🌎 #276: Who gets Long COVID?

Quinn Emmett
May 13, 2022
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Welcome back, Shit Givers.

The internet is a hellscape this week. I've never going to promise good news, but I will always promise real news that matters, how you can think about it, and what the hell you can actually do about it.

This Week, Summarized:

  • Water in the West
  • Who will get Long COVID?
  • The baby formula shortage, explained
  • Drug overdoses and gaslighting
  • Data privacy improvements

Reminder: You can read this issue on the website, or you can 🎧 listen to it on the podcast (shortly).

🕛 Reading Time: 11 minutes

Correction: Last week I said India & Pakistan together comprise 25% of the global population, which is incorrect. The entire subcontinent comprises 23% of the global total. Going forward, I'll list our corrections up top in an effort to maximize transparency with you folks (h/t Elana for the catch, and Isaac for setting the standard).


Lake Powell


Where the water goes from here

The news: As the historic drought/desertification/aridification continues in the American West (how the hell does this thing not have a name yet?), and as the earth heats up even quicker than expected, the massively complex and convoluted systems we built to make the West livable at scale (among the most complex we've ever built, anywhere) are having a come to Jesus moment:

Understand it: The great Western dams, rivers, and thousands of reservoirs -- including those like Flaming Gorge, Glen Canyon, and Lakes Powell and Mead, the Sacramento, San Joaquin, and Colorado Rivers -- simultaneously divert water and provide hydropower to tens of millions of people and acres of farmland in Southern California and the southwest.

And they're in trouble. Many of the dams are in poor condition, or just holding back far less water than they used to.

Less fresh water means less drinking water, less farming water, and less hydropower.

And less power from hydro is particularly complicated, because, well:

  • The west is getting hotter during the day, but especially at night, requiring more air conditioners
  • Western utilities have thousands of miles of power lines exposed to an increasing number of fires from the same heat
  • California can't decide whether to close its aging nuclear plant (and hasn't built any new ones in decades) and so will be increasingly dependent on renewable energy
  • But there already aren't enough batteries to store it and not enough battery materials in the domestic supply chain to build more, faster
  • All of those are connected and dependent on those same exposed power lines, which would cost billions and at least a decade to bury

Oh, and at some point, an earthquake is due.

Any way you slice it, more blackouts like those of 2020 are inevitable.

Not unlike COVID and public health, the day-to-day infrastructure and support systems of the 20th century simply aren't built to be tested in a real way, and so far, we seem disinclined to consider the broader implications.

And so: Mandated water restrictions. More efforts at water recycling and drip irrigation. More efforts at (increasingly dangerous) prescribed burns. More fighting over expensive, power-hungry, and ecosystem trashing (but maybe essential) desalination.

Fewer farms, fewer crops, and fewer farmers.

Maybe you find it less helpful to answer my big questions: Why is the West in this situation? Did it have to be this way?

And maybe that's because the answers are, "This infrastructure was the only way the West was going to be livable at scale, but it required perfect conditions" and "Those don't exist anymore, so maybe it can't exist at scale any longer, either."

All of which hundreds of thousands of Indigenous people who lived for thousands of years on those lands could attest to, had we not systemically wiped them out, and which their few descendants still fervently attest to.

There are no average precipitation years in the west, and far fewer now that we've done what we've done.

So those systems are failing. Meanwhile, the climate tech money flows, and Speaker Pelosi half-heartedly wants us to do something on climate, "for the children", but -- despite steadily, if incrementally, fewer emissions from countries like the US -- we're still not doing anywhere near enough, while the fossil fuel industry commits billions to new projects.

In a nutshell: The West is just beginning to undergo a huge number of tradeoffs that will come as a shock to most folks who've enjoyed and profited off almost a century of interrupted and relative bliss.

But that bliss was always a temporary facade, and so the tradeoffs will have to be larger, a holistic paradigm shift prompted by whatever the answer to this question may be:

If the West as we built it isn't sustainable, what version of it is?

⚡️Action Step: The fabulous Khan Academy has beta-launched a new middle school earth science curriculum. You can take it and provide feedback here (and donate, too).


Safety mask


Vaccine equity update: Just 15.9% of people in low-income countries have received at least one dose, and 34.5% of people worldwide have received zero doses.

Don't stop counting now

The news: We're losing our ability to contextualize COVID.

Last week I wrote:

"Raw case numbers are misleading, now. My (relatively) educated guess is 75% of real cases are testing positive at home (and thus not included in reported totals) or not testing at all -- thus: reported totals are maybe 25% of what's really out there."

Understand it: COVID cases, as reported in 2020, 2021, or 2022, were always a map, not the territory, a limited and often biased view into the landscape.

Hospitalizations and death reporting is somewhat more black and white, and thus more accurate (while misinformation situations like India, Egypt, Pakistan, etc blow that assumption away).

As states across the country pull back on counting and reporting rising COVID cases, with variants becoming better at immunity evasion, and with tens of millions of cases predicted this winter, we have to ask what else we lose when we stop doing the work.

For example, we continue to not get answers to unanswered questions, such as: What percentage of positive cases get Long COVID?

Why do we need the answer so desperately?

Well, so we can better understand current day-to-day personal risks, of course, but also so we can start immediately building research into what the most common symptoms are, who gets it, and why, and also an entirely new health care support structure for a mass disabling event that's still under way, and could affect billions directly and indirectly.

Already, up to 24 million Americans alone may be experiencing long-hauler symptoms. Current diagnosis is a process of elimination: Can this wide variety of symptoms be explained by any other diagnosis?

A parallel investigation we're apparently not doing: Once diagnosed, how do we treat Long COVID? There's no proven treatments yet (growth mindset!), but one may have at least some incremental benefit: Paxlovid.

And again we come back to measurement. Clinical trials are wildly expensive and often fail. COVID money is running dry everywhere, but considering (frantically waves hands) everything, maybe our immediate goal shouldn't be a cure, but something. Anything.

⚡️Action Step: Had COVID? Talk to your doctor and then direct your fine self or someone you love towards RECOVER, an NIH-led research project to better understand what the hell we're dealing with. Note: participants will not receive treatment. Find a study near you.


Maternity leave chart


The bottles are empty

The news: America's nationwide baby formula shortage is growing worse.

I'll let Judd tell it:

"The national out-of-stock rate for baby formula reached 43 percent last week. [...] There are a variety of reasons why baby formula is in short supply.

For months, the industry has struggled with supply chain challenges related to the pandemic. Then in February, Abbott Nutrition — one of a handful of major manufacturers — recalled three popular varieties of formula. Four babies were hospitalized with bacterial infections after drinking the formula and two died."

Understand it: Like abortion, it's helpful to remember the US has no guaranteed paid family leave, no guaranteed sick leave, and no more Child Tax Credit, so the repercussions of having a baby at all -- even if you choose to -- are enormous.

In addition, America sources over 95% of its formula domestically from just 3 companies.

These are policy choices. Whether we're talking time or money or both, being a parent is wildly expensive because we've decided it should be that way.

Yes, even if you breastfeed. Time off (again, not paid), the struggles to make it actually work, the pumps, the bags, the freezer space, the food that makes the milk -- if you can actually make milk at all. All of it costs actual money and also, FYI, babies eat ALL OF THE TIME. They are fucking relentless.

Nearly everything about breastfeeding -- from my very limited perspective as a VERY privileged father of three who could afford a lactation consultant, multiple pumps, a dishwasher, and lots of formula -- is mythologized. Sure, it's great for the baby, but it's also a tremendous, exhausting pain in the ass, and often just not an option.

We not only pay women less in general and don't give them time off to breastfeed, we shame them when they don't do it, whether it's by choice, or because they can't for one or more of the many, many reasons why many, many women can't.

At one point my wife and I had three kids under three. Being entirely dependent on breastmilk that could be left out six seconds too long, could be spilled, or could be left in the car or at the office, is a nightmare we were privileged to live through.

When it hit in the 50's, formula completely changed the game. It saved the lives of so many babies, and freed millions of women (read: your mom) from having to cry in public because you couldn't latch. Formula makes it easier for mothers to sleep, to travel, to take medicine, to be less stressed, for parents to adopt or use a surrogate.

So, yeah, supply chains are a mess and Abbott sucks, but like diapers, formula shouldn't ever (ever) be something parents have to fucking ration, for price or scarcity or both. Thank you for coming to my TED talk.

⚡️Action Step: Call your reps (especially the men) to ask them what they're doing about the formula shortage now and to make it easier to feed a baby overall. And if you're possibly able to donate breast milk, let's do this. Start by finding the closest Human Milk Banking location near you, go through the screening process, and let's feed some babies.



These are actual bad guys

The news: New federal estimates say almost 108,000 people died from drug overdoses in 2021, a 15% increase from 2020. Over 80,000 of those involved opioids, and 71,000 involved illegally manufactured fentanyl.

Understand it: Overdose deaths actually dropped for the first time in decades in 2018, but while correlation does not imply causation, they've sky-rocketed since then FOR SOME REASON.

From NPR:

"A recent study showed that for the first time in a decade, the number of teens who died from overdoses rose in 2020. (Addiction researchers) think it's primarily because fentanyl is becoming increasingly added into counterfeit prescription drugs, which are popular among this age group."

Further: You've heard of the notoriously monstrous Sackler family, Purdue Pharma, and OxyContin, but it turns out they weren't the final boss after all.

In The Washington Post, 1.4 million newly available records revealed Mallinckrodt Pharmaceuticals, the largest manufacturer of opioids in the US with a 27% share from 2006-2014, once "cultivated" 200+ doctors to reliably prescribe the drugs. Just a quarter of those doctors have been convicted, had their licenses revoked, or paid fines.

"Mallinckrodt’s 30 mg oxycodone tablet became the preferred drug on the street, according to the DEA. The baby-blue-colored pills, the equivalent to a hit of heroin, became so ubiquitous that the smuggling route from Florida to Appalachia became known as the “Blue Highway.”

I'm going to include two more quotes here from the company's promotional materials to doctors. I need you to know how truly fucked up and prevalent American gaslighting can be, whether we're talking cigarettes, fossil fuels, or opioids:

"The company’s promotional material, (included) a reggae song with the chorus: “You can start at the middle, you can start at the top. You can start with very little but that’s not where you should stop. Your patient needs relief, mon, so please do what you should.”


"With older adults, start dose low, go slow,” the company wrote in marketing material for drug industry trade shows. “But go!!”

I've gotta go for a walk.

⚡️Action Step: Your Action Step is simply to read the Washington Post piece, and share it.

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Face ID


Your face, for sale, marginally less

The news: The ACLU won a settlement this week with Clearview AI -- the sketchy face surveillance company used the world over.

Understand it:  Clearview isn't alone in this profiting off this historic invasion of privacy, as I've documented over and over. But every win for data privacy is just that -- a win.

Look. I think we can all agree that GDPR ("Accept all cookies?") is annoying and possibly an enormous waste of effort and money. But that doesn't mean we can't learn from it, that more and better data privacy laws aren't needed.

Connecticut is the 5th state with a data privacy law, meanwhile Congress has been trying to pass a federal version since we used carrier pigeons and is still at it, but have no doubt, it might never happen.

But like Paxlovid and Long COVID research, like California's water rationing, of course we need more, much more, and I will never keep pushing for more.

But we learn from every incremental bit of progress, however compromised, however tainted by industry. Each new law and improvement buoys activists and supporters, improves social norms, and begins to unravel structures designed to extract maximum profit at whatever social cost.

⚡️Action Step: Get involved with Fight for the Future to support antitrust bills, net neutrality, and fight facial recognition, among other essential movements of our time.


Lumberg referral

Thanks for reading, and thanks for giving a shit. Have a great weekend.

- Quinn

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