v a l l e j o n o c t u r n o

No Master Plan

From an article in The Atlantic on what is going on across corporations since the early 2000's-I saw this and worse during my last years in business and the rush to monetize the savings from ill-informed automations and efficiencies has created, finally, what we are witnessing at Boeing today. I can remember in the early 2000's as we were rolling out "improvements' with bad consequences a co-exec telling me we aren't running a hospital here. . .:

Minimal manning—and with it, the replacement of specialized workers with problem-solving generalists—isn’t a particularly nautical concept. Indeed, it will sound familiar to anyone in an organization who’s been asked to “do more with less”—which, these days, seems to be just about everyone. Ten years from now, the Deloitte consultant Erica Volini projects, 70 to 90 percent of workers will be in so-called hybrid jobs or superjobs—that is, positions combining tasks once performed by people in two or more traditional roles. Visit SkyWest Airlines’ careers site, and you’ll see that the company is looking for “cross utilized agents” capable of ticketing, marshaling and servicing aircraft, and handling luggage. At the online shoe company Zappos, which famously did away with job titles a few years back, employees are encouraged to take on multiple roles by joining “circles” that tackle different responsibilities. If you ask Laszlo Bock, Google’s former culture chief and now the head of the HR start-up Humu, what he looks for in a new hire, he’ll tell you “mental agility.” “What companies are looking for,” says Mary Jo King, the president of the National Résumé Writers’ Association, “is someone who can be all, do all, and pivot on a dime to solve any problem.”

The phenomenon is sped by automation, which usurps routine tasks, leaving employees to handle the nonroutine and unanticipated—and the continued advance of which throws the skills employers value into flux. It would be supremely ironic if the advance of the knowledge economy had the effect of devaluing knowledge. But that’s what I heard, recurrently, while reporting this story. “The half-life of skills is getting shorter,” I was told by IBM’s Joanna Daly, who oversaw an apprenticeship program that trained tech employees for new jobs within the company in as few as six months. By 2020, a 2016 World Economic Forum report predicted, “more than one-third of the desired core skill sets of most occupations” will not have been seen as crucial to the job when the report was published. If that’s the case, I asked John Sullivan, a prominent Silicon Valley talent adviser, why should anyone take the time to master anything at all? “You shouldn’t!” he replied.

As a rule of thumb, statements out of Silicon Valley should be deflated by half to control for hyperbole. Still, the ramifications of Sullivan’s comment unfurl quickly. Minimal manning—and the evolution of the economy more generally—requires a different kind of worker, with not only different acquired skills but different inherent abilities. It has implications for the nature and utility of a college education, for the path of careers, for inequality and employability—even for the generational divide. And that’s to say nothing of its potential impact on product quality and worker safety, or on the nature of the satisfactions one might derive from work. Or, for that matter, on the relevance of the question What do you want to be when you grow up?

How deep these implications go depends, ultimately, on how closely employers embrace the concepts behind minimal manning. The Navy, curiously, has pushed the idea forward with an abandon unseen anywhere on land. Within a few years, 35 littoral combat ships will be afloat, along with three minimally manned destroyers of the new Zumwalt class. The effort seemed to me a good test case for the broader questions bedeviling the economy: Can a few brilliant, quick-thinking generalists really replace a fleet of specialists? Is the value of true expertise in serious decline?

Environmental Injustice

From NYRB, a review of Josiah Rector's account of environmental justice in Detroit:

In Toxic Debt: An Environmental Justice History of Detroit, Josiah Rector, who teaches at the University of Houston, instead looks northward to Detroit and its environs. As a graduate student at Wayne State University in Detroit a decade ago, he first came across records that charted the city’s rich and often overlooked history of environmental justice organizing. It was also in Detroit that Rector, a white newcomer in a city that is nearly 80 percent Black, witnessed one of the most naked displays of environmental injustice in recent memory.

Beginning in 2014, the City of Detroit shut off the water of more than a quarter-million people. Starting at the same time, authorities in nearby Flint made a series of cost-cutting decisions that resulted in lead-laced water being pumped into thousands of homes. Astonishingly, Detroit’s water has been so foul for so long that its rate of childhood lead poisoning is twice as high as Flint’s—despite the fact that the city is surrounded by the largest freshwater system in the world. During Rector’s time there, moreover, Detroit recorded the highest rate of childhood asthma among the nation’s largest cities. A 2017 study estimates that air pollution causes 7 percent of all deaths in Detroit—more than twice the city’s rate of homicide.

After interviewing activists and immersing himself in the region’s archives, Rector concluded that the “existing literature on environmental justice did not give me the conceptual vocabulary I needed to make sense of what I was seeing in Detroit,” both past and present. A decade later, he has written a book that advances two major interventions. First, it pushes back the environmental justice movement’s genesis to midcentury union organizing. Second, and just as significantly, it firmly connects the effects of debt and austerity—that is to say, capitalism—to environmental racism.

“While most environmental justice studies examine communities on the ‘fence line’ of billowing smokestacks and toxic waste dumps,” Rector writes, “finance and real estate have been no less historically implicated in racialized environmental injustice than heavy industry.” Toxic Debt concretely documents this history by recovering the voices, names, and actions of individuals whose fights have been forgotten or buried.

Mask Up Now

From The Lancet:

Individualistic approaches to health, exemplified by the CDC's May 2021 mask guidance, ignore the impacts on health inequities, which have been exacerbated by the pandemic and continue to hinder vaccination access . Many are essential workers with high exposure risks and limited workplace protections, who face vaccination barriers due to a lack of sick leave and existing caretaking responsibilities. These inequities compound vulnerabilities for those at high risk for infection and severe outcomes, including older and disabled or chronically-ill adults and children, and institutionalized populations. Overlooked inequities yield disproportionate COVID-19 disease, disability, and death in oppressed and excluded communities—even where there is overall disease reduction. Yet, such groups have often been omitted from discussions of public health policy, with their lives treated as expendable.

Public health protection is inextricably linked with human rights promotion. The right to health has provided normative clarity in public health policy and legal accountability for public health outcomes, focusing on the need to prevent disease at the population level to ensure the highest attainable standard of health for all. In promoting individual rights to protect public health, the pandemic has shown the need for a response that prioritizes community trust and cooperative engagement. The CDC's decision to prioritize individual autonomy over public health ignores disease vulnerability, not only for at-risk individuals but the community.

Ongoing debates about CDC's mask guidance raise foundational questions about the meaning, purpose, and role of public health. Even as public health often seeks to project itself as “apolitical”, moral values permeate public health practice. Purportedly apolitical public health decisions, manifested in policy decisions that rationalize economic “reopening”, employ a cost-benefit analysis that prioritizes some lives over others and makes loss of life, sickness, and isolation seem acceptable, obscuring the reality that morbidity and mortality could be greatly decreased with appropriate structural mitigation.The current US approach continues to undermine the fundamental notion that all people are equal in dignity and rights. When the CDC Director speaks of a “pandemic of the unvaccinated”

, this implicitly assumes that those who become ill are responsible for their own suffering and that their deaths are acceptable—because they could have been vaccinated. These moral deficiencies reflect a larger neglect of collective responsibility, equity, and human rights in US public health policy. CDC guidance must consider the moral foundations of public health, providing a normative framework to support public health policy and practice.

Quipus

From  the NEH:

But what if a society being interrogated had no written words—and their mode of expression was itself a kind of elaborate lock? So it is with the Inca and their endlessly enigmatic counting tool, the quipu. The device comprises a series of colored cords hanging from a topmost strand. Tied into the pendant cords are a variety of knots that, depending on their type and position, encode various pieces of information, including values from a base-ten numbering scheme. Perhaps the mightiest empire of the New World, located in what is now Peru, substituted talking knots for an alphabet.

 “If we want to understand the Inca from their own point of view, the only sources available to us—i.e., the only ‘primary sources’—are the quipus,” writes anthropologist Gary Urton. A Harvard professor of pre-Columbian studies, Urton received $4,750 from NEH in 1993 to study the world’s largest archives of both quipu samples and Spanish documentation from the New World. Two grants of $30,000 each followed, which helped support the research that has made him an authority on the mysterious objects and their function. “I am studying the quipus,” he said, “in an effort to recuperate the Inca viewpoint on their world.”

That viewpoint was imperiled following the arrival of Spanish colonizers, led by Francisco Pizarro in 1526. The Inca were conquered, subjugated, and often enslaved. Wave after wave of European diseases killed off many of those who weren’t slain in battle. Only centuries later did we gain an appreciation of the people extinguished by the conquistadors’ swords. The site of Machu Pichu, located in the Inca heartland of Peru, is today one of the most visited attractions in South America, and examples of the sophisticated culture’s textile and ceramic output fill museums.

Quipus tell a story that is no less important: They were critical instruments of factotums and bureaucrats, an imperial language of record-keeping that helped tally censuses and tribute payments from far-flung communities to the capital city of Cuzco. Urton and others believe that some could contain even more complex ciphers, such as narrative histories or the names of deities. Unfortunately, their messages have frustrated modern interpreters. Though the Spanish transcribed a small number of quipu readings, none of them match the roughly 870 samples that still survive. The search goes on for the “Rosetta quipu,” as Urton puts it. If one could be found, it would represent more than an anthropological coup—it would forever unfasten the knot of a language lost to time.

Not So Smart AI

From an article on NYRB on IA costs and its shortcomings:

As Kate Crawford’s trenchant Atlas of AI demonstrates again and again, artificial intelligence does not come to us as a deus ex machina but, rather, through a number of dehumanizing extractive practices, of which most of us are unaware. Crawford, a senior researcher at Microsoft and a cofounder of the AI Now Institute at NYU, begins her tour of the AI universe in Silver Peak, Nevada, looking at the “open, iridescent green ponds” of brine pumped out of North America’s largest lithium mine. Lithium—the “li” in “li-ion” batteries—is an essential ingredient in our digital lives. Without it there are no laptop computers, no smart watches, no cell phones.

“The term ‘artificial intelligence’ may invoke ideas of algorithms, data, and cloud architectures,” Crawford writes, “but none of that can function without the minerals and resources that build computing’s core components.” She adds:

Many aspects of modern life have been moved to “the cloud” with little consideration of these material costs. Our work and personal lives, our medical histories, our leisure time, our entertainment, our political interests—all of this takes place in the world of networked computing architectures that we tap into from devices we hold in one hand, with lithium at their core.

Calling those networked computers “the cloud” is a perfect example of what Crawford sees as “the strategic amnesia that accompanies stories of technological progress.” While the metaphor invokes an image of data floating weightlessly in the sky, the reality is that the cloud takes up hundreds of thousands of acres of terrestrial real estate, typically located where electricity is cheap. (The world’s largest data center, as of 2018, in Langfang, China, covers 6.3 million square feet, the equivalent of 110 football fields.) Cheap, of course, is a relative term. A study from researchers at McMaster University found that, if unchecked, the computing industry as a whole could account for 14 percent of all greenhouse emissions by 2040—“about half of the entire transportation sector worldwide.”

Some of this carbon intensity has been driven by the belief that ever-bigger datasets are essential to train machine learning algorithms in order to create workable AI systems. (Machine learning is a kind of artificial intelligence, in which algorithms sort through enormous amounts of data using statistical methods to make classifications and predictions; the assumption is that more data delivers more accurate outcomes.) When researchers from the University of Massachusetts Amherst calculated the carbon emissions required to build and train a single natural language processing system—which teaches computers to interpret and use everyday language—they determined that it was around five times the lifetime emissions of the average American car.

Disinformation

Just ran into a crazy video from a guy who claims many things, most of them untrue about the virus, masks, and vaccines. What follows is a takedown of his insane quackery at a School Board meeting in the enlightened state of Indiana. Some one please save us from these buffoons.

From Edward Niremberg at Deplatform Disease:

A surprisingly large number of people have sent me a video that is inundated with disinformation about COVID-19 and its reach seems considerable so I have deemed it significant enough to address. In the video, one Dr. Dan Stock from Indiana at a school board meeting opines at length about all the things we’re supposedly doing wrong with COVID-19 (by the way, the FSMB has now stated that spreading misinformation about COVID-19 vaccination may put medical licenses at risk, though state medical boards have final say it seems; rest assured I will be examining the rules in Indiana quite closely). The speech is little more than a verbal gish gallop: a tactic used by science denialists wherein they post a bunch of links that they claim to support their points but in reality most of the citations are unsupportive or even unrelated to their claim- but this serves the appearance of evidence. He is doing this but with words- he is making a series of incorrect arguments (that are self-contradictory) and essentially seeking to overwhelm opposition with the volume of arguments he makes. The thing is, as I’ll discuss, he discredits himself very early on, so you don’t have to subject yourself to listening to his vile nonsense because I did it for you.

To begin, the speaker describes himself as a “functional family medicine physician,” which per him “means [he] is specially trained in immunology and inflammation regulation.” Firstly, this isn’t even how most sources define functional medicine. The Cleveland Clinic Center for Functional Medicine defines functional medicine as

a personalized, systems-oriented model that empowers patients and practitioners to achieve the highest expression of health by working in collaboration to address the underlying causes of disease.

This definition, admittedly, is completely meaningless because the foundation of literally all medicine is built on understanding the pathophysiology of conditions and addressing their underlying cause whenever that is possible (which unfortunately isn’t always feasible) and the implication that other clinician specialties do not do this is on its face pretty offensive. It is furthermore not what Stock describes, which most closely seems to describe an allergist/immunologist, which he is not. The title of “functional medicine physician” is usually a red flag for quackery and he’s already misrepresented his own expertise, so this isn’t off to a great start. An explanation of the problems with functional medicine generally may be found here. Also functional medicine is not a specialty recognized by the American Board of Medical Specialties nor the American Medical Association.

Next he claims that coronaviruses and all respiratory viruses are spread by aerosol particles which are small enough to go through your mask, which is a misleading in several ways. Aerosols refer specifically to very small droplets which in general can linger in the air for prolonged periods of time. While there is evidence that during certain medical procedures like intubation, SARS-CoV-2 can become aerosolized, most contact tracing studies do find that prolonged close contact with individuals is needed for transmission to occur (but obviously there are exceptions). There is definitely a role for aerosol transmission in COVID-19 but precisely how much is not well-defined. He then argues that masks don’t work because viruses are small enough to pass through them. The problem with this reasoning is viruses do not travel as individual viral particles- they are inside the aerosols and droplets. That’s what the masks block. The IDSA has graciously compiled the multitudinous, surfeit evidence demonstrating the effectiveness of masking here which anyone is free to peruse at their leisure.

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Mask or No Mask?

Josh Marshall say some things I'd like to say:

I will get to some points about the CDC’s updated masking policy in a moment. But first a few points about the CDC’s decision-making generally. I thought the earlier decision to end the masking guidance for the vaccinated was a mistake. I think the CDC was trying to balance the evolving science with immense public pressure to offer what amounts to a reward for vaccination, to declare the pandemic over or show the benefits of vaccination.

But after yesterday’s updated policy or reversal I kept seeing comments on Twitter, headlines in OpEds and comments from people on TV saying, “That’s it!” “That’s the final nail in the coffin of the CDC’s credibility!” Or ‘the experts’ or Fauci or whoever else. “First it was no masks! Now masks are back! Which is it??!?!!?”

Really people need to get the f*#$ over themselves.

COVID is an evolving pathogen. Our knowledge of it is evolving. We’re basically conducting, against our will, a live subject study with the entire human population. Science isn’t a book with all the answers. It’s an empirical process. By its nature it’s tentative and evolving. We are learning about the efficacy of the best vaccines. We’re learning about Delta COVID. And we’re trying to figure out how the two interact.

This isn’t a brief for anyone at CDC. Like I said, I think they’ve gotten some key decisions wrong, in ways I’ll describe in a moment. Mostly they are not clinical decisions but decisions which have sought to balance the available scientific knowledge with evolving public opinion. Or to be more specific, they are cases where they have sought to balance it with what we might call very understandable public exhaustion.

The fact is that we are living through an historic global pandemic. It’s complicated. We’re collectively having to make big decisions without anywhere near enough knowledge. It will continue to be bumpy. The problem isn’t that the CDC doesn’t have enough wizards to wave wands to make it disappear for you. The problem is the virus. And we are not done with it.

Future Trash

The fate of a corkpull from Real Life:

I am troubled by this corkpull. For one, it has to live in a drawer with all the other handheld kitchen tools including the cutlery. The knives, forks, and spoons have their segmented tray, but everything else just jumbles around. There are two ladles, much to my annoyance. The whisk always gets other things stuck in its wiry loops, loose chopsticks and metal skewers jamming up the works. In terms of burdensomeness, the corkpull has them beat: Its thick bulk reads to me as something like arrogance, incommensurate with its simple, single task. It’s this Oxo guy. Black, textured plastic, brushed steel (truly the worst finish, my fingers shrivel just thinking about it) and a top piece that clicks out to reveal a separate tool for cutting the foil.

Of course, it works impeccably. Unlike the two perfectly serviceable and far suaver waiters’ friend wine openers that also live in the drawer, the Oxo is effortless. Place the huge unit on top of the naked cork, twist the upper handle while holding the main shaft in place, and the corkscrew descends. It swivels down smoothly to pierce the cork until — without any additional pressure from the twisting hand — the cork begins to lift, up and out with a very quiet pop. Great. I suppose I should be happy to own such a perfectly functional piece, no muss, no fuss, no danger of injury, but what can I say? It’s ugly and I don’t like it.

You may not be surprised to hear that it was a gift. Life would be simpler if it had never entered the house, but between the gift-ness and its unfortunate excellence at performing its single task, I haven’t been able to get rid of it. Marcel Mauss, in his inquiry into the anthropology of the gift, asks “What power resides in the object given that causes its recipient to pay it back?” The gift corkscrew is freighted with a psychic weight that can’t be directly repaid, but can’t be forgotten. Despite its aesthetic offenses and the anxiety it causes me, sending it on to the abyss of the Goodwill donation bin or the eternity of the landfill feels irresponsible. And so I’m stuck with it, the unwilling caretaker for this and a panoply of other shitty objects that found their way into my small apartment.

It’s hard to live with objects these days. I want to surround myself with tools that help me perform my daily tasks, or beautiful objects that are frivolous but nice to look at and touch. I want things that last a long time, that are easy to fix, and that didn’t damage the people who made them or the places their materials were extracted from. The Oxo corkpull and a thousand other objects in my drawers and closets feel like barely-tolerable stowaways, unwanted gifts foisted on me by the complex and inexorable machinations of an economic system bent on destruction. “Every single thing you see is future trash,” says Robin Nagle, anthropologist of material cultures and anthropologist-in-residence at the New York Department of Sanitation. This system that “not only generates so much trash, but relies upon the accelerating production of waste for its own perpetuation” is big and cruel. The corkpull is a tiny piece of flotsam on a tide of material that flows through ships, stores, houses, hands, and all I can do is try desperately to manage the rivulet running through my own life. I hate it here.

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It will get Worse

From an article in The Atlantic regarding future possibilities forecast by academic Peter Turchin:

The fundamental problems, he says, are a dark triad of social maladies: a bloated elite class, with too few elite jobs to go around; declining living standards among the general population; and a government that can’t cover its financial positions. His models, which track these factors in other societies across history, are too complicated to explain in a nontechnical publication. But they’ve succeeded in impressing writers for nontechnical publications, and have won him comparisons to other authors of “megahistories,” such as Jared Diamond and Yuval Noah Harari. The New York Times columnist Ross Douthat had once found Turchin’s historical model­ing unpersuasive, but 2020 made him a believer: “At this point,” Douthat recently admitted on a podcast, “I feel like you have to pay a little more attention to him.”

Diamond and Harari aimed to describe the history of humanity. Turchin looks into a distant, science-fiction future for peers. In War and Peace and War (2006), his most accessible book, he likens himself to Hari Seldon, the “maverick mathematician” of Isaac Asimov’s Foundation series, who can foretell the rise and fall of empires. In those 10,000 years’ worth of data, Turchin believes he has found iron laws that dictate the fates of human societies.

The fate of our own society, he says, is not going to be pretty, at least in the near term. “It’s too late,” he told me as we passed Mirror Lake, which UConn’s website describes as a favorite place for students to “read, relax, or ride on the wooden swing.” The problems are deep and structural—not the type that the tedious process of demo­cratic change can fix in time to forestall mayhem. Turchin likens America to a huge ship headed directly for an iceberg: “If you have a discussion among the crew about which way to turn, you will not turn in time, and you hit the iceberg directly.” The past 10 years or so have been discussion. That sickening crunch you now hear—steel twisting, rivets popping—­­is the sound of the ship hitting the iceberg.

“We are almost guaranteed” five hellish years, Turchin predicts, and likely a decade or more. The problem, he says, is that there are too many people like me. “You are ruling class,” he said, with no more rancor than if he had informed me that I had brown hair, or a slightly newer iPhone than his. Of the three factors driving social violence, Turchin stresses most heavily “elite overproduction”—­the tendency of a society’s ruling classes to grow faster than the number of positions for their members to fill. One way for a ruling class to grow is biologically—think of Saudi Arabia, where princes and princesses are born faster than royal roles can be created for them. In the United States, elites over­produce themselves through economic and educational upward mobility: More and more people get rich, and more and more get educated. Neither of these sounds bad on its own. Don’t we want everyone to be rich and educated? The problems begin when money and Harvard degrees become like royal titles in Saudi Arabia. If lots of people have them, but only some have real power, the ones who don’t have power eventually turn on the ones who do.

In the United States, Turchin told me, you can see more and more aspirants fighting for a single job at, say, a prestigious law firm, or in an influential government sinecure, or (here it got personal) at a national magazine. Perhaps seeing the holes in my T-shirt, Turchin noted that a person can be part of an ideological elite rather than an economic one. (He doesn’t view himself as a member of either. A professor reaches at most a few hundred students, he told me. “You reach hundreds of thousands.”) Elite jobs do not multiply as fast as elites do. There are still only 100 Senate seats, but more people than ever have enough money or degrees to think they should be running the country. “You have a situation now where there are many more elites fighting for the same position, and some portion of them will convert to counter-elites,” Turchin said.

Donald Trump, for example, may appear elite (rich father, Wharton degree, gilded commodes), but Trumpism is a counter-elite movement. His government is packed with credentialed nobodies who were shut out of previous administrations, sometimes for good reasons and sometimes because the Groton-­Yale establishment simply didn’t have any vacancies. Trump’s former adviser and chief strategist Steve Bannon, Turchin said, is a “paradigmatic example” of a counter-elite. He grew up working-class, went to Harvard Business School, and got rich as an investment banker and by owning a small stake in the syndication rights to Seinfeld. None of that translated to political power until he allied himself with the common people. “He was a counter-elite who used Trump to break through, to put the white working males back in charge,” Turchin said.

Elite overproduction creates counter-elites, and counter-elites look for allies among the commoners. If commoners’ living standards slip—not relative to the elites, but relative to what they had before—they accept the overtures of the counter-elites and start oiling the axles of their tumbrels. Commoners’ lives grow worse, and the few who try to pull themselves onto the elite lifeboat are pushed back into the water by those already aboard. The final trigger of impending collapse, Turchin says, tends to be state insolvency. At some point rising in­security becomes expensive. The elites have to pacify unhappy citizens with handouts and freebies—and when these run out, they have to police dissent and oppress people. Eventually the state exhausts all short-term solutions, and what was heretofore a coherent civilization disintegrates.

Turchin’s prognostications would be easier to dismiss as barstool theorizing if the disintegration were not happening now, roughly as the Seer of Storrs foretold 10 years ago. If the next 10 years are as seismic as he says they will be, his insights will have to be accounted for by historians and social scientists—assuming, of course, that there are still universities left to employ such people.

 

Our Country is Broken

From Atul Gawande in the New Yorker:

o get out of this pandemic, we need fast, easy coronavirus testing that’s accessible to everyone. From the way people often talk, you might think we need a technological breakthrough to achieve this. In fact, we don’t have a technological problem; we’ve got an implementation problem. We could have the testing capacity we need within weeks. The reason we don’t is not simply that our national leadership is unfit but also that our health-care system is dysfunctional.

Many developed countries have met their testing needs, and ready access to speedy tests has been key to containing outbreaks and resuming social and economic activity. Whether you live in England or South Korea, scheduling is straightforward. No doctor’s order is required. Tests, where indicated, are free. And you typically get results within forty-eight hours.

In the United States, getting a test is anything but easy. Take a look at the Texas public directory of COVID-19 testing sites, which features a bold, red-highlighted disclaimer: “ATTENTION: Unless otherwise stated, deductible, co-pay, or co-insurance may apply. May require physician referral or prior authorization. Please call site to confirm.” Congress has mandated that insurers fully cover the costs both of testing and of the medical-office visit that produces the test order. But providers may still require payment until the insurer has confirmed coverage. Some twenty-eight million Americans had no insurance before the pandemic, including eighteen per cent of Texans, and millions more have lost their insurance since it started. Although legislation allowed states to expand Medicaid to cover coronavirus testing-related costs for the uninsured, many states (including Texas) have yet to do so. Health-care providers are left to seek disaster-relief funds to cover testing costs for the uninsured. The Texas disclaimer also warns that its test-site directory is incomplete. On another page, the Web site alerts you to additional considerations to take into account when seeking a test site, including what the screening criteria are (sites vary as to whom they are willing to test); whether the site is covered by your insurer; and what types of tests they provide (some may have only antibody tests, which do not help establish a diagnosis).

Appointments can take days, results days more. Most testing in the United States is done by four companies—Quest Diagnostics, LabCorp, BioReference Laboratories, and Sonic Healthcare. Through early August, results routinely took four days or more, making the tests essentially useless. Times improved only when testing volumes declined, because many people gave up on getting tested. The vast majority of infected Americans, including those with symptoms, never get tested. And we have not even reached the fall, when flu season will hit and coronavirus-testing needs and demand are expected to rise substantially. As the saying goes, it’s as messed up as a pile of coat hangers.

Further complicating matters, insurers don’t pay for testing that they don’t consider medically necessary. Yet testing people who don’t have symptoms will be important to getting COVID-19 under control. The Centers for Disease Control and Prevention estimates that around forty per cent of viral transmissions occur before an infected person has any symptoms. Yes, a combination of distancing, hygiene, and mask-wearing when people can’t stay six feet apart can markedly reduce such transmissions. But, in many situations, we can’t count on people being able to maintain those measures. Testing is the only way to know whether a person is potentially contagious and in need of isolation.

Such “assurance testing” has been required by countries such as Iceland, France, and Germany for travellers from abroad in order to avoid a mandatory two-week quarantine; by states from Maine and Massachusetts to Hawaii and Alaska for out-of-state travellers; by many U.S. hospitals for all patients admitted for non-emergent surgery; and by the film and television industry, which plans to do regular testing of cast and crew members in order to start production again. The federal government has recommended that nursing homes test all staff once a week. Numerous colleges and universities have included repeated testing in their protocols for bringing students back to campus. Individuals are seeking assurance tests before visiting older family members.

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