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Health | The Atlantic
Health | The Atlantic
Listen: The Virus is Peaking, But Help Is Going Away
Many provisions of the CARES Act ran out in July. Soon, state unemployment insurance will start to run out for people that lost work at the beginning of the pandemic. Congress and the White House have failed to pass new support and, even if an agreement is reached, Senate Republicans have signaled that they’ll prioritize confirming Amy Coney Barrett before the election.On this episode of the podcast Social Distance, executive producer Katherine Wells and staff writer James Hamblin talk with Diane Whitmore Schanzenbach, an economist at Northwestern University who studies the social safety net. She describes a dire situation for poor Americans and tremendous need for new relief funding.Listen here:Subscribe to Social Distance on Apple Podcasts, Spotify, or another podcast platform to receive new episodes as soon as they’re published.What follows is a selection of the conversation, edited and condensed for clarity:Katherine Wells: One thing I’ve had a hard time grasping is the scale of the problem we’re facing right now. How do you describe it in a way that people can understand how big it is?Diane Whitmore Schanzenbach: A way to think about it is through the access to food that families have. And we’ve got two broad measures of that. One is food insecurity. That’s the idea that families don’t have enough money to buy the foods that they want to eat. Sometimes it means hunger, and sometimes it means shifting to cheaper foods. And the rate of food insecurity—especially among families with kids—has skyrocketed during COVID-19. The best estimates are that the numbers have tripled. It used to be around 10 percent. Now it’s around 30 percent. Three out of 10 people with kids are food insecure right now.And that’s a broad measure. We can think about people reporting they don’t have enough to eat. And similarly, we’ve seen levels of people in the United States not having enough to eat that are unconscionable. They’re higher than anything we’ve seen on record. I just pulled the most recent numbers and 14 percent of people report to the Census Bureau that, over the first half of October, they sometimes or often don’t have enough to eat in their house. That’s a lot of kids.Wells: As I’m listening to you, rage is welling up inside of me. Why is this happening?Schanzenbach: When it comes to kids, two big things have shifted. One is schools and the other is family money that allows them to buy food. The question of schools is hard, right? We need to get the virus under control and there’s all sorts of moving parts. That’s a hard problem to solve. What is not a hard problem to solve is feeding people. We can give them money. We can give them food stamps, what is now called the SNAP program. There’s a lot of very straightforward policy solutions that could be implemented.And I should be quick to say that we’ve done some of those. [The CARES Act created] the Pandemic EBT program, which provides families money for school meals that they missed. We’ve been able to study it and we can show that it reduces food hardship as experienced by kids. That’s a really good program. We were worried that Congress wasn’t going to reauthorize it, but in the nick of time, they decided that they would reauthorize it through this year.What’s staggering is these numbers would be even worse if it weren’t for what we’re already doing. Just fundamentally, this is not hard to solve. It just takes money.Wells: How much did the CARES Act help?Schanzenbach: That’s a hard question to answer because so much other stuff was going on with the economy. It’s hard to know how much worse things would be if it weren’t for the CARES Act, but we can say they made some really smart policy decisions. That initial boost to unemployment insurance, that extra $600 a week, really made a big difference. Another policy change that they made was they increased SNAP benefits to people who weren’t already getting the maximum benefit. And it also gave states—this is not very exciting, but, boy, it makes a difference on the ground—they gave states flexibility to concentrate only on enrolling new families who were newly eligible for SNAP and not processing renewals and things like that.I wrote a paper for the Brookings Institution that tried to understand, given how much we’ve spent, why is there still so much suffering? We came up with three reasons. The first is that aside from that unemployment insurance bump, the rest of the benefits just weren’t all that generous. The second was: many of the benefits came with delays. At the beginning, people had to really wait to get their unemployment insurance. And the third is that there are a lot of holes in our safety net. A lot of families suffering food insecurity and hunger didn’t lose their jobs, but they lost income anyway. They lost shifts or they lost gigs. But because they didn’t lose their job, in most places, they’re not getting unemployment insurance. They’re just having to weather the shock without any additional public benefits.Wells: What’s the situation we’re in right now, given that many of the provisions of the CARES Act have expired? And the federal unemployment is out? What do we need now and what’s happening?Schanzenbach: We need something from Congress. And, of course, it’s been very frustrating as someone who studies the amount of hardship that the poor face, to see so much inaction. But I think we need a couple of things. We need more unemployment insurance. I’m not sure it needs to still be at $600, but it has to be something. A lot of people think $400 is maybe the right amount. I think it’s a no-brainer that we should be increasing SNAP benefits. During the Great Recession, we increased them by 15 percent. That was a very effective policy, both in terms of stimulating the economy and in terms of reducing hardship.We’re seeing so much hardship and we’re spending precious little relief aimed at the poor, which doesn’t make a lot of sense. And, of course, as someone who studies kids, I would argue that states really do need additional resources so they don’t have to cut school spending. As you may know, many states are under balanced-budget requirements. So when you get hit with an economic shock like this, the budget gets balanced on the backs of kids and other vulnerable populations.
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theatlantic.com
The Pandemic Broke America’s Understanding of Safety
On a normal day, the White House is one of the safest buildings in the world. Secret Service snipers stand guard on the roof, their aim tested monthly to ensure their accuracy up to 1,000 feet. Their heavily armed colleagues patrol the ground below and staff security checkpoints. Belgian Malinois guard dogs lie in wait for anyone who manages to jump the property’s massive iron fence.But safety means something different in a pandemic. Over the past few days, several aides to Vice President Mike Pence, including his chief of staff, have tested positive for the coronavirus. The outbreak is the second in the White House in a month, after dozens of people, including President Donald Trump himself, tested positive following the apparent super-spreader event hosted by the administration to celebrate the Supreme Court nominee Amy Coney Barrett.The outbreaks have been both utterly predictable and totally shocking. The Trump administration has consistently downplayed the severity of the coronavirus, encouraged Americans to resist safety measures, and promised that the pandemic is nearing its end. But the people orchestrating the country’s disastrous coronavirus response had no plausible deniability: The very best experts, information, and precautions were all available to them, even if they refused to pass that help on to others.People will write books on everything Donald Trump did wrong during the pandemic, with explanations both personal and ideological for his administration’s often willful failures. But for a group of people for whom self-preservation has long been an obvious goal, their willingness to put themselves in optional danger, given all the resources at their disposal, can’t be completely explained by Trump’s lack of empathy or his advisers’ policy goals. It suggests that on top of everything else, the administration fell prey to an error of intuition: Presumably, Trump and his coterie felt safe, despite the mortal danger nipping at their heels for all to see.Trumpworld’s infection fiasco is an especially bizarre case study of one of the pandemic’s defining features: how different feeling safe and being safe actually are. This misperception has played out in millions of homes and workplaces across the country as regular people make good-faith efforts to grapple with the swiftly changing circumstances of American life, absent the resources available to the federal government. Things that used to be safe, such as visiting grandparents and attending a friend’s wedding, are now potentially deadly. Things that used to be foreboding, such as the sight of many masked strangers in public, are now a source of comfort.This new sort of safety is difficult to adapt to, both practically and emotionally. Over the summer, previously innocuous private social gatherings, such as dinner parties and birthday celebrations, were cited as a primary driver of new infections all over the United States. In some instances, the people involved perhaps didn’t care about the risk or thought the pandemic was fake. But in others, they likely couldn’t imagine why they should be scared of time with loved ones. Many of these same people were wearing masks to the grocery store, using hand sanitizer, and otherwise doing what they understood to be asked of them.Safety is among the most powerful motivators of human behavior, which also makes the drive to feel safe a potent accelerant for confusion, disinformation, and panic. Staying safe requires an accurate, mutually agreed-upon understanding of reality on which to assess threats and base decisions. Since the pandemic arrived in the U.S., however, politicians have sparred over basic safety precautions and aggressive reopenings. The federal government and many of its allies at the state and local levels have actively undermined efforts to get people on the same page. These contradictions have sown confusion, even among those who disagree politically with the leaders encouraging people to flout masking and social distancing. When everyone is left to write their own version of Choose Your Own Pandemic Adventure, no one is safe.(Antoine d' Agata / Magnum)To understand how humans think about safety, you have to understand how they think about fear. To be safe, people need to be free from the threat of physical or mental harm. But to feel safe, people need to be free from the perception of potential harm, confident that they understand what the likeliest threats are and that they are capable of avoiding them. Whether their perception is accurate is often incidental, at best, to the feeling itself. “Fear reactions are very primitive,” Arash Javanbakht, a psychiatry researcher at Wayne State University, told me. “We don’t react so well or so accurately to conceptual threats.”People learn what or whom to fear in a few different ways, according to Javanbakht. The things we have experienced or observed ourselves, such as car accidents or the kinds of violence frequently depicted on the news, have a significant impact. So do the warnings of peers and authority figures. This assemblage of influences—family members, friends, co-workers, religious or cultural leaders—is as much a tribe now as it was when these instincts evolved, and the security and support that it can provide creates a profound psychological incentive to remain a member in good standing of one’s group.People’s dependence on group affiliation for safety and support can be so strong, in fact, that it sometimes overrides more logical assessments of fear and safety, Javanbakht said. Even in situations where the actions of the tribe’s leaders contribute to the group’s collective misery, many members will find it difficult to reject that leadership. Instead, studies have shown, people dig in their heels when confronted with evidence that challenges their beliefs or identity: They redouble their support for trusted authority figures and reject outside criticism, which they’ll often paint as proof that the group is under threat. Javanbakht compared this dynamic to softer forms of American tribalism, such as being a fan of the Cleveland Browns. The team’s leadership has been antagonizing its fanbase for decades, but some people cannot be mistreated into retracting their emotional and monetary support.Many Americans have come to understand their political affiliations in much the same way they do their affinity for particular sports teams or movie franchises, but with much darker implications than, say, getting your hopes up about an Atlanta Braves postseason run. On a basic level, you could see tribalist fear in how people scrambled for clarity early in the pandemic. The methods humans use to understand and pursue safety aren’t really built for quick, competent responses to novel threats. Fear abounds as people realize they don’t have a script to follow. (Buy six cases of bottled water.) Panic sets in. (Lysol the groceries.) They wait for guidance from existing leaders and search for previously overlooked ones. (Nice to meet you, Dr. Fauci.) They monitor the behavior of their peers. (Wear a mask.)In a country with a dwindling consensus on the basic experience of reality, though, tribal affiliation can be especially fraught. Trump and other leaders have conscripted supporters into cultural warfare, recasting safety measures as political attacks from the opposition and tools of social control. Some people have duly followed, rejecting simple precautions recommended by scientific experts, such as masks and open windows, and promoting some of the more extreme reactions to the pandemic: The virus is a hoax; it’s a bioweapon meant to hurt Trump’s reelection chances; it really is just the flu. Tribal affiliations have been exploited in American politics for centuries; influential people stoke fear against those outside their constituencies, such as ethnic and religious minorities, immigrants, and the poor, which intensifies supporters’ belief that loyalty to the group itself is their best bet for safety. But Trump, from whom this narrative radiates, has been especially adept at fomenting and wielding fear as a source of power in his brief political career. People who have built a significant portion of their identity around Trump fandom by attending rallies, joining Facebook groups, and buying merchandise likely have a psychological investment in his version of reality that’s too high to consider abandoning; for some of them, losing those beliefs might feel like a fate worse than the coronavirus. When the spell is that strong, according to Javanbakht, it generally requires a more immediate measure of danger to break it, such as the COVID-19 death of a loved one.Intuitive failures of safety extend beyond Trump and his acolytes. Ultra-strict adherence to pandemic precautions can itself be a display of tribal identity, especially as scientific understanding of the virus evolves and some safety measures, such as wiping down groceries with sanitizing wipes, can be dispensed with. No matter where their beliefs fall on the country’s political spectrum, people whose identity is more weakly tied to a political group have an advantage when it comes to adapting in response to new information. A relatively small proportion of conservatives are virulently anti-mask, and most liberals are not fully sequestered in their homes, Lysol-soaking their mail-in ballots.While these sets of behaviors share an underlying psychological mechanism, they are not equivalent. To belong to one tribe, people accept an outsize and sometimes irrational portion of responsibility for their own safety and that of others through self-abnegation and personal fastidiousness. To belong to the second tribe, people must refuse to care about others at all.(Al Bello / Getty)Over time, theoretically, the country’s collective understanding of safety should both improve and normalize, as the definition of safety is expanded to account for the pandemic, and the group—in this case, Americans as a whole—forms new norms to achieve it. In most of America, that hasn’t necessarily been the case so far, and any progress has been hard-won over sometimes-violent opposition. But the tribalist fear that causes those big variations often doesn’t account for smaller ones among families and social circles, which tend to be politically similar. Anyone who’s been holed up in their home for months, watching friends and family proceed with indoor weddings or spend their weekends inside bars—or anyone who’s invited a buddy to a day at the beach only to be rejected over amorphous safety concerns—knows that something more complicated is going on.Even among people with similar beliefs, a smooth, uniform pivot to a new understanding of safety requires diligent, competent, well-intentioned leadership. According to Eric Scott Geller, a psychologist at Virginia Tech who has studied safety for more than 40 years, the best way to get lots of people to adopt new safety precautions is to be explicit and consistent about what they are and why they’re important, and then demonstrate examples of people adhering to them repeatedly over time. As a whole, American leadership continues to do the opposite. “I’ve been in the business for a long time, and I’ve never seen anything quite like this,” Geller told me. “The biggest problem we have right now is mixed messages.”Left to their own devices, people chart their paths based on their personality, how they see the world, and how they relate to risk. According to Geller, many people presented with a barrage of contradictory instructions just grow tired and give up. Others become hypervigilant, their behavior calcifying against new information that might let them ease up and enjoy life a little more. Still others simply choose optimism, no matter how dangerously misguided—such as the belief that “herd immunity” is near, or the assumption that catching the virus will have no long-term consequences for them. “People will gravitate to the positive message because it’s convenient, and it’s not scary, it’s not fearful,” Geller said.And so the chaos of a country becomes the chaos within its families and communities. People spar over their assumptions and hastily made decisions based on half-understandings of scientific evidence. They’re forced to conduct their own awkward, fraught behavioral micro-negotiations before visiting relatives, celebrating a birthday, or going out for a beer on a bar’s patio. Americans have no common conception of the pandemic, which means you can’t assume that someone you’ve trusted for years isn’t about to expose you to a deadly disease, or even that you live on the same plane of reality. People feel bad about enforcing their boundaries, or they simply grow tired of constant vigilance. Occasionally, they just forget.In some ways, these tragic errors in intuition are convenient for leaders, both within and outside the government. Birthday parties and vacations and nights out on the town are easily framed as personal choices free from government influence, even though other countries have gone much further in giving their citizens tools to keep themselves safe and make good decisions—nationally coordinated testing programs, extensive government aid for businesses, a clear and consistent message about safety. You can see the same finger-pointing dynamic in how some college presidents set their charges up to fail, and then punished them for becoming infected. This approach reflects how, in America, blame for large-scale destruction and death is often shunted onto those with the least power to change policy or protect themselves. “Think about all the accidents on oil platforms, or drilling rigs,” Susan Silbey, a sociologist who studies safety at MIT, told me. “It's the same few companies over and over again. They always blame the workers.”(Matt Black / Magnum)Even with mixed messages from above, pandemic-era safety would be a little bit clearer to negotiate if talking about your behavior and asking questions about others’ wasn’t so excruciatingly awkward. Ensuring pandemic safety requires interrogating loved ones about whom they’ve been with and what they’ve been doing, and if they’ve been tested recently. If that sounds familiar, it’s because health educators ask people to go over the same topics anytime they have a new sexual partner. As it turns out, it wasn’t just the sex that made those conversations notoriously difficult to have, but the same strategies that public-health experts have developed to talk about sex might be just as useful in these new types of negotiations.As masks became both more common and more controversial in the United States during the spring, Logan Levkoff, a sex-and-relationship educator, found herself having the same conversation over and over again with her peers. The dynamics of pandemic health and sexual health make people anxious and cagey in very similar ways, about very similar types of precautions. Should you refuse to attend your cousin’s wedding unless she moves it outside? Should you tell your maskless friend to mask up? These situations are “still fraught with shame and stigma and assumptions about people’s politics,” Levkoff told me. “Often, if we don’t want to have someone make assumptions about us, and we don’t want them to feel we’re making assumptions about them, we just don’t say anything at all.”That avoidance can put people in riskier situations than they’d choose for themselves if they felt free to be picky. Even so, the desire not to anger loved ones in an already anxious and fearful time can be strong. “That’s where we get tripped up a bit,” Levkoff said. “We think that in those intimate relationships, it would be a violation of trust to ask.” She said that the politicization of public-health measures has likely exacerbated this dynamic. Conversations about safety can quickly devolve into arguments about political differences; less than two weeks out from the election, many people are probably happy to avoid poking that bear if they can avoid it.These conversations can even be hard among political peers, which in theory seems silly. We’re in a pandemic, after all. Isn’t transparency just reasonable? “We have this belief that our health is a measure of our character,” Levkoff explained. In America, being disease- and disability-free is often assumed to be an indicator of a person’s moral righteousness and good priorities. To you, asking a friend if she’s been to a house party recently might feel like checking a box on a to-do list. For her, it might feel like being told she’s some kind of degenerate.These dynamics rear their ugly head in less intimate interactions, too. After the University of Notre Dame’s president, John I. Jenkins, became one of the many people who tested positive for the coronavirus after attending the apparent White House super-spreader event celebrating Barrett, an unnamed member of the Notre Dame delegation told The New York Times that the group’s decision to go maskless was politeness, not politics—an attempt to blend in and adhere to the conventions set by the event’s powerful hosts. There are many ways in which people are expected not to rock the boat in American social culture. Those niceties can set people up to spread a deadly disease in an environment where the circumstances of safety have changed swiftly and confusingly.Looking for ways to have these conversations—or even just thinking about their implications at all—is half the battle. Broaching an uncomfortable issue or figuring out a new way to understand our friends and loved ones is awkward, but it’s certainly doable. Tread lightly. Reassure friends and family that you’re just trying to help everyone have fun. Volunteer information about your own behavior. Starting these conversations is often the hardest part, especially among people whose goals are the same, even if their methods differ. They’ve already made the most difficult concession: banishing the idea that the way we understood one another seven months ago is enough to get us through the months ahead.“We think we share the same values and norms,” Sibley, the sociologist, told me. “We think we know each other.”
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theatlantic.com