After the Flood Recedes Like Frederick Douglass, we can find inspiration for this moment in the oldest story of rebirth and renewal. by David W. Blight

Those with power who are planning our resurgence from the coronavirus need imagination and, above all, the humility of a long view of the human drama. To buoy myself one recent morning, after reading so much bad news, I did what the great abolitionist Frederick Douglass had done at an earlier moment of crisis: I sat and reread the Book of Genesis. One of the most profound rebirths, at least in spiritual and literary terms, occurs in the first eight chapters of that oldest story of all.

All over our culture and in journalism right now, we are encountering metaphors of renewal, revival, restoration, and rebirth. For a host of historical reasons, Americans borrowed the grand idea of rebirth after destruction and then made it their own.

Some narratives of renewal are constructed with an authentic sense of tragedy, an understanding that in our nature is the capacity for great good and great evil. These accounts have the chance to convey real hope. Some stories of renewal, though, are puerile, inauthentic, and ignorant. One can witness this every evening in presidential news briefings that, if nothing else, should convince teachers and researchers at all levels of why their work matters.

In existential crises, we look for historical grounding, and to markers in time for guidance. We may need state-of-the-art new vaccines, but we also need old wisdom. And in the quiet, if unbearable, tension caused by the realization that our society is structurally broken, we need the ancient voices. “In the mystery of prophecy,” wrote the theologian Abraham Heschel, “we are in the presence of the central story of mankind … In decisive hours of history it dawns upon us that we would not trade certain lines in the book of Isaiah for the Seven Wonders of the World.”

The menu of choices is vast. “There is no peace, saith the Lord, unto the wicked.” Or, “And they shall beat their swords into plowshares, and the spears into pruninghooks: nation shall not lift up sword against nation, neither shall they learn war anymore.” Or, “Every valley shall be exalted, and every mountain and hill shall be made low: and the crooked shall be made straight, and the rough places made plain.” Or, “I heard the voice of the Lord, saying, Whom shall I send, and who will go for us? Then said I, Here am I; send me.” Whether chastening or comforting or impossibly challenging, we may find solace in the prophet’s oracles, so many of which are tales of destruction and rebirth. They are just now profoundly useful to our own hour of history.

They were useful as well in the era of the Civil War, certainly one of our existential crises. Imagine how differently American history might have unfolded if the slaveholders’ republic known as the Confederacy had won the war. In the pivotal election year of 1864, it was still possible for the South to win. A wartime general election in the midst of civil war was unprecedented. Abraham Lincoln, running for a second term, faced stiff opposition to gain the nomination within his own party; when he overcame that, he encountered a bold and overtly racist campaign conducted by the Democratic Party, which ran the former Union General George B. McClellan for president. Democrats portrayed Republicans as radicals so devoted to racial equality that they would turn the country into a sea of “miscegenation” between blacks and whites. The Democrats also promised a vague negotiated peace with the Confederacy that would leave slavery maimed but intact.

The war was in a terrible stalemate in Virginia and Georgia, and death tolls had reached a horrific scale. Many Northerners could no longer bear the suffering and loss in that worst summer in American military history: In the six weeks from May 4 to June 15, the combined Union and Confederate casualties in the Virginia Overland Campaign reached 88,000 dead, wounded, or missing. The dying continued on all fronts through the election in the fall.

Stymied by their own creation—black freedom—some Republicans tried to skirt around or deny that they were the party of emancipation. But the freedom of the slaves was on the ballot in 1864, as was the future existence of a United States in a “rebirth,” as Lincoln had famously said in the Gettysburg Address, somehow around a more capacious vision of freedom. Events on battlefields may have saved Lincoln’s reelection as much as anything: Mobile Bay fell to the Union navy in late August and, most crucial of all, Atlanta fell to General William Sherman in early September. The war now seemed winnable. Hope suddenly reemerged along with the death tolls.

Frederick Douglass supported Lincoln and the Republicans in 1864, although they would not allow him to openly campaign for them. The former slave and incomparable orator represented the living embodiment, told brilliantly in his autobiographies, of the triumph over bondage. The Republican leadership wished him to remain politically invisible, but Douglass did not hide.

In October, at a national convention of black leaders in Syracuse, Douglass delivered a barn burner of a keynote speech. Nations could “learn righteousness” from supreme crises, he maintained. In a biblical turn of phrase, he saw the historical moment as one when “mourning mingles everywhere with the national shout of victory.” The Democrats, he believed, did the Confederates’ bidding; their victory would create a “white man’s country.” As though addressing Congress and a reelected Lincoln, Douglass employed a moving refrain four times in a single paragraph, calling for the passage of a Thirteenth Amendment to end slavery: “We implore you to abolish slavery,” he sang out. Only then, he said, would black freedom and the “national welfare” together achieve “everlasting foundations.”

Lincoln won a decisive popular-vote victory, drawing 2,206,938 votes to McClellan’s 1,803,787. Most remarkable, Lincoln carried a stunning 78 percent of the votes of soldiers, most of whom cast their ballots on the various war fronts. The war could now be seen through to its great results: the end of slavery and the remaking of the United States.

In his hometown of Rochester, New York, on the Sunday after the election, Douglass spoke at a celebration at the Spring Street African Methodist Episcopal Church, a pulpit he had occupied many times for lecture series. He praised Lincoln’s victory as “one to determine … life or death to the nation,” and the harbinger of “changes … vast and wonderful.” Douglass then drew upon the oldest rebirth metaphor in Western culture: Genesis and the tale of Noah’s Ark. The “waters of the flood were retiring,” he rejoiced, and he saw a “sign that the billows of slavery are rolling back to leave the land blooming again.”

In the ancient Creation story, God had made all life, including humans to have “dominion” over all living things. But after a time, people became so wicked and evil that God ordered one good man, Noah, to build an ark and place within it representatives of every living species. The deluge that obliterated all life on Earth lasted 40 days and nights. Finally, the “windows of heaven were stopped.” Noah sent a dove out of the ark’s window to see if the waters had abated. The bird returned without finding “rest for the sole of her foot.” Noah waited and sent out the dove again and this time she returned with an “olive leaf” in its bill. The third time Noah released the dove she did not return and Noah wondered, Could it be true? He “removed the covering of the ark and looked, and behold, the face of the ground was dry.” All life had been obliterated, but now it might be reborn.

Douglass pointed to Genesis and its story of creation, destruction, and revival to grapple with the meaning of Lincoln’s victory and the prospect for emancipation. He was not merely connecting with a black church audience; he reached for ancient wisdom to find a sense of sacred transformation amid the profane violence of war and the sordid practices of politics. He mixed the voice of the Hebrew prophets with his own. He told the packed pews that he discerned signs in the election of a “redeemed and purified nation,” not unlike Noah seeing green land. Douglass announced as well in the Rochester church that he planned in the following week to return for the first time to Baltimore, Maryland, the city from which he had escaped slavery in 1838.

On November 1, 1864, the state of Maryland adopted a new “free Constitution,” abolishing slavery in a referendum by the narrow margin of 30,174 to 29,799. Douglass made his dramatic return to Baltimore on the 16th, with reporters in tow. He addressed a primarily black crowd at a standing-room-only gathering at the Bethel AME church in Fells Point, the neighborhood on the harbor where he had come of age.

As he arrived, Douglass encountered a woman who introduced herself as his sister, Eliza Mitchell. They two had not seen each other in 28 years. Older than Frederick by seven years, Eliza had traveled the 60 miles from Talbot County on the Eastern Shore to see her famous brother. She had managed to purchase her freedom in 1844 and raised nine children, one of whom she named Mary Douglass Mitchell, in honor of her long-departed sibling. The contrasts at the church that day were joyous and achingly poignant. Eliza, her husband, and all nine children had worked in menial jobs in a slave society in order to live, while Douglass had become a citizen of the world. To fathom the meaning of freedom for former slaves, we have to see into both of those experiences.

Douglass took the pulpit at Bethel surrounded by American flags, as a choir sang “Home Sweet Home.” Unavoidably, in a three-hour address, the former slave made himself central to the story. As in Rochester earlier, he harkened back to Noah and Genesis. This time, though, he declared himself the dove, and therefore the messenger of renewal. “The fact that I am where I am is really the subject,” he said. This time he was himself the “sign” on the dark clouds. “The return of the dove to the ark, with a leaf,” Douglass said, “was no surer sign that the flood had subsided from the mountains of the east, than my coming among you is a sign that the bitter waters of slavery have subsided from the majestic hills and fertile valleys of Maryland.”

With such audacity, Douglass inserted himself into the story of Genesis, and brought with him his people and his country. He rhapsodized about how in 1838 he had escaped from a “doomed city,” but now returned to “greet with an affectionate kiss the humblest pebble from the shores of your glorious Chesapeake.” Douglass called the occasion a “day of wonders” that he “hailed with the joy of an exiled son.” Freedom could change everything, at least for a while, in a tear-filled church of memory. Americans love a redemption story, and Douglass surely knew he embodied one.

As Douglass rounded out his oration that day in Baltimore, he delivered a brilliant political analysis of the challenge ahead. The right of “self-ownership,” he said, now demonstrated the absurdity of “property in man.” He challenged white people to look inside and change their souls and recognize that their future, too, depended upon “absolute civil and political equality” for all. Black folk in a reimagined American nation could now demand the “restoration of all rights,” and the greatest among them was the right to vote, the “solid rock” of a new country.

In the wake of the flood, Noah sought the solid rock upon which to build anew. God gave it to him and his sons and their families in the form of a covenant, promised with the sign of a rainbow on a dark but brightening sky. In our current quest to reopen and renew, it is good to know how difficult, yet how utterly necessary, this great task was in the oldest rebirth story we know. Having a sense of history, James Baldwin once wrote, means an awareness that whatever happens to us, however terrible, we can know we are “not alone.” It has happened before. All of Noah’s seed and all the creatures of Earth are in this boat together.

How Have Prisons Dealt With Pandemics? Coronavirus is the latest pandemic to hit prisons, but what can history tell us about the appropriate response? by Hilary Marland, Clare Anderson and William Murphy

As the COVID-19 pandemic wreaks havoc across the world, the alarm has been sounded in prisons too”, the Commonwealth Human Rights Initiative reported early in April. It wasn’t wrong. Jails are high-risk environments for disease, where pathogens are easily transmitted. 

Prisoners are particularly vulnerable – the new coronavirus spreads rapidly in conditions of overcrowding, and many prisons have limited healthcare and poor levels of hygiene. Enhanced cleanliness regimes and the early release of inmates are now being considered by governments all over the world.

Such conditions were also highlighted in the late 18th century by prison reformer John Howard. His life was largely devoted to visiting prisons throughout Europe, castigating them for their chaotic governance and unhygienic conditions.

Howard’s State of the Prisons in England and Wales (1777) reported “a melancholy chronicle of damp, dark, dank, airless cells, famished prisoners, negligent authorities, apathy, corruption, disease and death”. Prisons were blighted by diseases associated with filth and overcrowding, including “gaol fever” – or typhus – that, according to Howard, destroyed more prisoners than were put to death in all the public executions in the kingdom.

Prisons were easy targets as deadly outbreaks of cholera spread across the globe in five major pandemic waves during the 19th century. Appearing to originate in India, the second pandemic of Asiatic cholera reached England in 1832 and we know from contemporary statistics that it took hold in many prisons, spreading rapidly and resulting in high mortality among prisoners already in poor states of health.

Wakefield House of Correction in Yorkshire suffered badly. It reported its first case when prisoner James Petty became ill on June 24 1832 and died the following day. Cholera raged in the prison in two successive outbreaks in 1832-3, accounting for 78 of the 158 cases in the town in the first wave alone – 21 of whom, including the prison governor, died. The overcrowded prison quickly released 75 prisoners committed for “trivial” offences.

It was only in 1854 that John Snow established that cholera was a waterborne disease, but well before this, in 1833, the water supply for Wakefield prison, which had been described as “highly loaded with animalculae and vegetable matters” was replaced, the prison diet enhanced and the building lime washed and fumigated with chlorine. Despite these measures, the disease again took hold late in that year, concentrated among prisoners committed for vagrancy who slept in one large cell. One-third of the prisoners were admitted to the prison infirmary, and a quarter of the cholera cases died.

As understandings of the causes of disease improved during the 19th century, sanitary reforms were implemented and new boards of health began collecting statistics on mortality and morbidity, including epidemic disease. Reforms also involved a vigorous programme of prison construction across Britain and its empire. Wakefield itself was rebuilt in 1847 with more than 700 separate cells, in keeping with modern prison design.

New statistics from colonial jails showed that in the 18 months following its establishment in 1858, one-third of the convicts sent to the Andaman Islands penal colony died of dysentery and diarrhoea. In Lower Bengal (India), tens of thousands of prisoners died from disease between 1843 and 1867. British and Irish prisoners in Bermuda succumbed to yellow fever in a series of outbreaks during the first half of the 19th century. Those in the Gibraltar hulks were far more susceptible than soldiers and civilians to the cholera epidemic of 1865. In most colonial locations, including Mauritius during the cholera epidemics of 1819-20 and 1867, prisoners were employed in street cleaning, transporting the dead and nursing.

As in Wakefield, the lack of social distancing in colonial jails provided an ideal environment for the communication of disease. Water supplies were often contaminated and conditions overcrowded. In Welikada and Slave Island prisons in Ceylon during the cholera epidemic of 1873-5, officials also worried about the spread of disease from prisons to the free population. As in Wakefield 40 years earlier, some low-risk prisoners, including debtors, were released – which had also happened in Barbados.

Prisoner perspectives

While the dangers of prisons and imprisonment during epidemic outbreaks became the subject of medical, administrative and public discourse, contemporary accounts by prisoners are rare. Among these, however, are letters written in Belfast prison in late October during the second wave of the 1918 influenza pandemic.

When “the flu” hit, the prison held 150 Irish nationalists. More than 100 fell ill. Ironically, this cohort may have been vulnerable because, as political prisoners, they had the privilege of association, both on their wing and at exercise. Their letters, usually to relatives, reveal much about the experience of all prisoners. They were frightened by the disease and, especially, the disease in prison. As Michael Stapleton wrote:

As far as possible we all should guard against panic; for that in itself leaves us liable to fall a victim. We should remain calm, cool, and confident. Although we have seen, and have helped to remove, some of our comrades on stretchers.

Jim Crowley, meanwhile, asked his mother if she could “imagine delirium while being locked up in cells for 13 hours in the dark”.

Even when prisoners were not in the middle of an outbreak the disease haunted their lives during 1918 and 1919, filling them with concern for their families outside.

While hygiene and medical care has improved in many prisons worldwide, there are many resonances between official responses to COVID-19 and the historical management of epidemics in prison, in large part because many prisons remain so overcrowded. The current crisis also reminds us of just how vulnerable the institutionalised populations we create become when epidemic disease takes hold.

Humans Are Too Optimistic to Comprehend the Coronavirus Why Americans didn’t see this pandemic coming. by OLGA KHAZAN

If America had taken the threat of coronavirus more seriously, countless deaths could have been prevented. The federal government could have stocked up on masks and testing reagents. The United States could have built field hospitals sooner, as China did, in dense places that were likely to be hardest hit. Officials could have advised people to avoid travel and mass gatherings earlier.

Instead, even as evidence of the coronavirus’s severity mounted, an epidemic of wishful thinking spread among both the American public and policy makers. As the virus roamed freely, Americans partied. In mid-March, Italians shared videos of themselves giving the advice they regretted ignoring early in the course of their country’s outbreak. Now some Americans wish they could similarly issue their past selves—and those of elected officials—a wake-up call. Some of us are asking, Why didn’t we see this coming?

The coronavirus caught the U.S. unprepared and turned into one of the biggest disasters in recent memory for many reasons: basic failures of testing equipment, officials reportedly trying to keep the president happy, a public-health system that has been underfunded for years, and a general lack of knowledge about the novel coronavirus’s behavior. But one easily overlooked reason is the human brain’s basic tendency toward optimism, even when the facts suggest we should be worried.

Of course, experts on infectious disease knew a pandemic would soon strike. In 2018, my colleague Ed Yong wrote that “a new infectious disease has emerged every year for the past 30 years.” A few weeks ago, my colleague Uri Friedman explained how intelligence officials and other experts had been warning, since 2012, of a pandemic that could destroy Americans’ way of life. In 2015, Bill Gates, not exactly a little-known figure, described the threat of an infectious virus in a speech that’s been watched millions of times on YouTube.

Nevertheless, outside the infectious-disease community, Americans and our leaders blithely hoped that the virus would somehow pass us over. Even though intelligence reports alerted the White House to the coronavirus threat as early as November, lockdowns in the U.S. did not begin until March. On January 22, the president said, “We have it totally under control.” Even after the Centers for Disease Control and Prevention warned of outbreaks in the U.S., on March 2, New York City Mayor Bill de Blasio urged New Yorkers to “get out on the town.” On March 5, Surgeon General Jerome Adams told Fox News that the risk of coronavirus “is low to the average American.”

Even I, a health reporter, did not initially realize how quickly the virus would descend on the United States, how severe its toll would be, or what shape the fight against it would take. There’s knowing something will happen, and then there’s understanding how, exactly, it will upend your life. On March 2, I spoke with Helen Chu, an epidemiologist at the University of Washington, and she told me that schools might soon shut their doors and sporting events might be canceled. I doubt it will come to that, I thought. After all, our leaders had assured us as much. Within days, schools were closed and the NBA had suspended its season.

That kind of naive optimism in the face of encroaching disaster is a pitfall of owning a human brain, several experts on the psychology of risk perception told me recently. People have trouble appraising exponentially growing problems, seeing exactly how they themselves might be affected, and understanding the best way to help when disaster arrives. Our brains aren’t designed to anticipate threats such as pandemics, which allows the tiny, brainless pathogens to get the upper hand as we fumble along. The only way to counteract these biases, experts say, is to prepare ahead of time. Which is, alas, something the United States also failed to do.

Perhaps for the good of entrepreneurs, American Idol hopefuls, and buyers of real estate on Miami Beach, humans are remarkably bad at imagining everything that could go wrong in a given situation. “We’re likely to have an excessively rosy outlook on life,” says Hersh Shefrin, a behavioral-finance professor at Santa Clara University.

One reason for this subconscious Pollyannaism is that we don’t use the deliberative part of our brain very much. As the psychologist Daniel Kahneman wrote in Thinking, Fast and Slow, our brain has two modes: A fast, intuitive method that’s driven by feelings, and a more analytical (and evolutionarily more recent) way of thinking that’s driven by data. The intuitive process tends to dominate, says Paul Slovic, a psychology professor at the University of Oregon. “We don’t go around calculating things in a scientific way; we just kind of are guided by our feelings, which are very much influenced by our experiences,” he told me.

This knee-jerk part of our brains mostly takes only past events into consideration, making us “prisoners of our experience,” as Slovic put it. One 1962 study of people living on a flood plain found they were unable to conceive of floods bigger than the largest flood they had ever witnessed. It’s easy to infer that Americans similarly couldn’t fathom a disease worse than other, less deadly outbreaks the U.S. has recently faced, such as Zika and Ebola. Despite our brushes with past plagues, Americans might have struggled to imagine one that would cause more than regional disruption and a couple of weeks’ headlines.

In some cases, experience can be instructive. Shefrin points out that some Asian countries reacted differently than the U.S. to the coronavirus because the region had faced SARS in the past. While these countries were aggressively testing and contact tracing, American policy makers were scrambling to remedy the neglected supply of N95 respirators in the Strategic National Stockpile—never replenished after 2009’s swine-flu outbreak, because officials decided to shift their focus to terrorism.

The “fast” instinct in our minds tends especially to minimize risks that are harder to picture. Abstract dangers, such as invisible diseases, seem less threatening to us than do tangible threats, such as terrorists or tornadoes. Our brain interprets low-probability events as having a practically zero chance of happening, and it’s basically hopeless at contemplating exponential figures—such as, say, the way infections spread through a population. The number of cases starts out small, so our fast, intuitive brain tells us it will stay small forever. This is why that riddle about the pond on which lily pads are doubling in volume every day is so tricky. (If the pond is fully covered with lily pads on day 40, on what day do the lilies cover half the pond? The answer is day 39.) “The thing that’s sinister about the exponential-growth curve is that it leaps up all of a sudden and overwhelms you,” Slovic said. In a piece for Nautilus a few years ago, K. C. Cole implicated this exponent innumeracy in explaining how climate change “was able to creep up on most of us with cat feet.” “The greatest shortcoming of the human race,” the physicist Albert Bartlett once said, “is our inability to understand the exponential function.”

This might explain why, on February 23, with 51 confirmed coronavirus cases in the U.S., President Donald Trump reiterated that the situation was “very much under control.” A month later, the number of cases was more than 44,000. Trump, according to Shefrin, is a very intuitive thinker. “He’s got very strong intuition, and he goes with his instincts,” Shefrin says. The problem, of course, is that our intuition isn’t always right.

By the time a disaster is on our doorstep—when hospitals are filling up in Italy but not yet in the U.S.—our minds wrongly soothe us once again. People have trouble envisioning themselves as the kind of person something bad might happen to. For instance, because elderly people have had the highest fatality rates from COVID-19, some younger Americans might think they themselves are invincible. “If we don’t see ourselves as being the victim of a disease like COVID-19, then we’ll be prone to underestimate the likelihood that we will in fact be such a victim,” Shefrin says.

On top of that failure of imagination, a concept called “motivated reasoning” falsely reassures us that the bad thing we don’t want to happen probably won’t. “If you’re the federal government, and you’re hoping to put together a reelection campaign based on economic prosperity, then the idea of global shutdown is a horrible thing,” says Nathan Novemsky, a marketing professor at Yale. “Things that we are motivated not to believe, we’re very good at not believing.”

When the disease finally arrives, and people start dying, our brains fall into a different snare: The number of people affected is too large to be psychologically meaningful. Slovic has found that when many people are affected by a disaster, a kind of psychological numbing occurs. Though people are capable of feeling deeply for a single victim and her plight, “compassion fade” can set in when a tragedy involves two or more victims. People’s positive feelings about donating to a needy child decline for two needy children. This perhaps helps explain why Americans can round up thousands of dollars to donate to individual sick people’s GoFundMe campaigns, but hesitate to support a universal health-insurance system. Similarly, a disease that is likely to wipe out 60,000 Americans, most of whom are strangers, can seem less dangerous than it really is.

The lessons from these gaps in our collective thinking can be useful in planning for future big, amorphous disasters, such as climate change. That is, if we accept and remedy them. In addition to raising awareness of these psychological pitfalls, experts told me, we should put into place mechanisms and laws that will override humans’ disaster-ignoring biases. Saying that we’ll surely be smarter next time isn’t enough; like the people on the flood plain, we probably won’t imagine that the really big one is coming.

Experts say the United States should commit resources to preparation ahead of time, so that our psychological blind spots don’t undermine us. Furthermore, government leaders can explicitly battle these biases by seeking a diversity of viewpoints to stress-test their opinions. But Trump seems to have done the opposite for months, pushing aside truth-tellers and promoting those who tell him what he wants to hear.

“Government is the tool that we convene to protect us from things that we can’t protect ourselves from as individuals,” says David Ropeik, a risk-perception author and consultant. That only works if the government response isn’t dictated by one individual acting on instinct. Individuals may be myopic, but if we strive to look together, we can more clearly see what’s brewing.

Cities of the Future Will Need A Lot of Trees Pavement doesn't breathe. by Alan Simson

The 21st century is the urban century. It has been forecast that urban areas across the world will have expanded by more than 2.5 billion people by 2050. 

The scale and speed of urbanisation has created significant environmental and health problems for urban dwellers. These problems are often made worse by a lack of contact with the natural world.

With research group the Tree Urbanistas, I have been considering and debating how to solve these problems. By 2119, it is only through re-establishing contact with the natural world, particularly trees, that cities will be able to function, be viable and able to support their populations.

Future cities

The creation of urban forests will make cities worth living in, able to function and support their populations: Treetopias.

This re-design will include the planting of many more urban trees and other vegetation – and making use of new, more creative methods. Although we didn’t fully realise it at the time, the 1986 Hundertwasserhaus in Vienna, a building that incorporated 200 trees in its design, was the start of more creative urban forestry thinking.

This has been carried on in Stefano Boeri’s Bosco Verticale apartments in downtown Milan, which incorporates over 800 trees as part of the building. Similar structures are being developed around the world, such as in Nanjing in China and Utrecht in The Netherlands.

The urban forest needs to be designed as a first principle, part of the critical infrastructure of the whole city, not just as a cosmetic afterthought. We know for example that in 2015, urban forest in the UK saved the NHS over £1 billion by helping to reduce the impact of air pollutants. In 2119, we may well look back on this present time as the equivalent of the Victorian slum.

Trees can create places which can greatly improve our health and well-being. Our urban forest can give us the spaces and places to help manage our mental health and improve our physical health. Research has indicated for example that increasing the canopy cover of a neighbourhood by 10% and creating safe, walkable places can reduce obesity by as much as 18%.

Cities built on trees

As rural areas become less productive as a result of climate change, cities – which previously consumed goods and services from a large hinterland – will have to become internally productive. Trees will be at the centre of that, contributing to the city energy balance through cooling, regulating and cleaning our air and water flows, and ensuring that our previously neglected urban soils function healthily.

Urban forests could also provide timber for building. We have a history of productive woodlands in the UK, yet alternative construction materials and a growth in an urban population with less knowledge of forest management means that the urban forest is rarely viewed as productive. We are now recognising the potential productivity of the urban forest, as campaigns to stimulate homegrown timber markets and achieve more efficient management efficiencies are proving to be successful.

Furthermore, economic growth is still deemed to be the prime symbol of the effectiveness of a city, but we need to be equally aware of other invisible values. This will open up new approaches to governance. Governance needs to embrace all forms of value in a balanced way and facilitate a new vision, considering how trees can help create liveable cities.

New opportunities

As the urban population rises, we need to get better at understanding the breadth and diversity of the values held about our urban forest. Individual people can hold several distinct values at once, as urban forests may contribute to their wellbeing in different ways.

The current guardians of our urban forest, mainly local authority tree officers, spend much of their time managing risks rather than maximising the opportunities of trees. They often receive complaints about trees and tree management, and it can sometimes be difficult to remember that people do care about trees. We need to develop viable partnerships between tree managers, community members and businesses to support trees in our cities.

Although the canopy cover of cities worldwide is currently falling, this is not the case in Europe, where it is increasing. Many European countries are acknowledging the fact that we have over-designed our towns and cities to accommodate the car, and now it is time to reclaim the public realm for our people – either pedestrians on foot or on bicycles.

Creative developments like the Hundertwasserhaus are not the only answer to creating Treetopia. We are and will continue to plant more street trees, urban groves and informal clusters of trees in our parks and green spaces. Treetopia has begun.

What the US Can Learn From South Korea About Using Technology to Flatten the Coronavirus Curve Testing and triage were both key to the strategy. by Michael Ahn

As countries around the world consider how best to reopen their countries, it’s worth considering how South Korea has been able to “flatten the curve” and even hold parliamentary elections without resorting to lockdowns. 

After seeing an initial spike in COVID-19 infections in February, South Korea implemented several measures to bring the disease’s spread under control, a progression I’ve followed as a researcher on public policy. South Korea was able to lower the number of new infections from 851 on March 3 to 22 infections as of April 17 and the mortality rate from COVID-19 hovers around 2%.

Several measures contribute to Korea’s success, but two measures were critical in the country’s ability to flatten the curve: extensive testing for the disease and a national system for promptly and effectively tracking people infected with COVID-19.

Testing and triage

From the 2015 MERS outbreak, Korea learned that infection to medical staff sapped the ability to control the virus as infected citizens in hospitals turned them into hotspots for infection. As a result, at the onset of COVID-19 infection, the Korean government ensured that proper personal protective equipment was provided to avoid infection to the medical staff. It also created physically separated testing and treatment sites for health care workers.

Once safe testing and treatment facilities were secured, the government began testing for COVID-19 at massive scale – over 440,000 people – which essentially covered all those with symptoms. People who test positive are quarantined in COVID-19 special units and treated.

South Korea focuses attention on treating people with severe symptoms and therefore less likelihood of recovery, rather than focusing on people with mild symptoms. This helped lower the mortality rate of COVID-19, as some of the most vulnerable populations with severe symptoms recovered. Countries focusing their effort on treating patients with a greater likelihood of survival may lead to a higher mortality rate as more vulnerable patients perish.

Extensive testing is a crucial step in identifying the state of the infection in the country – where the outbreaks are taking place, who is infected and who is not. This data then becomes a stepping stone for identifying any hotspots of infection in the country and to trace and identify the population that came in contact with those infected.

COVID-19 contact tracing system with roots in MERS

What distinguishes the Korean model in controlling COVID-19 is its ability to trace individuals diagnosed with the disease who may have come into contact with the infected individuals. It’s known as the COVID-19 Smart Management System (SMS).

South Korea’s Centers for Disease Control and Prevention (KCDC) runs the contact tracing system that uses data from 28 organizations such as National Police Agency, The Credit Finance Association, three smartphone companies, and 22 credit card companies to trace the movement of individuals with COVID-19. This system takes 10 minutes to analyze the movement of the infected individuals. For people who come in contact with an infected person, the KCDC informs the local public health center near the infected citizen’s residence and the health center sends the notification to them. If they test positive, they are hospitalized at the COVID-19 special facilities. Those without symptoms are asked to remain self-quarantined for 14 days.

The legal basis for accessing such personal information was prepared after the 2015 MERS outbreak when the government learned that tracing the movement of infected individuals and people who came in contact with them is crucial. As a safety measure, only epidemic investigators at KCDC can access the location information and once the COVID-19 outbreak is over, the personal information used for the contact tracing will be purged.

Could the US emulate South Korea?

South Korea’s model – relying on rapid testing availability, safe COVID-19 medical facilities and a government-run contact tracing system – helps avoid an authoritarian approach of shutting down an entire city as we have seen in China. A forced lockdown has democratic and human consequences of restricting individual freedom and stockpiling. It may have lasting consequences in the post-COVID-19 world such as the abuse of political power and the threat to freedom through intrusive surveillance.

Currently, the U.S. is considering re-opening the country or states out of concern over the economy. But without effective measures in place to contain the virus, it may lead to exponential growth in infection again.

Epidemiologists have said the key in defeating COVID-19 pandemic is in identifying hotspots of infection and severing the vicious cycle of infection. An effective contact tracing system is a crucial component in this approach and this can be potentially emulated in the U.S.

The U.S. has the necessary technology and data and the government could form a partnership with the relevant entities, such as credit card and telecommunications companies, law enforcement, health care, and other related public and private organizations to create a COVID-19 contact tracing system. With the help of such system, the government could identify the infected population and hotspots, trace and quarantine them for treatment in medical facilities that are, with government’s continued effort, supplied with the necessary PPE.

At the citizen level, the practice of wearing masks and social distancing should be strongly encouraged to prevent infection while the government tries to flatten the curve.

Currently, there is a sense of normalcy returning to South Korea. No cities are under lockdown, the restaurants, churches, bars, gyms and learning institutes are allowed to open if they observe the government quarantine guidelines, trains and buses run on schedule, grocery stores are fully stocked, and the country just successfully held parliamentary elections in mid-April. Citizens wear masks and exercise social distancing at all times which helps preventing further infection. South Korea’s approach to COVID-19 with its focus on technology suggests a possible path for the U.S. in reopening the country without having to subject citizens to the coercive authority of the state and compromise our democratic ideal.

Why Pharmacists Will Play an Even Bigger Role in the Battle Against the Opioid Epidemic Many more pharmacists can be engaged in providing naloxone-the life-saving drug- for their patients. by Victoria Tutag Lehr

When you stop at your local pharmacy to pick up a toothbrush or an antacid, soon you may also be able to buy an over-the-counter drug to reverse an opioid overdose. The lifesaving drug, naloxone, currently requires a prescription, but it may become available as an over-the-counter purchase in 2020. 

Despite the national decrease in opioid prescriptions since 2012, the opioid crisis continues. Access to prescription opioids have decreased due to stricter legislation, insurance regulations and the Centers for Disease Control Guideline for Prescribing Opioids for Chronic Pain. At the same time, the use of heroin and illegally manufactured synthetic opioids, such as fentanyl and counterfeit prescription opioids, has escalated.

In addition, nearly 80% of opioid overdoses involve multiple substances, compounding the risk of a fatal overdose. This reinforces the need for widespread, convenient naloxone access accompanied by training on how to administer this reversal drug.

As a professor of pharmacy and pharmacist, I believe that many more pharmacists can be engaged in providing naloxone for their patients.

Essential medication to save a life

An opioid overdose can depress a person’s respiratory center to the point where breathing stops, resulting in death. Naloxone can reverse this effect within minutes. With minimal training, anyone can safely administer naloxone in various forms – nasal spray, auto-injector or intramuscular injection – to effectively buy more time and get medical help for someone who has overdosed.

Naloxone has been used in hospitals for more than 40 years to reverse excess sleepiness and respiratory depression from opioid anesthesia and pain medication or to treat overdoses in the emergency room. During the 1990s, naloxone use expanded into communities to first responders, laypersons and, most importantly, to people who use drugs to reverse opioid overdoses.

The U.S. surgeon general issued an advisory in April 2018 encouraging family, friends and individuals at risk for an opioid overdose to carry naloxone and be trained to administer it. Research shows that wider access to naloxone is associated with fewer deaths. Naloxone could successfully reverse every witnessed opioid overdose, but only if naloxone is in the hands of a trained bystander. The challenge has been how to get naloxone to the people who need it.

In 48 states and the District of Columbia, pharmacists are now able to dispense naloxone under a standing order that does not require a physician’s prescription, or they can directly prescribe naloxone. But people may still be hesitant to ask for naloxone.

Why community pharmacists are key

Opioid use disorder is a chronic, relapsing, lifelong condition. Managing opioid use disorder requires sustained treatment and support, similar to other chronic conditions, such as diabetes and heart disease. But opioid use disorder often carries a social stigma, which can make people hesitant about seeking help through traditional health care channels.

People may be afraid to request a prescription for naloxone because they may be accused of misusing drugs. Others may not know how or where to obtain naloxone, particularly if they don’t have a regular health care provider. People who use drugs report feeling stigmatized, while providers including pharmacists may be uncomfortable starting a conversation with patients about the importance of carrying naloxone.

Yet the greater the access to naloxone, the more likely this lifesaving drug will be administered to reverse an overdose. I believe that pharmacists in the community are ideally positioned as a local resource to obtain naloxone. Community pharmacies have evolved into neighborhood health centers where individuals can access a variety of services outside a traditional clinical setting including immunizations, health screenings and lab monitoring.

Pharmacists can recommend and provide naloxone, opioid education and overdose prevention information to high-risk individuals and their support network. Pharmacists can make their pharmacy a safe and nonjudgmental resource, where people obtain and learn to administer naloxone, seek self-care advice and reduce harm from drug use, including clean needles and syringes. And pharmacists are well positioned to provide connections to local programs for recovery and support. They can make referrals to supportive health care providers and provide “whole person” care for vulnerable individuals.

Federal support to halt deadly overdoses

The U.S. Department of Health and Human Services recognizes the importance of addressing opioid use disorder and the opioid crisis with a 5-point strategy. This includes better access to opioid use disorder treatment, research funding, improved pain management and expanded naloxone availability in health care and community settings.

While naloxone is not yet available for purchase over the counter, the U.S. Food and Drug Administration supports this simple access and has developed a “drug facts naloxone label” with pictures making it easy for anyone to effectively administer the correct dose. Manufacturers can apply for over-the-counter status, and naloxone is expected to become available as an over-the-counter drug this year. The availability to purchase naloxone without a prescription and over the counter can remove the perceived stigma of having to request it from a health care provider or pharmacist.

Naloxone alone will not mitigate the opioid crisis. Yet the ability to reverse a fatal overdose – having someone nearby who carries and can administer naloxone – allows the survivor another chance to enter treatment that addresses the social, structural, genetic, behavioral and individual factors of opioid use disorder. Pharmacists have an important role in helping to remove the stigma associated with requesting and carrying naloxone by openly discussing its benefits and making naloxone available to all patients.

Victoria Tutag Lehr, Professor of Pharmacy, Wayne State University