Public education is almost always contentious in this country: Evolution! The pledge of allegiance! The Founding Fathers’ complicity in felonious (oft murderous) abduction & torture!
Now, we’re also arguing over whether it’s safe for schools to be open at all!
At the school board meeting, a white woman stood up at the podium, ripped off her mask, and said “I can’t breathe.”
(Unfortunately, I assume the resonance with the BLM protests was intentional. When I went to pick up my kids from school last week, a white mother was wearing a t-shirt with the traditional white on black BLM layout that said “Drunk Wives Matter.” My hometown is within a half hour’s drive of the national KKK headquarters.)
As is the way of things in our country right now, about half the parents in attendance were aghast. The other half cheered.
“The masks don’t work! Everybody knows the masks don’t work!” people shouted.
Oddly enough, though, the people saying “the masks don’t work” are actually correct. But so are the people who say that masks work. The word “work” is pretty nebulous!
As Joseph Allen & Helen Jenkins wrote in a recent New York Times editorial, many well-meaning people have been unhelpfully vague when defining goals for our pandemic response. Are we trying to minimize lifelong harms from all causes? Are we trying to minimize the number of deaths that occur this year? Are we trying to eradicate the virus that causes Covid-19?
Each of these goals would require that we take a different set of actions.
Masks “work” in the sense that when people are wearing face masks, there’s a lower probability of Covid-19 transmission during any interaction.
Masks reduce the number of viral particles that exit a person’s airspace as they speak or exhale. Of course, this presupposes that the person wearing a mask actually is shedding viral particles. But that’s the tricky thing about Covid-19 (or influenza)! Some people feel fine!
Masks also might reduce the likelihood of transmission when an unexposed person who is hoping to avoid or delay illness wears a mask. (Masks probably help with this, but it’s less well tested.)
Universal mask requirements are a great tool to delay transmission!
When worn selectively – for instance, only during hospital visits, or only when inside nursing homes – masks can also skew the demographics of transmission. With Covid-19, skewing the demographics of transmission is a great goal!
Even back before we had safe, effective vaccines, we could’ve saved huge numbers of lives by skewing the demographics of transmission! Some people are much more likely to recover from Covid-19 safely than others! (Major risk factors include advanced age, diabetes status, and probably smoking status. But there are also unknown risk factors – we don’t know why certain young healthy people can get so sick from this.)
Masks don’t “work,” though, if the goal is to prevent cases of Covid-19.
By May of 2020, it was already clear that Covid-19 would become endemic. We’d spread the virus too widely by then. The virus will never go away. Cases will never fall to zero.
Everyone alive today, and everyone born in the future, will be exposed to Covid-19 eventually. (With the possible exception of people who happen to die of other causes within the next few years.)
There’s still a strong argument for using masks to delay Covid-19 transmission: with more time, more people can be vaccinated! The vaccines work, by which I mean that the vaccines save lives.
Everyone will be exposed to Covid-19! The people who have been vaccinated are much more likely to survive! This front page article in my local newspaper is fear mongering; it’s a sort of fear mongering that I wholeheartedly endorse!
Vaccination is a safe, effective, time-tested medical practice. The principles behind vaccination were independently discovered centuries ago by scientists and healers in Africa, India, and China. Their discoveries were the basis for Edward Jenner’s smallpox vaccine.
When scientists say that vaccines “work” – vaccines save lives – we mean something very different than when we say that masks “work” – masks delay exposure!
In conjunction with vaccination, masks can be helpful!
Which is why the argument that children should currently wear masks in school is reasonable. Covid-19 tends not to be very dangerous for children, but occasionally it’s deadly. There’s a definite cost to wearing masks in school – muffled voices, hidden facial expressions, increased hassle – but children could be kept safer by delaying their exposure to Covid-19 until after a vaccine is approved for them.
(I feel lucky that my kids have already safely recovered from Covid-19 – I’m not beset by the same fear over this that other parents are navigating. But I understand their concern: raising children often feels terrifying because my heart would shatter if anything happened to these tiny, willful, fragile creatures.)
Most of the people who say “masks don’t work” are planning not to get the Covid-19 vaccine. Which means, weirdly, that they’re right! Without the end goal of eventual vaccination, masks don’t work! Even if universal masking policies were kept in place forever, Covid-19 is so infectious that everyone would still be exposed eventually!
The vaccines can save lives; masks cannot.
Obviously, I’m not arguing that you should ignore local mask requirements: I’m currently wearing a face mask as I type this! And there are lots of people who do want to be vaccinated who don’t have access yet – this isn’t much of an issue for adults in the United States, but vaccine access is an incredible privilege for most of the world’s population.
Because Covid-19 can be transmitted by people who feel fine, wearing a mask is a way to protect others. And personal preference isn’t a good reason to endanger the lives of the folks around us! That’s why we have traffic laws! Even if I think it’d be fun to go out driving while buzzed on booze, or to cruise on the left-hand side of the road, I shouldn’t be allowed to do it!
But also, I think it’s worth acknowledging that, within the full context of their actions, people’s denunciations of masks are actually scientifically accurate.
“Follow the science” is an unhelpful slogan – scientific analysis doesn’t result in a monolithic set of inarguable conclusions. At the heart of any policy, there are goals and priorities. These are set by philosophical or ethical considerations, not scientific fact.
“Follow the scientific findings that help us all achieve my goals for the world” doesn’t have the same pithy ring to it, though.
As a society, we’ve made enormous sacrifices during the Covid-19 pandemic. We’re wearing masks; we’re staying home; children are missing school.
We’re all cooperating to protect the people who are most at risk.
The risk profile for Covid-19 is opposite the risk from climate change. Covid-19 is more dangerous for the old. Climate change is more dangerous for the young, and for generations not yet born.
There’s another way to phrase this – Covid-19 is more dangerous for the wealthy, and climate change is more dangerous for those who currently have little or nothing. This is true both temporally and geographically.
(Wealth obviously protect individuals from Covid-19. Despite all his buffoonish posturing, when Donald Trump was infected, he received higher quality, more expensive medical care than almost anyone else. But on a population level, increased wealth is correlated with increased risk. Wealthy people are privileged to live longer, and in our capitalist society, people often accumulate wealth as they age.)
People with low risk from Covid-19 are making enormous sacrifices to protect others from it. But those with low risk from climate change are, in general, making no efforts to stop it.
Which conveys a clear message:
Younger people, you must solve this problem on your own. Despite your willingness to make sacrifices to protect us, we will not make sacrifices to protect you.
If we knew in March 2020 what we know now, we wouldn’t have closed schools. If you’re interested in some of the reasoning behind this, you should read this February 24, 2021 New York Times editorial from Nicholas Kristof.
We are hurting kids under the guise of protecting older people. But we’re not even succeeding. Schools have such low rates of Covid-19 transmission that we’re hurting kids without accomplishing anything.
People from “my” political party have orchestrated this harm, which makes it feel all the worse.
The New York Times recently printed an editorial from someone at the right-wing American Enterprise Institute chiding us for our totally un-scientific school closures. Members of the Republican party are positioning themselves as the defenders of public education.
The Republican party has been trying to undermine public schools ever since the Supreme Court decided that maybe Black kids deserve an equal chance to learn. And we’re letting them posture as the defenders of education?
During the vaccine roll-out, the New York Times set the stage for a big reveal – younger people were never in huge amounts of danger from Covid-19.
I don’t want to sound cavalier about this – Covid-19 is dangerous to people of all ages. It’s very similar to influenza.
Many people have a misconception that influenza is relatively harmless – sniffles & a runny nose – unless you’re elderly.
That’s not true.
Although the majority of cases of seasonal influenza are mild, it’s a deadly disease. Young healthy people die of influenza every year.
Most influenza deaths are recorded as “pneumonia” during post-mortem reports. To compare the dangers of Covid-19 to influenza, we’d want to measure how many more pneumonia deaths we’ve seen recently.
In a typical year, there are about 130,000 pneumonia deaths in the United States – these might be caused by influenza, coronaviruses, rhinoviruses, etc.
Many if not most of these deaths are caused by influenza – the column of numbers reporting verified influenza deaths is so low because we don’t always test for it, and when we do we typically use a low-quality antigen test.
Last year, though, was much worse – between January 1, 2020 and February 24, 2021, there were 670,000 pneumonia deaths in the United States. During those 14 months, five-fold more people died from this set of symptoms than we’d expect during a normal year.
We’ve also had about five times as many infections. Usually, about 30 million people contract seasonal influenza each year. The CDC estimates that perhaps 100 million people contracted Covid-19 during the ten months from February 2020 to December 2020.
That’s why the CDC’s roughestimates for the “infection fatality ratio” of Covid-19 are about the same as for influenza.
Last year, more people died from Covid-19 than would be expected from a typical year’s burden of seasonal influenza, but that’s because there were many more infections.
Seasonal influenza and Covid-19 are both deadly diseases. And it’s worth comparing them because the pandemic might be declared “over” once Covid-19 deaths fall to influenza-like levels.
That’s what most public health experts said when they were interviewed by Alexis Madrigal for an article in The Atlantic – that a reasonable goal is for Covid-19 “to mirror the typical mortality of influenza in the U.S. over a typical year.”
Which seems like a bit of a cop out. You’re going to call it “over” while people are still dying?
But we have to. Covid-19 will probably be with us forever. Like the coronavirus OC43, which we picked up from cows and which probably killed over a million people during the 1890 pandemic, Covid-19 will continue to make humans sick indefinitely.
Elderly people – especially those who weren’t exposed to Covid-19 as children – will always be particularly susceptible.
Early on during the pandemic – when we already had a good sense that younger people weren’t in much personal danger but also knew that we could only slow the spread of Covid-19 if younger people made sacrifices – we concocted a narrative that healthy young people were at high risk, too.
In March 2020, the New York Times printed an editorial from Fiona Lowenstein, a 26 year old who became tragically ill, saying “Millennials: if you can’t stay at home for others, do it for yourselves.”
In May 2020, the New York Times printed an editorial from Mara Gay, a 33 year old who became tragically ill, saying “I want Americans to understand that this virus is making otherwise young, healthy people very, very sick. I want them to know, this is no flu.”
This year, healthy young people have gotten very sick and even died of Covid-19 – which is tragic, but not unusual. Every year, healthy young people get very sick and die from influenza. This past year, with about five-fold more infections of an equivalently deadly disease, we’ve seen about five-fold more of these tragic young people’s deaths.
Now that a vaccine is available, though, the narrative has shifted.
In the February 28, 2021 New York Times Magazine, Kwame Anthony Appiah’s “Ethicist” column says that “Health care workers who are in their 20s and don’t have certain medical conditions aren’t at high risk if they contract Covid-19. Perhaps we could save more lives if we left them [to be vaccinated] until later.”
Now that we have a limited supply of vaccines, older, wealthier people benefit if young people are less afraid of Covid-19.
By delaying Covid-19 infection, young people increased their personal risk. Early during the pandemic, the virus was not particularly dangerous for young people. By now, though, there have now been millions of transmission events – millions of opportunities for mutant variants to arise.
And indeed, in February 2021 the New York Timesreports that “it is likely that the [new Covid-19 virus] variant is linked to an increased risk of hospitalization and death.”
Currently, we’re rationing the limited supply of Covid-19 vaccines based on age.
This is hypocritical, and potentially misguided.
When people develop such severe complications from Covid-19 that they require ventilation in order to have a chance of surviving, a younger person is more likely to benefit from the treatment. This holds both in terms of absolute number of lives saved, and is even more dramatic if you consider the years of life saved.
With a limited supply of ventilators, you can accomplish most by reserving them for the young – and we said that would be horrible.
In a March 2020 article for the New York Times, Sheri Fink wrote that the health department’s civil rights office would ensure “that states did not allow medical providers to discriminate on the basis of … age … when deciding who would receive lifesaving medical care.
In April 2020, Joel Zivot wrote for Medpage that “Rationing ventilators by age is wrong.”
Although we declared that it would be unethical to ration healthcare (ventilators) by age, we’re now rationing healthcare (vaccines) by age. The difference is that a different group of people – older, on average wealthier – benefits.
Rationing vaccines by age doesn’t even save the most lives.
Based on the CDC data, if both a 50-year-old and a 70-year-old are infected with Covid-19, the 70-year-old is about ten times more likely to die. That’s scary!
The major benefit of the vaccine is that it reduces the chance of severe illness if you are exposedto Covid-19. But we also know other ways to reduce the odds of exposure – a person can stay home, wear a mask near others, minimize the number of unique individuals they come into contact with.
If the 70-year-old has retired, they should be able to reduce the number of unique individuals they see each week to ten or fewer. But a 50-year-old grocery store clerk might see a thousand or more unique individuals each week, and have to spend time in fairly close proximity to each.
If the 50-year-old is at least ten-fold more likely to be exposed to Covid-19, then you’ll save more lives by giving the vaccine to them instead of to the 70-year-old.
Not only did we declare that rationing healthcare by age was wrong when it benefited younger people, but now we’re doing it even though it doesn’t save the most lives.
The unfairness is even more dramatic if we consider the risk of hospitalization. According to the CDC chart above, if both a 20-year-old and a 70-year-old are infected with Covid-19, the 70-year-old is about five times as likely to be hospitalized. But Medicare will pay the hospital bill. If a 20-year-old is hospitalized, they might face ruinous medical debt.
It’s quite likely that the obligations of most 20-year-olds – going to school, going to work, taking care of family – make them at least five times as likely to be exposed to Covid-19. We could stop lives from being ruined by medical debt if we vaccinated 20-year-olds first.
A friend of mine works in a take-out & delivery pizza restaurant in Chicago. For other people to be able to stay home and order food, he had to go in to work. His risk of exposure to Covid-19 was much higher than other people’s. As a healthy athlete in his late twenties, he wasn’t at high risk, but he was unlucky – when he got sick, he was so ill that he spent weeks in the hospital. He’s still recovering from his ruptured lung. He has no idea how to pay the $200,000 medical bill.
Because we’re rationing care by age, we’re not protecting people like him. Even though his risk – interacting with customers all day – made it possible for others to stay safe.
The Covid-19 pandemic has been awful, but I was pleased that people took fewer plane flights. Our carbon emissions briefly dropped.
Now that older people have received vaccines, though, they’ll resume flying.
For a February 17, 2021 article in the New York Times, Debra Kamin writes that “When the coronavirus hit, Jim and Cheryl Drayer, 69 and 72, canceled all their planned travel and hunkered down in their home in Dallas, Texas. But earlier this month, the Drayers both received the second dose of their Covid-19 vaccinations. And in March, armed with their new antibodies, they are heading to Maui for a long overdue vacation.”
“Americans over 65, who have had priority access to inoculations, are now newly emboldened to travel – often while their children and grandchildren continue to wait for a vaccine.”
Newly protected against Covid-19, they’ll increase their contributions to climate change.
Climate change has the opposite risk profile from Covid-19. Covid-19 is most dangerous for the old; climate change is most dangerous for the young, and for generations not yet born.
In some sense, it’s trivializing to even compare these. The risk from climate change is so much more severe.
If we make our planet inhospitable – if our crops fail due to storms or heat waves – the carrying capacity of Earth could easily fall by half.
We will see billions, not millions, of deaths.
Someone who is elderly today is unlikely to survive long enough to experience the worst effects of climate change – although it’s true that in severe weather events like Chicago’s fluke summer heat waves or Texas’s fluke winter storms, elderly people who live alone are exceptionally vulnerable.
Still, younger adults will have to endure worse calamities. They’ll live through more years of severe weather, crop failures, dangerous heat, lingering smog. And, since society will be forced to spend more money each year to maintain humanity’s precarious place on this planet – rebuilding after fires or floods – younger adults will face an increasingly inhospitable world with less wealth at their disposal.
Today’s children will encounter even worse. They’ll experience every disaster that today’s young adults will survive to see, and then some.
Generations not yet born may inherit a nightmare.
When people who currently have wealth were in danger, we created a narrative that everyone needed to make sacrifices. The largest sacrifices came from those who benefited least.
We’re still keeping children out of school – for almost no benefit in terms of Covid-19 transmission – in order to protect older, wealthier people.
Climate change is and has been caused primarily by those with the most wealth. If you can buy more meat, if you can take more plane flights, if you can purchase a bigger home, then you’re able to cause more climate change.
To stop climate change, we need wealthy people to make sacrifices. Buy less, fly less, eat plants.
But why would they?
Currently wealthy people aren’t in danger.
And – worse – currently wealthy people often became wealthy by treating the world as a competitive place. Now we’re asking them to cooperate? To make sacrifices for the sake of others?
Meat tastes good. Flying to Maui is fun. Doesn’t a person who worked hard deserve an enormous home?
A curious thought about the Gamestop stock trading phenomenon: Many small investors – often younger people – were convinced through emotional arguments to buy a few shares of stock and hold them with “diamond hands.”
Don’t sell, even if the price dips!
There was a strange cooperative / competitive system going on. The cooperative portion would have been illegal had it not been done in public – people were colluding to make the shares hard to get, which forced the hedge fund to pay more in order to cover their short sales.
Short sales: a hedge fund had borrowed many shares of the stock and sold them, hoping the price would fall and that new shares could be purchased more cheaply when it was time to return them. So the hedge fund had basically announced, “On such & such a date, I must have this stock, no matter the price!” If other people all cooperate and say, “On that day, don’t sell it for less than $420.00,” then the hedge fund has to pay $420.00 per share, even if the company that the stock represents is worthless.
But here’s the competitive portion – the company, Gamestop, is probably going out of business eventually. Driving to a strip mall to buy a video game cartridge instead of downloading it? The stock isn’t worth much money. So people wanted to cooperate to hurt the hedge fund, but people were also forced to compete because nobody wanted to be holding the stock at the end of the day.
Everyone would like to sell it for a bunch of money, but not everyone will get to sell it.
Even if more than a hundred percent of shares are short sold, not everyone will get to sell it – the hedge fund can satisfy all their contracts by buying a share, returning it to someone, buying the same share back from that person, returning it to someone else, and so on.
So if you know that everybody else has put in a “sell order” at $420.00, because they think it’s a funny number, you benefit by putting in a sell order at $419. That way you get almost as much money as anyone else, but you’re guaranteed to sell yours, whereas only a fraction of the people with $420 sell orders get to trade their (worthless) stock for money.
But then, if you know that other people are going to plug in a sell order at $419, you benefit from selling yours at $418. Because what if too many people sell their shares at $419?? You might still be left out!
So there was an incentive for savvy investors – wealthy people who might have thousands of dollars on the line – to convince other people to hold onto the stock no matter what … even while selling their own.
Billions of dollars changed hands. Some people “made” a lot of money. And it wouldn’t have happened without cooperation – lots of people colluding against the hedge fund.
But the particular people who benefited were determined by a con. By selling shares while promoting a narrative that “if we all hold with diamond hands, this is going to the moon!”
In some ways, our response to Covid-19 encourages me.
So many people – especially younger people – have shown themselves to be willing to cooperate.
A cloth mask traps your exhalations. Wearing a cloth mask makes your life worse, but it protects other people. Almost everybody in my home town wears a mask. Every young person at school wears a mask.
Young people are willing to make sacrifices to protect older people. But therein lies the con.
We’re not making sacrifices to protect them.
Our carbon emissions are no different from pulling off this face mask and intentionally coughing in a young child’s face. We ought to feel ashamed.
We’re fast approaching flu season, which is especially harrowing this year.
We, as a people, have struggled to respond to this calamity. We have a lot of scientific data about Covid-19 now, but science is never value-neutral. The way we design experiments reflects our biases; the way we report our findings, even more so.
For example, many people know the history of Edward Jenner inventing the world’s first vaccine. Fewer are aware of the long history of inoculation in Africa (essentially, low-tech vaccination) that preceded Jenner’s work.
So it’s worthwhile taking a moment to consider the current data on Covid-19.
Data alone can’t tell us what to do – the course of action we choose will reflect our values as a society. But the data may surprise a lot of people – which is strange considering how much we all feel that we know about Covid-19.
Indeed, we may realize that our response so far goes against our professed values.
Spoiler: I think we shouldn’t close in-person school.
Since April, I’ve written severalessays about Covid-19. In these, I’ve made a number of predictions. It’s worthwhile to consider how accurate these predictions have been.
This, after all, is what science is. We use data to make an informed prediction, and then we collect more data to evaluate how good our prediction was.
Without the second step – a reckoning with our success or failure – we’re just slinging bullshit.
I predicted that our PCR tests were missing most Covid-19 infections, that people’s immunity was likely to be short-lived (lasting for months, not years), and that Covid-19 was less dangerous than seasonal influenza for young people.
In my essays, I’ve tried to unpack the implications of each of these. From the vantage of the present, with much more data at our disposal, I still stand by what I’ve written.
But gloating’s no fun. So I’d rather start with what I got wrong.
My initial predictions about Covid-19 were terrible.
I didn’t articulate my beliefs at the time, but they can be inferred from my actions. In December, January, and February, I made absolutely no changes to my usual life. I didn’t recommend that travelers be quarantined. I didn’t care enough to even follow the news, aside from a cursory glance at the headlines.
While volunteering with the high school running team, I was jogging with a young man who was finishing up his EMT training.
“That new coronavirus is really scary,” he said. “There’s no immunity, and there’s no cure for it.”
I shrugged. I didn’t know anything about the new coronavirus. I talked with him about the 1918 influenza epidemic instead.
I didn’t make any change in my life until mid-March. And even then, what did I do?
I called my brother and talked to him about the pizza restaurant – he needed a plan in case there was no in-person dining for a few months.
My next set of predictions were off, but in the other direction – I estimated that Covid-19 was about four-fold more dangerous than seasonal influenza. The current best estimate from the CDC is that Covid-19 is about twice as dangerous, with an infection fatality ratio of 0.25%.
But seasonal influenza typically infects a tenth of our population, or less.
We’re unlikely to see a significant disruption in the transmission of Covid-19 (this is the concept of “herd immunity”) until about 50% of our population has immunity from it, whether from vaccination or recovery. Or possibly higher – in some densely populated areas, Covid-19 has spread until 70% (in NYC) or even 90% (in prisons) of people have contracted the disease.
Population density is hugely important for the dynamics of Covid-19’s spread, so it’s difficult to predict a nation-wide threshold for herd immunity. For a ballpark estimate, we could calculate what we’d see with a herd immunity threshold of about 40% in rural areas and 60% in urban areas.
Plugging in some numbers, 330 million people, 80% urban population, 0.25% IFR, 60% herd immunity threshold in urban areas, we’d anticipate 450,000 deaths.
That’s about half of what I predicted. And you know what? That’s awful.
Each of those 450,000 is a person. Someone with friends and family. And “slow the spread” doesn’t help them, it just stretches our grieving to encompass a whole year of tragedy instead of a horrific month of tragedy.
Based on the initial data, I concluded that the age demographics for Covid-19 risk were skewed more heavily toward elderly people than influenza risk.
I may have been wrong.
It’s difficult to directly compare the dangers of influenza to the dangers of Covid-19. Both are deadly diseases. Both result in hospitalizations and death. Both are more dangerous for elderly or immunocompromised people, but both also kill young, healthy people.
Typically, we use an antigen test for influenza and a PCR-based test for Covid-19. The PCR test is significantly more sensitive, so it’s easier to determine whether Covid-19 is involved a person’s death. If there are any viral particles in a sample, PCR will detect them. Whereas antigen tests have a much higher “false negative” rate.
Instead of using data from these tests, I looked at the total set of pneumonia deaths. Many different viruses can cause pneumonia symptoms, but the biggest culprits are influenza and, in 2020, Covid-19.
So I used these data to ask a simple question – in 2020, are the people dying of pneumonia disproportionately more elderly than in other years?
I expected that they would be. That is, after all, the prediction from my claims about Covid-19 demographic risks.
For people under the age of 18, we’ve seen the same number of deaths (or fewer) in 2020 as in other years. The introduction of Covid-19 appears to have caused no increased risk for these people.
But for people of all other ages, there have been almost three times as many people dying of these symptoms in 2020 compared to other years.
In most years, one thousand people aged 25-34 die of these symptoms; in 2020, three thousand have died. In most years, two thousand people aged 35-44 die of these symptoms; in 2020, six thousand have died. This same ratio holds for all ages above eighteen.
Younger people are at much less risk of harm from Covid-19 than older people are. But, aside from children under the age of eighteen, they don’t seem to be exceptionally protected.
Of course, my predictions about the age skew of risk might be less incorrect than I’m claiming here. If people’s dramatically altered behavior in 2020 has changed the demographics of exposure as compared to other years – which is what we should be doing to save the most lives – then we could see numbers like this even if Covid-19 had the risk skew that I initially predicted.
I predicted that four or more years would pass before we’d be able to vaccinate significant numbers of people against Covid-19.
I sure hope that I was wrong!
We now know that it should be relatively easy to confer immunity to Covid-19. Infection with other coronaviruses, including those that cause common colds, induce the production of protective antibodies. This may partly explain the low risk for children – because they get exposed to common-cold-causing coronaviruses so often, they may have high levels of protective antibodies all the time.
Several pharmaceutical companies have reported great results for their vaccine trials. Protection rates over 90%.
So the problem facing us now is manufacturing and distributing enough doses. But, honestly, that’s the sort of engineering problem that can easily be addressed by throwing money at it. Totally unlike the problem with HIV vaccines, which is that the basic science isn’t there – we just don’t know how to make a vaccine against HIV. No amount of money thrown at that problem would guarantee wide distribution of an effective vaccine.
We will still have to overcome the (unfortunately significant) hurdle of convincing people to be vaccinated.
For any individual, the risk of Covid-19 is about twice the risk of seasonal influenza. But huge numbers of people choose not to get a flu vaccine each year. In the past, the United States has had a vaccination rate of about 50%. Here’s hoping that this year will be different.
Which means that elderly people will always be at risk of dying from Covid-19.
The only way to protect people whose bodies have gone through “age-related immunosenence” – the inevitable weakening of an immune system after a person passes the evolutionarily-determined natural human lifespan of about 75 years – will be to vaccinate everybody else.
Depending on how long vaccine-conferred immunity lasts, we may need to vaccinate people annually. I worry, though, that it will become increasingly difficult to persuade people to get a Covid-19 vaccine once the yearly death toll drops to influenza-like levels – 50,000 to 100,000 deaths per year in the United States.
(Note: you may have seen articles in the New York Times suggesting that we’ll have long-lasting protection. They’re addressing a different question — after recovery, or vaccination, are you likely to become severely ill with Covid-19? And the answer is “probably not,” although it’s possible. When I discuss immunity here, I mean “after recovery, or vaccination, are you likely to be able to spread the virus after re-infection?” And the answer is almost certainly “yes, within months.”)
And I wrote about the interplay between short-lived immunity and the transmission dynamics of an extremely virulent, air-born virus.
This is what the Harvard public health team got so wrong. When we slow transmission enough that a virus is still circulating after people’s immunity wanes, they can get sick again.
For this person, the consequences aren’t so dire – an individual is likely to get less sick with each subsequent infection by a virus. But the implications for those who have not yet been exposed are horrible. The virus circulates forever, and people with naive immune systems are always in danger.
It’s the same dynamics as when European voyagers traveled to the Americas. Because the European people’s ancestors lived in unsanitary conditions surrounded by farm animals, they’d cultivated a whole host of zoogenic pathogens (like influenza and this new coronavirus). The Europeans got sick from these viruses often – they’d cough and sneeze, have a runny nose, some inflammation, a headache.
In the Americas, there were fewer endemic diseases. Year by year, people wouldn’t spend much time sick. Which sounds great, honestly – I would love to go a whole year without headaches.
But then the disgusting Europeans reached the Americas. The Europeans coughed and sneezed. The Americans died.
And then the Europeans set about murdering anyone who recovered. Today, descendants of the few survivors are made to feel like second-class citizens in their ancestral homelands.
In a world with endemic diseases, people who have never been exposed will always be at risk.
That’s why predictions made in venues such as the August New York Times editorial claiming that a six- to eight-week lockdown would stop Covid-19 were so clearly false. They wrote:
Six to eight weeks. That’s how long some of the nation’s leading public health experts say it would take to finally get the United States’ coronavirus epidemic under control.
For proof, look at Germany. Or Thailand. Or France.
Obviously, this didn’t work – in the presence of an endemic pathogen, the lockdowns preserved a large pool of people with naive immune systems, and they allowed enough time to pass that people who’d been sick lost their initial immunity. After a few months of seeming calm, case numbers rose again. For proof, look at Germany. Or France.
Case numbers are currently low in Thailand, but a new outbreak could be seeded at any time.
And the same thing is currently happening in NYC. Seven months after the initial outbreak, immunity has waned; case numbers are rising; people with mild second infections might be spreading the virus to friends or neighbors who weren’t infected previously.
All of which is why I initially thought that universal mask orders were a bad idea.
We’ve known for over a hundred years that masks would slow the spread of a virus. The only question was whether slowing the spread of Covid-19 would cause more people to die of Covid-19.
And it would – if a vaccine was years away.
But we may have vaccines within a year. Which means that I may have been wrong. Again, the dynamics of Covid-19 transmission are still poorly understood – I’ll try to explain some of this below.
In any case, I’ve always complied with our mask orders. I wear a mask – in stores, at school pickup, any time I pass within six feet of people while jogging.
To address global problems like Covid-19 and climate change, we need global consensus. One renegade polluting wantonly, or spewing viral particles into the air, could endanger the whole world. This is precisely the sort of circumstance where personal freedom is less important than community consensus.
The transmission dynamics of Covid-19 are extremely sensitive to environment. Whether you’re indoors or outdoors. How fast the air is moving. The population density. How close people are standing. Whether they’re wearing masks. Whether they’re shouting or speaking quietly.
Because there are so many variable, we don’t have good data. My father attended a lecture and a colleague (whom he admires) said, “Covid-19 is three-fold more infectious than seasonal influenza.” Which is bullshit – the transmission dynamics are different, so the relative infectivity depends on our behaviors. You can’t make a claim like this.
It’s difficult to measure precisely how well masks are slowing the spread of this virus.
But here’s a good estimate: according to Hsiang et al., the number of cases of Covid-19, left unchecked, might have increased exponentially at a rate of about 34% per day in the United States.
That’s fast. If about 1% of the population was infected, it could spread to everyone within a week or two. In NYC, Covid-19 appear to spread to over 70% of the population within about a month.
(To estimate the number of infections in New York City, I’m looking at the number of people who died and dividing by 0.004 – this is much higher than the infection fatality rate eventually reported by the CDC, but early in the epidemic, we were treating people with hydroxychloraquine, an unhelpful poison, and rushing to put people on ventilators. We now know that ventilation is so dangerous that it should only be used as a last resort, and that a much more effective therapy is to ask people to lie on their stomachs – “proning” makes it easier to get enough oxygen even when the virus has weakened a person’s lungs.)
Masks dramatically slow the rate of transmission.
A study conducted at a military college – where full-time mask-wearing and social distancing were strictly enforced – showed that the number of cases increased from 1% to 3% of the population over the course of two weeks.
So, some math! Solve by taking ten to the power of (log 3)/14, which gives an exponential growth rate of 8% per day. Five-fold slower than without masks.
But 8% per day is still fast.
Even though we might be able to vaccinate large numbers of people by the end of next year, that’s not soon enough. Most of us will have been sick with this – at least once – before then.
I don’t mean to sound like a broken record, but the biggest benefit of wearing masks isn’t that we slow the rate of spread for everyone — exponential growth of 8% is still fast — but that we’re better able to protect the people who need to be protected. Covid-19 is deadly, and we really don’t want high-risk people to be infected with it.
I’ve tried to walk you through the reasoning here — the actual science behind mask policies — but also, in case it wasn’t absolutely clear: please comply with your local mask policy.
You should wear a mask around people who aren’t in your (small) network of close contacts.
I’m writing this essay the day after New York City announced the end of in-person classes for school children.
A major problem with our response to Covid-19 is that there’s a time lag between our actions and the consequences. Human brains are bad at understanding laggy data. It’s not our fault. Our ancestors lived in a world where they’d throw a spear at an antelope, see the antelope die, and then eat it. Immediate cause and effect makes intuitive sense.
Delayed cause and effect is tricky.
If somebody hosts a party, there might be an increase in the number of people who get sick in the community over the next three weeks. Which causes an increase in the number of hospitalizations about two weeks after that. Which causes people to die about three weeks after that.
There’s a two-month gap between the party and the death. The connection is difficult for our brains to grasp.
As a direct consequence, we’ve got ass-hats and hypocrites attending parties for, say, their newly appointed Supreme Court justice.
But the problem with school closures is worse. There’s a thirty year gap between the school closure and the death. The connection is even more difficult to spot.
The authors link two sets of existing data: the correlation between school closures and low educational achievement, and the correlation between low educational achievement and premature death.
The public debate has pitted “school closures” against “lives saved,” or the education of children against the health of the community. Presenting the tradeoffs in this way obscures the very real health consequences of interrupted education.
These consequences are especially dire for young children.
The authors calculate that elementary school closures in the United States might have (already!) caused 5.5 million years of life lost.
Hsiang et al. found that school closures probably gave us no benefit in terms of reducing the number of Covid-19 cases, because children under 18 aren’t significant vectors for transmission (elementary-aged children even less so), but even if school closures had reduced the number of Covid-19 cases, closing schools would have caused more total years of life to be lost than saved.
The problem – from a political standpoint – is that Covid-19 kills older people, who vote, whereas school closures kill young people, who are intentionally disenfranchised.
And, personally, as someone with far-left political views, it’s sickening for me to see “my” political party adopt policies that are so destructive to children and disadvantaged people.
So, here’s what the scientific data can tell us so far:
We will eventually have effective vaccines for Covid-19. Probably within a year.
Covid-19 spreads even with social distancing and masks, but the spread is slower.
You have no way of knowing the risk status of people in a stranger’s bubble. (Please, follow your local mask orders!)
Schools – especially elementary schools – don’t contribute much to the spread of Covid-19.
School closures shorten children’s lives (and that’s not even accounting for their quality of life over the coming decades).
An individual case of Covid-19 is about twice as dangerous as a case of seasonal influenza (which is scary!).
Underlying immunity (from prior disease and vaccination) to Covid-19 is much lower than for seasonal influenza, so there will be many more cases.
Most people’s immunity to Covid-19 probably lasts several months, after which a person can be re-infected and spread the virus again.
So, those are some data. But data don’t tell us what to do. Only our values can do that.
How is white paint like the defeat of our nation’s (former!) white-supremacist in chief?
They’re pulling us back from the brink. Both ample cause for dancing in the street.
When I woke on Wednesday, November 4th, the news looked grim.
Before the 2016 election, I felt pretty sure that Donald Trump would win. I felt horrible about the prospect, but based on conversations I’d been having with people – and because the man embodies so much of our crass, self-serving, money-hungry national id – it seemed very likely that Trump would be elected.
But I had no prediction this time. I haven’t been talking to people. My family has returned to something vaguely like our regular life – my spouse is teaching, my kids are in school – but the local jail won’t let me inside, and I have far fewer conversations with folks around town. Our voices are muffled, and I can’t see their lips for extra help in parsing words.
I had hoped, obviously, that watching what the man has done to our country would induce people to vote for anyone else.
Nevertheless, almost half the people who voted wanted that man to stay in office.
Sure, Joe Biden clearly won the popular vote – but it wasn’t a landslide. It was something like 51% to 48%. Even ignoring, for a moment, the awfulness of the electoral college – a system that was designed so that some people could enjoy the FREEDOM to abduct, torture, and murder other people – 51% to 48% is quite close.
Almost half our nation’s voters think the president has been doing a dang fine job and should carry on with it.
On Wednesday morning, it looked like the electoral college might proffer another victory to our current president.
I didn’t take to the streets. Nor did I descend into my secret bunker.
I don’t even have a secret bunker. Although I did notice, when I went grocery shopping on Monday before the election, that the shelves were stripped bare of most types of canned beans. I imagine other people were stocking their secret bunkers.
And it’s not clear to me whether I’d be more in need of a secret bunker if Trump had won – four more years of ravage – or if Biden had won decisively, which might induce violence from the most prominent terrorist organizations in our country, the well-armed white supremacists.
I bought some dried beans. Which is silly, I know. With young children in the house, I almost never plan our meals well enough ahead of time to use dried beans instead of canned. And, in the event of TOTAL CHAOS, there’s no guarantee that we’d have running water to cook dried beans with. And also, maybe it’s excessively paranoid to be at the grocery store a day before a U.S. presidential election and feel an overwhelming dread of impending violence.
But maybe it’s not. That’s the thing. Maybe it’s not.
Any Rip Van Winkles who lay down for a nap in 2015 would have thought I was being absurd. But in 2020, other people had gotten to the canned beans before I did.
So, waking up, feeling nauseous at the gaping blood-red wound / chasm confronting me from the New York Times website’s map of the United States on Wednesday, I sat down to send sad emails to a few people I care about. Given that depression is normally a very private affair – too private, most people suffering in silence, alone – it felt almost cathartic to have the opportunity for such shared despair. Perhaps 52% of our nation felt the same hopeless nausea that I did.
During one of these sad emails, I wrote about stocks. I’d hedged my bets – stock in construction equipment like CAT in case Joe Biden wins and actually embarks on our sorely-needed infrastructure project; stock in HVAC (air conditioning) and Canadian agriculture in case Trump won.
And, sure, maybe I shouldn’t unload my Canadian ag stocks yet. If the obstructionists hold the Senate, maybe Biden will be stymied in his efforts to address climate change. But, you know what? At least he’s gonna try.
The other guy was going to keep tweeting that sacred-water-poisoning pipelines and mountain-wrecking coal mining would Make America Uninhabitable Later, and, after an erudite Black man had successfully governed our nation for eight years, lots of folks really wanted to maul something.
But, the dire need for air conditioning?
Well, let’s preface this by saying that air conditioning is going to be a really problematic feedback loop in our efforts to address climate change. The world gets hotter, people feel miserable, people use more air conditioning, air conditioning is a huge energy suck, which makes the world get even hotter. That’s bad. If a chemical company develops a more efficient coolant, it’ll be a huge boon.
Kinda strange for a hippie environmentalist like me to extol the efforts of companies like Dow chemical, but also, I’m a scientist, and, also, this is where we are in the world. Things would be different if we’d made better choices years ago.
No matter. This essay is a happy one, chock full of good news.
The first good news is that, pending a few lawsuits that will (eventually) fizzle in a tangled mess of illogic, Biden has won the U.S. presidency. Of our nation’s approximately 140 million eligible candidates for president, Joe Biden isn’t my number one pick. But, still. I voted for him. He’s good enough.
I’m quite happy he won.
(Given the stakes this year – buying dried beans on Monday, honestly! – that’s an understatement.)
Here’s some more good news: new paint!
Seriously. If you can spare a minute to read Science magazine’s layperson-friendly press release, please, click here!
There’s a charming new research article – published three weeks ago, but unnoticed by me until this morning – that describes how much cooling we could achieve by painting buildings with a fresh coat of this special formulation of white paint.
Sunlight shines down, ready to heat any buildings covered in black shingles or whatever, but sunlight will bounce off this white paint, and be reflected in a lovely spread of wavelengths to fly back harmlessly into outer space.
This is, after all, the usual problem with greenhouse gases. Carbon dioxide lets inbound sunlight pass through, but all our stuff down here on Earth absorbs the photons of sunlight and in return ships off a larger number (more entropy, more chaos) of lower energy (so that no energy is created or destroyed) infrared photons, and the greenhouse gases won’t let those new photons fly off into outer space, so our planet heats up.
Joe Biden. And white paint.
Our species is a bit less likely to face extinction in the coming centuries. And that sounds great to me!
My family had spring break travel plans for before the shutdown.
We canceled them.
At the time, we feared for our safety. My spouse said to me, “You caught the flu twice this year, even after you were vaccinated, and the second time was the sickest I’ve ever seen you. I’m really worried about what will happen if you catch this new thing, too.”
She wanted me to cancel my poetry classes in the local jail. My father, an infectious diseases doctor and professor of immunology, thought I should still go in to teach. “If somebody’s in there coughing up a lung, you should recommend he skip class next week,” my father told me.
But I was spooked. I felt glad when the jail put out a press release saying they’d no longer allow volunteers to come in – I didn’t want to choose between helping the incarcerated men and protecting my family.
My spouse is a high school science teacher. She felt glad that her biology classroom has over a dozen sinks. During the final week of school, she asked all her students to wash their hands for 20 seconds as soon as they walked into the room.
My spouse and I are both scientists, but it wasn’t until a week into the shutdown that I began to read research papers about Covid-19. Until then, we had gotten all our information from the newspaper. And the news was terrifying. Huge numbers of people were dying in Italy. Our imbecilic president claimed that Covid-19 was no big deal, making me speculate that this disease was even more dangerous than I’d thought.
Later, I finally went through the data from Italy and from the Diamond Princess cruise ship. These data – alongside the assumption that viral exposure should be roughly similar across age groups, if not higher for school children and young people who are out and about in the world – showed my family that our personal risk was probably quite low.
Still, we stayed inside. We were worried about harming others.
When I saw photographs of beaches packed with revelers, I felt furious. Did those selfish young people not realize that their choices could cause more people to die?
So it was shocking for me to learn that those selfish young people were actually doing the thing that would save most lives.
If we, as a people, had acted earlier, we could have prevented all these deaths. In January, it would have been enough to impose a brief quarantine after all international travel. In February, it would have been enough to use our current strategy of business closures, PCR testing, and contact tracing. In March, we were too late. The best we could do then – the best we can do now – was to slow the spread of infections.
Unfortunately, slowing the spread of infections will cause more people to die.
There’s an obvious short-term benefit to slowing the spread of infections – if too many people became critically ill at the same time, our hospitals would be overwhelmed, and we’d be unable to offer treatment to everyone who wanted it. We’d run out of ventilators.
This problem is exacerbated by the fact that we, as a people, are terrible about talking about death. There’s no consensus about what constitutes a good life – what more would have to happen for you to feel ready to die?
Personally, I don’t want to die. As my mind stopped, I’d feel regret that I wouldn’t get to see my children become self-sufficient adults. But I’d like to think that I could feel proud that I’ve done so much to set them on the right path. Since my twenties, I’ve put forth a constant effort to live ethically, and I’d like to imagine that my work – my writing, teaching, and research – has improved other people’s lives.
I’ve also gotten to see and do a lot of wonderful things. I’ve been privileged to visit four countries. I visited St. Louis’s City Museum when one of my kids was old enough to gleefully play. I have a bundle of some two dozen love letters that several wonderful people sent me.
I’ve had a good life. I’d like for it to continue, but I’ve already had a good life.
Many medical doctors, who have seen how awful it can be for patients when everything is done to try to save a life, have “do not resuscitate” orders. My spouse and I keep our living wills in an accessible space in our home. But a majority of laypeople want dramatic, painful measures to be taken in the attempt to save their lives.
Still. Even without our reluctance to discuss death, there would be a short-term benefit to slowing the spread of infections. The American healthcare system is terrible, and was already strained to the breaking point. We weren’t – and aren’t – ready to handle a huge influx of sick patients.
But the short-term benefit of slowing the spread of Covid-19 comes at a major cost.
The shutdown itself hurts people. The deaths caused by increased joblessness, food insecurity, educational disruption, domestic violence, and loneliness (“loneliness and social isolation can be as damaging to health as smoking 15 cigarettes a day”) are more difficult to measure than the deaths caused by Covid-19. We won’t have a PCR test to diagnose which people were killed by the shutdown.
Those deaths won’t all come at once. But those deaths are no less real, and no less tragic, than the immediate horror of a person drowning from viral-induced fluid buildup in their lungs.
And, perhaps more damning, if the shutdown ends before there’s a vaccine, the shutdown will cause more people to die of Covid-19.
Without a vaccine, slowing the spread of Covid-19 has a short-term benefit of reducing the rate of hospital admissions, at the long-term cost of increasing the total number of Covid-19 cases.
All immunity fades – sometimes after decades, sometimes after months. Doesn’t matter whether you have immunity from recovery or from vaccination – eventually, your immunity will disappear. And, for a new disease, we have no way of predicting when. Nobody knows why some antigens, like the tetanus vaccine, trigger such long-lasting immunity, while other antigens, such as the flu vaccine or the influenza virus itself, trigger such brief protection.
We don’t know how long immunity to Covid-19 will last. For some coronaviruses, immunity fades within a year. For others, like SARS, immunity lasts longer.
The World Health Organization has warned, repeatedly, that immunity to Covid-19 might be brief. But the WHO seems unaware of the implications of this warning.
The shorter the duration of a person’s immunity, the more dangerous the shutdown. If our shutdown causes the Covid-19 epidemic to last longer than the duration of individual immunity, there will be more total infections – and thus more deaths – before we reach herd immunity.
This is, after all, exactly how a one-time “novel zoogenic disease” like influenza became a permanent parasite on our species, killing tens of thousands of people in the United States each year. Long ago, transmission was slowed to the point that the virus could circulate indefinitely. Influenza has been with us ever since.
That’s the glaring flaw in the recent Harvard Science paper recommending social distancing until 2022 – in their key figure, they do not incorporate a loss of immunity. Depending on the interplay between the rate of spread and the duration of immunity, their recommendation can cause this epidemic to never end.
And, if the shutdown ends before we have a vaccine, the lost immunity represents an increased death toll to Covid-19. Even neglecting all the other harms, we’ll have killed more people than if we’d done nothing.
This sounds terrifying. And it is. But the small glimmer of good news is that people’s second infections will probably be less severe. If you survive Covid-19 the first time you contract it, you have a good chance of surviving subsequent infections. But prolonging the epidemic will still cause more deaths, because herd immunity works by disrupting transmission. Even though an individual is less likely to die during a second infection, that person can still spread the virus. Indeed, people are more likely to spread the virus during subsequent infections, because they’re more likely to feel healthy while shedding infectious particles.
This calculation would be very different if people could be vaccinated.
Obviously, vaccination would be the best way to end this epidemic. In order to reach herd immunity by a sufficient number of people recovering, there would have to be a huge percentage of our population infected. Nobody knows how many infections it would take, but many researchers guess a number around 60% to 70% of our population.
Even if Covid-19 were no more dangerous than seasonal influenza (and our data so far suggest that it’s actually about four-fold moredangerous than most years’ seasonal influenza), that would mean 200,000 deaths. A horrifying number.
But there’s no vaccine. Lots of people are working on making a vaccine. We have Covid-19 vaccines that work well in monkeys. But that doesn’t necessarily mean anything in terms of human protection. We’ve made many HIV vaccines that work well in monkeys – some of these increase the chance that humans will contract HIV.
It should be easier to make a vaccine against this coronavirus than against HIV. When making a vaccine, you want your target to mutate as little as possible. You want it to maintain a set structure, because antibodies need to recognize the shape of external features of the virus in order to protect you. HIV mutates so fast that its shape changes, like a villain constantly donning a new disguise. But the virus that causes Covid-19 includes a proofreading enzyme, so it’ll switch disguises less.
Still, “easier to make a vaccine against than HIV” is not the most encouraging news. Certain pharmaceutical companies have issued optimistic press briefings suggesting that they’ll be able to develop a vaccine in 18 months, but we should feel dubious. These press briefings are probably intended to bolster the companies’ stock prices, not give the general public an accurate understanding of vaccine development.
Realistically, a Covid-19 vaccine is probably at least four years away. And it’s possible – unlikely, but possible – that we’ll never develop a safe, effective vaccine for this.
If we end the shutdown at any time before there is a vaccine, the shutdown will increase the number of people who die of Covid-19. The longer the shutdown, the higher the toll. And a vaccine is probably years away.
The combination of those two ideas should give you pause.
If we’re going to end the shutdown before we have a vaccine, we should end it now.
For a vaccine to end the Covid-19 epidemic, enough people will need to choose to be vaccinated for us to reach herd immunity.
Unfortunately, many people in the United States distrust the well-established efficacy and safety of vaccines. It’s worth comparing Covid-19 to seasonal influenza. On a population level, Covid-19 seems to be about four-fold more dangerous than seasonal influenza. But this average risk obscures some important data – the risk of Covid-19 is distributed less evenly than the risk of influenza.
With influenza, healthy young people have a smaller risk of death than elderly people or people with pre-existing medical conditions. But some healthy young people die from seasonal influenza. In the United States, several thousand people between the ages of 18 and 45 die of influenza every year.
And yet, many people choose not to be vaccinated against influenza. The population-wide vaccination rate in the United States is only 40%, too low to provide herd immunity.
Compared to influenza, Covid-19 seems to have less risk for healthy young people. Yes, healthy young people die of Covid-19. With influenza, about 10% of deaths are people between the ages of 18 and 45. With Covid-19, about 2% of deaths are people in this age group.
I’m not arguing that Covid-19 isn’t dangerous. When I compare Covid-19 to seasonal influenza, I’m simply comparing two diseases that are both deadly.
The influenza vaccine saves lives. The data are indisputable.
But people don’t choose to get it! That’s why I think it’s unfortunately very likely that people whose personal risk from Covid-19 is lower than their risk from influenza will forgo vaccination. Even if we had access to 300 million doses of a safe, effective vaccine today, I doubt that enough people would get vaccinated to reach herd immunity.
Obviously, I’d love to be wrong about this. Vaccination saves lives.
Please, dear reader, get a flu vaccine each year. And, if we develop a safe, effective Covid-19 vaccine, you should get that too.
We don’t have a vaccine. The shutdown is causing harm – the shutdown is even increasing the total number of people who will eventually die of Covid-19.
Is there anything we can do?
Luckily, yes. We do have another way to save lives. We can change the demographics of exposure.
Our understanding of Covid-19 still has major gaps. We need to do more research into the role of interleukin 6 in our bodies’ response to this disease – a lot of the healthy young people who’ve become critically ill with Covid-19 experienced excessive inflammation that further damaged their lungs.
But we already know that advanced age, smoking status, obesity and Type 2 diabetes are major risk factors for complications from Covid-19. Based on the data we have so far, it seems like a low-risk person might have somewhere between a hundredth or a thousandth the chance of becoming critically ill with Covid-19 as compared to an at-risk person. With influenza, a low-risk person might have between a tenth and a hundredth the chance of becoming critically ill.
The risk of Covid-19 is more concentrated on a small segment of the population than the risk of influenza.
To save lives, and to keep our hospitals from being overwhelmed, we want to do everything possible to avoid exposing at-risk people to this virus.
But when healthy young people take extraordinary measures to avoid getting sick with Covid-19 – like the shutdown, social distancing, and wearing masks – they increase the relative burden of disease that falls on at-risk people. We should be prioritizing the protection of at-risk people, and we aren’t.
Because this epidemic will not end until we reach the population-wide threshold for herd immunity, someone has to get sick. We’d rather it be someone who is likely to recover.
Tragically, we already have data suggesting that a partial shutdown can transfer the burden of infection from one group to another. In the United States, our shutdown was partial from the beginning. People with white-collar jobs switched to working remotely, but cashiers, bus drivers, janitors, people in food prep, and nurses have kept working. In part because Black and brown people are over-represented in these forms of employment, they’ve been over-represented among Covid-19 deaths.
There is absolutely no reason to think that poor people would be more likely to safely recover from Covid-19 – indeed, due to air pollution, stress, sleep deprivation, limited access to good nutrition, and limited access to health care, we should suspect that poor people will be less likely to recover – but, during the shutdown, we’ve shifted the burden of disease onto their shoulders.
This is horrible. Both unethical and ineffective. And, really, an unsurprising outcome, given the way our country often operates.
If we want to save lives, we need for healthy younger people to use their immune systems to protect us. The data we have so far indicates that the shutdown should end now — for them.
It will feel unfair if healthy younger people get to return to work and to their regular lives before others.
And the logistics won’t be easy. We’ll still need to make accommodations for people to work from home. Stores will have to maintain morning hours for at-risk shoppers, and be thoroughly cleaned each night.
If school buildings were open, some teachers couldn’t be there – they might need substitutes for months – and neither could some students, who might switch to e-learning to protect at-risk family.
We’ll need to provide enough monetary and other resources that at-risk people can endure a few more months of self-isolation. Which is horrible. We all know, now that we’ve all been doing this for a while, that what we’re asking at-risk people to endure is horrible. But the payoff is that we’ll be saving lives.
Indeed, the people who self-isolate will have lowest risk. We’ll be saving their lives.
And no one should feel forced, for financial reasons or otherwise, to take on more risk than they feel comfortable with. That’s why accommodations will be so important. I personally would feel shabby if I took extreme measures to protect myself, knowing that my risk is so much lower than other people’s, but you can’t look at someone in a mask and know their medical history, much less whom they might be protecting at home.
All told, this plan isn’t good. I’m not trying to convince you that this is good. I’m just saying that, because we bungled things in January, this is the best we have.
First, some background: in case you haven’t noticed, most of the United States is operating under a half-assed lockdown. In theory, there are stay-at-home orders, but many people, such as grocery store clerks, janitors, health care workers, construction workers, restaurant chefs, delivery drivers, etc., are still going to work as normal. However, schools have been closed, and most people are trying to stand at least six feet away from strangers.
We’re doing this out of fear that Covid-19 is an extremely dangerous new viral disease. Our initial data suggested that as many as 10% of people infected with Covid-19 would die.
That’s terrifying! We would be looking at tens of millions of deaths in the United States alone! A virus like this will spread until a majority of people have immunity to it – a ballpark estimate is that 70% of the population needs immunity before the epidemic stops. And our early data suggested that one in ten would die.
My family was scared. We washed our hands compulsively. We changed into clean clothes as soon as we came into the house. The kids didn’t leave our home for a week. My spouse went to the grocery store and bought hundreds of dollars of canned beans and cleaning supplies.
And, to make matters worse, our president was on the news saying that Covid-19 was no big deal. His nonchalance made me freak out more. Our ass-hat-in-chief has been wrong about basically everything, in my opinion. His environmental policies are basically designed to make more people die. If he claimed we had nothing to worry about, then Covid-19 was probably more deadly than I expected.
Five weeks have passed, and we now have much more data. It seems that Covid-19 is much less dangerous than we initially feared. For someone my age (37), Covid-19 is less dangerous than seasonal influenza.
Last year, seasonal influenza killed several thousand people between the ages of 18 and 49 in the United States – most likely 2,500 people, but perhaps as many as 5,800. People in this age demographic account for about 10% of total flu deaths in the United States, year after year.
Seasonal influenza also killed several hundred children last year – perhaps over a thousand.
There’s a vaccine against influenza, but most people don’t bother.
Seasonal influenza is more dangerous than Covid-19 for people between the ages of 18 and 49, but only 35% of them chose to be vaccinated in the most recently reported year (2018). And because the vaccination rate is so low, our society doesn’t have herd immunity. By choosing not to get the influenza vaccine, these people are endangering themselves and others.
Some people hope that the Covid-19 epidemic will end once a vaccine is released. I am extremely skeptical. The biggest problem, to my mind, isn’t that years might pass before there’s a vaccine. I just can’t imagine that a sufficient percentage of our population would choose to get a Covid-19 vaccine when most people’s personal risk is lower than their risk from influenza.
When I teach classes in jail, dudes often tell me about which vaccines they think are too dangerous for their kids to get. I launch into a tirade about how safe most vaccines are, and how deadly the diseases they prevent.
Seriously, get your kids vaccinated. You don’t want to watch your child die of measles.
And, seriously, dear reader – get a flu vaccine each year. Even if you’re too selfish to worry about the other people whom your mild case of influenza might kill, do it for yourself.
We already know how dangerous seasonal influenza is. But what about Covid-19?
To answer that, we need data. And one set of data is unmistakable – many people have died. Hospitals around the world have experienced an influx of patients with a common set of symptoms. They struggle to breathe; their bodies weaken from oxygen deprivation; their lungs accumulate liquid; they die.
For each of these patients saved, three others are consigned to an agonizing death in the hospital, intubated among the flashing lights, the ceaseless blips and bleeps. At home, they’d die in a day; in the hospital, their deaths will take three weeks.
And the sheer quantity of deaths sounds scary – especially for people who don’t realize how many tens of thousands die from influenza in the United States each year.
Indeed, when people die of Covid-19, it’s often because their lungs fail. Smoking is obviously a major risk factor for dying of Covid-19 – a significant portion of reported Covid-19 deaths could be considered cigarette deaths instead. Or as air pollution deaths – and yet, our current president is using this crisis as an opportunity to weaken EPA airquality regulations.
Air pollution is a huge problem for a lot of Black communities in the United States. Our racist housing policies have placed a lot of minority neighborhoods near heavily polluting factories. Now Covid-19 is turning what is already a lifelong struggle for breath into a death sentence.
I would enthusiastically support a shutdown motivated by the battle for clean air.
But if we want to know how scary this virus is, we need to know how many people were infected. If that many people died after everyone in the country had it, then Covid-19 would be less dangerous than influenza. If that many people died after only a hundred thousand had been infected, then this would be terrifying, and far more dangerous than influenza.
Initially, our data came from PCR testing.
These are good tests. Polymerase chain reaction is highly specific. If you want to amplify a certain genetic sequence, you can design short DNA primers that will bind only to that sequence. Put the whole mess in a thermocycler and you get a bunch of your target, as long as the gene is present in the test tube in the first place. If the gene isn’t there, you’ll get nothing.
PCR works great. Even our lovely but amnesiac lab tech never once screwed it up.
So, do the PCR test and you’ll know whether a certain gene is present in your test tube. Target a viral gene and you’ll know whether the virus is present in your test tube. Scoop out some nose glop from somebody to put into the test tube and you’ll know whether the virus is present in that nose glop.
The PCR test is a great test that measures whether someone is actively shedding virus. It answers, is there virus present in the nose glop?
This is not the same question as, has this person ever been infected with Covid-19?
It’s a similar question – most people infected with a coronavirus will have at least a brief period of viral shedding – but it’s a much more specific question. When a healthy person is infected with a coronavirus, the period of viral shedding can be as short as a single day.
A person can get infected with a coronavirus, and if you do the PCR test either before or after that single day, the PCR test will give a negative result. Nope, no viral RNA is in this nose glop!
And so we know that the PCR test will undercount the true number of infections.
When we look at the age demographics for Covid-19 infections as measured by PCR test, the undercount becomes glaringly obvious.
Friends, it is exceedingly unlikely that such a low percentage of children were exposed to this virus. Children are disgusting. I believe this is common knowledge. Parents of small children are pretty much always sick because children are so disgusting.
Seriously, my family has been doing the whole “social distancing” thing for over a month, and yet my nose is dripping while I type this.
Children are always touching everything, and then they rub their eyeballs or chew on their fingers. If you take them someplace, they grubble around on the floor. They pick up discarded tissues and ask, “What’s this?”
“That’s somebody’s gross kleenex, is what it is! Just, just drop it. I know it’s trash, I know we’re not supposed to leave trash on the ground, but just, just drop it, okay? Somebody will come throw it away later.”
The next day: “Dad, you said somebody would throw that kleenex away, but it’s still there!”
Bloody hell. Children are little monsters.
It seems fairly obvious that at least as high a percentage of children would be infected as any other age demographic.
But they’re not showing up from the PCR data. On the Diamond Princess cruise ship, the lockdown began on February 5th, but PCR testing didn’t begin until February 11th. Anyone who was infected but quickly recovered will be invisible to that PCR test. And even people who are actively shedding viral particles can feel totally well. People can get infected and recover without noticing a thing.
We see the same thing when we look at the PCR data from Italy. If we mistakenly assumed that the PCR data was measuring the number of infections, and not measuring the number of people who were given a PCR test while shedding viral particles, we’d conclude that elderly people went out and socialized widely, getting each other sick, and only occasionally infected their great-grandchildren at home.
Here in the United States, children are disgusting little monsters. I bet kids are disgusting in Italy, too. They’re disgusting all over the world.
A much more likely scenario is that children spread this virus at school. Many probably felt totally fine; some might’ve had a bad fever or the sniffles for a few days. But then they recovered.
When they got their great-grandparents sick – which can happen easily since so many Italian families live in multigenerational homes – elderly people began to die.
So we know that the PCR test is undercounting the true number of infections. Unless you’re testing every person, every day, regardless of whether or not they have symptoms, you’re going to undercount the number of infections.
In a moment, we can work through a way to get a more accurate count. But perhaps it’s worth mentioning that, for someone my age, Covid-19 would seem to be about as dangerous as influenza even if we assumed that the PCR data matched the true number of infections.
If you’re a healthy middle-aged or young person, you should not feel personally afraid.
That alone would not be an excuse to go out and start dancing in the street, though. Your actions might cause other people to die.
(NOTE & CORRECTION: After this post went up, my father recommended that I add something more about personal risk. No one has collected enough data on this yet, but he suspects that the next most important risk factor, after smoking and age, will be type 2 diabetes. And he reminded me that many people in their 30s & 40s in this country are diabetic or prediabetic and don’t even realize it yet. Everyone in this category probably has elevated risk of complications from Covid-19.)
After you’ve been infected with a virus, your body will start making antibodies. These protect you from being infected again.
Have you read Shel Silverstein’s Missing Piece book? Antibodies work kind of like that. They have a particular shape, and so they’ll glom onto a virus only if that virus has outcroppings that match the antibody’s shape. Then your body sees the antibodies hanging out on a virus like a GPS tracker and proceeds to destroy the virus.
So to make an antibody test, you take some stuff that looks like the outcroppings on the virus and you put it on a chip. Wash somebody’s blood over it, and if that blood contains antibodies that have the right shape to glom onto the virus, they’ll stick to the chip. All your other antibodies, the ones that recognize different viruses, will float away.
An antibody test is going to be worse than a PCR test. It’s easier to get a false positive result – antibodies are made of proteins, and they can unfold if you treat them roughly, and then they’ll stick to anything. Then you’ll think that somebody has the right antibodies, but they don’t. That’s bad.
You have to be much more careful when you’re doing an antibody test. I wouldn’t have asked our lab tech to do them for me.
An antibody test is also going to have false negatives. A viral particle is a big honking thing, and there are lots of places on its surface where an antibody might bind. If your antibodies recognize some aspect of the virus that’s different from what the test manufacturers included on their chip, your antibodies will float away. Even though they’d protect you from the actual virus if you happened to be exposed to it.
If you’re a cautious person, though – and I consider myself to be pretty cautious – you’d much rather have an antibody test with a bunch of false negatives than false positives. If you’re actually immune to Covid-19 but keep being cautious, well, so what? You’re safe either way. But if you think you’re immune when you’re not, then you might get sick. That’s bad.
Because antibody tests are designed to give more false negatives than false positives, you should know that it’d be really foolish to use them to track an infection. Like, if you’re testing people to see who is safe to work as a delivery person today, use the PCR test! The antibody test has a bunch of false negatives, and there’s a time lag between the onset of infection and when your body will start making antibodies.
If you use the antibody test on a bunch of people, though, you can tell how many were infected. And that’s useful information, too.
In the town of Robbio in Italy (pop. 6,000), the PCR test showed that only 23 people had been infected with Covid-19. But then the mayor implored everyone to get an antibody test, and 10% of people had actually been infected with – and had recovered from – Covid-19. Most of them couldn’t even recall having been sick.
I don’t know who made the tests used in Robbio – maybe they were a little better, maybe they were a little worse. Based on my experience, I wouldn’t be so surprised if the true infection rate with Covid-19 in that town was really just 10% – nor would I be surprised to hear that the chips had a high false-negative rate and that the infection rate was 20% or more.
If you calculate the fatality rate of Covid-19 in Italy by assuming that the PCR tests caught every infection, you’d get a terrifying 10%.
If you instead assume that many other towns had a similar infection rate to Robbio, you’ll instead calculate that the fatality rate was well under one percent.
Italy has higher risk than the United States due to age demographics, smoking rates, and multigenerational households – and even in Italy, the fatality rate was probably well under one percent.
When researchers in Germany randomly chose people to take a Covid-19 PCR test (many of whom had no symptoms), they found that 2% of the population was actively shedding virus – a much higher number of cases than they would have found if they tested only sick people. And when they randomly chose people to take an antibody test, they found that 15% had already recovered from the infection (again, many of whom had never felt sick). According to these numbers – which are expected to be an undercount, due to false negatives and the time lag before antibody production – they calculated a case fatality rate of 0.37%.
That would be about three-fold more dangerous than seasonal influenza.
In the United States, our bungling president gutted the CDC, leaving us without the expertise needed to address Covid-19 (or myriad other problems that might arise). During the first few months of this epidemic, very few people managed to get a PCR test. That’s why our data from the PCR tests is likely to be a dramatic undercount – indeed, when we finally started producing accurate tests, the apparent growth in Covid-19 caseload superimposed with the growth in test availability.
In the absence of good PCR data, we have to rely on antibody data to track infections after the fact. Which is why a town in Colorado with zero reported infections, as measured by PCR, had sufficiently widespread exposure that 2% of the population had already recovered from Covid-19.
Yes, there were problems with the Stanford study’s data collection – they displayed advertisements to a random selection of people, but then a self-selected subset responded. The pool of respondents were enriched for white women, but Santa Clara’s outbreak probably began among Asian-Americans. And we all know that random sampling doesn’t always give you an accurate depiction of the population at large – after all, random polling predicted that a competent president would be elected in 2016.
Now look at us.
It’s also likely that people with a poor understanding of the biology could misinterpret the result of the Stanford study. They found that PCR tests had undercounted the infection rate in Santa Clara county, at the time of this study, by 85-fold.
It would be absurd to assume that you could simply multiply all PCR results by 85 to determine the true infection rate, but some people did. And then pointed out the absurdity of their own bad math.
In places where more people are being tested by PCR, and they’re being tested more often, the PCR results will be closer to the true infection rate. If you gave everyone in the United States a PCR test, and did it every day, then the PCR data would be exactly equal to the true infection rate.
If we had data like that from the beginning, we wouldn’t have been scared. We would’ve known the true case fatality rate early on, and, also, at-risk people could’ve been treated as soon as they got infected. We’d be able to save many more lives.
10% is roughly the proportion of young people who die of seasonal influenza. But only 1% of Covid-19 deaths are people younger than 35. The news reports don’t always make clear how much the risk of Covid-19 is clustered in a small segment of the population.
This has serious implications for what we should do next. If we were dealing with a virus that was about three-fold more dangerous than seasonal influenza for everyone, we might just return to life as normal. (Indeed, we carried on as normal during the bad years when seasonal influenza killed 90,000 people instead of last year’s 30,000.)
Because the risk from Covid-19 is so concentrated, though, we can come up with a plan that will save a lot of lives.
Healthy people under retirement age should resume most parts of their lives as normal. Schools should re-open: for students, Covid-19 is much less dangerous than seasonal influenza. I think that people should still try to work from home when possible, because it’s the right thing to do to fight climate change.
At-risk people should continue to isolate themselves as much as possible.
This sounds crummy, but at-risk people would just continue to do the thing that everyone is doing currently. And the plan would save many lives because the epidemic would end in about 3 months, after the virus had spread to saturation among our nation’s low-risk cohort.
Their data are easy enough to understand. In each of these graphs, they show a blue box for how long social distancing would last, and then four colored lines to represent how many infections we’d see if we did no social distancing (black), medium quality social distancing (red), good social distancing (blue), or excellent social distancing (green).
So, from top to bottom, you’re looking at the graphs of what happens if we do a month of social distancing … or two months … or three, or four … or forever.
And you can see the outcomes in the panels on the right-hand side. The black line shows what would happen if we did nothing. Infections rise fast, then level off after the virus has reached saturation. There are two important features of this graph – the final height that it reaches, which is the total number of severe cases (and so a good proxy for the number of deaths), and the slope of the line, which is how fast the severe cases appear. A steeper hill means many people getting sick at the same time, which means hospitals might be overwhelmed.
So, okay. Looking at their graphs, we see that social distancing saves lives … if we do it forever. If you never leave your house again, you won’t die of Covid-19.
But if social distancing ends, it doesn’t help. The slopes are nearly as steep as if we’d done nothing, and the final height – the total number of people who die – is higher.
(Often, one of their curves will have a gentler slope than the others — usually the good-but-not-excellent social distancing seems best. So you’d have to pray that you were doing a precisely mediocre job of not infecting strangers. Do it a little better or a little worse and you cause people to die. This isn’t an artifact — it’s based on the density of uninfected people when social distancing ends — but let’s just say “mathematical models are wonky” and leave it at that.)
In a subsequent figure, the Harvard team tried to model what might happen if we occasionally resumed our lives for a month or so at a time, but then had another shutdown. This is the only scenario in which their model predicts that social distancing would be helpful.
Even in the extreme case that we mostly stayed in our homes for the better part of two years, social distancing would case more deaths from Covid-19 than if we had done nothing.
That’s not even accounting for all the people who would die from a greater risk of domestic violence, hunger, drug addiction, suicide, and sedentary behavior during the shutdown.
When our data was limited, the shutdown seemed reasonable. We wouldn’t be able to undo the damage we’d done by waiting.
Except, whoops, we waited anyway. We didn’t quarantine travelers in January. The shutdown didn’t begin March, when the epidemic was well underway in many places.
Now that we have more data, we should re-open schools, though. For most people, Covid-19 is no more dangerous than seasonal influenza. We already have enough data from antibody testing to be pretty confident about this, and even if we want to be extremely cautious, we should continue the shutdown for a matter of weeks while we conduct a few more antibody studies. Not months, and certainly not years.
At the same time, we need to do a better job of protecting at-risk people. This means providing health care for everyone. This means cleaning our air, staunching the pollution that plagues low-income neighborhoods. This might mean daily medical checkups and PCR tests for people who work closely with at-risk populations.
Our country will have to be different in the future, but mostly because we, as a people, have done such a shitty job of creating justice and liberty for all. We need to focus on addressing the inequities that we’ve let fester for generations. That’ll help far more than using a bandanna to cover up your smile.
I should preface these remarks by stating that my political views qualify as “extremely liberal” in the United States.
I’m a well-trained economist – I completed all but the residency requirement for a masters at Northwestern – but I don’t give two shits about the “damage we’re doing to our economy,” except insofar as financial insecurity causes psychological harm to people in poverty. Our economy should be slower, to combat climate change and inequality.
One of my big fears during this epidemic is that our current president will accidentally do something correctly and bolster his chances of reelection. The damage that his first term has already caused to our environment and our judiciary will take generations to undo – imagine the harm he could cause with two.
And yet, in arguing that our response to the Covid-19 epidemic is misguided, I seem to be in agreement with our nation’s far right.
As far as I can tell, the far right opposes the shutdown because they’re motivated by philosophies that increase inequality. Many of them adore Ayn Rand’s “Who will stop me?” breed of capitalism, as though they should be free to go outside and cough on whomever they want. They dislike the shutdown because they think our lives are less important than the stock market.
By way of contrast, I care about fairness. I care about the well-being of children. I care about our species’ future on this planet. It’s fine by me if the stock market tanks! But I’ve written previously about the lack of scientific justification for this shutdown, and I’m worried that this shutdown is, in and of itself, an unfair response.
Quarantine could have prevented this epidemic from spreading. If we had acted in December, this coronavirus could have been contained. But we did nothing until several months after the Covid-19 epidemic began in the United States.
Then schools were closed: first for two weeks, then a month, then the entire year.
Stay-at-home orders were issued: first for two weeks, then extended to a month. No data supports the efficacy of these orders – haphazard, partial attempts at social distancing, from which certain people, like my buddy doing construction for a new Amazon facility, have been exempted. And no metrics were announced that might trigger an end to the shutdown.
Currently, the stay-at-home orders last until the end of April. But, as we approach that date, what do people expect will be different? In the United States, we still can’t conduct enough PCR tests – and even these tests yield sketchy data, because they might have false negative rates as high as 30%, and they’re only effective during the brief window of time — perhaps as short as one week — before a healthy patient clears the virus and becomes invisible to testing.
Based on research with other coronaviruses, we expect that people will be immune to reinfection for about a year, but we don’t know how many will have detectable levels of antibody in their blood. As of this writing, there’s still no serum test.
The Italian government is considering the dystopian policy of drawing people’s blood to determine if they’ll be eligible for a permit to leave their homes. If you were worried about the injustice that the virus itself imposed on people who are elderly or immunocompromised, this is worse!
We know, clearly, that the shutdown has been causing grievous harm. Domestic violence is on the rise. This is particularly horrible for women and children in poverty, trapped in close quarters with abusers. The shutdown is creating conditions that increase the risk of drug addiction, suicide, and the murder of intimate partners.
We don’t know whether the shutdown is even helping us stop the Covid-19 epidemic. And we still don’t know whether Covid-19 is scary enough to merit this response. As of this writing, our data suggest that it isn’t.
Covid-19 is a rare breed, though: a communicable disease where increased wealth correlates with increased risk.
And so we’re taking extreme measures to benefit the most privileged generation to ever walk the face of this Earth, at the cost of great harm to vulnerable populations. This is why I feel dismayed.
Hopefully I can present some numbers simply enough to explain.
Many diseases are more likely to kill you if you’re poor.
Malaria kills between 400,000 and one million people every year. The vast majority are extremely poor, and many are children – the World Health Organization estimates that a child dies of malaria every thirty seconds.
Wealth protects against malaria in two ways. Wealthy people are less likely to live in parts of the world with a high prevalence of malaria (most of the deaths each year occur in Africa and India), and wealthy people can buy effective anti-malarial medications.
I took prophylactic Malarone when I visited Ecuador and India. Lo and behold, I did not get sick.
I believe Malarone costs about a dollar per day. I am very privileged.
HIV kills between 700,000 and one million people every year. Again, the vast majority are poor. HIV is primarily transmitted through intimate contact – exposure to blood, needle sharing, or sex – so this virus rarely spreads across social boundaries in stratified communities.
In the United States, HIV risk is concentrated among people living in our dying small towns, people without homes in inner cities, and people trapped inside the criminal justice system.
It seems that these people are all easy to ignore.
Wealth will protect you even if you do contract HIV. We’ve developed effective anti-retroviral therapies. If you (or your government) can pay for these pills, you can still have a long, full life while HIV positive. About 60% of the people dying of HIV happen to have been born in Africa, though, and cannot afford anti-retrovirals.
The second-highest cause of death among people in low-income countries is diarrhea. Diarrhea kills between one million and two million people each year, including about 500,000 children under five years old.
These deaths would be easy to treat and even easier to prevent.
Seriously, you can save these people’s lives with Gatorade! (Among medical doctors, this is known as “oral rehydration therapy.”) Or you could prevent them from getting sick in the first place by providing clean water to drink.
We could provide clean water to everyone – worldwide, every single person – for somewhere between ten billion and one hundred billion dollars. Which might sound like a lot of money, but that is only one percent of the amount we’re spending on the Covid-19 stimulus bill in the United States.
We could do it. We could save those millions of lives. But we’re choosing to let those people die.
Because, you see, wealthy people rarely die of diarrhea. Clean water is piped straight into our homes. And if we do get sick – I have, when I’ve traveled – we can afford a few bottles of Gatorade.
Instead, wealthy people die of heart disease. Stroke. Alzheimer’s. Cancer.
If you’re lucky enough to live past retirement age, your body will undergo immunosenescence. This is unfortunate but unavoidable. In old age, our immune systems stop protecting us from disease.
Age-related immunosenescence explains the high prevalence of cancer among elderly people. All of our bodies develop cancerous cells all the time. Usually, our immune systems kill these mutants before they have the chance to grow into tumors.
Age-related immunosenescence also explains why elderly people die from the adenoviruses and coronaviruses that cause common colds in children and pre-retirement-age adults. Somebody with a functional immune system will get the sniffles, but if these viruses are set loose in a nursing home, they can cause systemic organ failure and death.
I haven’t seen this data presented yet – due to HIPAA protections, it can’t easily be collected – but Covid-19, on average, seems to kill wealthier people than influenza.
But on a population level, wealth is correlated with increased risk.
Part of this wealth gap is due to age. Currently we don’t have enough data to know exactly where the risk curves for seasonal influenza and Covid-19 intersect, but it seems to be around retirement age. If you’re younger than retirement age, seasonal influenza is more deadly. If you’re older than retirement age, Covid-19 is more deadly.
And in the United States, if you’re older than retirement age, you’re more likely to be wealthy.
Because these people were receiving expensive medical care, they were able to survive despite their other diseases. Imagine what would have happened if these people had chanced to be born in low-income countries: they would already be dead.
This is a tragedy: all over the world, millions of people die from preventable causes, just because they had the bad luck of being born in a low-income country rather than a rich one.
We don’t have data on this yet, but it’s likely that Covid-19 will have a much smaller impact in Africa than in Europe or the United States.
When my father was doing rounds in a hospital in Malawi, his students would sometimes say, “We admitted an elderly patient with …” And then my father would go into the room. The patient would be 50 years old.
Covid-19 is particularly dangerous for people in their 80s and 90s. Great privilege has allowed so many people in Europe and the United States to live until they reached these high-risk ages.
Our efforts to “flatten the curve,” in addition to increasing many people’s risk of death (from domestic violence, suicide, and the lifelong health repercussions of even a few months of sedentary living), will save relatively few lives, even among our country’s at-risk population.
The benefit of this shutdown is simply the difference between how many people would die if we did nothing, compared to how many people will die if we “flatten the curve.”
Assuming that our efforts to flatten the curve succeed – and neglecting all the other risks of this strategy – we’ll be able to provide ventilation to everyone. But there will still be a lot of deaths. The shutdown will not have helped those people. The shutdown is only beneficial for the small number who would be treated in one scenario, would not be treated in another, and who actually benefit from the treatment.
Their lives matter, too. Many of us have a friend or relative whose life was cut short by this. But something that we have to accept is that we all die. Our world would be horrible if people could live forever. Due to immunosenescence, it becomes increasingly difficult to keep people alive after they reach their late 70s and 80s.
And the priorities of elderly people are different from mine. I care deeply about the well-being of children and our planet’s future. That’s why I write a column for our local newspaper discussing ways to ameliorate our personal contribution to climate change. That’s why my family lives the way we do.
These priorities may be quite different from what’s in the short-term best interests of an 80-year-old.
Schools are closed. Children are suffering. Domestic violence is on the rise. All to protect people who have experienced such exceptional privilege that they are now at high risk of dying from Covid-19.
Our national response to Covid-19 is being directed by a 79-year-old doctor. I haven’t gotten to vote in the presidential primary yet, but if I get to vote at all, I’ll be allowed to choose whomever I prefer from a selection of a 77-year-old white man or a 78-year-old white man. Then comes the presidential election, where there’ll be an additional 73-year-old white man to choose from.
It makes me wonder, what would our national response be like if we were facing a crisis as risky as Covid-19, but where elderly people were safe and children were most at risk?
And then I stop wondering. Because we are facing a crisis like that.
I have yet to master the art of pillow talk. The other night, after my spouse and I turned off our bedside reading lights — at a time when a more reasonable soul might murmur a sultry something or whisper sweet dreams — I said:
“The Golden Record was a terrible idea!”
Apropos of nothing! Seriously, what is wrong with my brain?
Luckily, instead of sighing, or pretending to be asleep (as a normal person might have done), my spouse continued the conversation.
“What, Carl Sagan’s?”
“Yeah,” I said. “It’s terrible.”
“Well, nobody’s going to find it, but that’s not really the point.”
My spouse was alluding to the fact that our universe is really, really big. We launched the Golden Record aboard the Voyager spacecraft in 1972, and it has traveled something like 13 billion miles since then.
13 billion miles sounds pretty impressive! But miles are not very practical units for describing outer space. 13 billion miles is the same distance as 0.002 light years. Our galaxy is a flat disc of stars, approximately 1,000 light years thick and 100,000 light years across. Compared to those distances, the Golden Record may as well still be here on Earth.
And it’s not as though finding the Golden Record would be the easiest way for an extraterrestrial intelligence to learn of our existence. The Golden Record is traveling slowly and is trapped inside a small spacecraft. Our television and radio broadcasts move much faster, and they’ve been radiating in a ever-growing sphere for decades.
Still, I argued.
“They probably won’t find it, but isn’t it a bad idea to send a message that you are hoping won’t be found? Either no one sees it, and so it’s a waste, or else they do find it, and that’s worse, because then we’re doomed … “
“Right? I mean, maybe it’s silly to extrapolate from human history to predict what an alien species might do. But in human history … in prehistory, even … it seems like every time a voyaging people found a stationary culture, it ended in disaster for the people who weren’t traveling.”
“Homo sapiens traveled north and found the Neanderthal. The Neanderthal died. We traveled east and found the Denisovians. Denisovians died. Chinese people displaced the native Taiwanese, Europeans wrecked havoc all through North and South America.”
Given that it was bedtime, and all our lights were off, I definitely shouldn’t have been raising my voice.
“About the only example I can think of where the voyagers were eventually driven away was the Vikings in Greenland. Inuits lived there before, during, and after some twenty generations of Viking occupation. But, really, the Inuits won through luck. The Vikings pretty much refused to eat fish. Hmm, we’re big strong Vikings, we eat sheep! Well, Greenland’s not for grazing, so the sheep all died, and then the Vikings starved. Not that they had to. They could’ve switched to eating fish, just like their neighbors. But they were too proud. And then dead.”
My bedtime tirade wasn’t an accurate description of the Inuit diet – a lot of their calories came from seals and whales, which are generally considered less palatable than fish, and also rather more difficult to catch.
In recent years, some archaeologists have begun to argue that it wasn’t the Vikings’ fault that they all died. I’m sure it’s sheer coincidence that many of these contemporary Viking apologists are of vaguely Norse descent. Their theory is the Greenland Vikings had a stable civilization but were doomed by climate change. A huge volcano erupted half the world away — the whole planet cooled. Life was miserable for everyone. Greenland’s Vikings were abandoned by the mainland, which meant they lost their major trading partner.
These archaeologists claim that small farmers switched their diet early on, and that only the wealthiest of Greenland’s Vikings continued to raise cows and sheep until the end.
In any case, the Vikings died. Their conquest failed. But other times, voyagers brought devastation to stationary cultures.
The movie Independence Day had it wrong. The encounter wouldn’t have ended with Homo sapiens celebrating. If an extraterrestrial species was so technologically advanced that they could reach our planet, they would simply extract whatever resources they needed before moving along to harvest yet another insufficiently advanced world.
We should expect extraterrestrials to show the same forbearance toward us that a chimpanzee shows toward ants – chimpanzees are more clever than ants, and chimps use sticks to dig up anthills for food. Homo sapiens are more clever than chimpanzees, and we’ve harried chimps to extinction, cutting down their forests because we wanted wood.
An extraterrestrial species that was able to travel to our planet within a single individual’s lifetime would be more clever than us, and if they needed to extract something from our world, we’d be powerless to stop them.
“But the Golden Record was never really about aliens,” my spouse said. “It was about us. Whether we would change, if we knew we might have guests.”
That makes sense – given that my spouse and I are always exhausted, our home fluctuates between live-ably messy and an absolute disaster depending on how long it’s been since we’ve had grown-up friends over.
“If the goal is togetherness, though,” I said, “aren’t there better ways? Especially since a lot of people don’t even know about the Golden Record.”
“I still teach about it!”
“Yeah, but I mentioned the Golden Record in jail, and nobody knew what I was talking about. And, even then, is that the best we can do? The tiny chance of visitors sometime in the next few billion years? I mean, shouldn’t we be working on climate change, a global wealth tax, guaranteed basic income, wealth transfers to preserve natural wonders like the Serengeti or the Amazon Rain Forest?”
“Sure, I like having the Rain Forest.”
“So we should pay for it! But, right, I think those plans would do more than launching a recording of laughter. And none of those plans has the risk that we’d lure the cause of our own extinction.”
My spouse sighed. “Don’t we have a rule about not talking about human extinction at bedtime?”
“Do we? I thought it was just that I couldn’t talk about thermodynamic heat death of the universe.”
“No, it was more than that. No collapse of civilization as we know it, no heat death, nothing about the lifespan of our star. Not right when I’m trying to fall asleep.”
“It’s okay. I still love you. I just wish you hadn’t said all that at bedtime.”
“Well, I wish they hadn’t launched the Golden Record.”
It’s true that the risk is low. But why risk the Earth’s destruction at all when there are better plans available?
That’s what I was thinking while I fell asleep. As it happens, I wound up answering my own question. One virtue of the Golden Record is that it invites us to imagine Earth being destroyed – marauding aliens could learn our address and then come to stamp us out.
That’s a sad thought. So perhaps we should do what we can to protect the Earth. And not just from those unlikely marauders – maybe we should protect Earth from ourselves.
Otherwise we, as an entire species, will seem far more foolish than Greenland’s Vikings. Hmm, we’re big strong Americans, we eat sheep! We fly airplane, we buy new big screen TV, we stream video from satellite!
What can you say about a people who refuse to change their culture in the face of absolute calamity?
Chamayou argues that drone warfare is qualitatively distinct from other forms of state violence. The psychological rift stems from asymmetry – one side risks money, the other risks life.
The use of drones keeps U.S. soldiers safer. But in Chamayou’s opinion (translated by Janet Lloyd, and slightly modified by me for students to read aloud),
If the U.S. military withdraws from the battlefield, enemy violence will turn against targets that are easier to reach. Even if soldiers are safe, civilians are not.
Drone warfare compels enemy combatants to engage in terrorism. They cannot shoot back at the soldier who is shooting them – that soldier might be sitting in a nondescript office building thousands of miles away, unleashing lethal force as though it were a video game.
I don’t mean to trivialize the suffering of U.S. soldiers who are involved in drone warfare. Pilots have an extremely high suicide rate – they are expected to placidly shift from the battlefield to the civilian world each evening, and this is deeply disturbing to most people.
But enemy soldiers cannot fight back. They could shoot down the drone, but the U.S. military would launch a new one. There’s no comparison between that and the drone shooting a missile at your family’s home.
An enemy combatant can only put U.S. lives at risk by attacking the general public.
Our policies don’t always have the outcomes we want.
Not unexpectedly, somebody in class mentioned the War on Drugs. Banning marijuana caused a lot of problems, he said.
Somebody else disagreed – he’s been in and out of prison on drug charges for seventeen years, but has high hopes that this next stint of rehab is going to take. “I still think marijuana’s a gateway drug. That’s what I started with.”
“It’s not pot, it’s the lying about pot. They say over and over that marijuana’s as bad as heroin. What do they think will happen once kids realize marijuana’s safe?”
“If people could’ve bought pot, maybe nobody would’ve invented spice. Like that K2 stuff was sold as incense or whatever, but everybody knew it was pot replacer.”
“You take this,” a guy said, holding up a sheet of paper, “spray it with spice, send it into prison. Two thousand dollars, easy. You get somebody to OD, then everybody’s gonna want some. People like that feeling, right at the brink between life and death.”
Somebody sighed. “I know. I’ve done a lot of drugs, and with most drugs, I could take it or leave it. But that spice, man. No offense to anyone, but I’ve never sucked cock for drugs. For spice, though, I’d think about it.”
“You just get so sick.”
“So sick! I’ve kicked heroin, and that feeling sick was bad. But not like this. There were weeks when I had to set an alarm, get up every two hours to take another hit. Otherwise I’d wake up puking and shitting myself. And I’d be in there, you know, sitting on the toilet with a bag, still taking my hit.”
“I got that too. I was waking up every ninety minutes.”
“Would you have started smoking spice if marijuana was legal?” I asked.
“I mean, yeah, now you’re gonna have people who would. Because everybody knows about it. Like you had that summer two years ago, people all along the street, up and down Kirkwood, smoking it right out in the open. But, like, before it all started? Nobody would’ve sat down and tried to invent spice if they could’ve sold pot.”
“I remember reading a review of K2 spice on Amazon,” I said, “must’ve been in 2008, before it was banned, all full of puns and innuendo. The reviewer was talking about how it made him feel so ‘relaxed,’ in quotes.”
“ ‘Relaxed,’ shit, I get that. I never touched the stuff before this last time I came to jail. But I’ve smoked hella marijuana. So somebody handed it to me and I took this giant hit, the way I would, and I shook my head and said, ‘Guys, that didn’t do shiii …’ and, BAM, I fell face first into the table.”
“You were so out of it!”
“It was like, WHOA, blast off. I was lying there, like flopping all over. That night I pissed myself.”
“That sounds … “ I said, “… bad. A whole lot worse than smoking pot.”
“But you can get it!”
And there lies the rub. With so many technologies, we’re playing whack-a-mole. We solve one problem and create another. But sometimes what comes up next isn’t another goofy-eyed stuffed animal mole – the arcade lights flash and out pops a hungry crocodile.
Since people couldn’t buy pot, they started smoking a “not-for-human consumption” (wink wink) incense product that you could order online. Since enemy combatants can’t shoot back at soldiers, they plant more bombs in subways.
As one American soldier explains, “We must understand that attempts to isolate our force against all potential enemy threats shifts the ‘burden of risk’ from a casualty-averse military force onto the populace. We have lifted the burden from our own shoulders and placed it squarely upon civilians who do not have the material resources to bear it.”
recently played the board game Fists of Dragonstone. It was fun – the premise is that each turn a
spell is revealed and players will make a simultaneous, secret bid to acquire
its effect. The spells might earn
victory points, increase your future income, or help you thwart other players’
Each turn felt tense because Fists of Dragonstone uses “all pay” auctions. If you bid two dollars, you’ll lose this money whether or not you get the prize you wanted. This type of auction is a slippery beast – inherently stressful in the real world, but psychologically compelling within the safe confines of a game.
most people think of auctions, they imagine the type that eBay uses – only the
winner pays, and the amount paid is equal to the second-highest bid. In this type of auction, you ought to state
your intentions honestly. If you would
get $15 worth of joy from owning an item, you should bid $15 – you’ll either
get to have it for that amount of money (or less), or else learn that someone
else values the item more.
didn’t have such rampant wealth & income inequality, this type of auction
would arguably improve the world.
Objects would wind up in the hands of whomever valued them most,
boosting overall happiness.
In practice, of course, things don’t work out so well. Some people have access to far more money than others. Even if a wealthy person estimates that a blanket would provide $60 of happiness, and a poor person estimates that the same blanket would provide $10 of happiness, it might be that the poor person would actually get more happiness from the blanket. Inequality means that there’s no universal way to convert between money and joy, but the marketplace treats all our dollars the same.
In a board game, you can address inequality by doling out the same set of initial resources to each player. But the standard auction type – which rewards honest valuation – wouldn’t be much fun. Everyone should value each item equivalently, and so the game is reduced to a puzzle. It might be fun to solve once, but there wouldn’t be a reason to play again.
In an “all pay” auction, though, you benefit by being unpredictable. Because you lose your bid whether or not you win the auction, you should often bid zero even if there’s an item you’d like. You’re throwing away money if you make a non-zero bid but someone else bids higher.
You could still attempt to “solve” this sort of game, but the optimal solution invokes random behavior. You should make a bid somewhere between zero and your true valuation, with a certain probability assigned to each. That’s what a robot would do.
Most humans are pretty terrible at doing things that are actually random, though. When we try to create a fake list of outcomes from a set of coin flips, for instance, we usually hew to an alternating pattern of heads and tails.
we’re bad at making random choices – and we know that other players are bad at
it too – we fall back on misguided psychological reasoning. She bid nothing the last two rounds, so
maybe I can sneakily win this next auction with a $1 bid! We get to feel clever when our stratagems
succeed. We get to curse when they
fail. All much more fun than the honest
appraisal encouraged by auctions in which only the winner pays!
real world, though, an “all pay” auction is a recipe for waste.
This type of auction is a good proxy for many types of adversarial encounters. Political contests, computer security, sporting events. Even restaurant management, if people have a discrete budget set aside for eating out and are simply choosing which establishment to frequent.
of these situations, every player has to pay – to run for political office, you
invest years of your life and spend a whole bunch of money on
advertisements. It’s not as though you
get that time or money back when you lose.
All players spend their total bids, but only one gets the prize of
Contemporary political campaigns are incredibly expensive. So many people have already devoted years of their lives to the 2020 presidential campaign. The efforts of the losing side will have been wasted. Because major platforms are willing to air totally fraudulent advertisements, candidates have little chance of victory if they spend much less than their opponents.
Sure, sometimes people will console themselves with the thought that “We may not have won the election, but we changed the tenor of political discourse!” In our country, this is a fantasy. U.S. politics is sufficiently polarized that the winners rarely concern themselves with the expressed desires of the losing side. Two of our past three presidents lost the popular vote and still proceeded with their agendas as though they’d received an overwhelming mandate.
Security is another form of “all pay” auction. This is an asymmetrical game – your initial resources and victory conditions are clearly different if you happen to be playing as a homeowner or a thief – but the basic principle remains the same. One player bids an amount on security; the other player bids time and money to undermine it; depending on who bids more, a break-in succeeds or it doesn’t.
As in Fists of Dragonstone, players have an incentive to randomize their behavior. Sometimes a homeowner should display signs for a security system that hasn’t actually been installed. Sometimes a thief should pass by a house even if it looks like a juicy target. If players are too predictable, they can be narrowly outbid.
encryption is an auction like this. Equifax bid less than the people trying to
hack its servers; a huge amount of personal data was stolen. Mine too.
As an apology for low-balling their security bid, Equifax will send me a
settlement check for some amount between $125 and $0.03, depending on how many
of the other victims they choose to compensate.
could I do with three pennies?
I glued pennies together to make little legs for my laptop computer – three cents for the back legs, two for the front – hoping to improve air flow for the exhaust fan. When a computer overheats, programs malfunction. The operating system might freeze, the same way I do when I’m typing and somebody says “Hi” to me. My brain stutters – processing, processing – unable to determine whether I know this person, and, if so, from where.
Anyway, building these laptop stilts out of pennies seemed cheaper than any other materials. I’ve already built them, though. I don’t really need another $0.03 check from Equifax.
But this situation must feel frustrating for the people at Equifax, too. Improved encryption isn’t valuable in and of itself. This is an adversarial contest that produces only waste. A world in which companies spent little or nothing on computer security and other people simply chose not to breach their nonexistent defenses would be better than our world, in which data needs to be scrupulously guarded.
in which politicians didn’t advertise, trusting voters to learn about their
platforms from impartial sources, would be better than our world.
That’s not where we live, though. Instead, scientists are working to create quantum computers. These are marvels of engineering. In contrast to the behavior of macroscopic objects, certain properties of a quantum transistor can remain undefined during a calculation, collapsing into a discrete binary value only at the end. To accomplish this, the transistor must be guarded from its environs – you may have heard that “measurement” collapses wavefunctions, but measurement doesn’t mean that a human is looking at something. Measurement simply means that the state of an object becomes coupled with the state of its environment.
photon approaches, the state of the object becomes linked with the state of the
photon. They might’ve collided or not,
which narrows the range of space in which the object might exist, which narrows
the set of wavefunctions that could be summed to give its momentum. A collision-less encounter restricts us to a
different set of futures than if the photon hit the thing.
In practice, that means a quantum computer needs to be kept dark, and atmosphere-less, and very, very cold. For a long time – the transistors have to stay unmolested for the entire duration of a calculation.
these devices are very expensive to build and run.
might we want them? Well, they’d be
better than conventional computers at … um … at factoring the large numbers
that are used for computer encryption!
Quantum computers are fascinating. Our attempts to build them have helped us learn more about the workings of our world. But the actual existence of quantum computers – at least until we think of an application other than cracking computer security – will make the world worse.
Worried that people might copy data and then use quantum computers to decode it later — you know, after these computers have been invented — security experts say that we need to start spending more money on encryption now.
While playing Fists of Dragonstone, my friends would curse and shout after making an exorbitantly high bid and then seeing that every other player bid zero. I could have won with $1!
That’s basically what security experts are encouraging us to do. Not curse — overbid. They say that we should make extremely high bids on encryption now, to protect ourselves from a technology that might never exist. Otherwise, undesirables might gain access to the password-protected folder of risqué photographs that you and your partner(s) took. Or break into your bank account.
Occasionally, adversarial work improves the world. When restaurants compete, service might get better. The food, tastier.
But most adversarial contests are engines for waste. High-speed stock trading makes the market more fluid – you can log on and purchase a few dozen shares of whatever you’d like since AI algorithms are ready to facilitate transactions between buyers and sellers.
That’s a small service, though. High-speed trading firms shouldn’t be extracting as much wealth as they are in this country. Mostly they eavesdrop on others’ conversations, sneak in front of people who’re trying to buy something, then scalp it back at higher prices. Trading firms pay exorbitant rent on shelf space that’s close as possible to the stock exchange mainframes – if one scalper is microseconds faster than another, that’s the one who gets to shake you down.
board game, cooperation is generally less fun than adversarial play. For the former, players are trying to solve a
puzzle created by the designer. With
adversarial rules, players are using their intelligence to create puzzles for
each other in real time.
In a game, the waste is the entire point. Nothing tangible is produced, but the expended time leads to social camaraderie. The expended brainpower can give you a sense of satisfaction from having worked through intellectual puzzles. And, hopefully, you’ll have fun.
But – whoops – we’ve used the principles of good game design and mistakenly applied them to the real world. Fists of Dragonstone was fun; our political system shouldn’t be based on all-pay auctions. With major politicians poised to ravage the Amazon, cull the world’s few remaining old-growth forests, and dredge up Arctic oil fields, the people wealthy enough to make high bids on upcoming elections might well destroy us.
Featured image for this post: “Auction Today” by Dave McLean on Flickr.