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.
There’s broad scientific consensus that school closures hurt children, probably making a significant contribution to future increases in premature death.
There’s also broad scientific consensus that school closures – particularly elementary school closures – aren’t helpful in slowing the spread of Covid-19. Children aren’t major vectors for this virus. Adults just have to remember not to congregate in the teachers’ lounge.
Worldwide, a vanishingly small percentage of viral transmissions have occurred inside schools.
And … our district just closed in-person school for all children.
In-person indoor dining at restaurants is still allowed. Bars are still open.
Older people are sending a clear message to kids: “Your lives matter less than ours.”
For at-risk children, school closures are devastating. A disruption in social-emotional learning; lifelong education gaps; skipped meals.
But for my (privileged!) family, the closure will be pretty nice. I was recently feeling nostalgic about the weeks in August when my eldest and I spent each morning together.
Our youngest attends pre-K at a private school. Her school, like most private schools around the country, (sensibly) re-opened on time and is following its regular academic calendar.
My eldest and I will do two weeks of home schooling before winter break. And it’ll be fun. I like spending time with my kids, and my eldest loves school so much that she often uses up most of her energy during the day – teachers tell us what a calm, lovely, hard-working kid she is. And then she comes home and yells, all her resilience dissipated.
Which is normal! Totally normal. But it’s a little crummy, as a parent, to know you’ve got a great kid but that you don’t get to see her at her best.
Right now she’s sad about not going to school – on Monday, she came home crying, “There was an announcement that we all have to switch to online only!” – but I’m lucky that I can be here with her. Writing stories together, doing math puzzles, cooking lunch.
Maybe we’ll practice magic tricks. She loves magic.
Last month, I was getting ready to drive the kids to school. T. (4 years old) and I were in the bathroom. I’d just handed T. her toothbrush.
N. (6 years old) walked over holding a gallon-sized plastic bag.
“Father, do you want to see a magic trick?” she asked.
“Okay, but I have to brush my teeth while you’re doing it.”
“Okay,” she said, and opened the bag. She took out a multi-colored lump of clay. It was vaguely spherical. Globs of red, white, and blue poked up from random patches across the surface, as though three colors of clay had been haphazardly moshed together.
“So you think this is just this,” she said, but then …”
She took out a little wooden knife and began sawing at the lump. “This is just this?”, I wondered. It’s an interesting phrase.
Her sawing had little effect. The knife appeared useless. I’m pretty sure this wooden knife is part of the play food set she received as a hand-me-down when she was 9 months old. “Safe for babies” is generally correlated with “Useless for cutting.”
She was having trouble breaking the surface of her lump.
I spat out my toothpaste.
She kept sawing. She set down the knife and stared at the clay intently. A worthy adversary.
I stood there, watching.
She grabbed the knife again and resumed sawing. More vigorously, this time. She started stabbing, whacking. This was enough to make a tiny furrow. She tossed aside the knife and pulled with her fingertips, managing to pry two lobes of the strange lump away from each other.
“Okay,” she said, “it’s hard to see, but there’s some green in there.”
T. and I crouched down and peered closely. Indeed, there was a small bit of round green clay at the center of the lump.
“Wow!” exclaimed T. “I thought it was just a red, and, uh, blue, and white ball! But then, on the inside, there’s some green!”
“I know!” said N., happy that at least one member of her audience understood the significance of her trick. “And look, I might even get it back together!”
N. started performing magic when she was four. T. was asleep for her afternoon nap.
“Okay,” she said, “you sit there, and I’ll put on a magic show. Watch, I’ll make, um … this cup! See this cup? I’ll make it disappear.”
“Okay,” I said, curious. We’d just read a book that explained how to make a penny disappear from a glass cup – the trick is to start with the cup sitting on top of the penny, so that the coin looks like it’s inside the cup but actually isn’t.
I had no idea how she planned to make the cup itself disappear.
“Okay, so, um, now you’re ready, and …” she looked at the cup in her hands. Suddenly, she whisked it behind her back. And stood there, looking at me somberly, with her hands behind her back.
“I don’t have it,” she said.
Magic – convincing an audience to believe in an illusion.
Our species is blessed with prodigious longevity, probably because so many grandmothers among our ancestors worked hard to help their grandchildren survive.
(The long lives of men are probably an accidental evolutionary byproduct, like male nipples or female orgasms. Elderly men, with their propensity to commandeer resources and start conflicts, probably reduced the fitness of their families and tribes.)
After we reach our seventies, though – when our ancestors’ grandchildren had probably passed their most risky developmental years – our bodies fail. We undergo immunosenescence – our immune systems become worse at suppressing cancer and infections.
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.
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).
I live in a college town. Last week, students returned.
Yesterday’s paper explains that dire punishment awaits the students who attended a Wednesday night party. In bold letters atop the front page, “IU plans to suspend students over party.”
In the decade that I’ve lived here, many parties have led to sexual assaults, racist hate speech, and violence. The offending students were rarely punished. But this party was egregious because “there were about 100 people there.”
IU officials “have seen a photo … that shows a large group of young people standing close together outside a house at night, many of them not wearing masks.”
I’ve seen the images – someone filmed a video while driving by. There they are – a group of young people, standing outside.
Science magazine recently interviewed biologist Dana Hawley about social distancing in the animal kingdom.
When spiny lobsters are sick, their urine smells different. Healthy lobsters will flee the shared den. Leaving is dangerous, since the lobsters will be exposed to predators until they find a new home, but staying would be dangerous, too – they might get sick. To survive, lobsters have to balance all the risks they face.
My favorite example of social distancing in the animal kingdom wasn’t discussed. When an ant is infected with the cordyceps fungus, it becomes a sleeper agent. Jennifer Lu writes in National Geographic that “as in zombie lore, there’s an incubation period where infected ants appear perfectly normal and go about their business undetected by the rest of the colony.”
Then the fungus spreads through the ants body, secreting mind control chemicals. Eventually, the fungus will command the infected ant to climb to a high place. A fruiting body bursts from the ant’s head and rains spores over the colony.
Infection is almost always lethal.
If an ant notices that a colony member has been infected, the healthy ant will carry the infected ant away from the colony and hurl it from a cliff.
The herd immunity threshold isn’t an inherent property of a virus – it depends upon our environment and behaviors. In prisons, we’ve seen Covid-19 spread until nearly 90% of people were infected. In parts of New York City where many essential workers live in crowded housing, Covid-19 spread until 50% of people were infected.
In a culture where everyone kissed a sacred statue in the center of town each morning, the herd immunity threshold would be higher. If people wear masks while interacting with strangers, the herd immunity threshold will be lower.
In a world that maintains a reservoir of the virus, though, someone who hasn’t yet been exposed will always be at risk.
The New York Times recently discussed some of the challenges that colleges face when trying to reopen during the epidemic.
Most schools ban … socializing outside “social pods” – the small groups of students that some colleges are assigning students to, usually based on their dorms.
Most administrators seem to believe that a rule banning sex is unrealistic, and are quietly hoping that students will use common sense and refrain from, say, having it with people outside their pod.
In 2012, The Huffington Post published a list of the “Top 10 sex tips for college freshmen.” Their fourth piece of advice (#1 and #2 were condoms, #3 was not having sex while drunk) is to avoid having sex with people who live too close to you. “Students in other dorms = fair game. Students in same dorm = proceed with caution.”
I had a big group of friends for my first two years of college. After a breakup, I lost most of those friends.
This is crummy, but it would be much worse if I’d lost my friendships with the only people whom the administrators allowed me to spend time with.
We can slow the spread of Covid-19, but slowing the spread won’t prevent deaths, not unless we can stave off infection until there is a highly effective vaccine. That might take years. We might never have a highly effective vaccine – our influenza vaccines range in efficacy from about 20% to 80%, and we have much more experience making these.
Our only way to reduce the eventual number of deaths is to shift the demographics of exposure. If we reach the herd immunity threshold without many vulnerable people being exposed, we’ll save lives.
A college would best protect vulnerable students and faculty by allowing the students who are going to socialize to host dense parties for a few weeks before mingling with others. This would allow the virus to spread and be cleared before there was a risk of transferring infections to vulnerable people.
I’d draft a waiver. Are you planning to socialize this semester? If so, come do it now! By doing so, you will increase your risk of contracting Covid-19. This is a serious disease – it’s possible for young, healthy people to die from it. But, look, if you’re gonna socialize eventually, please just get it over with so that you don’t endanger other people.
With this plan, some young people might die of Covid-19. But some young people will die of Covid-19 even if everyone practices social distancing – slowing the spread of infections doesn’t save lives, it delays deaths. And fewer young people would die of Covid-19 than die of influenza each year.
When confronting cordyceps, which is almost always fatal, ants throw sick colony members off cliffs.
When ants confront less lethal fungal infections, they protect the colony by shifting the demographics of exposure and by ramping up to the herd immunity threshold as quickly as possible.
Malagocka et al. discuss demographics in their review article, “Social immunity behavior among ants infected by specialist and generalist fungi.”
Outside-nest foragers, who have the highest risks of acquiring pathogens from the environment, have limited access to the brood area with the most valuable groups, and are recruited from older individuals, who are less valuable from the colony survival perspective.
Konrad et al. discuss intentional exposure in their research article, “Social transfer of pathogenic fungus promotes active immunization in ant colonies.”
When worker ants encounter an infected colony member, they intentionally inoculate themselves. “Social immunization leads to faster elimination of the disease and lower death rates.”
It feels disquieting for me to defend the behavior of frat guys. Personally, I’d like to see the whole fraternity system abolished. And in March, when we knew less about Covid-19, I was appalled that people went out partying over spring break. But I was wrong. Perhaps inadvertently, those young people were behaving in the way that would save most lives.
the nurse called back and told us to use bleach on anything we touch, she said wash everything in hot water, insisted we won’t treat you if you’re asymptomatic, we won’t, and made us an appointment anyway. so we waited and waited with the dog-eared magazines and recall posters
It’s horrible to face the end. It’s almost worse to know that the things you fear are harmless to others. All the asymptomatic cases are like a slap in the face to those whose friends and family have died.
Braun et al. recently published a study in Nature showing that a large number of people who’ve never encountered Covid-19 may already have significant immunity. Parts of the Covid-19 virus are similar to the viruses that cause common colds, and exposure to those viruses might provide the immunity that lets people recover without ever feeling sick.
I believe we should be doing more to protect young people. Gun control, ending farm subsidies, fighting climate change. Enacting privacy laws to reign in the surveillance capitalists. Breaking up monopolies. Providing good careers despite automation. Making sure that everyone has clean air to breathe and clean water to drink. Getting nutritious food into our nation’s many food deserts. Providing equitable access to health care.
But, punishing young people for socializing?
We’re not making them safer. And we’re not making ourselves safer, either.
Seriously, I know we humans are selfish, but we have to be able to handle an epidemic better than ants.
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.
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.
Worldwide, people are making huge sacrifices to quell the Covid-19 outbreak. The burden of these sacrifices falls disproportionately on young people.
Across the United States, universities have closed for the year. My governor has announced that all elementary and high schools will be closed at least until May 1st. Bars, restaurants, and malls have been forced to shut down – their employees have been laid off.
Graduating during a recession greatly reduces people’s lifelong earnings. Young people who have the bad luck of entering the workforce in the next few years will suffer the consequences of this shutdown for their entire lives.
Childhood development has an urgency unmatched by other stages of life. When children don’t learn to socialize at the appropriate age, they will always struggle to catch up with their peers. Across the country, huge numbers of children were first learning to read in kindergarten and the early grades. Now they’re watching television. (My kids, too.) With schools closed until May, and summer break coming soon after, they might be watching TV for months. They’ll have to work harder to match other people’s educational achievements, for their entire lives.
Many students depend on school meals to stave off hunger. Kids on free & reduced-price lunch often dread holiday weekends – now, not only have their educations been yanked away, but they’re also suffering through worse food insecurity. Schools and communities are scrambling to provide resources.
Everyone is being asked to stay at home, to keep at least six feet away from other people.
The cost of social isolation is lower if you’re established in a white-collar or professional career. Many office workers can work from home. The people who were cleaning those offices, or selling coffee and bagels to people on their way to work, get laid off.
The cost of social isolation is lower if you have enough money to stock up on supplies. The cost of social isolation is much lower if you’re retired.
Everyone is being asked to make sacrifices, but young people are sacrificing more.
This pandemic wouldn’t be as bad if people could be tested for the virus. We could quarantine the sick and staunch the spread. But U.S. citizens don’t have access to a test.
As the virus reached into the United States in late January, President Trump and his administration spent weeks downplaying the potential for an outbreak. The Centers for Disease Control [a government agency gutted by our current president] opted to develop its own test rather than rely on private laboratories or the World Health Organization.
The outbreak quickly outpaced Mr. Trump’s predictions, and the C.D.C.’s test kits turned out to be flawed, leaving the United States far behind other parts of the world – both technically and politically.
Anyone who is currently younger than 22 – the people who are being made to sacrifice most during this crisis – was not allowed to vote in the 2016 election.
I was too young to understand the 1980s HIV crisis, but I imagine that it was at least as scary as the Covid-19 pandemic for the people at risk.
That virus was inevitably fatal. The deaths were agonizing. Rampant homophobia and cultural stigmatization – even in the medical community – meant there were few places to seek help.
The only way to keep safe was to make sacrifices. Fooling around is fun, but it seemed like it might kill you. To stay alive, you’d have to tamp down your desire.
But if you made that sacrifice, you’d be safe. The people making sacrifices were the people who’d benefit.
What about now, during the Covid-19 pandemic?
My whole family probably contracted Covid-19. There’s no way to know for sure, because at that time the U.S. didn’t even have tests for people experiencing the acute phase of the illness, and there’s still no antibody test to check whether someone was exposed to the virus in the past.
I fell sick on February 10th. I had a pretty bad case, it seems. I had to take high doses of naproxen, but the week-long fever still left me dizzy at times. The only way I could breathe well enough to sleep soundly was by taking puffs of my spouse’s albuterol inhaler. My joints ached so much that it hurt whenever I went running even three weeks later.
My children were sick on February 11th and February 13th. Each napped for half the morning and then felt better. They’d spiked a high fever, but these lasted less than a day.
Young people are being forced to make tremendous sacrifices. They will suffer the consequences of this disruption to their education for their entire lives. But they aren’t the people who benefit.
Young people have very little risk from Covid-19. It’s no fun to be sick, but when my children contracted what I assume to be Covid-19, it was no worse than any of dozens of other coughs or colds they come down with each year.
Most teenagers – whose lives are being up-ended by school closings – could contract Covid-19 and be totally fine.
My spouse asked, “What would you do about it? Not months ago, but if you were handed this crisis today?”
My answer was the same as always. We should enact a wealth tax – preferably a global wealth tax to undermine the tax havens – and use it to fund a guaranteed basic income.
Right now, there’s another rationale. Young people are making huge sacrifices during this pandemic; older people receive the benefit. A wealth tax used to fund guaranteed basic income would provide some recompense for the sacrifices of young people.
My family is practicing “social isolation,” although it hasn’t been mandated yet. My children are willingly making sacrifices for the benefit of others, insofar as a four- and six-year-old understand what’s happening. And yet I’ve seen little acknowledgement in the news of the enormous, selfless sacrifice that children are making – that young people across the country are being forced to make.
They will endure the consequences of this sacrifice for their entire lives. This sacrifice almost exclusively benefits others. And yet there’s been no talk of recompense. No gesture of gratitude from the people who benefit toward the people who are paying the costs.
Which, unfortunately, is how our country has often worked.