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!
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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.
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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.
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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.)
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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!
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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.)
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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.
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.
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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.
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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.”
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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.
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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.
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.
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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.
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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.
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.
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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.
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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.
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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.
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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.
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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.
If we don’t have a safe, effective vaccine soon enough, the only way to save some of those 450,000 people is to shift the demographics of exposure.
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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.
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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.
Covid-19 spreads so fast – and so silently, with many cases of infected people who feel fine but are still able to spread the virus – that it will almost certainly be a permanent resident of the world we live in. We’re unlikely to eradicate Covid-19.
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.
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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.
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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.
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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.
Even if you have relatively limited experience reading scientific research papers, I think you could make your way through this excellent article from Chistakis et al.
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.
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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.
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So, those are some data. But data don’t tell us what to do. Only our values can do that.
At the end of “Just Use Your Thinking Pump!”, a lovely essay that discusses the evolution (and perhaps undue elevation) of a particular set of practices now known as the scientific method, Jessica Riskin writes:
Covid-19 has presented the world with a couple of powerful ultimatums that are also strikingly relevant to our subject here. The virus has said, essentially, Halt your economies, reconnect science to a whole understanding of yourself and the world, or die.
With much economic activity slowed or stopped to save lives, let us hope governments find means to sustain their people through the crisis.
Meanwhile, with the din of “innovation” partially silenced, perhaps we can also use the time to think our way past science’s branding, to see science once again as integral to a whole, evolving understanding of ourselves and the world.
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True, the world has presented us with an ultimatum. We must halt our economies, reconnect science to a whole understanding of ourselves and our world, or die.
Riskin is a professor at Stanford. Her skies are blackened with soot. In the words of Greta Thunberg, “Our house is on fire.”
For many years, we’ve measured the success of our economy in terms of growth. The idea that we can maintain perpetual growth is a delusion. It’s simple mathematics. If the amount of stuff we manufacture – telephones, televisions, air conditioners – rises by 3% each and every year, we’ll eventually reach stratospheric, absurd levels.
In the game “Universal Paperclips,” you’re put in control of a capitalist system that seeks perpetual growth. If you succeed, you’ll make a lot of paperclips! And you will destroy the planet.
Here in the real world, our reckless pursuit of growth has (as yet) wrought less harm, but we’ve driven many species to extinction, destroyed ancient forests, and are teetering at the precipice of cataclysmic climate change. All while producing rampant inequality with its attendant abundance of human misery.
We must reconnect science to a whole understanding of ourselves and the world, or die.
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We are in danger. But Covid-19 isn’t the major threat we’re facing.
I consider myself to be more cautious than average – I would never ride a bicycle without a helmet – and I’m especially cautious as regards global pandemic. Antibiotic resistance is about to be a horrific problem for us. Zoogenic diseases like Covid-19 will become much more common due to climate change and increased human population.
I’m flabbergasted that these impending calamities haven’t caused more people to choose to be vegan. It seems trivial – it’s just food – but a vegan diet is one of our best hopes for staving off antibiotic resistant plagues.
A vegan diet would have prevented Covid-19. Not that eating plants will somehow turbocharge your immune system – it won’t – but this pandemic originated from a meat market.
And a vegan diet will mitigate your contribution to climate change, which has the potential to cause the full extinction of the human race.
Make our planet uninhabitable? We all die. Make our planet even a little less habitable, which leads to violent unrest, culminating in warring nations that decide to use nukes? Yup, that’s another situation where we all die.
By way of contrast, if we had made no changes in our lives during the Covid-19 pandemic – no shutdown, no masks, no social distancing, no PCR tests, no contact tracing, no quarantines – 99.8% of our population would have survived.
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Indeed, we often discuss the Covid-19 crisis in a very imprecise way. We say that Covid-19 is causing disruptions to learning, that it’s causing domestic violence or evictions. On the front page of Sunday’s New York Times business section, the headline reads, “The Other Way that Covid Kills: Hunger.”
Covid-19 is a serious disease. We need to do our best to avoid exposing high-risk people to this virus, and we should feel ashamed that we didn’t prioritize the development of coronavirus vaccines years ago.
But there’s a clear distinction between the harms caused by Covid-19 (hallucinogenic fevers, cardiac inflammation, lungs filling up with liquid until a person drowns, death) and the harms caused by our response to Covid-19 (domestic violence, educational disruption, starvation, reduced vaccination, delayed hospital visits, death).
Indeed, if the harms caused by our response to Covid-19 are worse than the harms caused by Covid-19 itself, we’re doing the wrong thing.
In that New York Timesbusiness article, Satbir Singh Jatain, a third-generation farmer in northern India, is quoted: “The lockdowns have destroyed farmers. Now, we have no money to buy seeds or pay for fuel. …. soon they will come for my land. There is nothing left for us.”
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Covid-19 is awful. It’s a nasty disease. I’m fairly confident that I contracted it in February (before PCR tests were available in the United States), and my spouse says it’s the sickest she’s ever seen me.
Yes, I’d done something foolish – I was feeling a little ill but still ran a kilometer repeat workout with the high school varsity track team that I volunteer with. High intensity workouts are known to cause temporary immunosuppression, usually lasting from 3 to 72 hours.
My whole family got sick, but I fared far worse than the others.
It was horrible. I could barely breathe. Having been through that, it’s easy to understand how Covid-19 could kill so many people. I wouldn’t wish that experience on anyone.
And I have very low risk. I don’t smoke. I don’t have diabetes. I’m thirty-seven.
I wish it were possible to protect people from this.
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Obviously, we should have quarantined all international travelers beginning in December 2019. Actually, ten days probably would have been enough. We needed to diecitine all international travelers.
By February, we had probably allowed Covid-19 to spread too much to stop it.
By February, there were probably enough cases that there will always be a reservoir of this virus among the human species. 80% of people with Covid-19 feel totally fine and don’t realize they might be spreading it. By talking and breathing, they put viral particles into the air.
By the end of March, we were much, much too late. If you look at the numbers from New York City, it’s pretty clear that the preventative measures, once enacted, did little. Given that the case fatality rate is around 0.4%, there were probably about 6 million cases in New York City – most of the population.
Yes, it’s possible that New York City had a somewhat higher case fatality rate. The case fatality rate depends on population demographics and standard of care – the state of New York had an idiotic policy of shunting Covid-19 patients into nursing homes, while banning nursing homes from using Covid-19 PCR tests for these patients, and many New York doctors were prescribing hydroxychloroquine during these months, which increases mortality – but even if the case fatality rate in New York City was as high as 0.6%, a majority of residents have already cleared the virus by now.
The belated public health measures probably didn’t help. And these health measures have caused harm – kids’ schooling was disrupted. Wealthy people got to work from home; poor people lost their jobs. Or were deemed “essential” and had to work anyway, which is why the toll of Covid-19 has been so heavily concentrated among poor communities.
The pandemic won’t end until about half of all people have immunity, but a shutdown in which rich people get to isolate themselves while poor people go to work is a pretty shitty way to select which half of the population bears the burden of disease.
I am very liberal. And it’s painful to see that “my” political party has been advocating for policies that hurt poor people and children during the Covid-19 pandemic.
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Because we did not act soon enough, Covid-19 won’t end until an appreciable portion of the population has immunity – at the same time.
As predicted, immunity to Covid-19 lasts for a few months. Because our public health measures have caused the pandemic to last longer than individual immunity, there will be more infections than if we’d done nothing.
The shutdowns, in addition to causing harm on their own, will increase the total death toll of Covid-19.
Unless – yes, there is a small glimmer of hope here – unless we soon have a safe, effective vaccine that most people choose to get.
This seems unlikely, though. Making vaccines is difficult. And we already know that most people don’t get the influenza vaccine, even though, for younger people, influenza is more dangerous than Covid-19.
Look – this is shitty. I get an influenza vaccine every year. It’s not just for me – vaccination protects whole communities.
Yes, there are clear positive externalities to vaccination, but I think this sounds like a terrible idea. Ethically, it’s grim – the Covid-19 vaccines being tested now are a novel type, so they’re inherently more risky than other vaccines. By paying people to get vaccinated, we shift this burden of uncertainty onto poor communities.
We already do this, of course. Drug trials use paid “volunteers.” Especially phase 1 trials – in which drugs are given to people with no chance of medical benefit, only to see how severe the side effects are – the only enrollees are people so poor that the piddling amounts of money offered seem reasonable in exchange for scarfing an unknown, possibly poisonous medication.
Just because we already do an awful thing doesn’t mean we should make the problem worse.
And, as a practical matter, paying people to do the right thing often backfires.
To illustrate, consider the recent introduction, in many Indian states, of schemes of cash incentives to curb sex-selective abortion. The schemes typically involve cash rewards for the registered birth of a girl child, and further rewards if the girl is vaccinated, sent to school, and so on, as she gets older.
These schemes can undoubtedly tilt economic incentives in favor of girl children. But a cash reward for the birth of a girl could also reinforce people’s tendency to think about family planning in economic terms, and also their perception, in the economic calculus of family planning, that girls are a burden (for which cash rewards are supposed to compensate).
Further, cash rewards are likely to affect people’s non-economic motives. For instance, they could reduce the social stigma attached to sex-selective abortion, by making it look like some sort of ‘fair deal’ — no girl, no cash.
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What happens if it takes a few years before there are sufficient doses of an effective vaccine that people trust enough to actually get?
Well, by then the pandemic will have run its course anyway. Masks reduce viral transmission, but they don’t cut transmission to zero. Even in places where everyone wears masks, Covid-19 is spreading, just slower.
I’ve been wearing one – I always liked the Mortal Kombat aesthetic. But I’ve been wearing one with the unfortunate knowledge that masks, by prolonging the pandemic, are increasing the death toll of Covid-19. Which is crummy. I’ve chosen to behave in a way that makes people feel better, even though the science doesn’t support it.
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We, as a people, are in an awful situation right now. Many of us are confronting the risk of death in ways that we have not previously.
More than 37 percent of deaths in 1900 were caused by infectious diseases, but by 1955, this had declined to less than 5 percent and to only 2 percent by 2009.
Of course, this trend will still hold true in 2020. In the United States, there have been about 200,000 Covid-19 deaths so far, out of 2,000,000 deaths total this year. Even during this pandemic, less than 1% of deaths are caused by Covid-19.
And I’m afraid. Poverty is a major risk factor for death of all causes in this country. Low educational attainment is another risk factor.
My kids am lucky to live in a school district that has mostly re-opened. But many children are not so fortunate. If we shutter schools, we will cause many more deaths – not this year, but down the road – than we could possibly prevent from Covid-19.
Indeed, school closures, by prolonging the pandemic (allowing people to be infected twice and spread the infection further), will increase the death toll from Covid-19.
School closures wouldn’t just cause harm for no benefit. School closures would increase the harm caused by Covid-19 and by everything else.
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.
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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.
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The FDA will approve any Covid-19 vaccine that cuts risk by half. It’s very unlikely that a Covid-19 vaccine will cut the risk by more than about two-thirds, and the vaccine will work least well for people who needprotection most.
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.
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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.
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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.
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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.”
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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.
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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.
Frank Brown Cloud 