There’s a certain kind of N95 mask that’s actually bad to wear for public health during the coronavirus pandemic.
San Francisco’s health officer warns that N95 masks with a vent on them actually cause a person’s germs to spread, rather than containing them close to the wearer’s face.
The warning is in the San Francisco health order, which says that any mask with a one-way valve — designed to facilitate easy exhaling — “allows droplets to be released from the mask, putting others nearby at risk.”
“As a result, these masks are not a face covering under this order and must not be used to comply with this order’s requirements,” said the health order, signed by Dr. Tomás Aragón, the health officer for San Francisco.
Exhalation vents can make the face cooler and reduce moisture buildup inside a face covering, the U.S. Centers for Disease Control and Prevention said — but the vents allow unfiltered exhaled air to escape. That defeats the point of wearing a mask, which is to keep potentially infectious oral droplets from spraying outward to other people.
To convert the N95 masks that have vent holes in the front, simply place a piece of tape over the external vent to cover it, health experts said.
As many as 20% to 50% of people infected with the coronavirus may never show severe signs of illness yet can still infect others. That’s why, health officials say, it’s so important to wear masks to keep the pandemic under control. It’s no coincidence that many nations that haven’t seen a sustained, out-of-control spread of the coronavirus have a public that universally wears masks when outside of the home, experts say.
San Francisco and other health officials around the country have urged the public to wear cloth face coverings to reduce the spread of the coronavirus. A couple dozen California counties require the wearing of face masks while in public — including Los Angeles, San Diego and Sacramento counties, as well as the nine-county San Francisco Bay Area — while other areas have made it a recommendation.
But there has been a backlash in a number of California counties, and officials have rescinded requirements to wear a mask. The latest to do so was Orange County, California’s third most populous county.
In general, officials suggest members of the public wear cloth face coverings, rather than N95 and surgical face masks that should be reserved for healthcare workers.
“If you are currently using a medical mask, keep using it as long as you can. Only throw it away when it gets dirty or damaged,” the San Francisco health department said.
Is any panic more primitive than the one prompted by the thought of empty grocery store shelves? Is any relief more primitive than the one provided by comfort food?
Most everyone has been doing more cooking these days, more documenting of the cooking, and more thinking about food in general. The combination of meat shortages and President Trump’s decision to order slaughterhouses open despite the protestations of endangered workers has inspired many Americans to consider just how essential meat is.
Is it more essential than the lives of the working poor who labor to produce it? It seems so. An astonishing six out of 10 counties that the White House itself identified as coronavirus hot spots are home to the very slaughterhouses the president ordered open.
In Sioux Falls, S.D., the Smithfield pork plant, which produces some 5 percent of the country’s pork, is one of the largest hot spots in the nation. A Tyson plant in Perry, Iowa, had 730 cases of the coronavirus — nearly 60 percent of its employees. At another Tyson plant, in Waterloo, Iowa, there were 1,031 reported cases among about 2,800 workers.
Sick workers mean plant shutdowns, which has led to a backlog of animals. Some farmers are injecting pregnant sows to cause abortions. Others are forced to euthanize their animals, often by gassing or shooting them. It’s gotten bad enough that Senator Chuck Grassley, an Iowa Republican, has asked the Trump administration to provide mental health resources to hog farmers.
Despite this grisly reality — and the widely reported effects of the factory-farm industry on America’s lands, communities, animals and human health long before this pandemic hit — only around half of Americans say they are trying to reduce their meat consumption. Meat is embedded in our culture and personal histories in ways that matter too much, from the Thanksgiving turkey to the ballpark hot dog. Meat comes with uniquely wonderful smells and tastes, with satisfactions that can almost feel like home itself. And what, if not the feeling of home, is essential?
And yet, an increasing number of people sense the inevitability of impending change.
Animal agriculture is now recognized as a leading cause of global warming. According to The Economist, a quarter of Americans between the ages of 25 and 34 say they are vegetarians or vegans, which is perhaps one reason sales of plant-based “meats” have skyrocketed, with Impossible and Beyond Burgers available everywhere from Whole Foods to White Castle.
Our hand has been reaching for the doorknob for the last few years. Covid-19 has kicked open the door.
At the very least it has forced us to look. When it comes to a subject as inconvenient as meat, it is tempting to pretend unambiguous science is advocacy, to find solace in exceptions that could never be scaled and to speak about our world as if it were theoretical.
Some of the most thoughtful people I know find ways not to give the problems of animal agriculture any thought, just as I find ways to avoid thinking about climate change and income inequality, not to mention the paradoxes in my own eating life. One of the unexpected side effects of these months of sheltering in place is that it’s hard not to think about the things that are essential to who we are.
We cannot protect our environment while continuing to eat meat regularly. This is not a refutable perspective, but a banal truism. Whether they become Whoppers or boutique grass-fed steaks, cows produce an enormous amount of greenhouse gas. If cows were a country, they would be the third-largest greenhouse gas emitter in the world.
According to the research director of Project Drawdown — a nonprofit organization dedicated to modeling solutions to address climate change — eating a plant-based diet is “the most important contribution every individual can make to reversing global warming.”
Americans overwhelmingly accept the science of climate change. A majority of both Republicans and Democrats say that the United States should have remained in the Paris climate accord. We don’t need new information, and we don’t need new values. We only need to walk through the open door.
We cannot claim to care about the humane treatment of animals while continuing to eat meat regularly. The farming system we rely on is woven through with misery. Modern chickens have been so genetically modified that their very bodies have become prisons of pain even if we open their cages. Turkeys are bred to be so obese that they are incapable of reproducing without artificial insemination. Mother cows have their calves ripped from them before weaning, resulting in acute distress we can hear in their wails and empirically measure through the cortisol in their bodies.
No label or certification can avoid these kinds of cruelty. We don’t need any animal rights activist waving a finger at us. We don’t need to be convinced of anything we don’t already know. We need to listen to ourselves. We cannot protect against pandemics while continuing to eat meat regularly. Much attention has been paid to wet markets, but factory farms, specifically poultry farms, are a more important breeding ground for pandemics. Further, the C.D.C. reports that three out of four new or emerging infectious diseases are zoonotic — the result of our broken relationship with animals.
It goes without saying that we want to be safe. We know how to make ourselves safer. But wanting and knowing are not enough.
These are not my or anyone’s opinions, despite a tendency to publish this information in opinion sections. And the answers to the most common responses raised by any serious questioning of animal agriculture aren’t opinions.
We can live longer, healthier lives without it. Most American adults eat roughly twice the recommended intake of protein — including vegetarians, who consume 70 percent more than they need. People who eat diets high in animal protein are more likely to die of heart disease, diabetes and kidney failure. Of course, meat, like cake, can be part of a healthy diet. But no sound nutritionist would recommend eating cake too often.
If we let the factory-farm system collapse, won’t farmers suffer? No.
The corporations that speak in their name while exploiting them will. There are fewer American farmers today than there were during the Civil War, despite America’s population being nearly 11 times greater. This is not an accident, but a business model. The ultimate dream of the animal-agriculture industrial complex is for “farms” to be fully automated. Transitioning toward plant-based foods and sustainable farming practices would create many more jobs than it would end.
Don’t take my word for it. Ask a farmer if he or she would be happy to see the end of factory farming.
Isn’t a movement away from meat elitist? No.
A 2015 study found that a vegetarian diet is $750 a year cheaper than a meat-based diet. People of color disproportionately self-identify as vegetarian and disproportionately are victims of factory farming’s brutality. The slaughterhouse employees currently being put at risk to satisfy our taste for meat are overwhelmingly brown and black. Suggesting that a cheaper, healthier, less exploitative way of farming is elitist is in fact a piece of industry propaganda.
Since the day after Donald J. Trump as elected in 2016, I’ve been fretting about the effect of his obvious unfitness and incompetence for the “world order” as we have known it. I’ve made clear that I don’t believe there’s any reason why the U.S. should be the perpetual guarantor of security for half the world, nor is it forever obligated to provide some kind of Pax Americana. That was a consequence of America’s unique position after World War II, having had the good fortune to escape the destruction of our homeland, which left us in the position of the last country standing. To our credit (and for our own profit) we did handle the aftermath of that war more competently than the world handled the aftermath of World War I.
But it has been clear to me from the moment Donald Trump came down that elevator that if he won, the world order as we knew it, which was already unstable, was going to be turned upside down with no coherent plan to replace it. His one simple understanding of the world was that he, and the United States, have been treated unfairly. Of course, nothing could be further from the truth. America and Donald Trump had it all.
Throughout the Cold War and the red-baiting and the military adventurism and the overweening self-regard that we assumed was our right as the Leader of the Free World, we managed to do a lot of things wrong and the price for that has been high. This is true even though, as Salon’s Andrew O’Hehir wrote in this searing account of America’s precipitous decline as revealed by the coronavirus, the American people hardly noticed:
We have an ingrained national tendency to behave as if the rest of the world simply doesn’t exist — or, on a slightly more sophisticated level, as if it were just a colorful backdrop for our vastly more important national dramas.
O’Hehir rightly observes that empires inevitably collapse, but America’s almost childlike inability to admit it even is an empire, even as it crumbles, may be unique in human history.
Still, for all its myopic arrogance, the one thing America clearly did right — and was justifiably proud of — was to create a technologically advanced society that was the envy of the world. For all our faults, Americans knew how to do things. We could get the job done.
Now the country that sent men to the moon and brought them home again, all the way back in the 1960s, is a fumbling mess, unable to manage the simple logistics of getting supplies from one place to another or coordinating a national set of guidelines in a public health crisis. The vaunted CDC, long thought of as the greatest scientific disease research facility in the world, fumbled in making a test that had already been produced in other countries.
Donald Trump is a completely incompetent leader — we know this. Literally any other president would have done a better job. He couldn’t accept that the crisis was real and that his “plan” to spend the year holding fun rallies and smearing his Democratic rival was going to be interrupted by his duties as president. So he lived in denial until the situation was completely out of hand. Other leaders would have listened to experts and pulled together a team that knew how to organize a national response. And no other president would be so witless as to waste precious time and resources with magical thinking about quick miracle cures.
But it’s not just him, is it? The U.S. government seems to have lost its capacity to act, and the private sector is so invested in short-term profit-making that it’s lost its innovative edge. The result is that the United States of America, formerly the world’s leader in science and technology, now only leads the world in gruesome statistics and body counts.
It’s still unclear exactly why the CDC felt it had to make its own test when another test, created by a German lab, was already available. According to those in the know, Americans just don’t use tests from other countries, ostensibly because our “standards” are so high. Apparently, they aren’t. In this case, the test we created was faulty, causing weeks of delay, and there was some kind of contamination in the lab. How can this be?
The government’s inefficiency and ineptitude in producing, locating and distributing needed medical supplies, combined with Trumpian corrupt patronage toward his favored states, is staggering. Stories of FEMA commandeering shipments of gear that were already paid for by states, and governors having to bid against each other for supplies because the federal government refused to use its power to take control in a global emergency, are simply astonishing. The country that planned the D-Day invasion is incapable of coordinating the delivery of medical supplies to New York City?
Apparently so. And the world is watching. The New York Times’ Michelle Goldberg wrote:
“If you look at why America rose so much after 1945, it was because America attracted the best scientists in the world,” Klaus Scharioth, Germany’s ambassador to America from 2006 to 2011, told me. “America attracted expertise. You had the feeling that all governments, be they Republicans or Democrats, they cherished expertise.” Like many Americanophiles abroad, Scharioth has watched our country’s devolution with great sadness: “I would not have imagined that in my lifetime I would see that.”
Sen. Tom Cotton of Arkansas, a rising Republican leader, evidently wants to ensure that American never attracts any expertise again:
If Chinese students want to come here and study Shakespeare and the Federalist Papers, that’s what they need to learn from America. They don’t need to learn quantum computing. It is a scandal to me that we have trained so many of the Chinese Communist Party’s brightest minds.
The rest of the world is moving on without us. This week 20 global leaders held a conference call pledging to “accelerate cooperation on a coronavirus vaccine and to share research, treatment and medicines across the globe.” No one from the United States was among them.
Why bother? No U.S. pledge of any kind is worth the paper it’s printed on and in any case, the U.S. is clearly unwilling to work cooperatively with the rest of the world anymore, even in a global catastrophe.
I think this says it all:
This pandemic is the first real global threat of the 21st century. It won’t be the last. These are the kinds of great, unprecedented challenges we are going to face going forward. Not only is the U.S. not leading the response, it’s barely participating in it.
The election of Donald Trump was about more than just this presidency. It signaled that America was no longer capable of competently governing itself, much less leading the world. Our devastatingly disorganized, scattershot response to the COVID-19 crisis has revealed that this problem goes much deeper than our politics. We couldn’t have lost our ability to do anything right at a worse time.
If people with no symptoms are spreading the coronavirus, as some studies suggest, it may be time to give face masks the kind of advertising and promotion that support condoms as lifesavers.
Are face masks going to become like condoms — ubiquitous, sometimes fashionable, promoted with public service announcements? They should be, one virus researcher says, if early indications are correct in suggesting that Covid-19 is often spread by people who feel healthy and show no symptoms.
David O’Connor, who studies viral disease at the University of Wisconsin-Madison, said: “If a substantial amount of transmission occurs before people feel sick, how do you stop that? By the time people feel sick and seek care, all the testing and isolation in the world would be too little, too late.”
Dr. O’Connor, who researches H.I.V. and other viruses, including the new coronavirus, said some recent research had shifted his thinking about the current pandemic.
“H.I.V. is also spread while people feel fine,” he wrote in an email, “and consistent, correct condom use is a barrier to sexual virus transmission that works.”
The coronavirus pandemic has sickened more than 438,100 people, according to official counts. As of Wednesday afternoon, at least 19,641 people have died, and the virus has been detected in at least 168 countries, as these maps show.
We spoke with several travel and hospitality workers. Each had their own story, but echoed similar concerns about the uncertainty about their future. In looking at an unprecedented worldwide coronavirus outbreak, they turned to the past: how their tourism industry had survived devastating hurricanes and destructive civil wars. They will survive this, too, they said.
A selection of their remarks is below. These interviews, conducted by telephone and email, have been edited and condensed for clarity.
With your family’s health concerns, are you worried about being exposed to the coronavirus?
As drivers we’re putting ourselves at risk. If coronavirus is coming from other countries, it’s coming from the airports, and who’s going to the airports? We do. Everyone who gets into the car is potentially a carrier. But in our position it’s either work and eat, or don’t work and don’t eat.
You’ve not been able to give a tour since Sunday. How does it feel to be out of work?
I have a lot of worries. I have two boys — 2 and 4 years old, and one is diabetic and I have to be sure there’s always money for insulin — so I always have to provide. I just can’t not provide.
Something I learned with Hurricane Maria is you have to have a Plan B in life, and it has to be a complete opposite of your Plan A. After the disaster, the whole infrastructure was down and the only people who worked were those who worked with their hands — so I got certified as an electrician. I’m worried right now but, down the line, I have many doors open.
A Chicago-based flight attendant for United Airlines, Maria Alpogianis, 51, has worked in the field for 25 years.
What is the physical and psychological toll?
I don’t feel I have a sense of job security. I really don’t. I’m flying with several very junior flight attendants who are terrified of losing their jobs and their insurance. I’ve been flying for 25 years and I, too, am afraid that I’m going to be furloughed.
When I leave somewhere I become concerned about not being able to get home because of the border closures. When we land we cringe because we don’t know what’s changed during the time we’ve been in flight.
A very American story about capitalism consuming our national preparedness and resiliency.
Why is the United States running out of face masks for medical workers? How does the world’s wealthiest country find itself in such a tragic and avoidable mess? And how long will it take to get enough protective gear, if that’s even possible now?
I’ve spent the last few days digging into these questions, because the shortages of protective gear, particularly face masks, has struck me as one of the more disturbing absurdities in America’s response to this pandemic.
Yes, it would have been nice to have had early, widespread testing for the coronavirus, the strategy South Korea used to contain its outbreak. It would be amazing if we can avoid running out of ventilators and hospital space, the catastrophe that has befallen parts of Italy. But neither matters much — in fact, no significant intervention is possible — if health care workers cannot even come into contact with coronavirus patients without getting sick themselves.
What a small, shameful way for a strong nation to falter: For want of a 75-cent face mask, the kingdom was lost.
I am sorry to say that digging into the mask shortage does little to assuage one’s sense of outrage. The answer to why we’re running out of protective gear involves a very American set of capitalist pathologies — the rise and inevitable lure of low-cost overseas manufacturing, and a strategic failure, at the national level and in the health care industry, to consider seriously the cascading vulnerabilities that flowed from the incentives to reduce costs.
Perhaps the only way to address the shortfall now is to recognize that the market is broken, and to have the government step in to immediately spur global and domestic production. President Trump, bizarrely, has so far resisted ordering companies to produce more supplies and equipment. In the case of masks, manufacturers say they are moving mountains to ramp up production, and some large companies are donating millions of masks from their own reserves.
But given the vast global need for masks — in the United States alone, fighting the coronavirus will consume 3.5 billion face masks, according to an estimate by the Department of Health and Human Services — corporate generosity will fall short. People in the mask business say it will take a few months, at a minimum, to significantly expand production.
“We are at full capacity today, and increased production by building another factory or extending further will take anywhere between three to four months,” said Guillaume Laverdure, the chief operating officer of Medicom, a Canadian company that makes masks and other protective equipment in factories around the world.
And though some nontraditional manufacturers like T-shirt factories and other apparel makers have announced plans to rush-produce masks, it’s unclear that they will be able to meet required safety standards or shift over production in time to answer demand.
Few in the protective equipment industry are surprised by the shortages, because they’ve been predicted for years. In 2005, the George W. Bush administration called for the coordination of domestic production and stockpiling of protective gear in preparation for pandemic influenza. In 2006, Congress approved funds to add protective gear to a national strategic stockpile — among other things, the stockpile collected 52 million surgical face masks and 104 million N95 respirator masks.
As the coronavirus began to spread in China early this year, a global shortage of protective equipment began to look inevitable. But by then it was too late for the American government to do much about the problem. Two decades ago, most hospital protective gear was made domestically. But like much of the rest of the apparel and consumer products business, face mask manufacturing has since shifted nearly entirely overseas. “China is a producer of 80 percent of masks worldwide,” Laverdure said.
Hospitals began to run out of masks for the same reason that supermarkets ran out of toilet paper — because their “just-in-time” supply chains, which call for holding as little inventory as possible to meet demand, are built to optimize efficiency, not resiliency.
“You’re talking about a commodity item,” said Michael J. Alkire, president of Premier, a company that purchases medical supplies for hospitals and health systems. In the supply chain, he said, “by definition, there’s not going to be a lot of redundancy, because everyone wants the low cost.”
In January, the brittle supply chain began to crack under pressure. To deal with its own outbreak, China began to restrict exports of protective equipment. Then other countries did as well — Taiwan, Germany, France and India took steps to stop exports of medical equipment. That left American hospitals to seek more and more masks from fewer and fewer producers.
WASHINGTON — In his State of the Union address, President Trump announced a bold plan to end the scourge of H.I.V. by 2030, a promise that seemed to fly in the face of two years of policies and proposals that go in the opposite direction and could undermine progress against the virus that causes AIDS.
In November, the Trump administration proposed a rule change that would make it more difficult for Medicare beneficiaries to get the medicines that treat H.I.V. infection and prevent the virus from spreading.
Mr. Trump has repeatedly urged Congress to repeal the expansion of Medicaid under the Affordable Care Act, even though Medicaid is the largest source of coverage for people with H.I.V. And he has promoted the sale of short-term health plans that skirt the Affordable Care Act, even though such plans usually exclude people with H.I.V.
To end the spread of the virus, federal health officials say they must reduce the stigma attached to gay men and transgender people who are at high risk so they will seek testing and treatment. But for two years the administration has tried to roll back legal protections for people in those groups.
Those opposing moves by the administration have AIDS activists baffled.
“The president’s announcement comes as a surprise, albeit a welcome surprise,” said Jennifer C. Pizer, the law and policy director at Lambda Legal, a gay rights group. “It represents an about-face on H.I.V. policy.”
The administration describes the plan to end the spread of H.I.V. as one of the most important public health initiatives in history. But the record shows a rather large gap between the administration’s words and deeds.
A Trump proposal would limit Medicare drug coverage.
Since Medicare’s outpatient drug benefit began in 2006, the government has required prescription drug plans to cover “all or substantially all drugs” in six therapeutic classes, including antiretroviral medicines to treat H.I.V.
In November, the Trump administration proposed a new policy to cut costs for Medicare by reducing the number of drugs that must be made available to people with H.I.V.
The proposal would allow certain exceptions to the requirement for Medicare drug plans to cover all drugs in the six “protected classes.”
Insurers could require Medicare beneficiaries to get advance approval, or “prior authorization,” for H.I.V. drugs and could require them to try less expensive medications before using more costly ones, a practice known as step therapy.
People with H.I.V. and doctors have condemned the proposals.
Bruce Packett, the executive director of the American Academy of H.I.V. Medicine, representing doctors who care for H.I.V. patients, said the administration’s proposals “could be catastrophic” for Medicare patients with the virus, as well as for the president’s campaign to end the epidemic.
“At least 25 percent of all people living with H.I.V. who are in care in the United States rely on Medicare as their insurer,” Mr. Packett said.
Those patients are 65 or older or have disabilities and often have other chronic diseases or conditions, so doctors need access to the “full arsenal” of medicines to treat H.I.V., Mr. Packett said.
Many of the Medicare patients with H.I.V. are taking medicines for their other conditions, so doctors have to worry about drug interactions, Mr. Packett said. In addition, he said, some have drug-resistant strains of H.I.V., and different patients often respond to the same drug in different ways.
“It’s important that providers have access to all the available options” among drugs to treat H.I.V., he said.
Requirements for prior authorization and similar restrictions can delay the start of treatment. Studies show that a rapid start to therapy, within a week or even a day of diagnosis, produces better results for patients and reduces the likelihood that they will infect others while waiting for treatment.
HONG KONG — Like many across East Asia, North Koreans have been exchanging presents this month to celebrate the Lunar New Year. But rather than tea, sweets or clothing, some in this impoverished, isolated country are giving the gift of crystal meth.
The gifting and use of methamphetamine, a powerful stimulant that has been blamed in health and addiction crises around the world, is said to be a well-established custom in North Korea. Users are said to inject or snort the drug as casually as they might smoke a cigarette, with little awareness of its addictive qualities or destructive effects.
“Meth, until recently, has been largely seen inside North Korea as a kind of very powerful energy drug — something like Red Bull, amplified,” said Andrei Lankov, an expert on the North at Kookmin University in Seoul, South Korea, who directs the news site NK News. That misconception, he said, highlighted a “significant underestimation” within the country of the general risks of drug abuse.
Methamphetamine was introduced to the Korean Peninsula during the Japanese colonial period, in the early 20th century, and defectors have reported that the North Korean military provided methamphetamine to its soldiers in the years after World War II. Since the 1970s, many North Korean diplomats have been arrested abroad for drug smuggling.
In the 1990s, the North’s cash-poor government began manufacturing meth for export, about two decades after it began sponsoring local opium cultivation and the production of opiates, according to a 2014 study by Sheena Chestnut Greitens, a University of Missouri political scientist. Finished meth was typically sent across the northern border into China, or handed off at sea to criminal organizations like Chinese triads or the Japanese yakuza.
But around the mid-2000s, meth production that was “clearly sponsored and controlled” by the government began to decline, the study said. That left a surplus of people with the skills to manufacture meth, many of whom created small-scale meth labs and began selling to the local market.
Amid a chronic lack of health care supplies and medical treatments in North Korea, many people take opiates and amphetamine-type stimulants as perceived medicinal alternatives, Ms. Greitens, the political scientist, said in an email. “Methamphetamine is highly addictive, so it’s easy for casual users to develop more dependence and addiction over relatively short amounts of time,” she said.
The drug’s popularity in North Korea as a Lunar New Year gift was first reported last week by Radio Free Asia, a United States government-funded news outlet. Radio Free Asia quoted several anonymous sources as saying that the custom was especially popular among the country’s young people.
The Radio Free Asia report could not be independently verified, and the North Korean government has long denied that its citizens use or produce methamphetamine. “The illegal use, trafficking and production of drugs which reduce human being into mental cripples do not exist in the D.P.R.K.,” the North’s state-run news agency said in 2013, referring to the initials of the country’s formal name, the Democratic People’s Republic of Korea.