This website places at your disposal a free ebook entitled The Authoritarians. I wrote this book in 2006 when a great deal seemed to be going wrong in America, and I thought the research on authoritarian personalities could explain a lot of it. (The book is set in that era, but you will have no trouble finding present-day examples of what the experiments found back then.)
August 23, 2018 (theauthoritarians.org)
Many people, including I, have labeled Donald Trump an authoritarian leader. But they are honestly baffled by the loyalty of his followers. The decades of research on authoritarian followers provide some answers.
Donald Trump received 46.7 percent of the vote in the 2016 election. An aggregation of public opinion polls available at https://projects.fivethirtyeight.com/trump-approval-ratings/ shows that he maintained this level of support until March of 2017, when his failure to repeal Obamacare produced a drop to 40%. Difficulties in fulfilling other campaign promises, such as building “the wall” and “locking up” Hillary Clinton may explain why the rating slid to a nadir of 36.4% in December 2017.
But since then Trump has regained about half of the ground he lost. He was back to 40% in February 2018 and since then about 41-42% of the public has approved of his performance. Considering all the things he has done in the past six months, that is astounding. But if you look at the poll results over this time and try to find some kind of reaction when (to cite recent examples) Trump began the trade wars with friend and foe alike, or absolved Putin in Helsinki of interfering in the 2016 election, or separated children from their parents at the Mexican border, you won’t find any! His base has been very loyal. I doubt he will lose more than a percent or two of his national support, and probably not even that, as a result of the August 21st “Tuesday Afternoon Massacre” (of Trump). And whatever he loses, he will soon get back.
In a sense, that shouldn’t surprise anyone. Has any president since Lyndon Johnson kept his campaign promises as energetically as Donald Trump has in his first 18 month in office? He has strenuously advanced his base’s causes, from all the executive orders he has signed to his nominations to the Supreme Court. And when he failed to achieve what he promised, he always blamed others for not supporting him, including the Democrats. And while economists warn it is too early to tell, Trump has received credit for the vibrant economy.
In another sense, however, the fidelity of Trump’s base remains astounding. He has made so many unforced errors because of his lack of understanding and low problem-solving intelligence, his vast ignorance, his enormous, never-ending dishonesty which seems as reflexive as his breathing, his explosive hostility, his uncontrollable vanity, his despicable demeaning of women, his squalid vulgarity, the stupidity of his stereotypes, the shabbiness of his thinking, the buffoonery of his parading, his attacks on the institutions he needs most to safeguard the country, his incredibly poor judgment about the character of those whom he has brought into his administration, his equally mind-numbing lack of judgment about foreign leaders, friend and foe, and his willingness to inflame Americans’ disagreements and turn them into conflagrations which make us that deeply divided house which the Gospels and Abraham Lincoln warned against—how can his supporters have stood so solidly behind him? You’d think they’d be having some second thoughts at least.
The main reason, I submit, is that most of Trump’s backers are authoritarian followers—people who submit too much to the leaders they consider legitimate, trust them too much, and give them too much leeway to do whatever they want. “Well yeah,” you might say. “But that’s like saying an apple is an apple because it’s an apple.” And it would be golden delicious example of a rhetorical tautology except social scientists have had a good, independent way of measuring this kind of authoritarianism since the 1970s. And it was clear from the first studies that political “conservatives”—from ordinary voters to elected officials—tended to score highly on this personality test (Chapter 6 of The Authoritarians, the book on this website). We can gain considerable insight into Donald Trump’s supporters from the research on authoritarianism.
Why Authoritarian Followers Believe What They Believe
Compared to most people, studies have shown that authoritarian followers get their beliefs and opinions from the authorities in their lives, and hardly at all by making up their own minds. They memorize rather than reason. Religion provides a good example of this: authoritarians tend to believe strongly in whatever religion they were raised, the result of having had their religion strongly emphasized to them while they were growing up. But at some point in their youth—typically in early to mid-adolescence—they usually have doubts about what they have been taught. When this happens they typically go to their parents for guidance, or clerics, or scriptures, or friends who profess strong belief. They are mainly seeking reassurance, and not surprisingly, they keep their beliefs.1
Persons who grew up in homes where religion was not stressed as much also develop doubts about the things they had been taught when they reached adolescence. But they are much more likely to do a two-sided search for the answers, such as reading Genesis and learning about the theory of evolution, talking to believers and nonbelievers, and so on. Some then keep their faith, but others become “weak believers” or even apostates.)
By the way, the failure to do a two-sided search for the truth of their beliefs leaves scar tissue on the psyches of authoritarian followers. A “very safe survey” revealed that most of the followers in a large sample of university students had doubts about their religious beliefs, which you would never have guessed from their answers to normal surveys. And most of these doubters said that no one whatsoever knew they had these doubts. They were a deep secret.2
Consensual Validation and Ethnocentrism
When your beliefs are memorized copies of other people’s opinions, you don’t really know why they are right. That means you don’t know IF your professed truths really are true. So how do you maintain your beliefs should events and discoveries contradict them?
Researchers discovered decades ago that people validate their social opinions socially to a certain extent by selecting news outlets, friends, and so on that will tell them they are right. This produces an illusion of consensus, at least among all the “right” people like themselves. Almost everybody does this, but authoritarian followers do it much more because they don’t have many ideas of their own, beliefs they have worked out for themselves and can defend. And they are much more likely to expose themselves only to sources of information that tell them what they want to believe. Getting only one side of a story raises the chances you will get it wrong, but as Ralph Peters, formerly the military analyst at Fox News, said recently, “People that only listen to Fox have an utterly skewed view of reality.”
The creation of an in-group in the lives of “right-thinkers” goes back to followers’ early childhood. The earliest such example most of them can recall involved the family religion (as opposed to say their gender, or race, or nationality). Their parents divided the world for them into people of their own faith, and an out-group consisting of everybody else. This “Us vs. Them” ethnocentrism appears to lay the foundation for many later prejudices and xenophobia.
Ethnocentrism comes naturally when we identify with a group, but authoritarian followers are profoundly ethnocentric. Whereas some people will deliberately expose themselves to different ideas, experiences, cultures to avoid living in an “echo chamber,” followers want to live smack dab in the middle of one and are glad to do their part of the echoing. Surrounding themselves with people who agree with them, clapping together, chanting together, cheering together, and marching together is convincing evidence for them that their beliefs are right.
Susceptibility to Liars
One consequence of the followers’ strong need for consensual validation, experiments have found, is that they will trust someone who says things they believe, even if there is a lot of evidence that the person does not really believe what he says. They’re just so glad to hear their views coming back to them, they ignore solid reasons why the person might be insincere or outright lying. Relatively UNauthoritarian people, on the other hand, are downright suspicious of someone who might have ulterior motives for reinforcing their beliefs.
It is therefore much easier to “con” authoritarian followers, as many a TV evangelist, radio shock-jockey and flag-waving politician knows. It’s no accident that Donald Trump, who had only loosely organized and not particularly right-wing political beliefs, became a Republican politician when he decided to declare war on both the Democrats and Republicans. That’s where the “suckers” are most concentrated, the people you can fool all of the time. (It’s another story, but the GOP largely brought this on itself by deliberately courting these folks.)
There’s a hidden danger to authoritarian leaders in all this. When they discover their followers will believe anything they say, even things that contradict something they said earlier, they get sloppy with their lies. Maybe Donald Trump always was careless with the truth. But it seems that over the past two years he has become downright reckless. His base will swallow anything, he has learned, so he just says the first thing that comes to mind.
The trouble is, for him and the future of his presidency, Truth happens. Constantly. It may be seen differently by various folks, but things did happen as they happened, not something else. You can only ignore the truth so long, and then reality will inevitably catch up with you. It will destroy you if you have been massively denying it.
Dogmatism
Dogmatism comes rather naturally to people who have copied other people’s beliefs rather than figure things out for themselves. When you don’t know why your beliefs are true, you can’t defend them very well when other people or events confront them. Once you’ve run out of whatever counter-arguments your authorities have loaded into you, you’re done. But being flabbergasted doesn’t mean you change your beliefs. You can keep on believing as much as before if you want. You can even pat yourself on the back for believing when it seems clear you are wrong. Some people do this, and you know who taught them to.
That is dogmatism, and experiments show that authoritarian followers have two or three times the normal amount of it because they believe many things strongly, but don’t know why. When the evidence and arguments against their beliefs becomes irrefutable, they simply shut down. If patriotism is the last refuge of the scoundrel, as Samuel Johnson said, dogmatism is the last resort of overwhelmed followers. Thus they agree with the statement, “There are no discoveries of facts that could possibly make me change my mind about the things that matter most in life.” That says it all.
The Role of Fear
In case you haven’t noticed it, authoritarian followers are more fearful, in general, than most people. (And wannabe dictators have known that for a long time.) There may be a genetic basis for being extra scared, since thresholds for emotional responses might be set, in part, by some snippets of DNA. But there certainly is an “environmental” source of the fear. Followers report that they were taught the world is a dangerous place much more strenuously than most people are taught—a fact confirmed by the parents. Some of this is quite predictable, such as fear of attacks by racial minorities. But the fearing parents super-sized their children’s fear of being hit by a car, or kidnapped as well.
Accordingly Donald Trump was well-placed to gain the support of authoritarian followers as he was a large and seemingly fearless, powerful man. All he had to do was say he saw the dangers the followers felt and he would fight to protect them. So he did. He would build a wall over 1000 miles long to keep Mexican rapists out. He would stop immigration from certain countries to keep terrorists from getting in and killing everyone. He promised to protect people who feared their jobs were going overseas to countries that he said were stealing America blind. “I am your voice,” he said. He would fight for them with all of his great might. And that was just what threatened people who felt powerless wanted.
Donald Trump grew some of his positions as he went along. He discovered he was once again anti- abortion, although he had to be told he was against punishing women who had one. He assured the Libertarians he would defend the Constitution as the Founding Fathers wrote it, even though it became clear he had very little idea what was in it. He pretended for the economic conservatives to be greatly concerned about the national debt, although he learned he couldn’t make it go away by declaring the United States bankrupt. And so on.
But the core connection between himself and his followers was their great fear of the future. As Ann Coulter, his strong promoter during the campaign and reputed source of his anti-immigration rhetoric, said “He had me with ‘Mexican rapists.’” Trump’s MAGA slogan resonated with masses of “forgotten Americans” who indeed felt America wasn’t great anymore. Everything was changing. All the old standards were being trashed. The things that gave them whatever precarious advantage they had in life, being white (and for most of them) being male counted for less and less. Instead the United States was filling up with bad people who would blow up your church, steal your jobs and get your kids hooked on drugs.
Trump’s Rallies
You can see all these forces coming together when the authoritarian leader and his followers come together at Trump rallies. Political parties hold rallies primarily to energize the faithful, and Trump supporters leave the arenas highly motivated to work for him. But they also get something from the event that (say) Hillary Clinton’s supporters did not need as much: reassurance that their beliefs are valid. Being in a crowd of True Believers and finding themselves reacting the same way as everybody else to whatever is happening tells them individually that they are right. And they do the same thing for the other people in the room with their contribution to the echo chamber.
Two powerful bonds are on display at Trump’s rallies: the followers’ bonds with the leader, and their bonds with each other. They feel they owe Trump big-time. He gave up his very glamorous, satisfying life, they believe, to fight for them. The least they can do is be grateful and supremely loyal to their “Voice.” It is their part of the deal, and in the early days of the 2016 campaign, until unfavorable comparisons with Hitler and other dictators made Trump stop it, the crowds insisted on taking a loyalty oath to him at the rallies.
The second bond, with one another, sustains their beliefs and enthusiasm afterwards. When they hear bad news about Trump, they tell each other the explanation that the president gave, and that is good enough. It doesn’t matter that it makes no sense or contradicts earlier things he said or promised. The important thing is they are hearing it from a fellow believer and it is their job to believe it and say it too. Research shows that authoritarian followers value group cohesiveness much more than other people do, and strongly condemn persons who stop believing what the group believes.
Beyond these bonds, while Trump supporters feel exposed and vulnerable on their own, they feel safe, strong, even powerful when they are members of a large, determined movement. They gain strength from the crowd, as surely as Trump himself does.
So What?
It seems clear that Donald Trump believes his best chance at remaining in power is to keep his base fired up. They are a minority in the country, by roughly 42% to 52%. But if they all vote, and enough of the majority does not, he will win.
So he doesn’t care what most of the voters think. He doesn’t care that critics can tear his positions and statements to shreds. He isn’t talking to them. He’s talking to his base.
Unfortunately for him, his devotion to his base, coupled with some abysmal choices of advisors and his own overwhelming hubris, have alienated a lot of Americans. Polls find that Democratic supporters are more enthusiastic about voting in the midterm election than Republican voters—the opposite of what he wants. Various by-elections show that while he has great influence over Republican primaries, he brings a sizeable anti-Trump reaction to the general election. So as he goes on feeding red meat to the masses that made him great again, he is infuriating a large group of electors who increasingly can’t stand him.
The very sizeable number of authoritarian followers in the United States have, in my view, joined together three times in recent history to endanger our democracy. They supported the war in Vietnam as it tore the country apart long after it was clearly lost. They supported Richard Nixon to the very end of Watergate and beyond. They will support Donald Trump long after it becomes indisputable that he is a felon and should be removed from office.
The good news is the Republic has survived the past crises, thanks largely to the honest reporting of the press that would not be intimidated, the division of powers enshrined in the Constitution, especially the independence of the judiciary, and the good judgment of most of the American people. And it can survive this latest threat for the same reasons. But the bad news is the authoritarian followers will remain, unwitting carriers of a cancer upon the nation that the next authoritarian leader will arouse and set marching.
I am not suggesting that people should exclude in any sense the most authoritarian elements in American society. With few exceptions, they are law-abiding citizens exercising their rights, and that should be respected and protected. But I do think their influence needs to be contained by outvoting them. And Donald Trump is betting that won’t happen.
The long run prospects encourage one. Trump has solid support among my generation of Americans, for example, especially men, but we are not going to last forever. Some suppose that people become more authoritarian as they age, and so one batch of old white men will just be replaced by another. But studies show that political opinions tend to be set in early adulthood and endure. Today’s youth, better educated and wonderfully less ethnocentric than their predecessors, give one great hope for the future of American democracy in the long run.
But this is like climate change. We were warned plenty that we were creating a disaster in the only atmosphere we’ve got, and we kept on doing it. Now we are facing the consequences. Whether American democracy endures could well depend on what happens at the polls in 2018 and 2020. Authoritarian leaders and authoritarian followers have no great love of freedom and equality. Those who do had better organize and get out the vote, or they will make Donald Trump look like the super-genius he believes he is.
Endnotes
1 Altemeyer, Bob and Bruce E. Hunsberger (1997). Amazing Apostates. Why Some Turn to Faith, and Others Abandon Religion. Amherst, NY: Prometheus Press, pp. 17-20, 32.
This is a good place for me to mention three limitations about the research I shall report. First, the results are always generalizations, i.e., overall differences between groups. So in this study some people who had a rigorous religious upbringing did make a two-sided search. (Most did not, however.) Second, the difference between “high” authoritarian followers and those whom I’ll call “low authoritarians” is relative, not absolute. The low authoritarians still have some inclinations to follow authorities, which can be ratcheted up by situational pressures. But it will be a much weaker inclination than that found in persons who have extra helpings of this trait. Finally, this study like most of the others I shall bring up was done in Canada. But there has been a very solid record of replication of Canadian findings about authoritarians when repeated in the USA, and vice-versa.
2 Altemeyer, Bob (1987). Enemies of Freedom. San Francisco, CA: Josey-Bass, pp. 151-154.
This “masterful treatment of one of the most complex periods of American history” (New Republic) made history when it was originally published in 1988. It redefined how Reconstruction was viewed by historians and people everywhere in its chronicling of how Americans — black and white — responded to the unprecedented changes unleashed by the war and the end of slavery. This “smart book of enormous strengths” (Boston Globe) has since gone on to become the classic work on the wrenching post-Civil War period — an era whose legacy reverberates still today in the United States.
The School of Life Our schools teach us about trigonometry, the 100 years war and the properties of atoms – but they too often forget to address the one topic we really need to understand in order to make sense of our lives: ourselves. Sign up to our new newsletter and get 10% off your first online order of a book, product or class: https://bit.ly/2TMs0dT For gifts and more from The School of Life, visit our online shop: https://bit.ly/38Zi5Gq Our website has classes, articles and products to help you lead a more fulfilled life: https://bit.ly/2UogbuN FURTHER READING You can read more on this and other subjects on our blog, here: https://bit.ly/3baWa0R “There is perhaps no greater priority in childhood than to acquire an education: it’s in the early years that we have to push ourselves with special vigour to learn the lessons, and acquire the experience, that will help us successfully manoeuvre around the pitfalls of adult life. By studying hard and intelligently, we’ll have the best chance of avoiding a middle-age of confusion and resignation, regret and sorrow. The clue to a successful adult life – we’re repeatedly told – lies in childhood education…” MORE SCHOOL OF LIFE Visit us in person at our London HQ: https://bit.ly/2v0OA8q Watch more films on SELF in our playlist: http://bit.ly/TSOLself You can submit translations and transcripts on all of our videos here: https://www.youtube.com/timedtext_cs_… Find out how more here: https://support.google.com/youtube/an… SOCIAL MEDIA Feel free to follow us at the links below: Facebook: https://www.facebook.com/theschoolofl… Twitter: https://twitter.com/TheSchoolOfLife Instagram: https://www.instagram.com/theschoolof… CREDITS Produced in collaboration with: Gabriella Marsh https://www.gabriellamarsh.com/About Title animation produced in collaboration with Vale Productions https://www.valeproductions.co.uk/
The lunacy of our testing system is the lunacy of our health system in microcosm.Photograph by Drew Angerer / Getty
To 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.
The economist Paul Romer has argued for going further, saying that regular testing for every person in the United States should be our lead strategy for getting society back to normal. Those with a recent negative test would have permission to go without a mask; those with a positive test would be required to isolate for two weeks. The small Italian town of Vò, outside Padua City, took a similar approach. It offered testing to all its thirty-three hundred inhabitants at two points over two weeks during lockdown. Eighty-six per cent of the population came forward in the first round. Almost three per cent were infected, half of whom had no symptoms. In the second round, seventy-two per cent of the population was tested, with a 0.3-per-cent new-infection rate. With these last few cases isolated, the town was able to reopen long before the rest of Italy could.
But is any of this remotely feasible when we can’t even make sure that sick people can get tested in a timely way? The lunacy of our testing system is the lunacy of our health system in microcosm. We are now paying the price of our long, uniquely American resistance to making sure that everyone has proper health-care coverage, and to building an adequate public-health infrastructure. We have not fully grappled with the difficulties we’re up against. But, if we do, we have a chance to fix the problem before the worst of flu season hits.
The need for speed
The course of infection with the sars-CoV-2 virus is relatively brief. It starts with perhaps as little as a few hundred viral particles getting into your respiratory passage; then, if they take hold, they multiply to a viral count so high that you are exhaling millions of viral particles per hour. You are typically at your most contagious around day five of infection. Symptoms usually begin about the same time. In more than eighty per cent of cases, adequate oxygen levels can be maintained without hospitalization, and the body’s immune system can reduce viral counts rapidly. In these mild to moderate cases, researchers have found almost no transmission a week after the onset of symptoms, although recovery takes upward of two to three weeks for a third of such patients. (In cases of serious illness, the reduction in viral counts can take a week or so longer.) The goal of testing is to detect the virus as early as possible during infection.
The standard diagnostic test involves, as tens of millions of people now intimately know, a swab of the cavity deep behind the nasal passage—or, as more recently authorized by the Food and Drug Administration, of just inside the nose. A few labs have been approved to test saliva. The sample from the patient is analyzed for evidence of viral genetic material. The method of analysis, real-time polymerase chain reaction, PCR, is a small wonder of science, and, if it detects the sars-CoV-2 virus, the diagnosis approaches a-hundred-per-cent accuracy: false positives are rare. But false negatives are another matter. The miss rate among people with a symptomatic infection is upward of twenty per cent, owing either to sampling problems (the swab didn’t pick up enough of a specimen) or a viral count too low to be detected. That miss rate is even higher during the four days or so before symptoms begin—going from a hundred per cent on the first day of an infection to sixty-seven per cent on the fourth day, according to a Johns Hopkins study. A negative test is not a guarantee that a person is infection-free.
A negative test is, however, an indicator that a person is unlikely to be contagious at the time the test was done. As a rule, infectiousness is directly related to viral load, and so are positive test results. Still, each day that passes after a negative test reduces its value. A one-time test is not an adequate solution, then, if you’re the Boston Symphony Orchestra and you want a hundred musicians to be able to practice every day as an ensemble again, with no masks or distancing, while some of them are blowing horns and woodwinds so hard that they have to shake the spit out of them. If a group is going to work or live together on an ongoing basis but can’t take the necessary restrictive measures, or wants to relax them, repeated assurance testing is necessary to avoid outbreaks.
How often the testing must be repeated varies from once a day to once a week, depending on the baseline prevalence of infections in the group, among other factors. It’s especially helpful for groups that can be isolated from the larger community. The National Women’s Soccer League did just that, confining participants in its month-long Challenge Cup to an athletic village it created outside Salt Lake City and testing participants on arrival and then before every game. Not a single athlete tested positive after initial screening and admission to the village.
A few critics have argued that PCR testing for people without symptoms is overly sensitive, catching many people when their viral counts are too low to be contagious. Some of them, it’s true, could be on the downswing of infection, but most will be on the upswing (when it’s important to catch them), particularly when they’ve had a previous negative test.
An oddity about sars-CoV-2 transmission is that many infected people, whether or not they have symptoms, won’t pass it along. (Contact-tracing studies find that, among people who live with someone diagnosed with covid-19, sixty to ninety per cent never become infected.) And yet a particular person can, in the right settings—like a crowded bar or workplace—infect scores of others. There is a measure in epidemiology called the dispersion factor, which indicates how much a disease clusters. sars-CoV-2 has an unusually low dispersion factor—an estimated eighty per cent of transmissions are caused by just ten per cent of cases. By contrast, the 1918 influenza had a very high dispersion factor: there was almost no clustering at all.
Perhaps just a subset of people are prone to spread sars-CoV-2. Or perhaps everyone with the infection sheds the virus, but only in occasional eruptions during a short period of infectivity. You stop the spread by avoiding large indoor crowds that could include a person in the midst of an eruption, by masking everyone to contain an eruption, and by testing people so you can identify and isolate positive cases during the period when they can erupt. But that is possible only if you get the results fast.
The Kansas State University football team is a cautionary example in this respect. It set out to create a bubble of its own when the N.C.A.A. allowed practices to begin on June 1st. All players were tested upon arrival and isolated as a group from the rest of the community—so far, so good. The first ninety-six players to arrive tested negative. A last group of twenty-four players, largely freshmen, arrived a few days later and were tested on a Friday. But they didn’t get the results until Monday—and that window was all the virus needed. As the Times reported, teammates spent the weekend hanging out. One player who would test positive played video games at an apartment with up to fifteen players; another infected player joined a group that drove out together to a lake. Although the protocol was to wear masks and maintain distancing off the field, the rules slipped. Within a week, two cases had become fourteen, and the team’s practices were shut down.
Unused capacity
To fix testing, we have to accelerate two lines of operation: test collection and test processing. The primary challenge of test collection—sticking a fifty-cent swab in someone’s nose—is last-mile logistics, which can be more intricate than most realize. You’ve got to manage people flow; it can be a challenge just to find locations where potentially infectious people can turn up without infecting others. Then there’s the flow of supplies, which involves having adequate quantities of the swabs and tubes that your particular lab requires, plus the personal protective equipment required for the staff. There’s the information flow—gathering and linking a patient’s information, the provider information, and the bar code on the specimen tube in a way that the laboratory can deal with. And there’s the financial flow—figuring out the billing system required to get reimbursed by the correct payer, which, for a particular person, could be Medicare or Medicaid, a private insurer, an employer, the state, the patient herself, or any number of other sources. Running a test-collection operation can be a nightmare for scores of reasons. You have to navigate supply shortages, neighborhoods that object to having lines of cars turn up at a pharmacy or clinic parking lot, business-insurance plans that may not cover you if you provide testing, and building owners with liability concerns. You may be unable to use your label printer and computer system if there’s no Wi-Fi in the parking-lot drive-up location you’ve picked.
Processing tests is a very different enterprise. It is exacting. Most diagnostic tests are performed by putting a sample into a device and getting a result. But large-scale molecular diagnostic testing—in which segments of genetic material are read—isn’t done with off-the-shelf kits; these are laboratory-developed tests, meaning that running them is less like operating an appliance than like doing a procedure, with multiple steps requiring precision and tight controls. The basic coronavirus PCR test starts with a reduction process—a series of steps to wash the specimen from the swab, inactivate any virus present, and separate out the genetic material (both human and viral). What arrives at the lab as a six-inch specimen tube of material is reduced, by means of chemical reagents and various machines, to a few extracted drops of nucleic acids. Then comes the viral-detection phase. Enzymes and probes—special stretches of DNA—are added that, under the right conditions, recognize and bind to sars-CoV-2 RNA. (The genome of coronaviruses is made of RNA, not DNA.) The binding of a probe triggers a reaction that creates a DNA transcription of the viral RNA template. That enables the final steps: the signalling process.
The mixture is now put into a PCR machine—in essence, a tiny oven that sequentially heats and cools the mixture to precise temperatures, triggering further reactions that generate new copies of the viral genetic material. Each cycle of heating and cooling doubles the number of copies. After thirty cycles, up to a billion copies of viral DNA are produced from each strand. A separate marker in the mix recognizes the DNA and releases a fluorescent dye that can be measured by an optical device in the machine; there’s a threshold above which the test is considered positive. The result is checked by a technician and released electronically back to the test site. Although labs are constantly making improvements to this chain of steps in order to increase efficiency and accuracy, the whole process, from receiving a sample at a lab to sending a result, typically takes between six and twelve hours.ADVERTISEMENT
Running a clinical laboratory in the United States requires making the entire collecting and processing operation run smoothly. That’s why testing here is dominated by such a small number of national laboratories. The big four commercial labs are really logistics and distribution companies wrapped around a network of regional laboratories. That’s also what makes them a chokepoint. As Quest and LabCorp have both warned, they do not have the ability to expand their systems quickly enough to meet current needs, let alone meet the demands that will come with flu season.
Yet we have other laboratories with large amounts of untapped processing capacity ready to provide next-day results. In July, for instance, I visited the Broad Institute, a large academic laboratory affiliated with M.I.T. and Harvard, in Cambridge, Massachusetts, which has provided coronavirus testing for area hospitals, clinics, and others. As Sheila Dodge, the senior director of Broad Genomics, explained as she walked me through its molecular-testing operation, they had the capacity to process up to thirty-five thousand tests per day. With a few weeks’ notice, they could expand that to a hundred thousand a day—more than fifteen per cent of the nation’s current capacity. But, when I visited, they were receiving just a few thousand test specimens per day. I saw an entire room of machines standing by, mostly idle.
It’s the same story elsewhere. I spoke to leaders at the University of Minnesota’s Genomics Center, who reported that they have unused capacity to deliver up to twenty-five thousand tests a day. And there are numerous other university-based and independent molecular-diagnostics laboratories with the ability to expand the country’s testing capacity. Several companies—including Guardant Health and Helix, in California; Kailos Genetics, in Alabama; and Ginkgo Bioworks, in Boston—are rolling out advanced molecular-testing techniques that could enable them to collectively process hundreds of thousands of tests a day. Whereas the usual charge for test processing is a hundred dollars or more, most of these labs are willing to charge much less—from fifty dollars to as little as twenty dollars. What’s missing is the logistics operation to connect their supply of tests to the people who need them and to the entities that pay for them.
These remarkable scientific enterprises aren’t sitting on their hands. Each is making a herculean effort to connect to places seeking tests, one by one. The Broad Institute has built support for more than a hundred area colleges. Nonetheless, the labs are connected to only a fraction of those they could serve.
Decades ago, electric companies were organized in the same way that laboratory testing is organized today. They were vertical monopolies that ran their own power plants, transmission lines, and customer operations. That arrangement got the job done, but it meant that many communities endured brownouts and blackouts from a shortage of capacity, while others had an oversupply. And the companies impeded innovation such as cleaner and cheaper energy. The creation of a national electric grid that physically connected the electricity supply, plus the Energy Policy Act of 1992, which required transmission-line owners to allow electric-generation companies access to their power lines, opened the door for load balancing, increased supply, lower costs, and alternative energy production.
We have no national grid for the generation, transmission, or distribution of our testing supply—or, for that matter, the supply of ventilators, masks, intensive-care beds, or almost any other health-care resources. Now we’re paying the price. In power generation, the worry is that our national grid is aging; in health care, the worry is that we have no grid at all.
A grid is the goal
To see what a functional national grid can deliver when it comes to public health, consider South Korea. It supported test collection, test processing, and the connections between them. On January 27th, when the country had seen just three confirmed covid-19 cases, officials from Korea’s equivalents to the C.D.C. and F.D.A. held an urgent meeting with clinical laboratories and medical manufacturers, telling them to develop PCR tests for the new coronavirus spreading out of control in China, and to coördinate manufacturing swabs, reagents, and other necessary supplies. The government created an accelerated authorization process. By February 4th, one lab had isolated viral specimens from the three cases and reproduced the genetic material from them. Government scientists had varying dilutions put into test plates and delivered to participating laboratories as a kind of final exam for their molecular tests. If a laboratory correctly identified all the positives and negatives, its test was approved. By February 6th, the South Korean government had validated and approved tests from forty-six laboratories. Afterward, it carried out periodic cross-checks to make sure that testing remained accurate.
At the same time, the government coördinated with hospitals, clinics, and public-health agencies to set up test sites, agreeing to cover the testing costs for patients (at a flat rate of sixty-seven dollars a test), and creating a common scheduling system. (Dial 1339 from anywhere in the country and you can schedule a test nearby that day.) That scheduling system also allowed them to balance the testing loads, connecting laboratories that had extra capacity to test sites where that capacity was needed. Today, South Korea, with as many people as Florida and Texas combined, has some six hundred test sites, served by a hundred and eighteen authorized laboratories, with, typically, a one-day turnaround time. That’s what a grid can get you. Other countries followed South Korea’s example.
We never did. In fact, the United States has stymied rather than accelerated the ability of laboratories to develop testing capacity. In the labs of my hospital system, the Mass General Brigham—as in other academic and commercial labs—scientists began developing a coronavirus test in January, concerned that the outbreak in Asia could become a danger here. But, through February, the F.D.A. authorized only the C.D.C.’s coronavirus test. On February 20th, the Department of Health and Human Services sent out an e-mail blast to labs nationwide summarizing the Administration’s policy.
It is a stunning document. It stated that the C.D.C. had the only authorized test protocol in the country, and that only it and select state and local public-health laboratories could use it. Other clinical laboratories were supposed to send their patients’ swabs to an already backlogged C.D.C. Not only did the notice provide no encouragement for laboratories to develop tests; it actually blocked one of the principal means for labs to do so, declaring that “clinical laboratories should NOT attempt viral isolation from specimens” collected from patients thought to be infected.
Neal Lindeman, the head of my hospital’s molecular-testing laboratory, could only shake his head as he read the notice. “I thought it was foolish and dangerous,” he said. “I decided to ignore the e-mail. I didn’t think this plan was going to work for the country. So we just continued working on our test in the background.”
And, as became widely known, the C.D.C.’s plan did not work; its test kit had contaminated probes, and its protocol was flawed. The virus spread undetected nationwide for a month while we delivered hardly any tests at all. On February 29th, the F.D.A. finally reversed course, announcing that laboratories could develop and deploy their own coronavirus testing programs, so long as they also applied for emergency authorization from the agency. But, unlike its Korean counterpart, it provided no plan to streamline the test-authorization process. On the contrary, the agency made clear that it was not enough for a laboratory to show that its test yielded accurate results on blinded specimens. A detailed review of protocols would be required as well. Even slight deviations from the C.D.C.’s protocol required the laboratory to submit a separate “bridging study”—a term that had not been defined. Nor did the F.D.A. have enough experts to do the detailed review the agency required.
The result: F.D.A. reviews took far too long. Furthermore, when a lab made improvements in its process—or adjustments to circumvent shortages in supplies—it had to return to petition for authorization all over again. The uncertainty about whether applications would succeed naturally made labs hesitate to make the investment necessary to scale up their operations. We’ve needed a speedier process, but we still also need the government to set and insure consistent standards. The F.D.A’s validation protocol needed reforming, not eliminating. So even some F.D.A. critics were shocked when, this August, in a barely reported move, the Trump Administration announced that lab-developed tests would no longer require F.D.A. review. This could open the door to tests with insufficient scientific oversight and yet more confusion for patients.
Even with the substantial capacity of F.D.A.-authorized coronavirus tests that we’ve already accumulated, the government launched no major effort to balance testing loads among them. There is still unmet demand and untapped capacity. At the same time, we are undersupplied with test centers. And we have no defined approach at all for some hundred million essential workers, students, and others who need access to assurance testing that health-care plans won’t pay for.
Conservatives have long opposed the government’s playing a direct role in addressing major gaps in the supply of health-care services. A third of U.S. counties have no childbirth facilities, and shortages of psychiatric beds are even worse. So maybe we should not be surprised that we have no such system for testing. It’s not just that we lack a national grid; we haven’t even agreed that we need one.
Innovation’s impasse
Will improvements in techniques and technologies get us out of our testing debacle? They can help a lot—but only if we fix the underlying problem we have with delivery.
Consider, for instance, pooled testing, in which you combine samples from a group of people in a single tube for a test run. A negative result will clear the entire group. If a tube comes up positive, you go back to the original samples and run them individually. During the Second World War, draftees were screened for syphilis through pooled testing. The Red Cross has used the technique to screen donated blood since 1999. In May, the Chinese government used the technique to screen the entire city of Wuhan, testing more than nine million people in ten days. (Just three hundred tests came back positive.)
Pooled testing is useful when you’re screening lots of healthy people for an uncommon disease and you don’t have enough testing machines or reagents. But we’ve made no commitment to setting up the systems required to physically screen large numbers of healthy people at scale—and pooling doesn’t work if you can’t collect the specimens to pool. In communities where disease rates are high, meanwhile, pooling isn’t so valuable: too many tests will come back positive, which slows the whole production line down to a crawl. Plus, the approach doesn’t do anything about bringing online unused lab capacity, which would be needed to deploy any testing strategy efficiently.
Sewage testing, one type of pooled testing, has real potential as a means of cost-efficient, large-scale screening. People infected with sars-CoV-2 shed the virus in their stool, and PCR testing of wastewater can detect the virus upward of four days before people typically obtain clinical testing. Several hundred communities have partnered with companies such as Biobot, a Boston-area startup, to monitor viral prevalence in their populations, and the C.D.C. has announced a National Wastewater Surveillance System to track the information. The technique could be especially useful when deployed in an institutional setting: for instance, to clear a nursing home or dormitory with a single daily PCR test. The University of Arizona prevented an outbreak when regular testing of sewage samples from twenty campus buildings turned up traces of the virus from a dormitory; swab-testing the three hundred and eleven residents the next day identified two with infections. The lower limit of detection still needs to be confirmed, but Biobot claims its system can pick up a single case in up to sixty-five-hundred people. And it’s comparatively cheap: the primary cost is installing a twenty-four-hour sampling system into a building’s wastewater outflow. But, again, the mere existence of the capability is not enough. Coördinated efforts and investment are required to deploy it. The supply of compositors, the sampling devices required, must be secured. And then you need a system to provide swift follow-up testing of individuals when a sewage test comes back positive.
What about at-home test collection? The F.D.A. has authorized a small number of companies—for example, LabCorp and the startup Everlywell—to give people home collection kits with specific, preapproved instructions for swabbing themselves or providing a saliva sample. Unsupervised self-collection can result in higher rates of missed infections, to be sure. And delivering and returning the tests by mail can add a couple of days to the testing process—although, as more labs gain approval for unsupervised collection kits, one can imagine pharmacies, workplaces, and schools facilitating pickup and drop-off sites that could speed it up. If we haven’t addressed the demand-capacity mismatch, however, the approach could still be slowed by lab-processing backups.
You could circumvent the lab bottleneck by means of tabletop “point of care” machines that can run sars-CoV-2 tests in clinics and other authorized settings without specialized personnel. They’re a marvel of miniaturization—akin to having your own electric generator. The White House uses these devices to test staff and visitors. There are versions that can run a PCR test in less than forty-five minutes. For those who have the money, such machines provide a means to buy your way around our broken system. But demand for the devices and the cartridges they require has far outpaced manufacturing capacity. Because each tabletop device can typically run only one sample at a time, the technology is at best a partial solution for getting to the millions of low-cost tests we need per day—there’s a difference between a Xerox machine and a printing plant. To deploy these devices, the country would still need a focussed national effort to boost the supply and get it to the populations that most need them.
A cheaper type of point-of-care test has emerged that takes just fifteen minutes. Unlike PCR tests, which detect the virus’s nucleic acids, this is an “antigen” test, which detects the virus’s proteins. Most involve machines. But the Abbott antigen test card, which has just come on the market, uses the same technology as home pregnancy tests and costs labs just five dollars. It embeds a filter-paper-like strip with antibodies that trigger the release of a dye and make a line appear when they recognize and bind to sars-CoV-2 proteins. The test is said to be almost as sensitive as PCR tests, but it has only been formally tested with (and authorized for) symptomatic patients. For people without symptoms, antigen tests are significantly less sensitive. The Abbott test card is still complex enough that it requires laboratory certification and a trained health-care worker to use it. But, with no machine needed, it’s easier to manufacture these tests at scale. The federal government has committed to buying a hundred and fifty million of these tests. How they’ll be distributed is unknown, however. With no grid to monitor need and link it with supply, distribution in this Administration has been left to the vagaries of political favor.
Simpler paper-strip antigen tests are in development that people can administer at home. They’d likely have yet lower sensitivity. But false negatives can be reduced by repeat testing—and that’s possible, because they’re cheap and fast. Advocates imagine people having a pack of strips at home and testing themselves every day or two in order to provide assurance for their school or workplace.
The weakness of antigen testing is not just its miss rate but also its rate of false positives. Two to three per cent of people without covid-19 nonetheless turn up positive with these tests, unlike with PCR testing. The antibodies that these tests use to recognize and attach to sars-CoV-2 proteins can also bind to unrelated proteins and cellular material. A quick, cheap test at the airport before you board a flight with a hundred other people sounds great. At present rates, one passenger might actually be unknowingly infected with the virus—current assurance-testing programs commonly find infection rates at or below one per cent. But two to three other uninfected passengers are likely to have a false positive result, be prohibited from boarding, and have to quarantine in whatever city they are in until they’re cleared by PCR testing. Today, most positive antigen tests will be false—an outcome that could prove untenable in many situations and inspire mistrust in the tests.
There are paper-strip molecular assays in development that, promising both precision and speed, could have the greatest transformative potential of any test. They recognize viral genetic material, typically using crispr-based technology, and are expected to avoid the false-positive problem of antigen tests. James Collins, an M.I.T. professor of biomedical engineering, is leading a team that, going a step yet further, is developing a face mask with a crispr-based sensor that signals if you develop a sars-CoV-2 infection.
We are on our way to an emporium of testing technologies. The trouble is that none of them will allow us to get around the necessity to upgrade and simplify our system for securing public health. Home-use paper-strip technologies have not yet received F.D.A. authorization. It will be months more before they can be produced in mass quantities. And, again, technologies do not implement themselves: we have to make sure that people actually have the tests in hand, that they won’t run out of them in hot-spot communities, that public-health authorities are notified when tests are positive, that positive cases get confirmatory tests and self-isolate, and that their contacts are traced and tested, too. If the development of essential technologies requires effort, skill, and investment, so does the delivery of them.
The San Francisco model
There are places in the country that have recognized that reality. San Francisco, one of the first American cities to be hit by the pandemic, has also been one of the best at curbing it. A big reason was Mayor London Breed’s decision, starting on March 6th, less than twenty-four hours after seeing the city’s first two confirmed cases, to back the aggressive recommendations of her city’s public-health director, Grant Colfax, to halt large gatherings, suspend nonessential travel, explore work-from-home options, and rapidly deploy a citywide testing program that remains one of the country’s most effective.
San Francisco’s leaders recognized the importance of universally available testing; residents needed to have an easy way to get tested regardless of what insurance they had or didn’t have, regardless of what relationship they had or didn’t have with a clinic, and regardless of whether or not they had a doctor’s order. The city’s hospitals, labs, and clinics were not going to meet that need, because that isn’t their job. In America, health-care systems are responsible for the care of individuals, not communities. So the city’s public-health department decided to step in.
It took an approach that resembles South Korea’s. Officials worked with local providers and laboratories to establish a network of free drive-through and walk-in sites, open to anyone who lives or works in the city. The city established a scheduling system, which people could access online or by phone, and outreach testing for nursing homes and other vulnerable communities. Public-health officers signed standing orders for each site, eliminating the need for a doctor’s referral. The city negotiated and paid most test costs. And officials made sure that they could enlist a network of labs to provide adequate capacity and keep turnaround time low. They established, in effect, a public option for testing. Although there are scores of other test sites provided by hospitals, clinics, and pharmacies across the city, the CityTest SF network has accounted for two-thirds of the city’s daily volume of tests. The program has literally been a lifesaver. Elsewhere in California, places like Los Angeles have exploded with covid-19 cases. San Francisco has kept the coronavirus contained.
All this, alas, makes San Francisco an anomaly. Historically, the work of public health has been separate from the work of health-care delivery, using measures outside the medical system to address controllable diseases like cholera, tuberculosis, and food poisoning. But even before the coronavirus crisis hit, the separation was making less and less sense. A wide range of diseases are now controllable with the modern tools of diagnostic testing, treatment, and prevention. As the coronavirus pandemic has demonstrated, the population-level distribution of medical tests, ventilators, and drugs matters as much to disease control as nonmedical measures such as masks and social distancing. Success requires integrating the systems focussed on individual care and those focussed on community needs.
We’ve long resisted that integration, though. The clearest indication is how we’ve spent our money. Spending per person on medical care was seventy-nine hundred dollars per American in 2008; it climbed to an estimated eleven thousand six hundred dollars in 2019. By contrast, the average spending per person allocated to state and local health departments was a measly eighty dollars per person in 2008, and fell to fifty-six dollars in 2019. Public-health agencies that are supposed to look after communities’ health have been forced to expand tattoo-parlor inspections while shrinking their programs to assure adequate maternal- and child-health services or screen for chronic illnesses like high blood pressure and diabetes.
Talk to city and state officials about what San Francisco accomplished, and you typically hear: “Just can’t do it.” So how has San Francisco been able to pull it off? In part, it’s because the last deadly pandemic it experienced—the H.I.V./aids crisis—taught the city that public health and medical care must work together. San Francisco has been a pioneer in guaranteeing that H.I.V. testing and treatment is readily available and affordable to all residents in need. Those reflexes, and the associated budgeting commitment, served the city well when the coronavirus arrived.
Some cities and even states—including Los Angeles, Illinois, Maine, and Tennessee—have created versions of San Francisco’s free coronavirus-testing model; the federal government set up test sites, too. Those sites received large numbers of people. But most programs don’t have sufficient funding to open enough sites—Illinois has only eleven, for instance—and the federal government opened just forty-one locations nationwide, most of which it shut down by the end of June, despite the accelerating spread of the disease. Some cities and states have run testing “blitzes,” providing public-sponsored, pop-up testing sites for a few days, with no scheduling required. But, again, because there isn’t the funding to open enough sites, lines are typically long. As cases spiked in July, almost a thousand people waited up to thirteen hours at such a site in Phoenix. Nor have these states created a system to shift testing loads to labs with capacity the way San Francisco did.
A serious national strategy for coronavirus testing—including universally available assurance testing for essential workers, travellers, students, and others—is clearly needed. Such a strategy would entail a major injection of funding, which would pay for itself many times over by getting the pandemic response, and therefore the economy, back on track. It would have the F.D.A. supervise the validation process for laboratory tests, but with a simplified and speeded-up process. And it would build our national grid for monitoring, distributing, and accelerating testing capacity, whatever technologies emerge.
Reclaiming public health
President Trump, backed by the Republican politicians who have protected him, is clearly uninterested in pursuing such goals. But even the most committed Administration would have struggled to overcome the effects of the long, collective neglect of our public-health systems. Hospitals and clinics have had the resources to spend tens of billions of dollars installing electronic medical-record systems. A whole industry has developed to deliver such capabilities. Yet our thinly staffed public-health departments, which are expected to compile thousands of diagnostic-test results per day and follow up on outbreaks, have nothing of the kind. Some still receive test results by fax and must manually enter them into databases. They lack the means to readily measure, let alone manage, a community’s availability of coronavirus tests, ventilators, hospital beds, or personal protective equipment. Not a single state in the country reports coronavirus-test turnaround time and rates of mask wearing—two of our most critical indicators for shutting the virus down. They’d like to; they just don’t have the ability to collect the information.
The pandemic has given us all a master class on infectious disease, diagnostics, and the reality that individual health is inseparable from community health. Polling shows that an overwhelming majority of Americans want the government to cover the costs of not only testing but also treatment for the coronavirus. In turn, support has grown for expanding Medicare to cover all Americans for their medical needs, and for investment in public health.
Epidemiologists expect us to encounter one of the worst falls and winters in American history. We will have more American dead in a single year from the pandemic than we saw during any year of war we’ve faced. On Election Day, we’ll have a chance to turn out a President who has sacrificed tens of thousands of American lives—and undermined essential government institutions—to serve his own desires. And yet, amid the carnage, there’s a lot we can still do to advance the essential work of collaboration. In New England, for example, the Assurance Testing Alliance (of which I am a founder) has been assembling a logistics grid that links schools, nursing homes, and other institutions that need regular testing to those who have the capacity to deliver it. Already, the alliance has pushed the total cost of a PCR test to fifty dollars, with a next-day turnaround time. And, beginning in August, and catalyzed by a Rockefeller Foundation effort, ten governors (so far) have formed an interstate compact to purchase and distribute enough rapid-testing devices and supplies for the delivery of five million tests. This compact enables what you’d think the United States government was created to provide: a confederation of states working to meet their common needs. Participating states share and coördinate their testing capacity, rather than bidding against one another, as they did in order to procure scarce ventilators and P.P.E. earlier in the pandemic. Alternative infrastructures like this will prove all the more important if Trump continues to control the federal government.
Such efforts aren’t a replacement for national leadership, but they start the work that must be done to make ordinary physical interaction safe again, and to begin creating the public-health system we deserve. As the former Surgeon General C. Everett Koop once said, “Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.” The pandemic has brought Americans a further lesson: our best chance for long, flourishing lives in the future requires that we build the foundations of our public health now.
Atul Gawande, a surgeon and public-health researcher, became a staff writer at The New Yorker in 1998.
The encyclical, dated 24 May 2015, was officially published at noon on 18 June 2015, accompanied by a news conference.[2] The Vatican released the document in Italian, German, English, Spanish, French, Polish, Portuguese and Arabic, alongside the original Latin.[3]
The encyclical is the second published by Francis, after Lumen fidei (“The Light of Faith”), which was released in 2013. Since Lumen fidei was largely the work of Francis’s predecessor Benedict XVI, Laudato si’ is generally viewed as the first encyclical that is entirely the work of Francis.[4][5]
The title of the social encyclical is an Umbrian phrase[4] from Francis of Assisi‘s 13th-century “Canticle of the Sun” (also called the Canticle of the Creatures), a poem and prayer in which God is praised for the creation of the different creatures and aspects of the Earth.[6]
The tone of the Pope’s phrasing has been described as “cautious and undogmatic, and he specifically calls for discussion and dialogue.”[7] For example, he states in the encyclical (#188):
There are certain environmental issues where it is not easy to achieve a broad consensus. Here I would state once more that the Church does not presume to settle scientific questions or to replace politics. But I am concerned to encourage an honest and open debate so that particular interests or ideologies will not prejudice the common good.[7]
He adds that “Although the post-industrial period may well be remembered as one of the most irresponsible in history, nonetheless there is reason to hope that humanity at the dawn of the twenty-first century will be remembered for having generously shouldered its grave responsibilities.”[1] Francis does state that concern for the natural world is no longer “‘optional’ but is an integral part of the Church teaching on social justice.”[8]
Francis reportedly has said that the encyclical was not really an environmental document at all.[9] The warming of the planet is a symptom of a greater problem: the developed world’s indifference to the destruction of the planet as they pursue short-term economic gains.[9] This has resulted in a “throwaway culture” in which unwanted items and unwanted people, such as the unborn, the elderly, and the poor, are discarded as waste.[9][10] This subtext makes the document “more profoundly subversive” than it appears on the surface.[9]
The real problem, according to Francis, lies in the fact that humans no longer see God as the Creator.[10] Thus we see “other living beings as mere objects subjected to arbitrary human domination” and do not realize that “the ultimate purpose of other creatures is not found in us.”[10] Francis says that instead of viewing humanity as having “dominion” over the earth, we must see that everything is interconnected and that all of creation is a “kind of universal family”.[8] Nature cannot be seen as something apart from humanity, or merely the place where we live.[8] He says that our social and environmental crises are thus one complex crisis that must be solved holistically.[8]
Environmentalism
Francis “pulls no punches” when lamenting pollution, climate change, a lack of clean water, loss of biodiversity, and an overall decline in human life and a breakdown of society.[8] “Never have we so hurt and mistreated our common home as we have in the last two hundred years,” he states.[1]
He “describe[s] a relentless exploitation and destruction of the environment, for which he blamed apathy, the reckless pursuit of profits, excessive faith in technology and political shortsightedness.”[2]Laudato si’ “unambiguously accepts the scientific consensus that changes in the climate are largely man-made”[11] and states that “climate change is a global problem with grave implications: environmental, social, economic, political and for the distribution of goods. It represents one of the principal challenges facing humanity in our day” and warns of “unprecedented destruction of ecosystems, with serious consequence for all of us” if prompt climate change mitigation efforts are not undertaken.[1][2]
The encyclical highlights the role of fossil fuels in causing climate change. “We know that technology based on the use of highly polluting fossil fuels – especially coal, but also oil and, to a lesser degree, gas – needs to be progressively replaced without delay,” Francis says. “Until greater progress is made in developing widely accessible sources of renewable energy, it is legitimate to choose the less harmful alternative or to find short-term solutions.”[1] The encyclical’s comments on climate change are consistent with the scientific consensus on climate change.[12]
More at: https://en.wikipedia.org/wiki/Laudato_si’
Netflix We tweet, we like, and we share— but what are the consequences of our growing dependence on social media? As digital platforms increasingly become a lifeline to stay connected, Silicon Valley insiders reveal how social media is reprogramming civilization by exposing what’s hiding on the other side of your screen. https://Netflix.com/thesocialdilemma ABOUT THE SOCIAL DILEMMA The world has long recognized the positive applications of social media, from its role in empowering protesters to speak out against oppression during the Arab Spring uprisings almost a decade ago, to serving an instrumental role in fighting for equity and justice today. And in 2020, during an astonishing global pandemic, social media has become our lifeline to stay in touch with loved ones, as well as proving to be an asset for mobilizing civil rights protests. However, the system that connects us also invisibly controls us. The collective lack of understanding about how these platforms actually operate has led to hidden and often harmful consequences to society—consequences that are becoming more and more evident over time, and consequences that, the subjects in The Social Dilemma suggest, are an existential threat to humanity. The Social Dilemma is a powerful exploration of the disproportionate impact that a relatively small number of engineers in Silicon Valley have over the way we think, act, and live our lives. The film deftly tackles an underlying cause of our viral conspiracy theories, teenage mental health issues, rampant misinformation and political polarization, and makes these issues visceral, understandable, and urgent. Through a unique combination of documentary investigation and entertaining narrative drama, award-winning filmmakers Jeff Orlowski (Chasing Ice, Chasing Coral) and Larissa Rhodes (Chasing Coral) have once again exposed the invisible in a manner that is both enlightening and harrowing as they disrupt the disrupters by unveiling the hidden machinations behind everyone’s favorite social media and search platforms. The film features compelling interviews with high-profile tech whistleblowers and innovation leaders including Tristan Harris of the Center for Humane Technology; the co-inventor of the Facebook “Like” button, Justin Rosenstein; Tim Kendall, former President of Pinterest and former Director of Monetization at Facebook; Cathy O’Neil, author of Weapons of Math Destruction; Rashida Richardson, Director of Policy at the AI Now Institute, and many others. Demonstrating how social media affects consumers on a personal level, these fascinating insider insights are seamlessly woven into a captivating narrative, including Vincent Kartheiser (Mad Men), that illuminates the very real consequences these seemingly innocent technologies can have on our everyday lives. SUBSCRIBE: http://bit.ly/29qBUt7
Wanting you to know that for those of you who missed the 1-hour event on August 30, 2020, or who wanted to see the show again; a recording of the Conversation Calvin had with Sue Beck was made and can be accessed on the Prosperos Website, Click the link below to view it.
Find out what fun, memories, or insights await you through these conversations with Calvin and interesting people. This is one of three events scheduled for this year. They are two more scheduled, held once a month.
In the beginning there was Covid-19, and the tribe of the white collars rent their garments, for their workdays were a formless void, and all their rituals were gone. New routines came to replace the old, but the routines were scattered, and there was chaos around how best to exit a Zoom, onboard an intern, end a workweek.
The adrift may yet find purpose, for a new corporate clergy has arisen to formalize the remote work life. They go by different names: ritual consultants, sacred designers, soul-centered advertisers. They have degrees from divinity schools. Their business is borrowing from religious tradition to bring spiritual richness to corporate America.
In simpler times, divinity schools sent their graduates out to lead congregations or conduct academic research. Now there is a more office-bound calling: the spiritual consultant. Those who have chosen this path have founded agencies — some for-profit, some not — with similar-sounding names: Sacred Design Lab, Ritual Design Lab, Ritualist. They blend the obscure language of the sacred with the also obscure language of management consulting to provide clients with a range of spiritually inflected services, from architecture to employee training to ritual design.
Their larger goal is to soften cruel capitalism, making space for the soul, and to encourage employees to ask if what they are doing is good in a higher sense. Having watched social justice get readily absorbed into corporate culture, they want to see if more American businesses are ready for faith.
“We’ve seen brands enter the political space,” said Casper ter Kuile, a co-founder of Sacred Design Lab. Citing a Vice report, he added: “The next white space in advertising and brands is spirituality.”
Casper ter Kuile is a Ministry Innovation Fellow at Harvard Divinity School and a co-founder of Sacred Design Lab.Credit…September Dawn Bottoms/The New York Times
Before the pandemic, these agencies got their footing helping companies with design — refining their products, physical spaces and branding. They also consulted on strategy, workflow and staff management. With digital workers stuck at home since March, a new opportunity has emerged. Employers are finding their workers atomized and agitated, and are looking for guidance to bring them back together. Now the sacred consultants are helping to usher in new rituals for shapeless workdays, and trying to give employees routines that are imbued with meaning.
Ezra Bookman founded Ritualist, which describes itself as “a boutique consultancy transforming companies and communities through the art of ritual,” last year in Brooklyn. He has come up with rituals for small firms for events like the successful completion of a project — or, if one fails, a funeral.
“How do we help people process the grief when a project fails and help them to move on from it?” Mr. Bookman said.
Messages on the start-up’s Instagram feed read like a kind of menu for companies who want to buy operational rites a la carte: “A ritual for purchasing your domain name (aka your little plot of virtual land up in the clouds).” “A ritual for when you get the email from LegalZoom that you’ve been officially registered as an LLC.”
‘People would cite SoulCycle’
The sacred consultant trend might be led by the co-founders of Sacred Design Lab — Mr. ter Kuile, Angie Thurston and Sue Phillips. They met at Harvard Divinity School, where they remain affiliated as inaugural Ministry Innovation Fellows, and founded their organization as a nonprofit in 2019.
Their backgrounds vary. Mr. ter Kuile, who lives in Brooklyn and co-hosts a popular Harry Potter podcast, wrote a book on how to “transform common, everyday practices — yoga, reading, walking the dog — into sacred rituals.” Ms. Thurston, who lives in Alexandria, Va., had worked at finding spiritual connection between people from different faiths. Ms. Phillips, of Tacoma, Wash., is an ordained minister in the Unitarian Universalist tradition.
What they have in common is an agreement that traditional religious institutions are not working and that corporate culture is largely soulless.
At Harvard Divinity School, scholars have been studying the trend away from organized religion for decades. Their consensus is that while attendance at formal services is at a historic low, people are still looking for meaning and spirituality. Dudley Rose, the associate dean for ministry studies, noted that secular spaces were doing a surprisingly good job of fulfilling this desire.
“People were meeting what they identified as spiritual needs, but doing them in organizations that had no apparent spiritual connection,” Mr. Rose said in an interview. “Like SoulCycle. People would cite SoulCycle.”
Mr. ter Kuile, Ms. Thurston and Ms. Phillips saw it like this: If part of religious work is finding people in need wherever they are, then spiritual innovators should go toward the workplace.
“Regardless of what you and I might think about it, the fact is that people are showing up in the workplace with these big deficits in themselves when it comes to belonging and connection to the beyond,” Ms. Thurston said.
Maceo Paisley, left, an experience designer, presents a prototype for a grief ritual at an event hosted by Sacred Design Lab.Credit…Suzanne Tennant
The Sacred Design Lab trio use the language of faith and church to talk about their efforts. They talk about organized religion as a technology for delivering meaning.
“The question we ask is: ‘How do you translate the ancient traditions that have given people access to meaning-making practices, but in a context that is not centered around the congregation?’” Mr. ter Kuile said.
The nonprofit says it has been thinking of sacred designs for companies like Pinterest, IDEO and the Obama Foundation.
Ms. Phillips doesn’t see corporations replacing organized religion — but, she said, she does see an opportunity for companies to bring people some of the meaning that they used to derive from churches, temples, mosques and the like.
She talks about her work like a pastor would. “We spend a lot of time doing witness and accompaniment of our clients,” she said. “We listen to their stories. We want to understand their lives. We want to understand their passion and their longing.”
Evan Sharp, the co-founder of Pinterest, hired Sacred Design Lab to categorize all major religious practices and think of ways to apply them to the office. They made him a spreadsheet.
“We pulled together hundreds of practices from all these different religions and cultural practices and put them in a spreadsheet and just tried to categorize them by emotional state: which ones are relevant when you’re happy, which are relevant when you’re angry, and a couple other pieces of metadata,” Mr. Sharp said.
When he had the data, he said, he took a few days and read it all. “This sounds embarrassingly basic,” he said, “but it really reframed parts of religion for me.”
It made him realize how many useful tools existed inside something as old-fashioned as his childhood church. “Some of the rituals I grew up with in Protestantism really have emotional utility,” he said. And Mr. Sharp saw that it was good.
‘It’s still an office’
There are perils, of course, with bringing elements of spirituality into the office.
The mixture of corporate and religious language can be odd. For example, here is how Mr. ter Kuile described his work for a tech company he declined to name: “We researched and authored a concept paper on The Soul of Work to stimulate bold ideas about how soul-centeredness will continue to grow as a core element of the future of work.”
Another challenge is that many workers are already devout on their own terms, on their own time, and are not at all hungry for soul-based activities between 9 and 5.
Angie Thurston, a co-founder of Sacred Design Lab. “People are showing up in the workplace with these big deficits in themselves when it comes to belonging and connection to the beyond,” she said.Credit…Rosie Brock for The New York Times
And: It’s hard to exhort workers to give their professional activities transcendental meaning when, at the same time, those workers can be terminated. “It can be done badly, and when done badly it can cause harm,” Ms. Thurston said. “For example, ‘How can we be in deep community if I can fire you?’”
Ms. Thurston cited a host of possible problems to grapple with: creating a workplace religion, mixing management and soulfulness, getting paid for spirituality. “Even if this is all done well and a workplace becomes really soul-centered, it’s still an office,” Ms. Thurston said. “These are the challenges.”
Companies hiring ritual consultants may think they are bringing workers a small perk. But those behind the movement are hoping for a bigger revolution.
Workers have achieved measured success recently in pressuring employers to address systemic racism — some companies are making Juneteenth a paid holiday, for example, and investing in Black- and minority-owned ventures — and the sacred design consultants are wondering if employees might also begin to demand spiritual goodness.
This possibility is what drew Bob Boisture to the divinity consultants. He is the chief executive of the Fetzer Institute, a Michigan nonprofit foundation that says its mission is “helping build the spiritual foundation for a loving world,” and which helps fund Sacred Design Lab. Mr. Boisture said he hopes the group’s work could eventually allow corporate employees to articulate complaints and stop projects or practices that they see as lucrative but immoral.
“We today pay attention to a business’s profits; the deeper question is whether the business ennobles or debases human existence,” Mr. Boisture said. “We encourage employees to bring moral concerns into the business conversation.”
And so the consultants find rituals and religious language and pull them out from their religious context, the better — in theory — to keep workers from feeling alienated. But rituals without religion can go haywire.
Tara Isabella Burton, the author of “Strange Rites: New Religions for a Godless World,” calls it the bespoke-ification of religion, or the unbundling of rituals — a reference to how cable TV packages split apart after the advent of streaming services. In the unbundled world, people pick what they want from different faiths and incorporate it into their lives — a little Buddhism here, a little kabbalah there. It is consumer-driven religiosity.
“The idea is that what we want, what feels good to us, what we desire, that all of this is constitutive of who we are, rather than community,” Ms. Burton said. “We risk seeing spirituality as something we can consume, something for us, something for our brand.”
Deepening one’s Zoom practice
In a workday spent at home, standing in front of a computer while meetings come and go, projects are received and filed, there is no differentiation. Every activity is, physically, the same.
I’m hungry for ritual. Every day, I get dressed, put on shoes, make coffee, pour it in a mug and tell my two housemates that I’m heading to work and will see ’em later. Then I walk in a few circles and settle in at a desk in the corner of our living room, just a couple feet away. This is my deranged coronavirus commute and it’s how I help my bleary mind realize that the workday has begun.
If my boss said we would be instituting a one-minute group breathing exercise in the evenings to mark the closing of our laptops, or beginning each meeting by all smelling a clove together, would I like it? I would.
It’s easy to blur the line between routine and ritual. Which category is it, for example, to have a habit of taking a shower and staring at the ceiling for five minutes after accomplishing my day’s main task? Does the label matter, if the action feels essential?
To be technical, though, Kathleen McTigue, a Unitarian Universalist minister and a mentor to Mr. ter Kuile, offers a definition. She describes rituals as elevated routines, with set intention, attention and repetition.
Kursat Ozenc has been in the corporate ritual game for a while, as a product designer at the software giant SAP. He wrote “Rituals for Work” last year, and in January will publish a follow-up of sorts, “Rituals for Virtual Meetings.” I called him for recommendations on how to deepen my Zoom practice.
Mr. Ozenc advised incorporating thoughtful interruptions. He suggested beginning conference calls with a moment of silence. He recently heard about a smelling ritual, where everyone in a meeting retrieves a common kitchen spice, maybe cinnamon, and smells it at the same time to get a co-sensory experience. He is hoping to incorporate this into his guidance, as a way to bind people together.
“In the physical world, we experience the same senses together, the same temperature, the same smell of food heating up,” Mr. Ozenc said.
Sue Phillips, a co-founder of the Sacred Design Lab, talks about her work like a pastor would. “We spend a lot of time doing witness and accompaniment of our clients,” she said.Credit…Ruth Fremson/The New York Times
Ms. Phillips, the minister, had a few other ideas. She suggested using a repetitive meeting structure, which can be calming for participants. This might take the form of starting each team meeting with the same words, a sort of corporate incantation.
Others suggested workers each light a candle at the start of a meeting, or pick up a common object that everyone is likely to have in their homes.
Glenn Fajardo, a teaching fellow and lecturer at Stanford’s design school who is researching rituals for virtual work, said to think of the workday like a movie, with structure and cuts and suspense, based on predictable arcs.
“Say to the group, ‘During this part of the conversation, everybody’s going to turn off our video,’” Mr. Fajardo said. “Or, ‘While we’re doing this activity, I want you to look at your notebook.’”
“Part of what you’re doing with ritual is creating these chunks people can remember, creating this element of something familiar and something new.”
Jeffrey D. Lee, the bishop of the Episcopal Diocese of Chicago, helped organize a three day retreat last year with Mr. ter Kuile and others. The purpose of the retreat was to allow spiritual entrepreneurs to brainstorm with traditional religious leaders. He described one participant as “an experience designer creating potent rituals for executives.”
Bishop Lee said he was happy to find the religious impulse at play, even if it was in places where the ultimate calling was profit. “We’re really aware of being on the shadow side of religious observance, a truly historic decline,” he said, “so there’s some good news in here for how people are hungry for ritual.”Correction: Aug. 28, 2020
An earlier version of this article misspelled the name of a participant in a Sacred Design Lab event in a photo caption. He is Maceo Paisley, not Maceo Paisely.
Nellie Bowles covers tech and internet culture from San Francisco for The New York Times. Before joining The Times, she was a correspondent for “VICE News Tonight.” She has written for California Sunday, Recode, The Guardian, and the San Francisco Chronicle. @nelliebowles
A version of this article appears in print on Aug. 30, 2020, Section BU, Page 1 of the New York edition with the headline: Doing God’s Work. Order Reprints | Today’s Paper | Subscribe
As it’s been a while since I wrote to you, and I thought I’d share both a video of a guided meditation that I did with our Daily Mindfulness Club members this week, for you all to enjoy.
In this meditation, I teach three things: The value of feeling difficult sensations in your body to help transform your relationship to them The power of acceptance and different ways to come to acceptance Reflecting on a quote from Byron Katie
