Keep Masks in Heathcare: a letter to Oregon hospital administrators

 

I write regarding the responses from the OHA to KATU's report on a recent protest against the lifting of the state mask mandate in healthcare settings.(1) The OHA statements are inadequate and non-responsive.

 

Mask mandates work well to reduce the quantity of airborne viral particles, in part because the presence of a mandate signals the serious need for protections (2, 3).  Although case numbers are undercounted because of lack of access, accuracy, and reporting of testing, wastewater levels remain persistently high in Multnomah County and hospitalization rates remain persistently high in Oregon (4, 5).

 

Graph of Multnomah County Wastewater from Biobot, levels March 15, 2023: 607copies/mL  (higher than any time before 21/22 surge, persistently high since summer 22). Graph of Oregon hospitalizations for COVID-19 from OHA Public Tableau, as of March 15 2023 (persistently high: since May 2022 has not gone below 200)

Further vaccination is currently unavailable; I and many Oregonians received a bivalent booster over six months ago, and are considered "up to date," although vaccine efficacy appears to wane in less than three months (6, 7).  Most COVID deaths at this point are among those who are vaccinated (8).  Those who are immunocompromised may not receive the same benefit from vaccination (9).  Moreover, because of the unchecked spread and evolution of the virus, vaccination cannot keep up with evolving variants (10). To slow the continued evolution of the virus to ever-more immune-evasive variants, we must slow the spread of infection.  

 

In addition, death and longcovid are not the only negative individual outcomes from infection.  Current evidence suggests infected adults and children are at greater risk of new onset diabetes (11, 12, 13), adults are at increased risk of cardiac problems (14, 15) and the long-term impact on children’s cardio-vascular health is uncertain (16). In addition, people can experience kidney injury (17, 18), liver damage (19), erectile dysfunction (20, 21), hearing loss (22-25), immune dysfunction (26-29), brain and memory dysfunction (30), ocular damage (31, 32) and dermatological complications (33, 34). In fact there are few organs that SARS-CoV-2 can’t harm, largely because COVID-19 is a vascular disease (35-37) with immune-mediated severity impacting multiple organs (38, 39). SARS-CoV-2 is an airborne virus that is transmitted via the respiratory system (40), but the disease it causes is not localized to the respiratory tract (41) with its multi-organ, multi-system impacts stemming from its vascular nature, the associated immune perturbation, and other systemic effects. 

 

The observable increase in community illness and chronic ill health (42, 43) should motivate those responsible for public health to take all possible measures to insure our well-being.  That is not what lifting the mask mandate in healthcare conveys. 

 

Perhaps, if the dangers to public health will not motivate state leaders, those responsible for health care systems will consider not only their ostensible goal of doing no harm, but also their legal liabilities (44).

 

For all these reasons and more, I urge you to maintain mask mandates in the healthcare settings for which you are responsible. 

 

Thank you.

 

 

 

 

(1) Group in Portland protests lifting of mask mandate in medical settings https://katu.com/news/local/group-in-portland-protests-lifting-of-mask-mandate-in-medical-settings

(2) Lifting Universal Masking in Schools — Covid-19 Incidence among Students and Staff  https://www.nejm.org/doi/full/10.1056/NEJMoa2211029

(3) Death Panel Podcast: Why Mask Mandates Work w/ Ellie Murray  https://soundcloud.com/deathpanel/why-mask-mandates-work-w-ellie-murray-030923

(4) Biobot Covid-19 Wastewater Monitoring in the U.S. https://biobot.io/data/

(5)  OHA Public Tableau: Oregon's Hospitalization Trends by Severity https://public.tableau.com/app/profile/oregon.health.authority.covid.19/viz/OregonCOVID-19HospitalCapacity/HospitalizationbySeverity

(6) Waning Immunity Against XBB.1.5 Following Bivalent mRNA Boosters https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9900747/

(7) Bivalent booster effectiveness against severe COVID-19: Outcomes in Finland, September 2022 – January 2023 https://www.medrxiv.org/content/10.1101/2023.03.02.23286561v1.full.pdf

(8) Why Do Vaccinated People Represent Most COVID-19 Deaths Right Now?  https://www.kff.org/policy-watch/why-do-vaccinated-people-represent-most-covid-19-deaths-right-now/

(9) mRNA COVID Vaccine Effectiveness Lower in Immunocompromised People https://www.technologynetworks.com/vaccines/news/mrna-covid-vaccine-effectiveness-lower-in-immunocompromised-people-367003

(10) Bivalent COVID Boosters Offer No Extra Protection, Studies Suggest https://www.usnews.com/news/health-news/articles/2023-01-11/bivalent-covid-boosters-offer-no-extra-protection-studies-suggest

(11) Diabetes risk rises after COVID, massive study finds https://www.nature.com/articles/d41586-022-00912-y

(12) Diabetes after SARS-CoV-2 infection https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00324-2/fulltext

(13) Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 Years https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e2.htm

(14) Long-term cardiovascular outcomes of COVID-19 https://www.nature.com/articles/s41591-022-01689-3

(15) The impact of COVID-19 and COVID vaccination on cardiovascular outcomes https://academic.oup.com/eurheartjsupp/article/25/Supplement_A/A42/7036729

(16) SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001064

(17) Pathophysiology of COVID-19-associated acute kidney injury https://www.nature.com/articles/s41581-021-00452-0

(18) Covid-19: Infection increases the risk of kidney disease even in mild cases https://www.bmj.com/content/374/bmj.n2189

(19) Impact of COVID-19 on liver https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462210/

(20) Tip of the iceberg: erectile dysfunction and COVID-19 https://www.nature.com/articles/s41443-022-00540-0

(21) COVID-19 Infection Is Associated With New Onset Erectile Dysfunction: Insights From a National Registry https://www.smoa.jsexmed.org/article/S2050-1161(21)00158-6/fulltext

(22) Sudden sensorineural hearing loss in COVID-19: A case series from the Wrightington, Wigan and Leigh Teaching Hospitals, United Kingdom https://pubmed.ncbi.nlm.nih.gov/34558562/

(23) Incidence of Hearing Loss in COVID-19 Patients: A COVID Hospital-based Study in the Eastern Part of India https://ijcrr.com/uploads/3357_pdf.pdf

(24) COVID-19 and Sudden Sensorineural Hearing Loss: A Systematic Review https://www.frontiersin.org/articles/10.3389/fneur.2022.883749/full

(25) Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis https://www.cambridge.org/core/journals/canadian-journal-of-neurological-sciences/article/hearing-loss-tinnitus-and-dizziness-in-covid19-a-systematic-review-and-metaanalysis/0AAEFD3E7D35CCF68415E38BDC493E63

(26) Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection https://www.nature.com/articles/s41590-021-01113-x

(27)   Autoimmunity is a hallmark of post-COVID syndrome https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-022-03328-4

(28) Immuno-proteomic profiling reveals aberrant immune cell regulation in the airways of individuals with ongoing post-COVID-19 respiratory disease https://www.sciencedirect.com/science/article/pii/S1074761322000462

(29)   COVID-19 and Immune Dysregulation, a Summary and Resource https://whn.global/scientific/covid19-immune-dysregulation/

(30) COVID Effects on the Brain, a Summary and Resource https://whn.global/scientific/covid-effects-on-the-brain-a-summary-and-resource/

(31) COVID-19 and Eye A Review of Ophthalmic Manifestations of COVID-19 https://journals.lww.com/ijo/Fulltext/2021/03000/COVID_19_and_Eye__A_Review_of_Ophthalmic.8.aspx

(32) SARS-CoV-2 infects and replicates in photoreceptor and retinal ganglion cells of human retinal organoids https://www.cell.com/stem-cell-reports/fulltext/S2213-6711(22)00104-7?

(33) Common skin signs of COVID-19 in adults: An update https://www.ccjm.org/content/89/3/161

(34) Dermatologic manifestations and complications of COVID-19 https://www.sciencedirect.com/science/article/pii/S0735675720304861?via%3Dihub

(35) COVID-19 – A vascular disease https://www.sciencedirect.com/science/article/pii/S1050173820301286?via%3Dihub

(36) COVID-19: A Serious Vascular Disease with Primary Symptoms of a Respiratory Ailment https://academic.oup.com/jalm/article/6/5/1099/6317833

(37) Is coronavirus a disease of the blood vessels?   https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/is-coronavirus-a-disease-of-the-blood-vessels

(38) COVID-19 infection: an overview on cytokine storm and related interventions https://virologyj.biomedcentral.com/articles/10.1186/s12985-022-01814-1

(39) SARS-CoV-2 infection results in immune responses in the respiratory tract and peripheral blood that suggest mechanisms of disease severity https://www.nature.com/articles/s41467-022-30088-y

(40)Ten scientific reasons in support of airborne transmission of SARS-CoV-2 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00869-2/fulltext

(41) Similarities and Differences between Flu and COVID-19​ https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm

(42) Long Covid is keeping millions out of work – and worsening labor shortage in the US https://www.theguardian.com/commentisfree/2022/sep/15/long-covid-is-keeping-millions-out-of-work-and-worsening-our-labor-shortage

(43) Long COVID Appears to Have Led to a Surge of the Disabled in the Workplace https://libertystreeteconomics.newyorkfed.org/2022/10/long-covid-appears-to-have-led-to-a-surge-of-the-disabled-in-the-workplace/

(44) Hospitals That Ditch Masks Risk Exposure

https://blog.petrieflom.law.harvard.edu/2023/02/20/hospital-liability-covid-infection/

 

Pirates are Progressive

 

 

 

In Brecht & Weill's "Threepenny Opera" the song "Pirate Jenny" expresses a downtrodden woman worker's desire for revenge against her oppressors and for autonomy and adventure for herself.  She imagines a pirate ship giving her the decision to destroy her enemies, and giving her the chance to depart with the pirates. 

 

It's a fantasy, but it has some grounding in truth.  There were, historically, women pirates in what's known as the Golden Age of Piracy--the late seventeenth and especially the early eighteenth century.  Among the most famous were Anne Bonny and Mary Read, whom we know of because they had the bad luck to enter the historical record by getting caught. 

 

The--ahem--employment opportunities available to women in piracy is of a piece with other things we know about pirates in that early eighteenth-century era.  As both scholarly sources and popular culture record,  golden age pirates formed communities far more egalitarian and democratic than the wider society. 

 

Peter Linebaugh and Marcus Rediker note in their book The Many Headed Hydra:  Sailors, Slaves, Commoners, and the Hidden History of the Revolutionary Atlantic, first published in 2000, that

 

"Women were few aboard ships of any kind in the eighteenth century, but they were numerous enough to inspire ballads about cross-dressing female warriors that became popular among the workers of the Atlantic. Bonny and Read, whose exploits were announced on the cover page of A General History of the Pyrates and no doubt in many another yarn of their own day and after, cursed and swore like sailors, carried their weapons like those well trained in the ways of war, and boarded prize vessels as only the most daring and respected members of pirate crews were permitted to do. Operating beyond the reach of the traditional powers of family, state, and capital, and sharing in the rough solidarity of life among maritime outlaws, they added another dimension altogether to the subversive appeal of piracy by seizing the liberties usually reserved for men, at a time when the sphere of social action for women was narrowing."

 

Linebaugh and Rediker's book focuses on the multicultural proletarian resistance to the massive organization and exploitation of human labor that enabled the rise of capitalism, and they highlight the congruence among the plantation, the factory, and the ships both mercantile and military that linked the transatlantic economy. 

 

Writing history "from below,"  they note, they "recover some of the lost history of the multiethnic class that was essential to the rise of capitalism and the modern, global economy. The historic invisibility of many of the book’s subjects owes much to the repression originally visited upon them: the violence of the stake, the chopping block, the gallows, and the shackles of a ship’s dark hold."

 

Ships brought together workers from around the world.  In Europe, "the enclosure of land and the removal of thousands of people from the commons," the common land that had previously been the source of shared resources and survival, meant that people were displaced and "redeployed to the country, town, and sea. Expropriation was the source of the original accumulation of capital, and the force that transformed land and labor into commodities."  Those sailors, often conscripted, press-ganged, or kidnapped into their new roles, suffered brutal, top-down control.  But they also encountered each other, and thus began to develop a common language and a common culture of resistance and rebellion. 

 

As David Graeber notes in his postumously published book Pirate Enlightenment, or the Real Libertalia, which came out this year, these rebellious and globally multicultural environments became "perfect laboratories of democratic experiment."  While Graeber's focus is on pirate communities in Madagascar, he places these in context of the enlightenment ideas and pirate legends of the era, as part of a project of "decolonizing the Enlightenment."  Suggesting that the popularity of "pirate legends" marks them as themselves "a material force in history," he calls them "the most important form of poetic expression produced by the emerging North Atlantic proletariat, whose exploitation laid the ground for the industrial revolution." 

 

Unlike the lawful ships they escaped from or took over, pirate ships were noted for democracy--electing their captains, collectively agreeing on their codes of conduct, offering every sailor a say in major decisions, and providing a system of checks and balances in operation.  As Graeber points out, the phenomenon of "pirate amity" was real:  although they were "constantly armed and frequently drunk" they "virtually never came to blows with one another." 

 

This amicable democratic governance extended to their economies, since both rations and booty were usually divided fairly equally; even if the captain and officers got twice or one-and-a-half times the share of loot that a common sailor got, that difference was far less than in legal military or mercantile ships--or, certainly, in modern corporations.  They also offered workers compensation.  The common image of pirates with eye patches, wooden legs, or hooks for hands reflected some of the physical dangers of sailing, but those injured were generally given a larger share of any prizes. 

 

The popular tales of pirates that resonate most for me today are not those in boys' books or Disney rides, but two televisual series that offer especially egalitarian, anti-imperialist, and queer tales:  Black Sails, which streamed on STARZ from 2014-2017, and Our Flag Means Death, which will be releasing a second season on HBO sometime this year. 

 

As in historical accounts, the casts are multiracial and multigender.  Graeber notes that a pirate ship might include "Englishmen, Swedes, escaped African slaves, Carribean Creoles, Native Americans, and Arabs," and both series reflect this diversity in the crews we see.  These pirate tales also include women, as I began by noting, and they also include queer people. 

 

Evidence sugests that Anne Bonny and Mary Read were lovers, and that sexual relationships between men were common on pirate ships, even sanctioned by the relation of matelotage.   Our Flag Means Death also includes a nonbinary character played by a nonbinary actor. 

 

Both series also offer forms of class critique from below.  Black Sails is more serious, violent, and explicitly anti-imperialist, while Our Flag Means Death is much lighter and funnier, more... gay.

 

These shows do include, between them, most of the romantic cliches of the genre that are omitted from the Under the Banner of King Death: Pirates of the Atlantic, a Graphic Novel, out this year from Marcus Rediker and David Lester with Paul Buhle. That book offers no "hunts for buried treasure, no ghost ships, no wronged aristocrats driven to sea, and no pirates in love with the governor’s beautiful daughter."

 

But all of these texts still speak to "why we need pirates,"  "as long as there are powerful people to be resisted and causes of social justice to be fought for."