Living with Covid is like being lost in the forest

A few weeks ago, I ran across an opinion column by Ben Shapiro titled “When does the COVID-19 panic end?” I keep thinking about it, and how much it pissed me off, so I decided I might as well get it out of my system by writing about it.

Two weeks to slow the spread.

That was the original rationale for the lockdowns, masking and social distancing: Prevent transmission of the coronavirus so that Americans could be assured that we would not overwhelm hospital capacity, causing needless death.

The “two weeks to slow the spread” concept was from March of 2020, back when we knew almost nothing about COVID-19. All we had was news of the outbreaks in Wuhan, China, where it had apparently been contained^[1]If we believe China. and in Lombardy, Italy, where it exploded through the population, overwhelming hospitals and killing lots of people.

Making matters worse, the CDC and the FDA had screwed up our disease surveillance for COVID-19, so we had no good information about how the virus was behaving here. All we knew was that (1) we were past the point where we could manage it with testing and isolation, (2) all our numbers — cases, hospitalizations, and deaths — were doubling every few days, and (3) we didn’t want to be the next Lombardy. So we had few choices other than hunkering down to suppress the wave.

(And even then there were pundits panicking that we were committing “economic suicide,” a fear which has proven unfounded by subsequent economic developments.)

Wait until a vaccine is available.

That was the next goal post: an admonition to continue to take precautions to avoid spreading the coronavirus until a vaccine could be developed. […]

Wait until every adult has a chance to get the vaccine.

That was the final rationale for caution. […]

And yet.

We are told that we are experiencing a massive COVID-19 crisis. We have been told that the vaccinated must mask up again; that the unvaccinated should be barred from public establishments; that children must be masked in school.

This is disingenuous. Shapiro is trying to paint a picture of moving goal posts — public health officials using ever-changing criteria to keep keep enforcing their petty rules. But that’s not what happened.

For one thing, the “two weeks” figure was from a Trump White House press event. Few public health professionals believed it could be that short. And though the lockdowns lasted longer than two weeks, they were gone within a few months, and most places haven’t gone back to restrictions that severe.

That lockdown period gave healthcare professionals and hospitals time to learn better ways to manage Covid patients — remdesivir, dexamethasone, prone positioning, better ventilator protocols, and so on.

(Then there’s Shapiro’s cheap trick of counting “Wait until a vaccine is available” and “Wait until every adult has a chance to get the vaccine” as two separate things.)

As for Shapiro’s mock mystification about the continued public health concerns, the answer is pretty simple: Between the time the vaccination program started and now, several of the COVID-19 variants have begun to spread widely, especially the much more virulent Delta variant.

Vaccinated people can and do catch the Delta variant, in higher numbers than for the original SARS-CoV-2 virus on which our vaccines were based, and they can then spread it to others. We may have about half our population vaccinated, but the Delta variant is about twice as likely to break through a vaccinated person’s immunity, and within unvaccinated people, it seems to spread at least two or three times faster than original COVID-19. So while vaccinated people are largely protected from serious illness, the unvaccinated population is much worse off.

The statistics simply do not bear this out. According to the seven-day rolling average as calculated by The New York Times, fewer than 400 Americans per day are dying of COVID-19; at the height of the pandemic, well over 3,000 were.

I have the advantage of writing this three weeks in the future. Since Shapiro wrote that, the 7-day average death rate has risen about 150% to 1295 per day. The new case rate has gone up 42%, hospitalization rates are up 56%, and ICU hospitalization rates have gone up 65%.^[2]I’m using data from Covid Act Now, so my numbers differ slightly from Shapiro’s.

The current delta variant spike has resulted in a massive case count, particularly in Florida, but deaths are not following cases —

Stop!

Deaths always lag behind cases, but the death rate is still going up. On July 1, the 7-day average Florida Covid death rate was 30/day. By the time Shapiro’s column was published in August 8, it had already nearly tripled to 88/day, and since then it’s nearly tripled again to 246 per day. That’s an eight-fold increase in less than 2 months.

Every time we’ve been hit with a new wave of COVID-19 cases, some people have tried to use the initial low death rates to minimize the threat. It’s true that this time, for the first time ever in the pandemic, there’s a solid scientific reason — vaccination — to believe deaths will be reduced. But until we’ve seen the whole wave of deaths, it’s too soon to declare victory.

Those who are vaccinated are not dying of COVID-19; their death rate is minuscule. Those who are unvaccinated have chosen not to vaccinate; they are independent adults capable of determining their own approach to risk and reward.

I’m not comfortable dismissing the harm to the unvaccinated. Being unvaccinated isn’t always a choice: Children aren’t allowed to get the vaccine, some people have allergic reactions, and some people have compromised immune systems, so the vaccine does little for them.

Furthermore, most of the remaining unvaccinated people are not anti-vax nutcases. Many are decent people who have concerns about some aspect of the vaccine they don’t understand. Many of them are confused or misinformed. often because they have been deliberately misled by the aforementioned anti-vax nutcases. These people do not deserve a serious illness or death just because they are uncertain, confused, or the victims of disinformation.

Even if you still think we should dismiss the fate of unvaccinated people, please remember that some vaccinated people, including the old and vulnerable, can catch COVID-19 from unvaccinated people, and some of those vaccinated people will get very sick and some will die. So if the new case rate grows ten-fold, as it has since June, then vaccinated people will be exposed to 10-times as much Covid, resulting in an increase in breakthrough cases, hospitalizations, and deaths.

Finally, although SARS-CoV-2 does not mutate terribly fast, it does occasionally spin off mutant variants, and the more people who have Covid, the more chances there are for mutant strains to arise. Thus the more likely we are to face additional variants, some of which could be faster spreading, deadlier, or able to escape vaccination.

Unlike other behavioral health problems, such as smoking or obesity, COVID-19 is contagious, which means no one is making decisions just for themselves.

All of which requires us to ask the question: When are we done?

When are we done telling children to mask up to protect adults who don’t want to vaccinate? When are we done telling businesses to close up or bar customers based on vaccination status? When are we done with mask mandates (data suggests that mask mandates are ineffective, even if masking is sometimes useful), with evidence-free social distancing rules (six feet is pure conjecture), with the ever-vacillating, Delphic pronouncements of Dr. Anthony Fauci? We have hit the goal posts; every adult now has the capacity to protect himself. There are no other realistic goal posts: Zero COVID-19 cases was never a realistic goal.

When is the job of government done?

And yet.

Our public health “experts” continue to promote more and more outrageous restrictions. […] There is no limiting principle to this, no end goal. There is only a bureaucratic and political elite unwilling to treat citizens as adults, recognize their own limitations and leave us all alone.

This is a variation on a common argument: We can’t do anything effective about Covid, they say, so we might as well accept the risk of Covid and go back to normal life without restrictions.

That argument wouldn’t piss me off nearly as much if many of these same people hadn’t been reaching the same conclusion over and over again at every stage of the pandemic. They proclaim that we should go back to normal and denounce anyone who says otherwise. Hundreds of thousands of Americans have died since the first time I heard that argument. And it’s a bad argument, because accepting the risks of Covid doesn’t look like they think it does.

Let me see if I can explain…

Imagine you’re driving through a forested area in a large national park. You see something interesting through the trees and pull over. You get out of the car, grab your cotton hoodie to fend off the slight chill, and walk into the woods to get a closer look. Maybe you find what you’re looking for and take a few pictures, or maybe you don’t. Either way, you eventually head back toward where you parked the car.

After walking for several minutes, you feel like you should have reached the car already. You press on a little further, and still don’t come to it. You look around, and you think maybe the uneven terrain has caused you to curve to the left a bit, so you turn right and head off in that direction, hoping to intercept the road. After about 45 minutes, you’re still in the woods. Maybe you got turned around. The sky is overcast, so you can’t navigate by the sun even if you could see it through the canopy. You decide to go back the way you came, hoping to find where you took the wrong path. maybe something will look familiar. Two hours later, you’re still lost, and the sun is starting to go down. The air is getting colder as night falls.

What happens to you next depends a lot on your ability to accept an important conceptual change in circumstances: You are no longer a person trying to find your way back to your car. You are now a person trying to survive the night in the deep forest. You need to stop thrashing around wasting energy and sweating into your clothes and start thinking about finding shelter and maybe starting a fire.

If this stretches into the next day and beyond, you may find yourself needing to accept yet another conceptual change: You are no longer trying to survive in the forest. You are now trying to live in the forest, meaning you need to find water and food.

As your situation becomes increasingly perilous, you need to accept the new reality and change your behavior to deal with it realistically if you want to survive.

The same principle likely applies to the COVID-19 pandemic: Our situation has changed, and we need to change our behavior to deal with it. Or to put it another way: Shapiro and others may be right that we will have to learn to live with Covid, but maybe what we’re doing now is what that looks like.

I’m not saying the solution to endemic Covid will be exactly the policies we’re following today — because there’s a lot of stupid stuff going on in both directions — but if we’re still living with Covid five years from now, our lives are going to have to adapt to the new reality.

It may seem drastic to alter our lives so much, but I contend that it only seems drastic because we’re not thinking in the proper historical context. We’ve already altered our lives to mitigate many other risks, but some of those adaptations have been baked into our lives for so long that we don’t normally notice them.

For example, we have a lot of adaptations to guard against diseases:

• The water we drink is processed and filtered by gigantic water treatment plants, except for people who have their own wells, because they they have smaller filtration systems of their own. The water moves through our cities and houses in sealed systems that keep it separated from sources of contamination.
• We have systems for dealing with waste water too: It’s dumped into sceptic tanks or drained away in massive city-scale sewer systems, and it’s processed before being released to the environment. This is our normal life in a world with waterborne diseases like typhus, cholera, and dysentery.
• Almost every single house has a refrigerator that allows occupants to store foods for longer periods without spoiling. We likely bought those foods from refrigerated display cases at grocery stores, and the foods arrived at those stores in refrigerated trucks, and may have been transported in refrigerated shipping containers.
• We also have stoves, which allow us to cook food to kill pathogens. Or foods may be heated to safe temperatures in food preparation plants and then sealed in cans or bottles to prevent contamination. Once the sealed containers are opened, we serve the food immediately or refrigerate it to prevent disease.
• Restaurants follow all of these practices for handling food and water, and ten times more. They pile on tons of additional processes, procedures, and equipment for preventing food contamination, including sneeze guards, gloves, cleaning chemicals, and appliances for holding foods at appropriate high or low temperatures.

Outside the realm of disease, we go through a lot more trouble to protect ourselves against danger:

• We build fully enclosed and sealed homes to protect ourselves from weather and animals.
• We have heating and cooling systems to protect us from extreme temperatures.
• We have locks and latches and alarm systems to protect us from intruders.
• We put an enormous effort into making sure building materials resist fires.
• We protect against the hazards of electricity with things like circuit breakers, conduit, electrical boxes, ground fault circuit interrupters, arc fault circuit interrupters, polarized outlets, and grounded appliances.
• Cars have dozens of safety systems such as headlights, marker lights, windshield wipers, tubeless tires, dual brake systems, rounded and padded interior surfaces, anti-burst door locks, seat belts, air bags, ignition interlocks, and crumple zones…
• Commercial aircraft have multiple redundant systems, and crews are trained to deal with a variety of emergencies from fires to turbulence to water landings.
• As I write this, Hurricane Ida has made landfall in New Orleans. Buildings have storm shutters on their windows, and the whole city is protected from flood by a system of levies. Thousands of people were evacuated in advance, and rescue and relief personnel are standing by with supplies.

I don’t see how adapting our lives to a new risk like Covid is in principle any different from all those other safety measures we live with every day.

To be clear, I’m not talking about doing exactly the same things we’ve been doing for the past 18 months. We were taken by surprise last year, we were at the beginning of the learning curve, and there was a lot of bad information from both official and non-official sources. We’ve thrashed around a bit finding answers, but I assume we’ll get better at this.

Let me try my hand at imagining what a mature, well-developed plan for dealing with COVID-19 might look like^[3]Please remember that I am not an expert on this subject, so this is at best some informed speculation.:

• Vaccines will do most of the work. If it turns out to be necessary, we should aim to produce enough vaccine to support periodic vaccination and/or booster shots, like we do with the flu vaccines every year, possibly even combined with the flu vaccine.
• If more dangerous variants come along, we should make new vaccines that target them.
• We should improve air filtration and/or fresh-air exchange in the buildings we live and work in, so that aerosolized COVID-19 cannot build up when the buildings are occupied. This needs to happen ASAP for some buildings, but others can probably wait. I imagine better ventilation and filtering will be part of most new construction eventually.
• We should have a standing COVID-19 surveillance program, just like we do for other diseases, so that we have a good idea what the virus is doing and can quickly spot outbreaks.
• We need to make testing easier and more available, especially at-home rapid testing.
• We need better masks. Everyone should be able to get masks that offer protection comparable to an N95 mask, but which are more comfortable, more reusable, easier to don and doff, and more attractive. The technology is relatively easy, but we will need to revise regulations on masks so that sellers are able to accurately communicate their capabilities to buyers.
• When COVID-19 outbreaks and flare-ups occur, we should be ready to respond with appropriate combinations of mitigation steps. These could include:
  • As always, wash your hands.
  • Massive testing, to spot outbreaks before they infect too many people.
  • Contact tracing, to identify the causes of the outbreak, and therefore how to mitigate it.
  • Community masking, for source control and personal protection.
  • Social distancing rules, including, if things get really bad…
  • Partial lockdowns, intelligent ones, informed by the latest scientific studies, and based on a good understanding of how Covid is spreading.

With planning and preparation, we ought to be able to implement most of these mitigation steps without a lot of disruption. And in a world where we occasionally evacuate tens of thousands of people for hurricanes and wildfires, we should be able to implement even as severe a mitigation as a partial lockdown without more pain than necessary. And if the levels of mitigation responses are pre-planned with a clear understanding of the triggering criteria, people will be able to plan ahead. It may even be possible for insurance companies to estimate the risks well enough to offer some kind of lockdown insurance.

We may not ever be able to go back to the way things were, but with technology we already have, or could easily develop, we should be able to get to a place where we really are living with Covid and managing it as just one more health risk among many.