economic development initiative for the north of England.

In a post-pandemic world, better rail networks could speed the economic recovery by providing access to major urban centers by residents of even distant, midsize and legacy cities, bringing in areas across a larger landscape that have been left to decline economically in recent decades.

The deadly coronavirus has laid waste to so much and taken tens of thousands of American lives so far. The rebuilding process, which stands to be a national project not seen since the Great Depression or the aftermath of World War II, might well be more effective if it is structured on a more regional basis. A more megaregional future awaits.

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