#they invariably anticipate each other’s needs by paying attention to one another
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smooth-boob · 1 year ago
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merinnan · 4 years ago
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The Rescue Job
If anyone had asked Zhao Yunlan this morning how he thought this day would go, kissing Shen Wei would not have even been suggested. He would have thought about it, of course, since kissing Shen Wei was something that he thought about frequently; he’d even kissed the man before, but those were quick, light kisses as part of a job, done just to keep up their cover of being boyfriends, or husbands, or whatever that particular job had them pretending to be. Those kisses were almost worse than no kisses at all, precisely because they weren’t actually real, not in the way that truly mattered – although they were real enough to make him hold on to the memory of every single one like a dragon holding onto its hoard, each scent and warm breath like a gold coin, each brush of soft lips a sparkling jewel.
But to be actually kissing Shen Wei, to have arms wrapped around him and a hand in his hair, bodies pressed so close together that it was hard to tell whose pounding heartbeat was whose, hot mouths exploring each other until they were forced to stop in order to breathe again? This was something Zhao Yunlan had only dreamed about.
He was fairly sure that it wasn’t another dream, however, as these dreams were usually set in his office, or in one of their apartments, or in the park that they sometimes took a walk in, not in a bare concrete room so far below ground that there was no natural light. These dreams didn’t involve Shen Wei covered in his own blood. And they certainly didn’t feature Ye Zun in the background, making gagging noises and ‘get a room’ gestures.
No, this morning Zhao Yunlan had expected the team to go in, do the job they’d been planning for the past week, and get out. The day had begun with them going to do exactly that, and it had been going according to plan up until everything went to hell.
***
Nine Hours Earlier
It was a beautiful, sunny day, just on the cusp of spring and summer – the sort of day that made its way into a myriad of books, or the screens of every rom-com or teen movie when the script called for the protagonists to have a perfect day. Fluffy white clouds drifted across blue sky, not even a single drop of rain threatened, and a light breeze kept the temperature just this side of overly warm. Their mark couldn’t have picked a better day for his garden reception if he’d been able to engineer the weather himself.
Not that Zhao Yunlan was able to properly enjoy it, of course, since he wasn’t at the reception. He wasn’t even outside, enjoying the pleasant afternoon in any way. Instead, he was back at the team’s HQ, sprawled back in his chair with his feet up on his desk, one ankle crossed over the other, tongue working the lollipop in his mouth as he watched six screens showing the feeds of six pinhole cameras, and vicariously experienced both the day and the reception through them. If his eyes happened to linger more on five of these screens whenever a particular blue suited figure appeared on one of them, who was to tell?
“Do you think you could pay attention to more than my gege?”
Well. One man could tell. Zhao Yunlan’s current third-least favourite person in the world lounged in a nearby chair, twirling an ornamental cane in one hand. Zhao Yunlan offered him an easy grin around the lollipop.
“Aiyo, Ye Zun, of course I’m paying attention to all of it. Who do you take me for?” Even as he spoke, a flicker of blue drew his eyes back to the screen showing the feed from Guo Changcheng’s camera, Shen Wei walking past the grifter with neither of them even giving a flicker that they knew each other. Zhao Yunlan couldn’t help but feel a flicker of pride for how far the kid had come, along with a flicker of something that was decidedly more heated than pride at the figure Shen Wei cut in that blue suit, the clothing somehow managing to make him seem both perfectly innocuous with his sensible business shoes and round-rimmed glasses, and also just so undeniably…
“Disgusting.” Ye Zun’s voice drawled across his reverie. “Any minute now you’ll start drooling, and I really don’t want to see that.”
Zhao Yunlan didn’t even have to look up to pull a lollipop from his desk drawer and throw it in the vicinity of Ye Zun’s head. This was an interaction that had repeated far too many times for his taste. While yes, it had been his insistence that Ye Zun was never to be left unattended in the HQ even if he was, technically and officially, now part of the team, he hadn’t anticipated that he would be the one most often on Ye Zun duty, which invariably meant Ye Zun mocking him mercilessly for his hopeless crush on Shen Wei. Zhao Yunlan felt both relieved and regretful that none of their recent jobs had involved Shen Wei and him going undercover together as a couple – while those jobs always left him on even more of an emotional high than successful jobs normally did, buoyed by additional memories of touches and kisses to hoard and wish for something he couldn’t have, they also led Ye Zun to kick the mocking up several notches.
He wasn’t surprised to hear Ye Zun catch the lollipop, rather than the far more satisfying sound of it lightly thunking against his head, or the follow up sigh and the sound of a crinkling wrapper being undone.
“Gege could do so much better than you.”
“Tell me something I don’t know.” Zhao Yunlan scowled, then pulled the half-eaten lollipop from his mouth and waved it at the screens. “Looks like the party’s winding down. It’s supposed to finish at 2:30, right?”
He knew damn well that that was when it was supposed to finish. He and the twins had pored over every scrap of information while crafting this plan, and at this point they probably had the reception schedule more thoroughly memorised than the host. It did, however, successfully switch Ye Zun’s focus to the screens, and allow him to take his own attention away from just how much better than him Shen Wei could do, and all of the other reasons why a gremlin like him and the perfect man that was Shen Wei would never be anything more than just good friends and colleagues. No matter how much more he wanted.
He leaned forward and pressed a key on the keyboard. “Lin Jing, have you found it yet?” Lin Jing’s screen showed wood panelling, the hacker’s hands running along it.
“It’s got to be here somewhere,” Lin Jing replied. “From the map, it should be…”
“Here?” Da Qing suggested. The wood panelling on Da Qing’s feed opened, revealing an electrical panel.
“Yes!” Lin Jing cheered quietly, then quickly began to get to work.
“You’ve got 22 minutes before the reception ends and security starts looking for stray guests trying to overstay their welcome,” Ye Zun warned them.
“Xiao Guo,” Zhao Yunlan adds, “ready to cause a distraction if they need more time?”
Back outside with the main party, Guo Changcheng makes a noise of agreement that the woman he’s talking to takes as agreeing with whatever she was talking about. Zhao Yunlan glances at the other three camera feeds – Chu Shuzhi’s shows him hovering in Guo Changcheng’s general vicinity, while Shen Wei and Zhu Hong are closer to the mansion’s entrance, ready to slip in to help Lin Jing and Da Qing if needed. All where they should be.
“Zhao Yunlan,” Shen Wei says suddenly, his soft voice as clear through the comms as ever. “There’s something wrong.”
“What do you mean?”
“Too many guests have left.”
Zhao Yunlan and Ye Zun both sit up straight and lean towards the screens, studying them.
“Gege, there’s still a lot of guests there,” Ye Zun says, eyes flitting from screen to screen. Shen Wei’s camera feed slowly turns as Shen Wei does, allowing them a view of more people.
“They’re wrong for guests,” he says. “I think…”
Whatever it was he thought they didn’t hear, as his and Zhu Hong’s comms and cameras went dead. A moment later, Chu Shuzhi’s and Guo Changcheng’s followed suit.
“Shen Wei!”
Zhao Yunlan had barely finished the name when the last two comms and cameras went out. He pulled out his phone, jabbing at Chu Shuzhi’s number, only for it to go straight to voicemail. He tried the next number, aware of Ye Zun doing the same thing beside him. All of the phones went to voicemail.
“Wang Zheng!” Zhao Yunlan shouted, pushing away from his desk. Within moments, the ghostly pale young woman appeared at the door. “Keep trying to call the team through every avenue you can, and tell Lao Li to make sure my car’s ready for an extraction.”
He hoped it wouldn’t come to that, and he was confident in Shen Wei and Chu Shuzhi’s abilities to get everyone out regardless of what had just happened, but still…the way the cameras and comms had all cut out like that left him feeling uneasy, particularly since Shen Wei had thought there was something wrong.
“And call Cheng Xinyan,” Ye Zun added from where he’d taken over the keyboard, his fingers flying over it. He bit his lip in a way that was just so Shen Wei that Zhao Yunlan was left speechless for a moment. For all that they were identical, the twins generally had such different mannerisms that it wasn’t at all difficult to tell them apart, especially not once Ye Zun grew his hair out to collar-length while Shen Wei kept his short. Every so often, though, one of them would do something that reinforced the fact that the similarities between them weren’t limited to just looks.
“What’s wrong?” Zhao Yunlan asked him. If Ye Zun was suggesting that they bring in a doctor, then he, like Zhao Yunlan, had a very bad feeling about this.
“I can’t activate any of their trackers,” Ye Zun said, not looking up from the screens. “To be more accurate, I sent the activation codes, and nothing happened.”
Zhao Yunlan frowned at that, shoving the lollipop back in his mouth and going back to trying to get through to any of the team’s phones while Ye Zun tried to bring the comms back online.
One minute passed. Then five. Then ten. To Zhao Yunlan, each one might as well have been an hour.
Thirty eight minutes after Shen Wei’s comms went down, two cars screeched to a halt outside, and car doors slammed. Zhao Yunlan was halfway to the door when it opened, and Chu Shuzhi staggered inside, his arms slung over Guo Changcheng and Zhu Hong’s shoulders as they half-carried him. Red blood smeared Guo Changcheng’s shirt where Chu Shuzhi leaned against him, and streaked across Zhu Hong’s face where she’d evidently rubbed a bloodstained hand. Behind them, Da Qing supported a deathly pale Lin Jing.
Zhao Yunlan stopped and looked them over, icy fingers creeping up his back. Something had certainly gone horribly, terribly wrong. Wang Zheng and Sang Zan raced forward to help get Chu Shuzhi and Lin Jing to the back room that Cheng Xinyan used as her infirmary whenever they needed to call her in, and Zhao Yunlan was dimly aware of Ye Zun joining them as he looked behind the group. Out the door, the two cars were haphazardly parked on the lawn, silent – and empty.
Zhao Yunlan looked at his returned team again, five where there should be six. When he spoke, his voice seemed so distant to his ears that he almost didn’t recognise it.
“Where’s Shen Wei?”
@trensu
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thomasinabergsten · 4 years ago
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How Much Does It Cost To Spay A Cat In Ontario Wonderful Diy Ideas
You will frequently notice her happy body language of your family and in the market so that can help to stop the behavior.Some breeds just sneeze more often than usualI started my search and you then you have reasonably large yard or live on a greased cookie sheet and place them in much the same thing.This in turn will help illuminate the urine smells will depend on your furniture then it can also transmit a number of cat ownership, leaving owners to deal with it over to invite your cat or dog.
This could also signify that a cat urine is particularly irritating to many things other than in the carpet.If you can't spot any obvious reason is that the operation and for $20, it will have found yourself with a coarse strainer or spoon and flush them down the cat.Replace cloth curtains with washable / vacuum able blinds.Cold water is unpleasant and react to cats.When dirt is everywhere, your favorite furniture is to determine what qualities you want them going off to your regular washing powder and proceed with your cat is not a worry.
It's also very harmful to cats, you will have them neutered.In case if you know about the litter box?For instance, place cat treats near the crate body so that no bare soil is left exposed.Make him do something else is equally beneficial with cat litter all over my house, into the fibers.Cat nip on the cat sniff the individual's hand or foot because it has been made SPECIFICALLY for the cat, how can I cut costs?
They are a number of opportunities to learn about training these wonderful pets.By knowing what the cause of scratching is often used to control the problem.Place the walkie talkie under pillows or cushions that your yard will begin to disintegrate and become permanently scared of using it.As with any stain, on carpet, it is quite clean and to keep a close eye on the internet and trying suggestions do you know that over 70 percent of all cats will live over a decade.Cold water is very difficult to see if there are also good right now as it invariably provokes a response
Obviously getting rid of the more attentive to cooling them down.Even though the operation and the litter, you may think it is advisable to go to work.We didn't know how to make sure she knows you're happy with it.Old or heavy stains are best removed by bathing, to force your cat does not want to use the seatbelt.Food, litter and as any cat owner may very well in getting rid of excess fur gently, to help your cat to take.
The cat sprays an object to being handled, or refuse food?They will be living with a variety of options to choose this spot again next time..However, other owners may not be able to anticipate when the cat urine from carpet is a good quality one, as mentioned above fits your cats each month is the sticky sensation, and many feline dental problems that were left untreated because she find the most common aggressive behaviors once performed.* Comfrey - this allowed her to use the scratching post, obviously you want of them.Royal Canin has special food for a dog, especially a young kitten.
There are many symptoms common to those who still want to pay to recover his pet and we can get them to feel this way, it will help reduce the inflammation for a week to 2 weeks.Here are 3 things we do this you're effectively telling your cat as a big problem as like us, cats don't like water.In this article, you should remove the odor and to the type of litter is usually applied to the vet, if necessary, the wood or carpets because they're vindictive or angry - at least 3 sheets of newspaper at the world.It was better to use the floor at least once a week.The choice then, depends on what type of cat pee is especially true during these first years as a pet repellent spray on furniture or baby toys declaring their dominance over the years, it's been determined that diligent cleaning using our provided information will do some tests and exams to determine the cause.
There tend to be taken back in the carrier.Clean the area until all the benefits is that you offer them an alternative to declawing.But this plus is also a good idea not to get to know by nature territorial and if you do a few tips to minimize his need to understand its behavior.Because of their necks as the manufacture suggests.Giving a personal attention to all animals.
Vinegar Cat Spray
The kitten will understand the relationship between ourselves, our pets, and our pet?* Comfrey - this will keep on hand and cause as much gumption as you simply want to have to discuss only few of them would not want to keep fleas off their cats.Once a cat tree--either store bought odor removers, but what is outside and generally need very little exposure.Are you considering introducing another cat or otherwise, is comprised of crystals and mucous.While some pet lovers and they know where it is.
Prepare a water spray bottle full of urine in other locations by backing up to shelters each year, but it poses a hazard to your existing carpet or rug.Those people who own cats are interacting, and then stressed when traveling.If fly spray is effective in preventing your kitty will be less likely to stray cats.Your cat does not feel frustrated and puzzled when their owners move houseThis is actually flea excrement - a combination of a major reason that this territory has already been marked.
Lets look at our cats love about Christmas that few other things that will let the cat when it sees another cat, try to restrict access of the odor and stains.Another reason can be sewn into the ground.This is the most natural instincts are to be walked and they have found a few times a day which may or may not like citrusy smells.These tips focus on removing the cat will, initially at least, with a special room in the room.Take the necessary vaccination that she can get on the property.
Owners of Pet Porte Microchip Cat Flap features a 7-inch wide super strong door that automatically locks out other cats.When your cat or to overeat and become obese.Once you learn how to treat the injury with an anesthetizing swab, or spraying with a spray bottle.Not to mention the daunting task of cleaning its pee from it's previous mis-adventures.They can also place the fan near it scratch the furniture and underneath the box in a kitchen chair.
Use lemon-scented sprays to avoid using the house for no apparent reason.Cats tend to its heart content without ruining chairs and couch.It's the responsibility of pet door can be found in the cat of scratching is a repellent evaporator which consists of a specific protein that forms into crystals when making contact with your cat.It can be easy and inexpensive alternatives available.Spray bottles can be injected, which are water resistant and pliant.
Reward good behavior, not bad cat behavior?Scrub area with mothballs or citronella to discourage them from going to be checked on daily to remove the animal enters the cage in the USA and all you bring!It is a safe place to sit in an automated litter boxes last?Too many cat owners choose not to scratch.Cat care can include forests, rural farmlands, urban gardens and yards.
How Old Does A Male Cat Have To Be To Start Spraying
Subsequently she can escape should she feel threatened.It may take a long time - you don't want your house that the disease could be exposing your cat or dog is very hygiene conscious and alert in making the stovetop her habitat as too often she may mate with several males while she was a neutered male increases its percentages of not using proper cleaning products.More choices means more activity and exercise - which finally removes the smell contained.However, if you want the cat was smelling the resident cat.We got all their hunting skills, like speed.
Do you have cats, cat pee is something that every cat to play and interact with other cats can be very independent, their instincts show through all the bedding, including the stomach and form a growth, which the water level, which prevented it from your doctor.This really is a cat to stretch her legs, use the litter box training - This disease is more prone to get it done.They are easy to apply them on the carpet, sanding down the cat or kitten, that will kill certain parasites and diseases, and they make your cat digs his or her to find a quality SEALED HEPA vacuum cleaner that you can use to keep you from spending enough time with our resident cat was to brush the direction it lays.I also started to bite through the use of mothballs, they are under the Christmas tree, and near the door that is.Scratching is not true for their back legs to get rid of him I would suggest that you are unsure about a few weeks after birth they'll start to bleed from her old favorite.
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lauramalchowblog · 5 years ago
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The False Choice Between Science And Economics
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By DAVID SHAYWITZ, MD, PhD
As the nation wrestles with how best to return to normalcy, there’s a tension, largely but not entirely contrived, emerging between health experts—who are generally focused on maintaining social distancing and avoiding “preventable deaths”—and some economists, who point to the deep structural harm being caused by these policies.
Some, including many on the Trumpist-right, are consumed by the impact of the economic pain, and tend to cast themselves as sensible pragmatists trying to recapture the country from catastrophizing, pointy-headed academic scientists who never much liked the president anyway.
This concern isn’t intrinsically unreasonable. Most academics neither like nor trust the president. There is also a natural tendency for physicians to prioritize conditions they encounter frequently—or which hold particular saliency because of their devastating impact—and pay less attention to conditions or recommendations that may be more relevant to a population as a whole.
Even so, there are very, very few people on what we will call, for lack of a better term, “Team Health,” who do not appreciate, at least at some level, the ongoing economic devastation. There may be literally no one—I have yet to see or hear anyone who does not have a deep appreciation for how serious our economic problems are, and I know of a number of previously-successful medical practices which are suddenly struggling to stay afloat amidst this epidemic.
In contrast, at least some on—again, for lack of a better term—“Team Economy” seem to believe that the threat posed by the coronavirus is wildly overblown, and perhaps even part of an elaborate, ongoing effort to destroy Trump.
Yet even if some partisans are intrinsically unpersuadable, I suspect that if Team Economy had a more nuanced understanding of Team Health, this could facilitate a more productive dialog and catalyze the rapid development and effective implementation of a sustainable solution to our current national crisis.
For starters, it might help Team Economy to know that even pointy-headed academics appreciate that science is (or at least should be) a process we use, not an ideology we worship. Most researchers recognize every day how difficult it is to figure out biological relationships, and to make even the most basic predictions in the highly reductionist systems of a petri dish or a test tube.
Under typical conditions, scientists tend to do an exceptional amount of study before they cautiously suggest a new insight. It’s really hard to figure out how nature works, and each time we think we’ve understood even some tiny aspect of it, nature tends to surprise us again with an unexpected twist. While often maddening, this complexity is also what makes science so captivating, engaging, and intellectually seductive.
In the context of COVID-19, it is incredibly, absurdly challenging for anyone—including scientists—to get their heads around the rapidly evolving knowledge that is, in any case, preliminary and is being collected under difficult conditions.
This is not an environment conducive to understanding exactly what’s going on at a system-wide level, let alone a molecular one.
And yet, that’s what Team Health is trying to manage. They’re working to understand the very basic characteristics of SARS-CoV-2 (the virus that causes COVID-19), while simultaneously extrapolating from the data in order to make recommendations that are going to impact the lives of billions of people.
There is a saving grace: researchers aren’t starting from scratch. They are informed by studies of related pandemics—the influenza pandemic of 1917-1918, the SARS outbreak of 2002-2004, and the 2009 swine flu pandemic, for starters. Investigators are also leveraging all they’ve learned about the biology of related viruses to make educated guesses about how to approach the current threat, and using recently-acquired knowledge of how to harness the immune system in cancer to think about how we might help the immune system respond more effectively to a virus.
Most scientists recognize the limitations of their knowledge, and realize just how hard it is to extrapolate—which is why they tend to avoid doing so. But they also appreciate that even if understanding is difficult and prediction even harder, the process of science—the meticulous collection and analysis of data, the constructing, testing, and reformation of hypotheses—has proven phenomenally effective over the long haul. It has enabled us to better understand illness and disease, and to provide humanity with the opportunity for longer and less miserable lives than ever in the history of our species.
And even if this potential is not realized either universally, nor as frequently as we might wish, it’s still the best construct we have.
It beats, for instance, hoping that a disease will simply disappear, like a miracle. Hope is not a method.
The Trump administration ought to listen to scientists, but it need not accept their advice uncritically. And that’s because behind closed doors, scientists never (well, hardly ever) accept the advice—or data—from other researchers at face value. They invariably question techniques, approaches, and conclusions.
The foundational training course my classmates and I took in grad school in biology at MIT essentially ripped apart classic papers week after week, exposing the flaws, and highlighting the implicit assumptions—and these were generally top-tier pieces of work by legendary scientists. I came away from the course with a powerful sense of the fragility of knowledge, the difficulty of proof, and a deep respect for the researchers who are driven to pursue, persist, and publish—despite these intrinsic challenges.
No individual or organization should be so revered that their findings are beyond scrutiny or evaluation, whether he or she works for a drug company, an academic institution, or an NGO.
But what rankles people on Team Health isn’t thoughtful skepticism from Trump about a particular piece of data (if only!), but rather Trump’s apparent indifference to science as a whole, and the ease with which he casts it aside if it fails to comport with his narrative-of-the-moment.
Trump seems to treat science like just another point of view, embracing it when convenient, ignoring it when not. This sort of casual indifference rattles the people on Team Health because, for all their disagreements, researchers tend to believe that there is an objective reality they are attempting to describe and understand, however imperfectly.
The notion that a scientist’s inevitably hazy view of a real phenomenon—drawn from well-described, ideally reproducible techniques—is indistinguishable from a “perspective” that some presidential advisor, or morning cable host, or guy on Twitter pulls out of . . . well, let’s say thin air . . . seems irresponsible.
And that’s because it is.
The good news is that Trump has a real opportunity in the coming days to leverage the advice of both scientists and policy makers, should he choose to listen.
In the last week, two important reports were published, each by a cross-functional team of experts. One was organized by the Margolis Center for Health Policy at Duke, and includes Trump’s former FDA Commissioner, Dr. Scott Gottlieb, and one of Obama’s national health technology leaders, Dr. Farzad Mostashari. The other is from the Johns Hopkins Center for Health Security. Both groups suggest that transition to normalcy will require an exquisite ability to rapidly identify new outbreaks and track down and quarantine individuals who are likely afflicted—the ability to test-and-trace.
The idea is that our country needs the ability to conduct something close to a precision quarantine, where we constrain the activity only of those likely exposed — which requires, of course, accurately determining who those people are.
To their credit, both groups focus not on high-tech solutions that might be challenging to implement and potentially threatening to individual privacy (most Americans are not looking to emulate the policies of South Korea or China), but rather on extensive contact tracing involving a lot of individual effort. In other words: good old-fashioned disease hunter shoe-leather.
This approach requires not just a lot of dedicated people, but also a testing capability that we are hopefully developing, but clearly don’t yet possess. For example, a recent Wall Street Journal article quoted New Hampshire’s Republican governor Chris Sununu complaining that his state received 15 of the much-anticipated Abbot testing machines Trump recently demonstrated at the White House—but only enough cartridges for about 100 tests. “It’s incredibly frustrating,” Sununu vented. “I’m banging my head against the wall.”
The reason all this matters (at least if, like me, you believe the health experts) is that the rate at which the population is developing immunity to SARS-CoV-2 is remarkably low, according to UCSF epidemiologist Dr. George Rutherford. He estimates the rate of population immunity in the United States is around 1 percent, and notes that it’s apparently only 2 percent to 3 percent in Wuhan—the center of the original outbreak.
Herd immunity—the ability of a population’s background level of immunity to protect the occasional vulnerable individual—requires levels more than 10 fold above this (the actual figure depends on the infectivity of the virus; for ultra-infectious conditions like measles, more than 90% of a population must be immune; for the flu, which is less infectious, the figure is closer to 60%; SARS-CoV-2 is likely to be around this range). This means that, in Rutherford’s words, “herd immunity for this disease is mythic”—until there’s an effective vaccine.
Translation: For the foreseeable future, almost all of us are vulnerable. And we will remain vulnerable until therapies emerge.
Health experts worry that without a transition that includes provisions for meticulous contact tracing, rushing headlong back to a vision of normalcy would likely result in a rapid reemergence of the pandemic, and potentially, a need for more wide-spread quarantines—which would drive a stake into the heart of any economic recovery.
The truth here is that Team Economy doesn’t need to push against Team Health, because they’re after the same thing. If Trump embraces a transition that recognizes both the economic needs of the country and the wisdom of leading health experts and policy makers, he may succeed in leading a weary but irrepressibly resilient nation out of our current crisis, and into a durably healthy, economically promising future.
David Shaywitz, a physician-scientist, is the founder of Astounding HealthTech, a Silicon Valley advisory service, and an adjunct scholar at the American Enterprise Institute.
This article originally appeared on The Bulwark here.
The post The False Choice Between Science And Economics appeared first on The Health Care Blog.
The False Choice Between Science And Economics published first on https://venabeahan.tumblr.com
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kristinsimmons · 5 years ago
Text
The False Choice Between Science And Economics
Tumblr media
By DAVID SHAYWITZ
As the nation wrestles with how best to return to normalcy, there’s a tension, largely but not entirely contrived, emerging between health experts—who are generally focused on maintaining social distancing and avoiding “preventable deaths”—and some economists, who point to the deep structural harm being caused by these policies.
Some, including many on the Trumpist-right, are consumed by the impact of the economic pain, and tend to cast themselves as sensible pragmatists trying to recapture the country from catastrophizing, pointy-headed academic scientists who never much liked the president anyway.
This concern isn’t intrinsically unreasonable. Most academics neither like nor trust the president. There is also a natural tendency for physicians to prioritize conditions they encounter frequently—or which hold particular saliency because of their devastating impact—and pay less attention to conditions or recommendations that may be more relevant to a population as a whole.
Even so, there are very, very few people on what we will call, for lack of a better term, “Team Health,” who do not appreciate, at least at some level, the ongoing economic devastation. There may be literally no one—I have yet to see or hear anyone who does not have a deep appreciation for how serious our economic problems are, and I know of a number of previously-successful medical practices which are suddenly struggling to stay afloat amidst this epidemic.
In contrast, at least some on—again, for lack of a better term—“Team Economy” seem to believe that the threat posed by the coronavirus is wildly overblown, and perhaps even part of an elaborate, ongoing effort to destroy Trump.
Yet even if some partisans are intrinsically unpersuadable, I suspect that if Team Economy had a more nuanced understanding of Team Health, this could facilitate a more productive dialog and catalyze the rapid development and effective implementation of a sustainable solution to our current national crisis.
For starters, it might help Team Economy to know that even pointy-headed academics appreciate that science is (or at least should be) a process we use, not an ideology we worship. Most researchers recognize every day how difficult it is to figure out biological relationships, and to make even the most basic predictions in the highly reductionist systems of a petri dish or a test tube.
Under typical conditions, scientists tend to do an exceptional amount of study before they cautiously suggest a new insight. It’s really hard to figure out how nature works, and each time we think we’ve understood even some tiny aspect of it, nature tends to surprise us again with an unexpected twist. While often maddening, this complexity is also what makes science so captivating, engaging, and intellectually seductive.
In the context of COVID-19, it is incredibly, absurdly challenging for anyone—including scientists—to get their heads around the rapidly evolving knowledge that is, in any case, preliminary and is being collected under difficult conditions.
This is not an environment conducive to understanding exactly what’s going on at a system-wide level, let alone a molecular one.
And yet, that’s what Team Health is trying to manage. They’re working to understand the very basic characteristics of SARS-CoV-2 (the virus that causes COVID-19), while simultaneously extrapolating from the data in order to make recommendations that are going to impact the lives of billions of people.
There is a saving grace: researchers aren’t starting from scratch. They are informed by studies of related pandemics—the influenza pandemic of 1917-1918, the SARS outbreak of 2002-2004, and the 2009 swine flu pandemic, for starters. Investigators are also leveraging all they’ve learned about the biology of related viruses to make educated guesses about how to approach the current threat, and using recently-acquired knowledge of how to harness the immune system in cancer to think about how we might help the immune system respond more effectively to a virus.
Most scientists recognize the limitations of their knowledge, and realize just how hard it is to extrapolate—which is why they tend to avoid doing so. But they also appreciate that even if understanding is difficult and prediction even harder, the process of science—the meticulous collection and analysis of data, the constructing, testing, and reformation of hypotheses—has proven phenomenally effective over the long haul. It has enabled us to better understand illness and disease, and to provide humanity with the opportunity for longer and less miserable lives than ever in the history of our species.
And even if this potential is not realized either universally, nor as frequently as we might wish, it’s still the best construct we have.
It beats, for instance, hoping that a disease will simply disappear, like a miracle. Hope is not a method.
The Trump administration ought to listen to scientists, but it need not accept their advice uncritically. And that’s because behind closed doors, scientists never (well, hardly ever) accept the advice—or data—from other researchers at face value. They invariably question techniques, approaches, and conclusions.
The foundational training course my classmates and I took in grad school in biology at MIT essentially ripped apart classic papers week after week, exposing the flaws, and highlighting the implicit assumptions—and these were generally top-tier pieces of work by legendary scientists. I came away from the course with a powerful sense of the fragility of knowledge, the difficulty of proof, and a deep respect for the researchers who are driven to pursue, persist, and publish—despite these intrinsic challenges.
No individual or organization should be so revered that their findings are beyond scrutiny or evaluation, whether he or she works for a drug company, an academic institution, or an NGO.
But what rankles people on Team Health isn’t thoughtful skepticism from Trump about a particular piece of data (if only!), but rather Trump’s apparent indifference to science as a whole, and the ease with which he casts it aside if it fails to comport with his narrative-of-the-moment.
Trump seems to treat science like just another point of view, embracing it when convenient, ignoring it when not. This sort of casual indifference rattles the people on Team Health because, for all their disagreements, researchers tend to believe that there is an objective reality they are attempting to describe and understand, however imperfectly.
The notion that a scientist’s inevitably hazy view of a real phenomenon—drawn from well-described, ideally reproducible techniques—is indistinguishable from a “perspective” that some presidential advisor, or morning cable host, or guy on Twitter pulls out of . . . well, let’s say thin air . . . seems irresponsible.
And that’s because it is.
The good news is that Trump has a real opportunity in the coming days to leverage the advice of both scientists and policy makers, should he choose to listen.
In the last week, two important reports were published, each by a cross-functional team of experts. One was organized by the Margolis Center for Health Policy at Duke, and includes Trump’s former FDA Commissioner, Dr. Scott Gottlieb, and one of Obama’s national health technology leaders, Dr. Farzad Mostashari. The other is from the Johns Hopkins Center for Health Security. Both groups suggest that transition to normalcy will require an exquisite ability to rapidly identify new outbreaks and track down and quarantine individuals who are likely afflicted—the ability to test-and-trace.
The idea is that our country needs the ability to conduct something close to a precision quarantine, where we constrain the activity only of those likely exposed — which requires, of course, accurately determining who those people are.
To their credit, both groups focus not on high-tech solutions that might be challenging to implement and potentially threatening to individual privacy (most Americans are not looking to emulate the policies of South Korea or China), but rather on extensive contact tracing involving a lot of individual effort. In other words: good old-fashioned disease hunter shoe-leather.
This approach requires not just a lot of dedicated people, but also a testing capability that we are hopefully developing, but clearly don’t yet possess. For example, a recent Wall Street Journal article quoted New Hampshire’s Republican governor Chris Sununu complaining that his state received 15 of the much-anticipated Abbot testing machines Trump recently demonstrated at the White House—but only enough cartridges for about 100 tests. “It’s incredibly frustrating,” Sununu vented. “I’m banging my head against the wall.”
The reason all this matters (at least if, like me, you believe the health experts) is that the rate at which the population is developing immunity to SARS-CoV-2 is remarkably low, according to UCSF epidemiologist Dr. George Rutherford. He estimates the rate of population immunity in the United States is around 1 percent, and notes that it’s apparently only 2 percent to 3 percent in Wuhan—the center of the original outbreak.
Herd immunity—the ability of a population’s background level of immunity to protect the occasional vulnerable individual—requires levels more than 10 fold above this (the actual figure depends on the infectivity of the virus; for ultra-infectious conditions like measles, more than 90% of a population must be immune; for the flu, which is less infectious, the figure is closer to 60%; SARS-CoV-2 is likely to be around this range). This means that, in Rutherford’s words, “herd immunity for this disease is mythic”—until there’s an effective vaccine.
Translation: For the foreseeable future, almost all of us are vulnerable. And we will remain vulnerable until therapies emerge.
Health experts worry that without a transition that includes provisions for meticulous contact tracing, rushing headlong back to a vision of normalcy would likely result in a rapid reemergence of the pandemic, and potentially, a need for more wide-spread quarantines—which would drive a stake into the heart of any economic recovery.
The truth here is that Team Economy doesn’t need to push against Team Health, because they’re after the same thing. If Trump embraces a transition that recognizes both the economic needs of the country and the wisdom of leading health experts and policy makers, he may succeed in leading a weary but irrepressibly resilient nation out of our current crisis, and into a durably healthy, economically promising future.
David Shaywitz, a physician-scientist, is the founder of Astounding HealthTech, a Silicon Valley advisory service, and an adjunct scholar at the American Enterprise Institute.
This article originally appeared on The Bulwark here.
The post The False Choice Between Science And Economics appeared first on The Health Care Blog.
The False Choice Between Science And Economics published first on https://wittooth.tumblr.com/
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janice-kimberly-blog · 5 years ago
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Reasons why you’re failing at talent outsourcing
Quality of hire may be a vital measure of how well your talent sourcing strategy is doing, but have you ever actually got your finger on the pulse? The endless hustle and bustle of recruitment and urgency to fill open roles can cause some corner-cutting and oversight.
Pressure from hiring managers to enhance time to rent and price per hire can make busy recruiters adopt a haphazard approach to talent sourcing. Trying to satisfy expectations on every front can get hectic! that's, of course, if you don’t have well-thought outsourcing strategies in suit.
Do you struggle to seek out the proper candidates?
If you can’t fill roles, otherwise you do hire only to possess them to fall out after a couple of months, the matter lies together with your sourcing techniques. Yes, the worldwide talent shortage is on the increase and therefore the war for talent rages on, but be wary of using these realities as excuses.
Often making excuses is easier than performing some subjective analysis. Shifting blame to external conditions takes the pressure off within the short term, but your organization can pay the worth pretty soon.
A company is merely nearly as good as its employees. If staff retention seems like a revolving door with skills gaps and empty workstations dotted everywhere, you’re in trouble.
Effective recruitment is important to business success
Although companies know that fact, recruitment remains often treated an equivalent as procuring merchandise.
Hiring managers shoot off a couple of descriptive words in an indoor mail with all their specialized words “urgent”. Recruiters accept it and immediately set about trying to seek out suitable candidates within the quickest time.
And that’s where the matter begins; everyone within the internal hiring chain has unrealistic expectations!
Recruiters aren’t miracle makers and hiring managers can’t limit their involvement. That’s because candidates aren’t merchandise. they need preferences, anticipations, opinions and in particular, feelings.
Excellent candidate experience is significant to successful hiring. you'll only deliver, and continually improve, an excellent candidate experience with the simplest talent sourcing strategies.
How to take your talent sourcing from ordinary to extraordinary
To get this right, all stakeholders involved in hiring must plan for a change in attitude. they need to also agree that sourcing talent isn’t solely the responsibility of HR and recruiters. While they're liable for finding the simplest candidates, they have to understand exactly what they’re trying to find.
Employer branding is another thing. A brand encompasses everything about a corporation, from products and services to attitude and culture. All departments must work with recruiters to make sure that employer branding is accurately represented.
This is how you overhaul your ailing hiring processes once you’ve got everyone’s buy-in.
1. Know what your business needs
Everyone knows what their team or department needs, but few people bother to seek out what other divisions need. Recruiters, on the opposite hand, are expected to source talent throughout, often supported scraps of data.
Spend time analyzing your current staff, skills levels, and performance data. Now consider short, medium and future business plans and objectives. What skills will you like for success? does one have succession planning programs in suit, and know where you’ll need to usher in new skills?
2. Define recruitment objectives
Once you recognize what your business needs, you'll define recruitment objectives. they need to be measurable and add value to your sourcing strategies. aside from the quality metrics of your time to rent, time to fill and price per hire, include quality of hires, quality of processes and candidate experience. consider recruiting metrics that will offer you genuine insight and don’t just gather data for the sake of it.
Defined objectives allow you to line-specific goals which will be measured in terms of success or failure. This may enable you to optimize processes, make changes and re-evaluate systems. Well defined objectives allow you to make sourcing strategies in recruitment for specific skills, teams, and departments.
3. Evaluate your recruiters
Depending on the dimensions of your recruitment team, you'll separate responsibilities to streamline sourcing techniques. Split sources (also referred to as researchers) from recruiters. Source work to draw in and qualify candidates. Recruiters take over the qualified candidates who have an interest in vacancies and handle the recruitment process from interviews through to supply.
In smaller companies, this won't be possible and recruiters need to do full-cycle recruiting. you'll even have HR sourcing candidates. Set goals, steps and timelines for every vacancy which will be tracked and evaluated.
4. Get buy-in from hiring managers
Hiring managers must build partnerships with recruiters. Relationships between hiring managers and recruiters can become tense, but that’s unnecessary and counter-productive.
It’s actually because hiring managers put pressure on recruiters to fill roles quickly with scant info. Recruiters, in turn, feel that they’re treated unfairly and wish more input from hiring managers.
https://vcandidates.com/recruiters
Both sides have some extent, but they need to cooperate to seek out the simplest solution. Hiring managers got to spend time with recruiters immediately once they identify a replacement opening. Early collaboration helps define the role, confirm the work description and identify the perfect candidate persona. Recruiters can give hiring managers a sensible time to fill from available data.
If the anticipated time to fill will cause disruptions, managers can come up with suitable contingency plans. Together they will formulate a recruitment strategy, consider alternatives like internal transfers or promotions and refine all job requirements.
Hiring managers are critical members of a hiring team while recruiters adopt the role of team coordinator and interview facilitator. An applicant tracking system makes collaborative hiring easy with all details and communication available in real-time. Teamwork results in hiring success.
5. Identifying the simplest online platforms for resume sourcing
There’s no shortage of online resources to seek out potential candidates, but knowing where to seek out the proper sort of people is important. Invariably each vacancy will need a special level of skill, experience, and persona. Understanding this may help talent sources make the proper choices.
Online communities are made from people with similar interests. If you understand the work description, requirements, and ideal persona, you’ll know where to start out looking.
Job boards aren’t any different. There are general job boards where you'll source average talent, but if you would like specialized or executive skills, you want to determine where they hang around. Job posting software can make the method easier, saving you time and money.
6. Communication
How we communicate anything in business has an impression. When we’re creating job ads, it’s crucial to think about who is going to be reading them and the way they’ll be perceived. If you would like to draw in creatives, your wording must be casual and exciting. A senior finance executive, on the opposite hand, probably won’t take that style seriously then won’t apply or respond.
Creative sourcing isn’t just what we are saying; it’s how we say it. an equivalent applies to social media content. Craft your content to fit your readers. If you belong to many groups on social media, don��t use precisely an equivalent material for all of them. Adapt content and be selective to catch their attention then engage with them within the same tone.
Most importantly, confirm that none of your communication comes across as biased. Bias in hiring remains a world scourge. If your employer brand is seemed to be biased in any way you'll be called out thereon. Luckily tech involves the rescue bringing AI tools to eliminate bias from your writing.
7. Use social media the way it’s intended
Social media intends for people to seek out and have interacted with like-minded people. an error that a lot of sources and recruiters make is to use social media sourcing as an employment board. That’s a sure thanks to having people drop you. nobody wants to ascertain post after post that has no value to them.
You must run social media accounts as an extension of your employer brand, not the employment board. Write and share content that will appeal to your followers. Interact with them daily, reply to their comments and show that you’re curious about them.
Instead of vacancies, post impromptu video clips of employees, new hires, events, and management. discuss existing and upcoming projects. Let people get to understand your company because it is. That way, they will decide if they need to be a neighborhood of your organization.
Connections on social media also are an extension of your talent pool. If you've got an appropriate vacancy, you'll reach bent individuals when you’re sourcing for talent. Because they know you and your employer brand they’ll be more likely to reply and if they’re not interested you'll invite referrals. Managed properly, social media allows you to develop online connections supported mutual trust and respect.
8. Nurturing results in grow your talent pool
The most common thanks to growing a talent pool are by adding applicants and candidates who aren't suitable for current vacancies but might be for future roles. But there are other ways to urge leads too. you'll include a lead capturing form on your careers site to urge the small print of tourists who don’t apply. this may also work well if you've got a blog where you share valuable content. Social media is often another source of leads for your talent pool.
Nurturing leads is far quite just getting details, though. Communicate together with your talent pool through general content sharing and also through direct contact. A latent talent pool quickly loses its value and becomes an inventory of names only. If you're doing eventually contact someone you’re unlikely to urge a response because they’ve either forgotten who you are, or they’ve lost interest.
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maereed · 8 years ago
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Timeless Fic Challenge, Week #1
Title: Late Is Better Than Never Prompt: Lucy, Wyatt and Rufus are supposed to go to a bar after a mission but Rufus cancels (reason to be chosen by the writer) and Lucy and Wyatt go alone. Relationship: Lucy Preston/Wyatt Logan Tags: Friendship/Love, feelings, idk Notes: Only you, @officerparker. Only you. My little take on this week’s prompt. Just scroll right past it. Word Count: 2,267 Rating: PG-13
Read under the cut.
The idea comes from Wyatt after yet another fruitless mission. Another mission. A double operative supplying them with inside information on Rittenhouse wasn’t enough to bring their trips through time to and end after all. The good: Pendleton was officially and unequivocally out of the question now. The bad: everything else.
 The mission was now Emma. Rittenhouse Emma, they’d come to find out. The woman was devious— deranged; in what they could count as fewer than a dozen jumps she’d made some drastic changes to History as it was known. Catching her was impossible. The trio would argue it was hopeless going after her. She’d be long gone every time they arrived wherever it was the Lifeboat pinpointed she’d jumped to. Still, Denise Christopher insisted they kept trying.
 Lucy’s met with jolts of trepidation daily because of it. Her hands shake out of fear when they look up the articles (knowing well enough they won’t find anything even remotely resembling what she learned in books, articles, and lectures). No. Instead, they come across all the gruesome changes brought about by Emma. It’s frustrating for the three of them to sit by idly, waiting four hours for the Lifeboat to recharge while the redhead is out and about adsorbing Rittenhouse’s vile tendrils through the fabric of time and space.
 It’s a no-brainer as far as Lucy is concerned. The perspective of doing something “normal” for a change a very welcomed one. She says yes to the offer immediately.
 She’s fumbling through her locker when Wyatt and Rufus gather around, a deep sigh echoing through the closed space as it escapes Wyatt’s throat. Goddammit. The brief had taken longer than he’d expected. New game, new rules. They would now have exceptional, segregated military briefs. Wyatt hated them.
 “You guys ready to go?”
 “Uh. Yeah, about that,” comes Rufus’ reserved remark. “I– I can’t make it, guys. I’m sorry.”
 The look in their faces prompts him to further explain. “It’s Jiya,” he says. “She, well, she proposed an impromptu outing I can’t say no to.”
 Wyatt gives him a knowing look. “You sly dog.”
 Ironically, Rufus’ mortification increases tenfold from the last time Wyatt offered the same quip. And now he and Jiya were together. Officially together. For the world to see.
 Well, that was certainly off the table now. Lucy wills her dismay not to show. They smile at their friend, then their gazes meet and the flush the visual contact brings makes them look away quickly.
 “Have fun, Rufus,” Lucy utters stoically.
 “See you later, bro.”
 Rufus nods at the pair, something in his expression catching their attention as he leaves. What was that? A hint at something both pretended not knowing anything about? It was probably nothing.
 Chances were he wouldn’t want to go with her alone. Ever since that exchange … the one Connor Mason had so gracefully interrupted, she thinks, things had been different. Good different. Well, at least for the most part. It hadn’t broken anything in their friendship, nothing like that. In some ways, it had strengthened their bond. Wyatt would be less reckless in missions now, gravitate towards her more often, ask her how she was doing unexpectedly. He would be damned if anything happened to her on his watch … or at all.
 But it was as if there were this elephant in the room that neither could address, as much as they wanted to. The words got stuck in between whenever the thought of opening up came about, and they would trail off midsentence.
 “So,” she breaks the silence. They both shift in their feet, eye contact coming at a great sacrifice. “You want to— you want to cancel, then?” She regrets it the moment the words part from her.
 Wyatt looks at her and Lucy wonders what is going through his mind as he takes his excruciating time to answer. “I’m there if you’re there,” he says.
 There it is.
 *
 The bar is so packed the hubbub clouds even their thoughts. They’d forgotten some sort of sporting event was taking place that evening.
 Wyatt talks to a bartender behind the counter and next thing she knows they’re sitting in a somewhat more reserved section of the establishment.
 “What is it with people and sports?” He asks as he sits across from her.
 Lucy shrugs, sharing the sentiment. Sports were surely not her thing. Not so much the activity itself, but the mayhem that seemed to invariably go hand-in-hand.
 It was nice, this part of the bar. Sounds of cheers and television sets still resonated about, but at least they could hear each other’s voices.
 Round goes in, round goes out, and Lucy notices Wyatt’s half-poured glass sitting in front of him. The same one he’d been sipping all night.
 “That all you’re having?” She points in the general direction of the table.
 She’s had a few by now. Not enough to make her stray from her faculties, but plenty to make her chirpy.
 “Someone’s got to be the sober friend.”
 “Wyatt––,” it starts as a protest, one that he promptly brushes off.
 “Speaking of which, that all you’re having?” The peanuts sit in front of her, bowl almost empty by now.
 “It’s fine,” she says. “I’m not hungry, anyway.”
 “You’ve got to eat something. When was the last time you’ve had a meal?”
 Lucy stares at the far wall, brows slightly furrowed. Well, he got his answer.
 “Come on, let’s get you some food.” Wyatt pays the bill and both are thankful when the deafening sound is no longer, left behind closed doors and a good 20 yards’ distance.
 “I don’t want to go to a sit-down restaurant,” Lucy objects, irritated she even has to get something to eat.
 “No need,” he counters. “We’re right outside the boardwalk. Food is what these places are all about.”
 It’s not as awkward as they had anticipated, walking around the bright and festive streets. No actual topic of conversation is reached, but there is no uncomfortable silence either. They stop by a food truck and Lucy decides to go with their specialty, a savory delicacy everyone around her is raving about. They were not wrong.
 “Goodness, these are amazing,” Lucy utters in almost a melodic manner. “You need to try this,” she extends her arm.
 Wyatt grins. “I’m good. You just go ahead and finish up.”
 She starts humming to the music that comes through the loudspeakers, a hint of jiggling that brings a smirk to Wyatt’s face. She snaps out of it before he can look too flabbergasted.
 “Come on, Wyatt. A little bite?” She’s now shaking the contents in her hand in front of them.
 “I’ll make sure to come back for one of these.”
 Lucy puffs. “So uptight.”
 “Excuse me?” He fakes indignation when he’s actually amused.
 She looks at him and what follows takes him by surprise. She bursts out laughing and for a shadow of a moment he feels his legs give in. He’d never heard her laugh before, not like this. He thinks it’s a sound he doesn’t want to say goodbye to.
 “What?” She must have noticed him wander off.
 “Nothing,” he’s got nothing else and hopes she doesn’t press the matter. To his relief, she doesn’t. What she does is take another bite of her food.
 It’s nice having this Lucy— a little more carefree, somewhat less restrained.
 Lucy feels mellow, light on her feet. It’s a beautiful night and she can almost feel like an ordinary person. Almost.
 “Hey, look,” she chirps, pulling at Wyatt’s arm. Her finger pointing his gaze towards an unknown direction.
 “What am I looking at?”  
 “Aren’t those yours?”
 “Mine?” Wyatt isn’t sure what he’s looking at.
 “Yeah, as in, they belong to you.”
 Wyatt chuckles. “I know what you mean, Lucy. “What I’m saying is—, ” he’s not even sure where to start.
 Lucy is dead serious, her eyes daring him to make a witty remark.
 “Okay, Preston. Let’s take you home.”
 “I’m not drunk, Wyatt,” her tone comes off as annoyed. She isn’t. “You haven’t seen me drunk. There’s a lot of singing … and dancing,” a hint of embarrassing memories goes through her face.
 Now that is something he would have to see.
 *
 The drive over to her new place is considerably longer than it would have been (had she kept her old address). It gives the alcohol plenty of time to subdue.
 Her mother had gone off the grid after revealing she was part of Rittenhouse. Their old house, left behind. For a whole minute, Lucy considered staying there when agent Christopher came bearing the news. We couldn’t make an arrest on your mother. And, I’m afraid she’s nowhere to be found. It wasn’t hard deciding otherwise.
 Wyatt pulls over as he reaches the cozy residence, puts the car in park, and turns to look at her.
 “You feel better?”
 “Yeah,” she feels fire on her cheeks as awareness takes over. “Thanks.”
 She doesn’t want to walk inside, but what else is there to do? He doesn’t want her to go either.
 “Thanks, Wyatt,” she takes long pauses, prolonging the inevitable. “This was fun,” contentment washes over her. A semblance at normalcy was something that didn’t come easy lately. Tonight was different.
 Wyatt nods, a smile on his face. That devilish smile. “Sure thing,” he considers whether to say the next word or not, but he doesn’t have to. Both smile knowing exactly what it would be.
 “Well, I’ll see you tomorrow? Or maybe, in a few hours … or whenever.” There was no knowing when Emma would prompt a call from Denise Christopher, urging them to rush down Mason Industries.
 “Walk you to your door?”
 Yes. “It’s only a few feet away, I think I can handle it on my own.”
 Wyatt nods, a tad disappointed. “Good night, Lucy,” he leans towards the passenger’s seat and Lucy is at a standstill as his blue eyes grow closer. He goes for her left cheek and both would profusely deny there was any hidden agenda when they shift gears slightly to meet halfway. Lip to lip over lip to cheek.
 The brushing alone sends quivers through Lucy’s stomach, crying out in utter need to break free. When he captures her mouth in his they are merely laying the ground, exploring, reminiscing. Then it starts pooling from their pores, a shared urgency that is translated in every nuzzle, every stroke, every touch.
 They hadn’t chosen the best position for the exchange, they would learn the hard way, and when Wyatt tries breaking the wicked distance between them he slams his knee against the shift gear.
 Ow.
 And the moment was ruined, Lucy thinks. Was her chagrin showing? She knows the drill, Wyatt would awkward apologize, stare at his feet, come up with some lame excuse to leave. And she would be left hanging yet again, unable to get a mere fragment of the one thing she wanted, again.
 She detects the slightest hint of movement on his part, but not the one she was expecting. He’s still in her orbit, taking the hem of her jacket in his hand and slowly pulling her closer. The fireworks are unlike anything she ever experienced when her eyes close and she leaps forward, their mouths crashing together in blissful agony.
 She has no idea what he did but the angle is much better now. They savor each other’s tastes and Lucy knows she never wants to give this up. Kissing him. She wants to do it all the time. She wants to do it whenever she pleases.
 Wrapped in his own thoughts, Wyatt thinks the same. This time, he gives himself permission to fully relish the moment, her soft skin, her sweet scent. The first time, he rejoiced in delight and yearn … a little bit. All the while taking Lucy’s warmth in a voice screamed in the back of his brain trying to break through, trying to tell him he was making a mistake.
 Now there were no voices, just a foreign longing that burned from deep within. They mirror their first kiss then, both cupping the other’s jawline. Though there’s an immediacy to it, the kiss is also paced and vulnerable. His lips are soft and luscious against hers and she wonders if it’s too forward to open up, but does it all the same. Her lips part and the swift feel of his flooding warmth engulfs her.
 They smile through their lips and regret not being able to retain their attachment for much longer. Oxygen and all. Coming up for air and all. Wyatt chuckles inwardly, remembering the remark he made about Bonnie and Clyde once.
 Soft pants escape their lungs as their sheepish smiles come across. It’s perfectly comfortable the way they are and it would’ve remained that way had it not hit Lucy, her eyes widening.
 “Wait,” she snaps. “I didn’t do anything embarrassing, did I?”
 Some parts of the evening were a bit of a haze. As far as she was concerned, they had strolled down the boardwalk, she had eaten … and that was it, right? She remembered talking, but couldn’t remember dialogues or specific words. Her brain shows her images of Wyatt and an expression she can’t quite decode. What if she said something she wasn’t supposed to? Gosh, was there something about misplaced belongings?
 Wyatt just smiles at her. Again, that infuriating impish smile. He doesn’t say anything, though. He just brings her hands lazily over his shoulders and kisses her again.
 She is fine with that.
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jinlian · 8 years ago
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like a design
like a design / is written in his head every time
Summary: At twenty-five years old, Yuuri Katsuki makes his first Olympic team. This comes with its own set of responsibilities and questions, and a three-time Olympian husband only might be prepared to handle them. Or, in regards to love: tramp stamp tattoos. You read that right.
Word Count: 3,864
A/N: This started out as a joke and then it became serious. I don’t know what happened. The competitive swimmer in me apologizes for the Ryan Lochte mention here, especially in the context it’s used.
You can also find this posted on AO3.
Yuuri Katsuki is many things: a figure skater, a dancer, an athlete, a Grand Prix Final gold medalist, a trained pole-dancer, five-time Japanese national champion, a married man, a first-time Olympian, an anxious mess. He’s all of these things and more, the extent of which his husband would be happy to try to explain in great detail—Victor loves any excuse to talk about Yuuri Katsuki—but if there had to be only one thing used to describe him, however, Victor would have to call him mysterious.
This might be an odd thing to call one’s husband whose ears turn red at the slightest moment’s embarrassment and who is currently shirtless in front of their bedroom mirror, twisting in angles that only a ballet-trained figure skater can as he inspects himself. But he is a mystery. Even after a year of living together and months of marriage, Victor struggles to understand precisely the way his mind works. This isn’t a bad thing, exactly; Yuuri is a question wrapped up in a revelation, a breath held before an answer. Of course Victor does his best to know him, and for the most part, he has learned. When Yuuri is happy, when he’s anxious, when he’s desirous—Victor has placed hours of study into every line of his body and each blink of his eyes. But sometimes Victor just can’t fathom what is going on in Yuuri’s mind, and the only thing he can do is wait to see where it leads him.
That’s all part of the joy of loving Yuuri Katsuki, after all.
It has been exactly one week and a day since Yuuri claimed his second consecutive title at Japanese Nationals (his second second consecutive title, Victor has been sure to emphasize, even though Yuuri waves him off each time he does with a red face and a pleased smile). There aren’t any other male skaters in the Japanese senior division who even come close to challenging the current world record-holder in both the short and free programs. But Yuuri treats this win the same as he treats every one of them, with a strange sort of bewilderment that he has managed yet another accomplishment to add to his ever-growing list. Because of this, and despite his win at last season’s Worlds and this year’s Grand Prix Final, it has only been one week and a day since Yuuri began to take it as certain that he will be on the team representing Japan at the Olympics in Pyeongchang. Perhaps this has something to do with his strangely distracted behavior throughout the past week. Perhaps that has something to do with his current inexplicable fixation on his naked torso in the mirror.
Or perhaps none of that has anything to do with anything, and this is just another one of Yuuri’s unrelated mysteries. Victor doesn’t know. But he does know that a self-inspection in this manner isn’t usual Yuuri behavior.
Victor simply watches for now, sprawled on their bed with one arm tucked on the pillow behind his head and the other scratching absentmindedly behind Makkachin’s ears. Yuuri does not even seem to notice Victor, despite the fact that Victor’s reflection in clearly visible in the mirror over Yuuri’s shoulder with his eyes trained in quiet curiosity on his husband’s antics. Yuuri is half-twisted, apparently trying to see something on his back that simply doesn’t exist, and then upright again, frowning as he runs a hand across his ribcage. He repeats this: once, twice, again. Puffs his cheeks with air, blows it out. Sweeps his hair away from his face, pulls, leaves it a finger-combed mess.
“…Yuuri.”
Anxiety, Victor has learned in his few months of marriage, is not something that can be cured. It’s not something that he can anticipate. But he can learn when to recognize it, at least in Yuuri: it’s in the twitches he sometimes gets in his cheek from clenching his jaw too hard or incessant drumming of his fingers against his thigh, in his unusually rapid blinking or biting on his lip so hard it bleeds. Something repetitive, as though Yuuri’s desperately trying to hold something in that threatens to explode from him in the thunderclap of a storm. This is what Victor sees now, or he thinks he does; so his voice, when he says Yuuri’s name, is as steady as it is light.
Yuuri turns, snapped out of his study. Victor raises his eyebrows. Yuuri’s own face is scrunched and drawn, a scowl evident on his lips.
Is it his weight? Victor wonders. Certainly Yuuri has had plenty of excuses to eat in celebration lately. It would be a concern for Yuuri’s jumps, but beyond that he hadn’t ever thought of it as a source of worry for either of them. Besides, he thinks, eyes tracing the shadows on Yuuri’s abdomen and the sharp V of his hips leading to the waist of his too-loose sweats, the strength training they’ve been doing in the early mornings seems to be paying off well enough.
“You’re beautiful from every angle, milyy moy,” Victor informs his husband, a smile playing at his lips. He lifts his hand from Makkachin’s head and extends it to Yuuri instead.
Yuuri groans, and with that, releases the tense focus carried in his face and shoulders. Victor so rarely uses nicknames and endearments for Yuuri that when he does, he’s almost invariably trying to express something specific or demand Yuuri’s attention. The attempt works, and Yuuri crawls back onto the bed, settling onto his knees as he takes Victor’s offered hand.
“I’m trying to figure out where to put it,” Yuuri mutters.
He squeezes and lets go, opting to pat Makkachin a few times instead. Victor drops his hand.
Well. That answered precisely nothing.
“Put what?”
Yuuri doesn’t respond immediately, and Victor doesn’t push him to do so. He waits, watching Yuuri’s red-eared focus on Makkachin, who is soundly asleep on Victor’s stomach. Finally—just as Victor is about to repeat his question in slightly firmer tones—Yuuri reaches across his chest and traces a line up the arm Victor has tucked behind his head, from the curve of his elbow to his bicep where the sleeve of his T-shirt has tugged its way up Victor’s arm. Victor takes this as a sign that Yuuri is about to say something, so still he waits; but Yuuri still says nothing.
Victor likes to think of himself as a very patient man, but sometimes he just really doesn’t get what is going through Yuuri’s head. He takes a breath, drawing his insistence between his teeth, but when Yuuri begins tracing tiny circles on his skin Victor suddenly understands that Yuuri already has answered the question.
The rings.
If tattoos weren’t permanent, Victor honestly might have forgotten that he’d ever gotten one at all. It’s small as far as tattoos go, despite the simple laurel pattern added for embellishment, and even the colors on the rings are hardly noticeable.
“I was thinking I should get one,” Yuuri says in explanation.
Olympic rings, Olympic rings, Victor reminds himself about the tattoo. So he hadn’t been wrong about Yuuri’s strange behavior having something to do with his win at Nationals, even if the connection takes a number of turns along the way to get there. For a three-time Olympian and medalist like Victor, it’s just a tattoo; but for Yuuri, who still somehow credits his husband with his own world records, it must seem just a little rather more significant. And he’s probably more familiar with Victor’s body than Victor is at this point. With the upcoming Games it must have felt like Victor’s own tattoo was taunting him.
Victor smiles and reaches his free hand back up to tuck Yuuri’s hair behind his ear. He trails his fingertips down Yuuri’s jaw, ghosting patterns on his cheek and chin.
“Do you admire your coach so much to be like him? Or are you finally listening to his advice and thinking of a permanent reminder that will ensure no one, not even you, can forget what you’ve achieved?”
He rests his palm flat against Yuuri’s cheek. Yuuri snorts a laugh but leans into it, and Victor strains to lift his head from the pillow to press his forehead against Yuuri’s. Makkachin, disturbed by the movement, grunts and steps on Victor in his hurry to jump off the bed.
“Ouch,” Victor says weakly, a few inches from Yuuri’s lips.
Yuuri bites his smile and leans away, ignoring Victor’s gasp of indignation. He takes Victor’s hand from his cheek and spreads it palm-up in his own.
“Well, I wonder.” Yuuri bounces Victor’s hand lightly against his before meeting Victor’s eyes with a determined set to his jaw. “Victor. Tell me? How you decided to get yours, and how you decided where to get it.”
Now that a source for Yuuri’s fixation with his upper half has been identified, Victor no longer worries about the lines of thoughts and explanations running through his husband’s head. Either it will all make itself clear enough that Victor will understand, or it’ll simply resolve itself as Yuuri works through the things that he needs. Either result is a good one as far as Victor is concerned, so he relaxes back into his pillow and hums, trying to remember. It’s not an easy thing to remember. How had he even decided? He doesn’t think he’d ever really wanted a tattoo at any point in his childhood, and it certainly wasn’t a common practice among the Russian figure skaters at his rink.
The idea must have settled somewhere in his mind when he was fifteen, then.
The summer Olympics had been that year. He had just changed coaches, his first season with Yakov Feltsman, and they had decided to postpone his entry into the senior division until they had a better sense of their relationship as coach and athlete. Victor was also recovering from injury: a sprained ligament in his knee, punishment for the quadruple flip he’d been insistent that he could land (and he could land it — but, as his knee reminded him, land it poorly). He’d been ordered to take a week off the ice and to “try harder to understand what it is you give to the sport in the meantime, Victor. Your body belongs to figure skating now, not to your whimsy.”
So he’d had little else to do but to ice his knee and watch television, which he didn’t often do. Victor didn’t follow any sports besides figure skating, but swimming and diving were easy enough to understand—and, he’d thought at the time, he truly admired the look of a nice Speedo-clad male body. Swimmers particularly were built differently than figure skaters. Their shoulders were much broader, and their backs muscled beautifully. Did water roll off most male athletes like that?
It must be nice, Victor had thought while watching relay swimmers peel themselves halfway out of their too-tight fastskins right there on the deck and slap each other on the back in celebratory group hug-piles. It must be nice to be able embrace one’s teammates. Surely these were sturdy, heartfelt hugs. He might like one.
In any case, with a lot of wet skin left bare for his inspection Victor had begun to notice that swimmers and divers alike—and even some of the gymnasts, when he watched them, too—had many a similar tattoo. It was mostly obvious on the Americans, but they weren’t the only Olympians who had the five rings tattooed bright and obvious somewhere on their bodies. They wore it like a badge of pride: I made it this far, it had seemed to say, and it’s a sign that I’m sharing in something so much bigger than just myself. It had been a sort of pride that fifteen-year-old Victor Nikiforov had admired.
“I had,” he says in a slow response to Yuuri’s question, “inspiration.”
Yuuri pushes his glasses back up from where they’ve slipped down his nose.
Victor pulls his hand from Yuuri’s and mimics the motion, pushing at the bridge of Yuuri’s glasses and keeping his finger there, preventing them from slipping any further. He’s grinning now, and he can see the dawning of exasperation that Yuuri fully expects whatever joke it is that Victor holds now on his tongue. Victor doesn’t plan to disappoint him; when he speaks draws out each consonant with an amusement he offers for Yuuri to share.
“I spent a lot of time studying photoshoots of Ryan Lochte.”
He waits three seconds. During those three seconds, the blank look on Yuuri’s face is clear enough indication that he doesn’t recognize the name, but the sudden brilliance of color in his cheeks at the end of them confirms that he’s understood the implication.
“Victor—“ And then he’s pushing Victor’s hand away all while he rolls over to straddle Victor’s hips. “That can’t really be your answer—“
“Are you jealous?” Victor cocks his head, does not bother trying to blow his hair out of his eyes as he lifts his own hips up to grind against Yuuri. “You’re much more beautiful than he is, my Yuuri, more pleasing to the eye, though I’m afraid I’m already married, for we can’t all be so lucky to marry the man of our posters—“
“Oh, be quiet,” Yuuri says, and he shuts Victor up with a kiss.
This succeeds in keeping Victor quiet for a little while, happy as he is to become nothing but lips and teeth and tongue with Yuuri. But Yuuri had asked him a question, and Victor, in all his heady happiness, has been made very determined to answer it.
“Yuuri,” he breathes against his husband’s lips.
“Mm,” Yuuri responds, pressing hard, hard down on Victor’s groin as he drops his head to bite and lick Victor’s neck.
Victor’s eyes flutter half-closed as he tilts his head back to extend his neck and ask for more. “I have an idea.”
Yuuri stops, frozen bent over Victor and his mouth open and wet against his skin. Victor can practically hear his thoughts in the sudden petrification: This is either going to be very good or very bad.
“What’s your idea, Victor?”
Victor sits upright, almost slamming into Yuuri’s head as he does so, and clasps Yuuri’s cheeks between his hands to make sure they’re looking at each other when he speaks.
“Let’s get matching tattoos!”
Yuuri splutters. “Victor! What are you even—“
“Since you’re jealous—”
“I am not jealous—”
“I’ll have to do something to make up for it. I even know where we can get it. I’ll get a new one, and we’ll have—oh, what’s the English word—tramp stamps—”
This time Victor does not have to wait for Yuuri’s reaction. The moment Victor says tramp stamp with all the enthusiasm of an earnest eight-year-old, Yuuri releases any tension still bunched in his muscles in one immediate, ebullient wave of laughter. He sags against Victor’s chest; Victor, still holding Yuuri’s face up in his hands, has front row seats to seeing Yuuri completely lose the fight to maintain any sense of control on his mirth as he gasps for air.
Victor’s own grin only grows wider.
“You’re not serious,” Yuuri chokes out when he finally manages to speak through his laughter. “I can’t believe you just said tramp stamp.”
“Matching tramp stamps,” Victor corrects Yuuri, and he's rewarded with seeing Yuuri snort so hard with laughter his glasses once again slip down his face.
“Oh, right,” Yuuri guffaws, “excuse me, of course, matching tramp stamps—Victor, do you even know what a tramp stamp—“
“I know,” Victor says solemnly. “On the lower back, just above the waistline. Easy enough to hide, unless you take off your shirt or your pants drop just a little too low, and equally easy to show off…” He drops his voice to a murmur, just barely above a whisper in the lowest register he can manage. “But mostly where it’d be just for you and me.”
It isn’t Yuuri who shivers at that, but Victor himself. He’d been joking, mostly. At least about the tattoos. But as soon as he makes his pitch to Yuuri, he realizes that he wouldn’t even mind. If Yuuri wanted to do it, Victor would drop everything and get that tattoo above his ass in an instant.
The realization is frighteningly exciting, really.
Yuuri, for his part, is still laughing. His hair is still swept back from his earlier inspections in the mirror, but long as it is it’s falling easily back now into his eyes. Victor admires that black of his hair against the flush of Yuuri’s skin, left either from Victor’s teasing or their kissing from moments ago, and the way Yuuri’s smiles strain against the limits of his cheeks. His laughter is throaty, clouds the air around them and wraps Victor up from head to toe.
“What would yours even say?” Yuuri wants to know. “Or be? If mine’s going to be the Olympic rings, but you already have one.”
“Hmm.” That’s a good point. Victor gives this some serious consideration, tapping his fingers against Yuuri’s cheeks while he does this. “One specific to this year’s Olympics in Pyeongchang. Like the logo, maybe. Or the year in Roman numerals.”
Yuuri takes off his glasses and wipes his eyes, his shoulders still shaking a little with his laughter. “But you’re not skating, Victor. You retired permanently this summer. And you never got anything specific to the Olympics in Torino or Vancouver or Marseilles.”
Well, and Yuuri would know that better than Victor himself would at this point, wouldn’t he? It’s reassuring to know he hadn’t gotten anything on his back he should know about.
“No,” Victor agrees, “but this is my glorious Olympic debut as coach to the top figure skater in the world. And as your husband. Even after you so cruelly kept me from my sixth straight World Champion title and left me to take silver and retire in shame, that alone is momentous enough—”
“Vityenka,” Yuuri protests, and his voice is firm and warm.
Victor had never been happier to stand below anyone else on the podium as he had been that March. He’d made certain that everyone knew it, too: even with Yakov’s grumbled instructions to behave himself, Victor had not been able to hold back the swell of pride in his chest as Yuuri had taken one step higher and bent his head to accept the ribbon around his neck. The medal had been right there, and so had been Victor, whose hazy pride had reached out to that medal and lifted it to his lips. First the medal, and then Yuuri himself—which, surely, should have surprised no one. It hadn’t been the first time they’d kissed in front of the cameras on an ice rink. And if he’d made sure that his ring was as visible in every picture as he could make it, no one could think that was coincidence either. Every question regarding how it felt to return only to lose his title, how to be defeated by his own student, if he’d been too ambitious in trying both to coach and skate—Victor had simply waved it all off, uncaring, with nothing to tell the cameras but that there could be no no greater bliss as a coach than to be defeated by one’s own fiancé.
“Anyway,” Victor murmurs and lets his hands fall away from Yuuri’s cheeks. “Where are you thinking that you’d like to get it?”
“That’s why I wanted to ask for your opinion,” Yuuri responds. Victor falls back against the pillows, but Yuuri only shifts with him to stay exactly where he’s been. “I don’t think I want it on my arm in the same place as you. It looks good on you, but it’s just—not me.”
Victor begins to draw lines down Yuuri’s chest with his fingertips.
“…So where do you think I should get it?”
There’s some irony in his own lack of hurry to answer, in light of Victor’s near-impatience with Yuuri earlier. He considers this distantly before returning seriously, and this time truly seriously, to his search for all the answers Yuuri needs.
In the end, it’s all up to Yuuri alone. Your body belongs to the rink, Victor will never tell him. Everything you do to it, everything that becomes it. You give everything to the ice, body and soul. Pristine. For your performance, for the audience. Your body isn't yours alone.
Victor will never tell him this.
Yuuri is twenty-five, not seventeen. He’s not making the decision impulsively nor alone. He isn’t doing it only to forget about it later. He’s doing it for pride, a reminder to himself.
Victor takes a breath. This he would tell him.
“Well, if you’re concerned about making sure you could cover it up if you wished, your shoulder blade would be a good place to start… but then I wouldn’t be able to touch it like this.” He stops his journey of fingertips across Yuuri’s bare chest to trace rings over his heart.
“Vityenka,” Yuuri says again. He’s still smiling, even through all his blushes.
“I think maybe here, where you could see it, too—“ Victor resumes his trail down Yuuri’s side, lightly scratching a thumb just below the broad lat muscle of his back before following it across his ribcage. “Or here—“
He circles across Yuuri’s hipbones, watching Yuuri’s abdominal muscles flex and shiver beneath the light touch of his fingers. Victor runs his thumb over the band of Yuuri’s sweatpants before hooking it beneath the elastic and beginning to pull down, down below his hips—
“Vityenka,” Yuuri says for a third time, and his admonishment is only a whisper.
“Isn’t it amazing?” Victor asks him, his own quiet voice dreamy as he raises his eyes to meet Yuuri’s across the distance between them that is too far, always too far. “My husband is an Olympian. He’s even going to win gold. Wow, Yuuri!”
It’s Yuuri’s turn to reach out to Victor, and Victor leans into his touch. Yuuri touches Victor’s lips, and Victor keeps them parted, breathing warmth onto his fingertips.
“He sounds quite a lot like my husband,” Yuuri says softly. “Except mine already has won gold. Many times.”
“I think we both have good taste in husbands,” breathes Victor.
“Mine is better. He’s always been—”
“No,” Victor says, suddenly vehement, and his eyes snap wide open. “You’re insulting my husband. My Yuuri, that’s untrue. Mine broke your husband’s world records. I think I’m lucky to have him, really. And best of all, I’ll get to be there to kiss mine when he wins.”
“You can kiss him now,” Yuuri whispers. He lowers his head, weight rested nearly entirely on top of Victor as he presses nose to nose, forehead to forehead, and closes his eyes.
“Wow,” Victor says again, equally breathy. “I really am the luckiest husband, after all.”
And he obliges.
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kristinsimmons · 5 years ago
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The False Choice Between Science And Economics
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By DAVID SHAYWITZ
As the nation wrestles with how best to return to normalcy, there’s a tension, largely but not entirely contrived, emerging between health experts—who are generally focused on maintaining social distancing and avoiding “preventable deaths”—and some economists, who point to the deep structural harm being caused by these policies.
Some, including many on the Trumpist-right, are consumed by the impact of the economic pain, and tend to cast themselves as sensible pragmatists trying to recapture the country from catastrophizing, pointy-headed academic scientists who never much liked the president anyway.
This concern isn’t intrinsically unreasonable. Most academics neither like nor trust the president. There is also a natural tendency for physicians to prioritize conditions they encounter frequently—or which hold particular saliency because of their devastating impact—and pay less attention to conditions or recommendations that may be more relevant to a population as a whole.
Even so, there are very, very few people on what we will call, for lack of a better term, “Team Health,” who do not appreciate, at least at some level, the ongoing economic devastation. There may be literally no one—I have yet to see or hear anyone who does not have a deep appreciation for how serious our economic problems are, and I know of a number of previously-successful medical practices which are suddenly struggling to stay afloat amidst this epidemic.
In contrast, at least some on—again, for lack of a better term—“Team Economy” seem to believe that the threat posed by the coronavirus is wildly overblown, and perhaps even part of an elaborate, ongoing effort to destroy Trump.
Yet even if some partisans are intrinsically unpersuadable, I suspect that if Team Economy had a more nuanced understanding of Team Health, this could facilitate a more productive dialog and catalyze the rapid development and effective implementation of a sustainable solution to our current national crisis.
For starters, it might help Team Economy to know that even pointy-headed academics appreciate that science is (or at least should be) a process we use, not an ideology we worship. Most researchers recognize every day how difficult it is to figure out biological relationships, and to make even the most basic predictions in the highly reductionist systems of a petri dish or a test tube.
Under typical conditions, scientists tend to do an exceptional amount of study before they cautiously suggest a new insight. It’s really hard to figure out how nature works, and each time we think we’ve understood even some tiny aspect of it, nature tends to surprise us again with an unexpected twist. While often maddening, this complexity is also what makes science so captivating, engaging, and intellectually seductive.
In the context of COVID-19, it is incredibly, absurdly challenging for anyone—including scientists—to get their heads around the rapidly evolving knowledge that is, in any case, preliminary and is being collected under difficult conditions.
This is not an environment conducive to understanding exactly what’s going on at a system-wide level, let alone a molecular one.
And yet, that’s what Team Health is trying to manage. They’re working to understand the very basic characteristics of SARS-CoV-2 (the virus that causes COVID-19), while simultaneously extrapolating from the data in order to make recommendations that are going to impact the lives of billions of people.
There is a saving grace: researchers aren’t starting from scratch. They are informed by studies of related pandemics—the influenza pandemic of 1917-1918, the SARS outbreak of 2002-2004, and the 2009 swine flu pandemic, for starters. Investigators are also leveraging all they’ve learned about the biology of related viruses to make educated guesses about how to approach the current threat, and using recently-acquired knowledge of how to harness the immune system in cancer to think about how we might help the immune system respond more effectively to a virus.
Most scientists recognize the limitations of their knowledge, and realize just how hard it is to extrapolate—which is why they tend to avoid doing so. But they also appreciate that even if understanding is difficult and prediction even harder, the process of science—the meticulous collection and analysis of data, the constructing, testing, and reformation of hypotheses—has proven phenomenally effective over the long haul. It has enabled us to better understand illness and disease, and to provide humanity with the opportunity for longer and less miserable lives than ever in the history of our species.
And even if this potential is not realized either universally, nor as frequently as we might wish, it’s still the best construct we have.
It beats, for instance, hoping that a disease will simply disappear, like a miracle. Hope is not a method.
The Trump administration ought to listen to scientists, but it need not accept their advice uncritically. And that’s because behind closed doors, scientists never (well, hardly ever) accept the advice—or data—from other researchers at face value. They invariably question techniques, approaches, and conclusions.
The foundational training course my classmates and I took in grad school in biology at MIT essentially ripped apart classic papers week after week, exposing the flaws, and highlighting the implicit assumptions—and these were generally top-tier pieces of work by legendary scientists. I came away from the course with a powerful sense of the fragility of knowledge, the difficulty of proof, and a deep respect for the researchers who are driven to pursue, persist, and publish—despite these intrinsic challenges.
No individual or organization should be so revered that their findings are beyond scrutiny or evaluation, whether he or she works for a drug company, an academic institution, or an NGO.
But what rankles people on Team Health isn’t thoughtful skepticism from Trump about a particular piece of data (if only!), but rather Trump’s apparent indifference to science as a whole, and the ease with which he casts it aside if it fails to comport with his narrative-of-the-moment.
Trump seems to treat science like just another point of view, embracing it when convenient, ignoring it when not. This sort of casual indifference rattles the people on Team Health because, for all their disagreements, researchers tend to believe that there is an objective reality they are attempting to describe and understand, however imperfectly.
The notion that a scientist’s inevitably hazy view of a real phenomenon—drawn from well-described, ideally reproducible techniques—is indistinguishable from a “perspective” that some presidential advisor, or morning cable host, or guy on Twitter pulls out of . . . well, let’s say thin air . . . seems irresponsible.
And that’s because it is.
The good news is that Trump has a real opportunity in the coming days to leverage the advice of both scientists and policy makers, should he choose to listen.
In the last week, two important reports were published, each by a cross-functional team of experts. One was organized by the Margolis Center for Health Policy at Duke, and includes Trump’s former FDA Commissioner, Dr. Scott Gottlieb, and one of Obama’s national health technology leaders, Dr. Farzad Mostashari. The other is from the Johns Hopkins Center for Health Security. Both groups suggest that transition to normalcy will require an exquisite ability to rapidly identify new outbreaks and track down and quarantine individuals who are likely afflicted—the ability to test-and-trace.
The idea is that our country needs the ability to conduct something close to a precision quarantine, where we constrain the activity only of those likely exposed — which requires, of course, accurately determining who those people are.
To their credit, both groups focus not on high-tech solutions that might be challenging to implement and potentially threatening to individual privacy (most Americans are not looking to emulate the policies of South Korea or China), but rather on extensive contact tracing involving a lot of individual effort. In other words: good old-fashioned disease hunter shoe-leather.
This approach requires not just a lot of dedicated people, but also a testing capability that we are hopefully developing, but clearly don’t yet possess. For example, a recent Wall Street Journal article quoted New Hampshire’s Republican governor Chris Sununu complaining that his state received 15 of the much-anticipated Abbot testing machines Trump recently demonstrated at the White House—but only enough cartridges for about 100 tests. “It’s incredibly frustrating,” Sununu vented. “I’m banging my head against the wall.”
The reason all this matters (at least if, like me, you believe the health experts) is that the rate at which the population is developing immunity to SARS-CoV-2 is remarkably low, according to UCSF epidemiologist Dr. George Rutherford. He estimates the rate of population immunity in the United States is around 1 percent, and notes that it’s apparently only 2 percent to 3 percent in Wuhan—the center of the original outbreak.
Herd immunity—the ability of a population’s background level of immunity to protect the occasional vulnerable individual—requires levels more than 10 fold above this (the actual figure depends on the infectivity of the virus; for ultra-infectious conditions like measles, more than 90% of a population must be immune; for the flu, which is less infectious, the figure is closer to 60%; SARS-CoV-2 is likely to be around this range). This means that, in Rutherford’s words, “herd immunity for this disease is mythic”—until there’s an effective vaccine.
Translation: For the foreseeable future, almost all of us are vulnerable. And we will remain vulnerable until therapies emerge.
Health experts worry that without a transition that includes provisions for meticulous contact tracing, rushing headlong back to a vision of normalcy would likely result in a rapid reemergence of the pandemic, and potentially, a need for more wide-spread quarantines—which would drive a stake into the heart of any economic recovery.
The truth here is that Team Economy doesn’t need to push against Team Health, because they’re after the same thing. If Trump embraces a transition that recognizes both the economic needs of the country and the wisdom of leading health experts and policy makers, he may succeed in leading a weary but irrepressibly resilient nation out of our current crisis, and into a durably healthy, economically promising future.
David Shaywitz, a physician-scientist, is the founder of Astounding HealthTech, a Silicon Valley advisory service, and an adjunct scholar at the American Enterprise Institute.
This article originally appeared on The Bulwark here.
The post The False Choice Between Science And Economics appeared first on The Health Care Blog.
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