Nicole Karlis

How toxic masculinity became a threat to public health

As if the first two waves of COVID-19 hospitalizations in the United States weren't enough to inspire serious political changes to stop the coronavirus, health experts have sounded the alarm that a third wave is underway. Coronavirus cases and hospitalizations are rising across the nation, specifically in the Dakotas, Nebraska, and Montana, as the seasons change and the election nears.

It's certainly taken a lot of resilience and strength to persevere through this pandemic — particularly given the backdrop of political chaos, uncertainty and immense change in our daily lives. Yet perhaps it is this attitude of "staying strong," and acting stoically — which is rooted in a culture that favors and thrives off toxic masculinity — that has hurt and continues to hurt us the most.

Toxic masculinity, which has become a household phrase over the last few years, is when the archetypal image of masculinity, like displaying strength, becomes harmful to oneself. In 2005, in a study of men in prison, psychiatrist Terry Kupers defined toxic masculinity as "the constellation of socially regressive male traits that serve to foster domination, the devaluation of women, homophobia, and wanton violence." The phrase is used to describe the issues men face or sometimes, wrongfully, justify them. Certainly, in a patriarchal society, toxic masculinity not only defines people but politics — as its mores trickle into our entertainment, discourse and politics.

Notably, the pandemic response is being led by the most psychologically compromised, toxic men in America. As I wrote last weekend, President Donald Trump's insistence on depicting himself as so strong as to be able to "work through" his COVID-19 illness is deeply harmful, and apt to put Americans' lives at risk who mimic his behavior — either by working while sick or hiding symptoms.

Meanwhile, Trump's re-election campaign has tried to frame Trump as a "warrior" — masculine, strong and void of emotion. The administration's individualistic, pick-yourself-up-by-your-bootstraps rhetoric personifies toxic masculinity, and trickles down to Trump's underlings, too. In June, Vice President Mike Pence wrote an op-ed essay in The Wall Street Journal claiming there was no second wave of COVID-19, despite all the evidence to the contrary. "We are winning the fight against the invisible enemy," Pence wrote then, adding "our greatest strength is the resilience of the American people."

Yet as psychologists will warn, there is a dark side to resilience.

"There is no doubt that resilience is a useful and highly adaptive trait, especially in the face of traumatic events," psychologists Tomas Chamorro-Premuzic and Derek Lusk wrote in Harvard Business Review. "However, when taken too far, it may focus individuals on impossible goals and make them unnecessarily tolerant of unpleasant or counterproductive circumstances." In other words, self-sufficiency is not always a show of strength; humans, as social creatures, rely on others for society to function and to remain healthy. Denying that means hurting ourselves, either by delaying care or eschewing guidance that may help us or save others.

I've often wondered how much my so-called "resilience" in all of this is just making me numb and tolerant, in an unhealthy way. When looking at which countries have the pandemic somewhat under control, we look and judge their leaders. It's interesting to do this through a gendered lens. For example, New Zealand has some of the lowest coronavirus numbers in the world under Prime Minister Jacinda Adern's leadership. That's partly because she never advertised grandiose ideas about being above or stronger than the coronavirus. As I've previously written, the strengths—such as empathy and compassion— Ardern has brought throughout her tenure are the very same traits that have been used against women seeking leadership positions in the workplace and in the public sector. When male leaders display traditionally feminine qualities, they can also be maligned as weak — former House Speaker John Boehner, for example, used to shed tears in public; Politico's response was to ask, "Why Does John Boehner Cry So Much?"

It's obvious the Trump administration is terrified of appearing "weak" during the pandemic. But where has that gotten us? Prioritizing the economy over our health. Over 8 million infections, and 218,000 Americans dead. And the politicizing of wearing masks, as though wearing them were a sign of weakness — something Trump mocked his opponent Joe Biden for at their first and so far only debate.

As much as toxic masculinity's social repercussion are harmful to our physical health, it is also taking a toll on our mental health. A study published in JAMA Network Open in September showed that three times as many Americans met criteria for a depression diagnosis during the pandemic compared to before it. According to an analysis of Google Trends, symptoms of anxiety increased too.

Why? In part, it could be a result of having to power through these extraordinarily abnormal times without seeking help — that "bootstraps" mentality innate to toxic masculinity. One's attempts to hold it together can devolve into emotional suppression, which in return can cause more emotional distress. In July 2018, Penn State researchers found that women tried to suppress their fears about the Zika virus reported higher levels of fear later. "It turns out that not only is suppression ineffective at handling fear, but it's counter-productive," one researcher said. "It creates a cycle of fear — and it's a vicious cycle."

As a society, many of us — particularly men — haven't been authorized to express sadness publicly, and these studies reflect that. With over 200,000 Americans dead of coronavirus, their loved ones are grieving. Seven months later, we've yet to have a moment of national reflection to mourn.

As it is with the death of a loved one, grief isn't lessened by ignoring one's uncomfortable emotions. Instead, it requires collective vulnerability, compassion and patience. As author David Kessler told HBR:

Emotions need motion. It's important we acknowledge what we go through. [...] We tell ourselves things like, I feel sad, but I shouldn't feel that; other people have it worse. We can — we should — stop at the first feeling. I feel sad. Let me go for five minutes to feel sad. Your work is to feel your sadness and fear and anger whether or not someone else is feeling something. Fighting it doesn't help because your body is producing the feeling. If we allow the feelings to happen, they'll happen in an orderly way, and it empowers us. Then we're not victims.

As we try to stay strong through this pandemic, the strength we seek to feel will come from falling apart and allowing ourselves to feel the loss and the chaos—physically and emotionally. By persevering through that, still standing in so much unknown, we can experience real strength. In other words, the non-toxic kind.

Is the pandemic making us drink more or less? It's complicated

Are people drinking more or less during the pandemic? It's a question that's been on the mind of researchers, and the public alike. Humans often turn to alcohol in difficult times, which comes with its own problems: research shows that when you turn to drinking to cope with stress it's more likely to turn into a problem. Yet as recently as last year, studies found that American millennials just weren't that into drinking, perhaps because of related trends in wellness and healthy lifestyles.

Now that we're seven months into the pandemic, researchers are beginning to look at data and polls to study how drinking behaviors have changed.

According to a recent report in the journal JAMA Network Open, Americans are drinking 14 percent more often during the coronavirus pandemic. The study compared responses from a survey of 1,540 participants of their self-reported drinking habits in spring to the year prior. For women, the increase was up to 17 percent compared to last year. Specifically, heavy drinking for women—which was defined as four or more drinks within a couple of hours—increased by 41 percent. The study's participants were between the ages of 30 and 80; the data collected was from the RAND Corporation American Life Panel.

"Women were particularly affected in our data," Michael Pollard, a sociologist and co-author of the paper told Salon. "The higher baseline distress, and likely greater increases in distress during the pandemic, suggest that women will similarly increase the use of alcohol to cope at higher levels than men; it is certainly a concern."

Pollard said since women typically have higher levels of mental distress than men, coupled with larger increases in domestic labor at home, it's no surprise that women reported drinking more than men once the pandemic started. The pandemic has had a greater economic and social impact on women than men. Women, and particularly women of color, are more likely to be "essential" workers, too, who are under particular stress.

"Heavy alcohol use by women specifically has been somewhat overlooked by the scientific literature, but clearly it is a real and growing concern," Pollard told Salon. "For example, some of my colleagues at RAND conducted a review of the last 20 years of assessments of the efficacy of Alcohol Use Disorder treatments, and concluded that we simply don't have scientific evidence to inform whether or not those treatments are as effective for women as men—because nobody has set out to study it, and because women are systematically under-enrolled in these studies."

Indeed this study's findings are congruent with what was reported on at the beginning of the pandemic. In the United States, alcohol sales increased by 55 percent the week ending March 21, 2020, compared to the previous year, according to Nielsen data. But this was also during a time when people were stockpiling because it was unclear whether or not the groceries stores would be safe, and how long the lockdown restrictions would last.

According to a separate study by researchers at Washington State University, one in four adults reported a change in alcohol use immediately after stay-at-home orders were issued. Interestingly, the study surveyed more than 900 twin pairs from March 26 to April 5, 2020. An estimated 14 percent of respondents said they drank more alcohol than the week prior.

"We expected that down the road people might turn to alcohol after the stay-at-home orders were issued, but apparently it happened right off the bat," Ally Avery, lead author of the study and a scientific operations manager at WSU Elson S. Floyd College of Medicine, said in a statement. "It shows the need to make sure there is more mental health support since it had an impact on people right away."

The situation varies between countries, curiously. A study by researchers at the University College London found that young Australians are actually drinking less during lockdown, partly because of the lack of social opportunities. Those who reported drinking less reports that they've had an improved financial situation and physical health. Similarly, a July poll from Alcohol Change UK found that 37 percent of 1,647 UK residents surveyed had attempted to manage their alcohol consumption during lockdown by having alcohol-free days, reducing the amount of alcohol they purchased, or attending a virtual support group. However, the same study did find that one in five of drinkers surveyed were drinking more frequently during the pandemic.

Notably, before the pandemic, Americans were drinking more than they were just prior to Prohibition.

"Consumption has been going up. Harms (from alcohol) have been going up," Dr. Tim Naimi, an alcohol researcher at Boston University, told AP News in January. "And there's not been a policy response to match it."

Yet, as mentioned briefly above, there is a nascent movement of younger people abstaining. In the last few years, so-called "Dry January" — a monthlong abstinence from alcohol drinks — has become trendy.

"I have seen preliminary studies that suggest depression and anxiety peaked early in the pandemic, but returned back to normal after a month or two," Pollard said. "A big question now is, will alcohol use behaviors persist, or will they go back to the way they were before COVID-19?"

It will be interesting to see if, as the pandemic continues apace, Dry January is popular in 2021.

All things considered, it appears that drinking patterns have bifurcated. Some drinkers now drink more, and others abstain more. The polar reaction suggests that many have reconsidered the role of alcohol in their life.

Schadenfreude: Feeling guilty about wishing Trump ill? Therapists say it's 'normal'

When President Donald Trump tweeted that he tested positive for COVID-19 last week, the internet reacted with a mix of sympathy, shock, and other less savory emotions. The New York Times wished Trump well in the name of American unity. Presidential candidate Joe Biden said he was praying for the "health and safety" of Trump and his family.

Many others struggled to feel sorry for Trump.

As my Midwestern aunt said: "The Christian in me is struggling; I find it very hard to have sympathy for him." She said the calculus of sympathy was affected by Trump's unresponsiveness towards the pandemic and its victims: after months of downplaying the coronavirus — which has taken over 200,000 Americans' lives, ruined the economy, and left millions of people out of work with minimal federal government relief — the news about Trump's health, to my aunt and millions of others, appeared to be karmic retribution; or poetic justice; or maybe just what happens when you don't listen to scientists.

That schadenfreude was, it seems, a common emotion among the public — and also, a rancorous reaction that plagued many with guilt, and sparked discussions over decorum. "There's something downright poetic about the possibility that — after years of being forced to watch Trump's every move on TV — we might be getting to watch him die," Carlos Maza opined on Twitter. Meanwhile, many right-wing pundits and news sites, including Breitbart and the Washington Times, scolded prominent figures who had wished death upon Trump. Twitter itself said it would take down any tweets wishing him death.

Some on Twitter qualified that they don't wish Trump ill; they merely want him to go away, or suffer the consequences of his actions for once. "I don't want Donald Trump to die. I want him to go to jail. Get better soon," wrote author Emma Kennedy.

Various religious texts, including the Bible, promote forgiveness as a pillar of a healthy human existence. Western culture, which draws heavily on Christian notions of morality, is deeply influenced by this notion of forgiveness. Yet many, clearly, find it hard to forgive those who have deeply wronged or hurt us, whether physically or psychologically. That's led to complicated public emotions as we watch Trump grapple with a deadly virus while infecting other people around him.

Hence, many are torn between figuring out the "right" or "wrong way" to respond. Yet therapists tell Salon this could be an opportunity for society to have a bigger conversation around emotional health.

"When we talk about emotions we can have multiple emotions at once and all parts can be true," therapist Amalia Miralrío, LCSW, LMSW, M.Ed, told Salon. "So we can be really happy that he's sick, and we can also hold this value that we don't like to wish ill on people — both parts can be true."

Mel Schwartz, a psychotherapist and author of "The Possibility Principle," told Salon that "either/or thinking" — meaning when we believe something is either right or wrong, or good or bad and there's no nuance in between it — can be harmful.

"In Western culture, our minds have been trained to think reality exists in these two separate compartments," Schwartz said, adding that in therapy he often encourages his clients to reach a point of "authenticity" which involves "complexity." "Authenticity shouldn't be confused with the truth, but authenticity is more about my truth, and my truth should be open to reconsideration and reevaluation, and that's the process I take my clients through."

Schwartz said he's had clients who have struggled with their responses to Trump getting sick, to which he self-disclosed his own process around the situation.

"My first instinct was 'Ah there is a God, how just,'" Schwartz said about when he first learned Trump had the coronavirus. "As heinous as I find [Trump], he was a victim of his father's emotional and psychological tyranny.... then I tried to get in touch with a higher level of compassion and try to find an underbelly here."

Schwartz provided an example of how a person could communicate that they are struggling with having sympathy for Trump, and acknowledging the truth of their emotions.

"A part of me feels good and affirmed that he fell prey to this virus, but do I wish him harm? It's a tough question, I struggle with that, I'd like to say I wish him a recovery because I'd know it would be the right thing or the virtuous thing to do," Schwartz said. He noted that, from politicians on both sides, we only hear these straightforward "right" responses. "We're not genuine in our communication, which requires complexity," he added.

As many experts have pointed out, Trump's leadership behavior mimics that of an emotional abuser — from gaslighting to name-calling to blame-shifting and lying. In a way, there are parallels between the public grappling with complicated emotions around feeling sorry or not feeling sorry (or feeling both) for Trump, and what survivors of abuse can face.

Miralrío said that a reaction of joyful schadenfreude to Trump's COVID-19 diagnosis could be a way for some to reclaim power in an otherwise powerless relationship dynamic.

"It's a way of reclaiming that sense of power, a way of feeling like someone who has exerted abuse of power and control over you and when that person suddenly loses some of that, you feel that you are gaining a greater sense of equality in the dynamic," Miralrío said. "It's normal to have this emotional response when you are feeling really disempowered in a relationship and feeling that someone is actually trying to harm you."

Finally, David Grammer, a Licensed Marriage and Family Therapist said that he doesn't believe people are responsible for their immediate reactions.

"We have our animal instincts that are like 'Take him down,'" Grammer said, adding he wasn't pleased with his own initial response to learning about Trump's diagnosis. "It's more about how we overcome those responses. For me it brought up some work around 'How can I let go of some of my own personal feelings about what he's done?' Because beyond voting, I can't do anything to change his choices and how he's handled things, so it's a bit of letting go of what we can't control."

Secret Service agents 'frustrated' by virus exposure risk from Trump's hospital stunt: report

On President Trump's third day in the hospital where he was being treated for COVID-19, the president left the hospital in a motorcade to drive around the block waving at well-wishers before returning. The publicity stunt, which disregarded federal safety guidelines for close contact between infected persons and others, has alarmed doctors, public health experts and Secret Service agents.

According to the Centers for Disease and Control (CDC), a person who contracts COVID-19 can safely be around others again only when they've met three specific criteria: First, when it has been ten days since symptoms first appeared for the infected person. Second, when 24 hours has elapsed with no fever (without the use of fever-reducing medications). And third, when other symptoms are improving.

Considering the public information issued to the public by White House physician Sean Conley, Trump doesn't meet any of the aforementioned criteria. Trump was diagnosed with COVID-19 on Thursday, according to his spokespeople.

Likewise, some doctors were horrified at the prospect that Trump would expose his security detail to coronavirus, a risk made higher by the physical properties of the presidential vehicle fleet. James Phillips, an attending physician at Walter Reed, tweeted, "That Presidential SUV is not only bulletproof, but hermetically sealed against chemical attack. The risk of COVID19 transmission inside is as high as it gets outside of medical procedures. The irresponsibility is astounding. My thoughts are with the Secret Service forced to play."

Phillips added on Twitter: "Every single person in the vehicle during that completely unnecessary Presidential "drive-by" just now has to be quarantined for 14 days. They might get sick. They may die. For political theater. Commanded by Trump to put their lives at risk for theater. This is insanity."

During the drive-by, Trump sat in the back of the vehicle wearing a black cloth mask. There were at least two Secret Service agents in the vehicle. Both seemed to be wearing N95 masks, which can be an effective barrier against the coronavirus, but they aren't an absolute guarantee — especially in close quarters with an infected person.

Judd Deere, a White House spokesman, said in an email to the New York Times that "appropriate precautions were taken in the execution of this movement to protect the President and all those supporting it, including PPE [personal protective equipment]."

Deere said the drive-by was "cleared" by the medical team. However, after the parade, CNN reported that there were escalating concerns in the Secret Service. As they reported:

"That should never have happened," one current Secret Service agent who works on the presidential and first family detail said after Trump's drive-by, adding that those agents who went along for the ride would now be required to quarantine.
'I mean, I wouldn't want to be around them,' the agent said, expressing a view that multiple people at the Secret Service also voiced in the wake of Sunday's appearance. 'The frustration with how we're treated when it comes to decisions on this illness goes back before this though. We're not disposable.'
Another veteran Secret Service agent also expressed deep dismay at the Walter Reed ride, though was sympathetic for those around the President given the difficulty in pushing back on the commander-in-chief.
"You can't say no," the agent said.

A third agent told CNN that Trump's stunt was "reckless."

On Monday, Trump criticized the media on Twitter for reporting on the backlash to his motorcade.

"It is reported that the Media is upset because I got into a secure vehicle to say thank you to the many fans and supporters who were standing outside of the hospital for many hours, and even days, to pay their respect to their President," Trump tweeted. "If I didn't do it, Media would say RUDE!!!"

After the tweet, Trump announced he will be discharged from the hospital on Monday. In his message, he continued to downplay the virus that has killed over 200,000 Americans.

"Don't be afraid of Covid. Don't let it dominate your life," Trump wrote. "Don't let it dominate your life. We have developed, under the Trump Administration, some really great drugs & knowledge. I feel better than I did 20 years ago!"

However, as doctors explained to Salon, the treatment Trump received in the hospital is not what all Americans would receive if they tested positive for COVID-19."

The therapies that President Trump is getting are available to many patients with COVID-19, [but] there are two issues," Dr. Georges Benjamin, executive director of the American Public Health Association, told Salon by email. "The first is VIP medicine where there is the risk of over-treatment or under-treatment because of who he is and not his clinical condition. We don't know the extent of this either way because they have not been as transparent with his clinical status."

"The second issue is the fact that he has universal access to all the care he needs from the military health care system, which in fact has all the attributes of a single payer health system: a form of health care funding and delivery he has politically opposed," Benjamin added. "Most Americans do not have access to that kind of care at one of the best hospitals in the world. Access to any test he needs, and any medication, without a concern for costs."

Expert: Uber-funded ballot measure in California would create 'permanent underclass of workers'

Those who took high school civics may recall that our democracies lives on fractions. A majority vote — one-half plus one — is what it takes to pass a bill in most legislative bodies. The constitution requires a "supermajority," meaning two-thirds of a governing body, for only the most important and crucial matters: to override a presidential veto, or remove an officer via impeachment, say.

If two-thirds seems like a high threshold for a congressional body, what about seven-eighths? That's the super-duper-majority that would be required to overturn Proposition 22 — the Uber- and Lyft-funded ballot measure that will appear on California ballots this November — should it pass this fall.

You read that right: the astroturf ballot measure written by some of Silicon Valley's biggest corporations, which is written to keep these companies' contractors from achieving benefits or a stable, salaried job, would require a seven-eighths majority of state legislators in both state chambers in order to be overturned — such a difficult threshold to meet that experts say it would be effectively permanent.

The origin of Proposition 22

It all goes back to California's Assembly Bill 5, which went into effect on January 1, 2020. The impetus for AB5 was to make gig economy work into more stable and reliable work, and reduce worker exploitation; currently, driver-contractors like those who work for Uber or Lyft are not guaranteed health care of any other benefits if they work more than 40 hours a week, as they are legally contractors rather than employees.

Likewise, such drivers and deliverypersons often make less than minimum wage after their own expenses are accounted for. AB5, which put into place a "test" to determine whether someone is a contractor or employee, was designed to lift these kinds of workers out of poverty.

Yet since AB5 passed through California's state legislature, Uber and Lyft have refused to comply; instead, they chose to pour over $180 million into the astroturf campaign for Proposition 22. Similar gig worker-reliant companies have chipped into the campaign, too. DoorDash has donated $47.5 million; Instacart has donated $27.5 million, and Postmates has contributed a little over $10 million.

According to Ballotpedia, Proposition 22 is the most expensive ballot measure contest in California, and the United States — and if it passes, it will set an example for the corporations that funded it that they could use as a model in other states. Indeed, the companies are funneling so much money into this campaign because there's a lot at stake. For example, Los Angeles and San Francisco are two of the five largest markets for Uber, which has stated in financial disclosures that new regulations in major metro areas could negatively affect their financials. Many of their workers have criticized these companies for pouring so much money into a campaign as they struggle to receive basic support, like personal protective equipment and hand sanitizer, from their employers during the pandemic.

Proposition 22 is more than just a determination of classification, though. Labor experts fear it will be a major setback for labor rights, the community at large, and that it will send the wrong signal to other states who have been exploring ways to regulate these companies.

"They have basically operated as though the law does not apply to them," Ken Jacobs, the chair of the UC Berkeley Center for Labor Research and Education, told Salon. "And I think that signals to other states around the country, 'Don't try to enforce your laws because we have the political power and resources to defeat you if you do.'"

We spoke to experts about the fine print of Proposition 22, and how it will affect Uber and Lyft drivers in the state of California if passed.

1. Very few drivers will actually qualify for health insurance benefits

Uber and Lyft have positioned Proposition 22 as a "third way" solution to provide more benefits to drivers. The campaign states on its website that voting "yes" on Proposition 22 will provide drivers with "new benefits and protections in these tough economic times including a minimum earnings guarantee, access to health care benefits and insurance against illnesses and injuries acquired on the job."

Yet this depends on a driver's "engaged time," according to the proposition, meaning the time between accepting a ride and completing the ride. This doesn't factor the time a driver is waiting in between drives. For drivers who average 25 hour per week of engaged time during a calendar quarter, Uber and Lyft will provide "subsidies equal to 82% the average California Covered (CC) premium for each month." For those who average between 15 and 25 hours of "engaged time" each quarter, the companies will provide healthcare subsidies equal to 41 percent the average CC premium for each month.

"They purport to have a healthcare reimbursement piece here, but it's very weak and very few drivers would qualify, or at least qualify for the larger amount of it," Jacobs said.

Rey Fuentes, Skadden Fellow at the Partnership for Working Families, told Salon that drivers would essentially have to drive 40 hours a week to get that 25 hours of engaged time to qualify for the best offer. In a report Fuentes co-authored, he notes a second way in which drivers will be essentially cheated of quality healthcare options. "By using the definitions section to ensure that the maximum benefit is actually 82 percent of an average premium payment for the lowest-cost healthcare plan on the Covered California insurance exchange, not a worker's actual premium expenses," the report states.

2. Drivers won't be guaranteed paid leave or paid sick days

Under the current California state and federal law, app-based workers are required to have a minimum of eight weeks of paid family leave, and three days of paid leave for illness or care of a family member. None of this is part of Proposition 22. In the report Fuentes co-authored, the researchers call this omission "glaring," especially in the pandemic, in which many rideshare and delivery drivers are considered to be "essential workers."

"Although some app-based companies have created limited sick leave benefits to respond to this crisis, these plans are voluntary and temporary, and cannot be added to this initiative before voters can weigh in on the ballot measure," the authors write.

Fuentes says there are many drivers who drive to make money to help support a sick family member.

"They're doing it because they're caring for individuals who have illnesses and families, or they have an illness themselves that they can't have traditional employment because your work arrangements are precarious," Fuentes said. "That's why it's actually more important that those workers get things like paid sick leave or paid family leave."

Since drivers have to work at least 40 hours a week to reach 25 hours of "engaged time," taking a vacation will likely affect whether they qualify for healthcare benefits.

3. Drivers won't be able to unionize

This year, more drivers have been organizing to protest unfair labor practices and the lack of protections during the pandemic. However, if Proposition 22 passes, drivers won't be able to unionize and leverage the power of collective bargaining. Under federal law, according to the National Labor Relations Board (NLRB), app-based drivers are said to lack benefits of collective bargaining because they're more like "entrepreneurs," legally speaking. While the legality of this is disputed by various labor organizations, Fuentes said this leaves an opening for states to "establish a separate organizing statute that gives workers the lawful ability to form a union under state law."

"The ballot initiative, however, would prevent the state legislature from ever considering a collective bargaining regime unless it gets a 7/8ths vote of the state legislature, which is an impossible threshold," Fuentes said.

4. Proposition 22 reverses key worker benefit if there's a car accident

"From a driver's perspective this is actually one of the things we think is so harmful about the ballot initiatives," Fuentes said. "California provides workers compensation protection to drivers injured on the job, and that benefit is covered through what is called no-fault coverage."

Even if they are at fault for the accident or contributed to it, all workers in California are covered by the workers compensation statute. Fuentes said Proposition 22 "reverses that."

"This suggests to us very clearly that workers could be denied coverage if they're even partially at fault, which is not something that should ever happen with a workers compensation scheme," Fuentes said. "And the broader part is that workers who are seriously injured and partially disabled or permanently disabled, you can access that up to a lifetime benefit through California's Workers Compensations Temporary Disability Program, but the ballot initiative capped at two years."

5. These reversals and precedents will be most likely permanent

Most astonishing is that Proposition 22, if passed, will be very difficult to amend, since that would require a seven-eighths (87.5%) vote in each chamber of the California State Legislature. Fuentes said this will "lock in" a "permanent underclass of workers."

"All the historic workplace safety protections that California has enacted to protect workers, all of those things are still vitally necessary and even more so now during COVID-19," Fuentes said. "From an abstract perspective, the idea that some of the richest companies in the world are passing a ballot initiative that would exempt their workers from basic labor protections is just, I think beyond the pale."

Here's why culture and politics are complicating Midwestern efforts to defeat the coronavirus

As a Californian with family in the Midwest, my Instagram feed has become a slideshow of two jarringly different pandemic experiences. I see acquaintances in Kansas having large parties, no masks in sight, literally popping bottles of champagne indoors. An old friend having a big wedding in Wisconsin, and a gender reveal party in Illinois, too, were both mask-free affairs. This observation of the digital world transcends into the real one: a close friend who just returned from Iowa said it looked like the pandemic "never happened."

The culture around the pandemic in the San Francisco Bay Area, where I live, is much different. In many ways, life still feels like it did in March, when the region first descended into a shelter-in-place status. I don't know anyone here in California who's hosted or attended a gathering with more than 10 people without observing the recommended mitigation strategies like wearing a mask, being outside and social distancing. Salons, gyms and hotels are just starting to open. Indeed, the difference between the Midwest and California is a bit confusing, particularly as cases rise in the Midwest.

According to the Covid Tracking Project, the Midwest is currently experiencing a coronavirus surge. And while there's a mix of reasons behind this new surge— including the (possibly premature) reopening of some cities, universities and schools, and big gatherings like the the Sturgis motorcycle rally— there is a strong link between the low likelihood of public mask-wearing and the places where cases are rising, as The New York Times has reported. Indeed, the Midwest seems to struggle uniquely with mask-wearing, as the Times county-level data reveals.

Given what we know about the success of mitigation strategies like donning a mask, it may seem peculiar for states like Iowa to suddenly surge in cases. That suggests that the midwestern surge originates not because of lack of public health knowledge, but because of cultural reasons, or because of the politicized nature of masks, or both — something that is borne out by locals' observations.

Take Polk County, Iowa, for example. Over the summer, the state of Iowa emerged as a coronavirus hotspot. Nola Aigner Davis, Public Health Communications Officer of the Polk County Health Department in Iowa, told Salon Polk County remains one of the top 10 hotspots in the United States. Davis emphasized that it's been difficult to get the coronavirus under control in part due to the lack of people wearing masks and social distancing.

"There are people who are still skeptical about this disease and [how] dangerous and deadly it can be. . . . or it's just people who this isn't something they're accustomed to, like wearing a mask or social distancing," Davis said. "Well, we see every day that people are hospitalized and people are dying from this disease."

Davis said she's concerned about her constituent having "COVID-19 fatigue," a neologism that describes the condition in which the constant stress of the pandemic eventually leads to complacency, and the inability to make good decisions. Davis said COVID-19 fatigue reveals itself when, for instance, people who are awaiting coronavirus test results don't stay home until they've discovered whether or not their are positive.

"This is something that no one thought would last this long," Davis added. "We would not be wearing masks this long, we would not be social distancing this long; I think when you develop a new way of life that people are not accustomed to, and you want your old life back, it's just very tiresome."

Brady Kirkpatrick, who lives in Omaha, Nebraska, said the state has been "mostly lax" about the pandemic since the beginning. In Omaha, where coronavirus cases were rising in the summer, the city council passed a mask mandate. However, Kirkpatrick said that in his experience, "most businesses only require you to wear your mask upon entry."

"At the gym, about half the members wear masks while working out," Kirkpatrick said. "It seems that most people aren't very concerned about it since the cases here are fairly low, and the city is pretty spaced out."

Omaha is seeing lower cases after the mask mandate, even if not everyone is taking it seriously as Kirkpatrick says. However, according to AP News, the state's seven-day rolling average for positivity rate is rising.

"Overall, many people here are sick of COVID and the rules that have been enforced," Kirkpatrick said.

The state of Wisconsin is currently in a state of emergency, as hospitals in the northeast part of the state are near capacity and local resources remain strained. In Dane County, where the University of Wisconsin–Madison (UW) is located, the county experienced its first significant surge in September since the pandemic began, according to Dane County Executive Joe Parisi, which it's still battling. The University started in-person classes, but paused them one week later because of a coronavirus outbreak. However, the county's health officials say in-person classes weren't the only reason behind the surge.

"The number of cases associated with UW is a concern, but plenty of virus is spreading elsewhere in the community too," Janel Heinrich, Director of Public Health Madison & Dane County, said in a statement.

In Louisville, Kentucky, Lori Cheek told Salon over email that it's hard to "comprehend" how "most of the people are dealing with this pandemic at this point." Wearing a mask is not the norm where she lives, Cheek says.

"I'm scared to go inside the public areas in my own apartment building," Cheek said. "I only take the elevator to and from my 6th floor apartment when I'm taking my bike in and out of the building, and every time the door opens, there's someone trying to get in the elevator with me without a mask."

According to a Gallup poll published in mid-July, forty-four percent of U.S. adults say they "always" wear a mask when outside their homes, and 28 percent say they do so "very often." Interestingly, a majority of those who wear masks are either women or Democrats. The poll found that 61 percent of Democrats polled said they always wear a mask. Among Republicans, a majority of them said they wear masks infrequently. A Pew Research Center study found a similar partisan divide.

Both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend cloth masks for the general public. Health experts strongly agree that the evidence is clear that masks can help prevent the spread of COVID-19.

Yet the act of wearing a mask has become politicized in part due to President Trump's rhetoric and resistance around it. In Wisconsin, where there's currently a statewide mask mandate, a conservative law firm is asking a state court to block the enforcement—despite the state's health department's recommendations to wear them and avoid large gatherings.

"It is a proven method to prevent the spread of COVID-19," Jennifer Miller, a spokesperson at the Wisconsin Department of Health Services, told Salon in an email. "That said, masks and/or face coverings do not take the place of social and physical distancing, so we also encourage people to stay home as much as possible, maintain at least six feet of separation between themselves and others when they must go out, avoid large gatherings, and follow simple health hygiene habits like washing their hands frequently and thoroughly and covering coughs and sneezes."

According to the World Health Organization, there have been 33,249,563 confirmed cases of COVID-19 around the world and over one million deaths. The United States accounts for more than 20 percent of the global death toll. Indeed, many are wondering how the United States will ever overcome this pandemic, especially as states in the Midwest enter the autumn and winter seasons.

"If we don't practice these mitigation strategies, we're never going to see this virus go away," Davis from the Polk County Health Department in Iowa said.

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