On complexity and seemingly good ideas.

On complexity and seemingly good ideas.

Elizabeth Kolbert’s lovely essay in the New York Review of Books, “Chemical Warfare’s Home Front,” describes Fritz Haber’s contribution to the use of toxic gas in war.

Haber orchestrated the use of chlorine to suffocate all animal life – including soldiers – downwind of his nation’s troops. And his plan succeeded. After unleashing 300,000 pounds of chlorine gas, huge numbers of people died. Soldiers– some of whom suffocated, some whose lungs burned, some who committed suicide when enveloped by the gas – as well as horses, cows, chickens, wildlife.

Chemical warfare is horrible, but Haber’s battlefield “experiment” was considered a success. Military researchers then concocted more dangerous chemical agents, like DNA-crosslinking mustard gas and muscle-clenching Sarin nerve gas.

#

Fritz Haber’s other ideas were seemingly more beneficial for humanity. Haber was awarded the Nobel Prize in chemistry for making synthetic fertilizer.

Synthetic fertilizer let us grow more crops.

We could feed billions more people!

The global population soared.

If we hadn’t invented synthetic fertilizer, the global population would still be under four billion people.

Climate change would still be a huge problem – the most outrageous polluters haven’t been the most populous nations. Climate change was caused primarily by the United States and other wealthy nations, whereas overpopulation will first devastate equatorial nations.

A seemingly good idea – more fertilizer! – has greatly exacerbated the scale of suffering.

#

Kolbert discusses the invention of chlorofluorocarbons, which seemed like great coolants. With CFCs, Frigidaire could build cheaper refrigerators! Regular families could keep their ice cream cold without spending as much on electricity.

Unfortunately, CFCs also dissolve our ozone layer. More dangerous ultraviolet radiation began to reach us from the sun, causing horrible skin cancers.

CFCs seemed like a good idea — they do work great as coolants — but they caused awful problems as part of a bigger system.

Kolbert quotes the chemist F. Sherwood Rowland, who said, in reference to his studies of CFCs, “The work is going very well, but it looks like the end of the world.”

#

Anthropologist Joseph Tainter argued civilizations collapse when overwhelmed by complexity.

Like the children’s nursery rhyme about the old lady who swallowed a fly — then a spider to catch the fly, then a cat to catch the spider — our complicated solutions can create new, perhaps worse, problems.

This is the theme of Jenny Kleeman’s Sex Robots and Vegan Meat. Kleeman investigates several industries that purport to solve our world’s problems – You can eat meat without killing animals! You can make a baby without a mother’s body! – without addressing the fundamental causes of these problems.

Describing her travels, Kleeman writes:

I head back to my hotel as the reassuring cloak of darkness falls on Las Vegas. I’m exhausted. Music is thumping out of huge speakers mounted on the building’s exterior: throbbing, pounding beats that are supposed to entice gamblers into the hotel’s casino. I wipe my key card and flop down on the giant bed.

On the bedside table, there’s a metal dish full of individually wrapped pairs of earplugs: wax ones, foam ones, silicone ones – a profusion of solutions supplied by the management to the noise pollution problem caused by the management.

They could just switch the music off, of course, but they have provided a little piece of technology instead so they don’t have to.

My head is full of Eva, [a prototype interactive sex doll] who has the body of a real woman, but can be beaten without feeling a thing. Rather than dealing with the cause of a problem, we invent something to try to cancel it out.

Perhaps we should eat different foods. Perhaps our attitudes about sex or the importance of a sociable community are making our lives worse. Perhaps if we addressed these issues directly, we wouldn’t need sex robots or vegan meat.

Clean meat is one of many possible futures of food, so long as we continue to eat meat. We will always have the power to not want it anymore, or to want it much less.

That is where the real power lies: in harnessing our desires, rather than in mastering technology. Until we do, we will be even further removed from where our food comes from, and will feel even less responsible for it.

We will be perpetuating the kind of thinking that caused the meat mess in the first place.

#

In April 2020, I described two major drawbacks to our efforts to “slow the spread” of Covid-19 instead of providing targeted protection for the people at high risk of severe illness.

1.) Immunity to most coronaviruses lapses within a matter of months. Keeping the virus in circulation longer increases the total number of infections and makes it more difficult to shield people at high risk from eventual exposure.

2.) Each infection encompasses some number of viral replications and thus genetic drift. If a population of 20 people transfers a virus between themselves one by one, rather than all catching it from the same initial carrier, the virus has 20-fold more generations to mutate and better evade our immune systems.

#

Admittedly, my April 2020 prediction about the timeline for vaccine development was quite wrong – I thought this might take three to five years. I’m thankful that I was wrong. I’m obviously grateful for the fantastic work done by vaccine developers so far.

For these vaccines to effectively staunch viral transmission, we’ll need to vaccinate large numbers of people – immunity from prior infections won’t necessarily help much because immunity to this particular virus lapses so quickly, and because people’s prior infections were staggered in time. (Indeed, we’ll probably need to vaccinate large numbers of people repeatedly, because some of our data suggests that vaccine-derived immunity to this also lapses on a timescale of months.)

Unfortunately, we live in a country where large numbers of people distrust the medical establishment. Even if we had sufficient doses of the vaccines available today, I don’t know what percentage of our population would choose to get them.

#

Masks definitely reduce viral transmission. It was obviously a good idea for everyone to wear masks anywhere that high risk and lower risk people share the same space.

Cooperation definitely makes for a better place to live. In places that enacted mask orders, it’s obviously a good idea to follow them.

It’s worth remembering, though, that any fix – even something as simple as this piece of cloth covering my nose and mouth – can have unintentional consequences. New virus variants – which our current vaccines may be less effective against – are a predictable result of our effort to “slow the spread” with masks.

And yet.

I volunteer with Pages to Prisoners, an organization that sends free books to people who are incarcerated. We’ve included a sheet of information about Covid-19 with each package recently, helping to explain that Covid-19 is not a hoax, that it’s a dangerous respiratory disease, that masks and social distancing can help people reduce their risk.

I’m currently revising this information sheet – it was put together months ago, when we understood less about this virus – and I’m still recommend that everyone wear masks.

Not just because prisons are places where many low risk and high risk people are confined together — although, they are. Outrageous sentencing practices have led to a large number of elderly people being stuck in prison.

But also, anecdotal evidence suggests that people are more likely to develop severe illness from Covid-19 when they are exposed to a large number of viral particles at once.

Viruses reproduce exponentially – you can get sick if you inhale even one capsid. But you’re more likely to get seriously ill if you inhale a whole bunch of viral particles. If you’re initially exposed to a small number of particles, your body will have more time to fight off the infection before it makes you feel sick.

Research studies from military bases have shown that Covid-19 will continue to spread even when everyone wears masks and tries to stay six feet away from each other. But we haven’t tested – an experiment like this would be totally unethical – whether we’re more likely to see asymptomatic or mild cases when people’s initial exposure is to a small number of viral particles.

It’s quite likely, though.

So, although I think our efforts to “slow the spread” weren’t the best plan last year, I’ll still be recommending masks.

On conspiracy.

On conspiracy.

We are wearing masks. At school, at work, at the grocery store. I jog with a bandanna tied loosely around my neck, politely lifting it over my face before I pass near other people.

Slowing the spread of a virus from which we have short-duration immunity is dangerous, as I’ve described at length previously, but one consequence of universal mask orders is unambiguously good – the herd immunity threshold to end the pandemic is lower in a world where people always wear masks around strangers.

We all want to get through this while causing as little harm as possible.

Covid-19 is real, and dangerous. Some of the data are complicated, but this much is not: to date, ~200,000 people have died from Covid-19.

Covid-19 is extremely easy to transmit. Because our behaviors so readily affect the health of others right now, we must decide collectively how to respond. My county has decided that we should wear masks. And so I do.

Only those with whom we are closest will see us smile in person. Family. If we’re lucky, a close group of friends.

We share the same air.

During the pandemic, those we love most are our conspirators.

Our conspirators are the select few whom we breathe (spirare) with (com).

On moral outrage.

On moral outrage.

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.

#

We now know that Covid-19 can be transmitted by people who feel no symptoms, and that it was widespread in this country by March.

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.

People are making this choice even during the pandemic, when the choice to experience an excruciating death puts medical professionals at risk and reduces the quality of care available for everyone else.

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 more dangerous 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.

#

To be absolutely clear, vaccination would be the best way to resolve this crisis. Vaccination saves lives. The basic principle of inoculation was used for hundreds of years in Africa, India, and China, before it was adapted by Edward Jenner to create the first smallpox vaccine.

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.

I get vaccinated against influenza every year.

Yes, you might have heard news reports about the influenza vaccine having low efficacy, but that’s simply measuring how likely you are to get sick after being vaccinated. We also know that the vaccine makes your illness less severe.

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.

If we could go back in time, we’d obviously do things differently. It’s only based on where we are now that physicians like David Katz argue we need to end the shutdown based on the principle of “harm minimization.”

Based on the data we have, I agree.

Ending the shutdown now, but only for some, will save lives.

#

So, those selfish young people crowding on beaches? I looked at the photos and hated them.

But it turns out that their selfish actions were actually the exact plan that will save most lives.

I’ve had to swallow my moral indignation. I hope you can too.