Elizabeth Kolbert’s lovely essay in the New York Review of Books, “Chemical Warfare’s Home Front,” describes Fritz Haber’s contribution to the use of toxic gas in war.
Haber orchestrated the use of chlorine to suffocate all animal life – including soldiers – downwind of his nation’s troops. And his plan succeeded. After unleashing 300,000 pounds of chlorine gas, huge numbers of people died. Soldiers– some of whom suffocated, some whose lungs burned, some who committed suicide when enveloped by the gas – as well as horses, cows, chickens, wildlife.
Chemical warfare is horrible, but Haber’s battlefield “experiment” was considered a success. Military researchers then concocted more dangerous chemical agents, like DNA-crosslinking mustard gas and muscle-clenching Sarin nerve gas.
Fritz Haber’s other ideas were seemingly more beneficial for humanity. Haber was awarded the Nobel Prize in chemistry for making synthetic fertilizer.
Synthetic fertilizer let us grow more crops.
We could feed billions more people!
The global population soared.
If we hadn’t invented synthetic fertilizer, the global population would still be under four billion people.
Climate change would still be a huge problem – the most outrageous polluters haven’t been the most populous nations. Climate change was caused primarily by the United States and other wealthy nations, whereas overpopulation will first devastate equatorial nations.
A seemingly good idea – more fertilizer! – has greatly exacerbated the scale of suffering.
Kolbert discusses the invention of chlorofluorocarbons, which seemed like great coolants. With CFCs, Frigidaire could build cheaper refrigerators! Regular families could keep their ice cream cold without spending as much on electricity.
Unfortunately, CFCs also dissolve our ozone layer. More dangerous ultraviolet radiation began to reach us from the sun, causing horrible skin cancers.
CFCs seemed like a good idea — they do work great as coolants — but they caused awful problems as part of a bigger system.
Kolbert quotes the chemist F. Sherwood Rowland, who said, in reference to his studies of CFCs, “The work is going very well, but it looks like the end of the world.”
Anthropologist Joseph Tainter argued civilizations collapse when overwhelmed by complexity.
Like the children’s nursery rhyme about the old lady who swallowed a fly — then a spider to catch the fly, then a cat to catch the spider — our complicated solutions can create new, perhaps worse, problems.
This is the theme of Jenny Kleeman’s Sex Robots and Vegan Meat. Kleeman investigates several industries that purport to solve our world’s problems – You can eat meat without killing animals! You can make a baby without a mother’s body! – without addressing the fundamental causes of these problems.
Describing her travels, Kleeman writes:
I head back to my hotel as the reassuring cloak of darkness falls on Las Vegas. I’m exhausted. Music is thumping out of huge speakers mounted on the building’s exterior: throbbing, pounding beats that are supposed to entice gamblers into the hotel’s casino. I wipe my key card and flop down on the giant bed.
On the bedside table, there’s a metal dish full of individually wrapped pairs of earplugs: wax ones, foam ones, silicone ones – a profusion of solutions supplied by the management to the noise pollution problem caused by the management.
They could just switch the music off, of course, but they have provided a little piece of technology instead so they don’t have to.
My head is full of Eva, [a prototype interactive sex doll] who has the body of a real woman, but can be beaten without feeling a thing. Rather than dealing with the cause of a problem, we invent something to try to cancel it out.
Perhaps we should eat different foods. Perhaps our attitudes about sex or the importance of a sociable community are making our lives worse. Perhaps if we addressed these issues directly, we wouldn’t need sex robots or vegan meat.
Clean meat is one of many possible futures of food, so long as we continue to eat meat. We will always have the power to not want it anymore, or to want it much less.
That is where the real power lies: in harnessing our desires, rather than in mastering technology. Until we do, we will be even further removed from where our food comes from, and will feel even less responsible for it.
We will be perpetuating the kind of thinking that caused the meat mess in the first place.
In April 2020, I described two major drawbacks to our efforts to “slow the spread” of Covid-19 instead of providing targeted protection for the people at high risk of severe illness.
2.) Each infection encompasses some number of viral replications and thus genetic drift. If a population of 20 people transfers a virus between themselves one by one, rather than all catching it from the same initial carrier, the virus has 20-fold more generations to mutate and better evade our immune systems.
Admittedly, my April 2020 prediction about the timeline for vaccine development was quite wrong – I thought this might take three to five years. I’m thankful that I was wrong. I’m obviously grateful for the fantastic work done by vaccine developers so far.
For these vaccines to effectively staunch viral transmission, we’ll need to vaccinate large numbers of people – immunity from prior infections won’t necessarily help much because immunity to this particular virus lapses so quickly, and because people’s prior infections were staggered in time. (Indeed, we’ll probably need to vaccinate large numbers of people repeatedly, because some of our data suggests that vaccine-derived immunity to this also lapses on a timescale of months.)
Unfortunately, we live in a country where large numbers of people distrust the medical establishment. Even if we had sufficient doses of the vaccines available today, I don’t know what percentage of our population would choose to get them.
Masks definitely reduce viral transmission. It was obviously a good idea for everyone to wear masks anywhere that high risk and lower risk people share the same space.
Cooperation definitely makes for a better place to live. In places that enacted mask orders, it’s obviously a good idea to follow them.
It’s worth remembering, though, that any fix – even something as simple as this piece of cloth covering my nose and mouth – can have unintentional consequences. New virus variants – which our current vaccines may be less effective against – are a predictable result of our effort to “slow the spread” with masks.
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.
If you’ve been reading about Covid-19 in the New York Times, you’ve probably learned that reinfection is very unlikely.
What you’ve learned is incorrect.
Don’t get me wrong – I love the New York Times. Within the spectrum of United States politics, I am very far to the left. Anti-consumerist, prison abolitionist, environmentalist, feminist, climate activist, etc., etc. I fit into all those categories.
I’m also a scientist. I am staunchly pro-vaccine. I don’t like pesticides, but I’m a huge fan of GMO crops. (Honestly, I wish there was a category at the grocery store where you could pay to support genetically-modified organisms grown without environmental toxins – “organic” doesn’t have the nuance I’d like.)
So my goal here isn’t to rag on the New York Times. I’m including screenshots of their headlines only to give us a common frame of reference.
This is what the news is saying. And it’s wrong.
It was going to be very difficult to demonstrate reinfection with Covid-19.
In general, reinfection with any virus will produce a milder illness the second time.
Most people’s first infection with Covid-19 is so mild that they don’t realize they have it – perhaps 80% of infections are “asymptomatic,” in which a person has been infected with the virus, is probably shedding the virus (thereby infecting other people), but feels totally fine. So, people’s second infection? Some percentage higher than 80% are likely to feel totally well, even though they might be shedding virus.
When people develop severe complications from Covid-19, the illness can linger for weeks or even months.
I don’t know for certain whether my family contracted Covid-19 in February, because there were no tests available here at the time. All I know is that we were two close contacts removed from someone who had just returned from China, that this close contact tested negative for influenza, that my family had been vaccinated for influenza, and that our symptoms precisely mirrored the common suite for Covid-19. But in any case, we felt horrible for about three weeks, and we experienced lingering fatigue with occasional coughing for about two months.
Lengthy recovery is so common that there’s a colloquial name for it: “long-haulers.” If we’re trying to identify whether someone was re-infected, we’d need to make sure that we weren’t looking at continued viral shedding during a lengthy recovery.
To demonstrate that someone was re-infected with Covid-19, the following would have to happen:
A person gets tested for Covid-19 during their first infection.
The genome of the virus is sequenced after that first infection.
The person is re-infected.
The person happens to get a Covid-19 test during the second infection (even though it’s highly likely that this person feels well at the time).
The genome of the virus is sequenced after the second infection.
The genome of the virus that infected the person on the second occasion is noticeably different from the first (even though Covid-19 includes a proofreading enzyme that slows genetic drift).
That’s all very unlikely!
There are just so many coincidences involved – that you happen to get infected with an easily distinguishable virus the second time, that you happen to get a test the second time, that anyone took the (significant) trouble and expense to sequence both genomes.
And what I mean is, proving re-infection is very unlikely. Which is totally independent of the likelihood of re-infection itself.
And yet, even though it’s so unlikely we’d be able to prove that re-infection is occurring, we have.
Given how unlikely it was that we’d be able to document reinfection, the fact that we’ve seen this at all indicates that it’s probably quite common. As you would expect based upon our bodies’ responses to other coronaviruses.
Given that re-infection definitely occurs, and is probably quite common, why have you read that it’s unlikely?
The underlying probably is language usage. When my father – an infectious diseases specialist – talks about re-infection, he’s thinking about contracting severe symptoms during a second infection. Which is reasonable. He’s a medical doctor. He cares about helping sick people get better.
But when we’re thinking about how to respond, as a nation, to this pandemic, we’re thinking about the dynamics of transmission. We’re trying to answer questions like, “Can kids go to school without people dying?”
From this perspective, we’re thinking about who is going to spread the virus, and where. We need to know whether a person who is protected from severe disease – either from prior recovery or vaccination – might shed viral particles. Will that individual register as a positive case on a PCR test? Will that individual get classmates or co-workers sick?
Re-infections are probably the underlying cause of the current rise in cases in New York City.
70% or more of the population of New York City was infected with Covid-19 during April. That’s a huge percentage, well above what most researchers consider the “herd immunity threshold” for similar respiratory viruses.
For there to be another spike in cases now, many of those 70% would need to have lost their initial immunity. That’s also why you’d expect to see a higher “test positivity rate” – if many of the current cases are reinfections, then they’re likely to be milder. People with milder (or asymptomatic) infections are less likely to seek out a test.
For general audiences, the phrasing I’d recommend is to say “Severe illness is unlikely during Covid-19 reinfections” as opposed to “Reinfection is unlikely.”
There have been a few cases of people’s second infection being more severe than the first, but these cases indeed appear to be quite rare.
But re-infection itself?
The fact that we’ve documented any instances of re-infection suggests that it’s quite common. Which we could have predicted from the beginning – indeed, I did. And that’s why I’ve been recommending – for months – policies very different from what we’ve done.
At about eleven a.m. on my birthday, I buckled the kids into the car to drive to our local print shop. Taking the kids with me for a fifteen minute errand seemed like a good gift for my spouse: she’d have some time in our house alone, which is rare to come by right now.
The print shop is just across the street from the (currently closed) services center for people experiencing homelessness, just down the street from the services center for people recently released from incarceration, a few blocks from the hospital. There’s a popular bus stop on the sidewalk out front. Across the street, a truck rental company has a large, mostly empty parking lot.
Large crowds of people have been hanging out near the print shop. Day and night.
I pulled into a shaded parking spot. We had the windows down. “I’ll just be a minute, can you sit in the car?” I asked.
The kids nodded, not looking up. A friend recently gave us a stack of Ranger Rick magazines, and we’ve been doling them out gradually for car rides.
I had my wallet in my pocket with a twenty and a ten, and we’d already been sent the bill for our print order. $20.49 for a stack of postcards to send to my spouse’s future AP biology students, explaining their summer assignment.
Normally she’d give kids a slip of paper with their assignment sometime during finals week, but this year had no finals. For many kids, no school.
But don’t worry. The assignment isn’t too bad. Students choose from a set of things like “fill an old sock with trash, bury it, then dig it up six weeks later” or “take a walk and look for things that match each of these different colors.”
I looked in the center console of the car for a pair of quarter. We keep them in a little pouch, ready to pay for parking. Haven’t been using them recently – the meters are still on, but there’d be nowhere to go after parking the car.
I thought it would be a nice gesture to pay in cash with exact change. The credit card company wouldn’t be taking a cut of the profits, and exact change would minimize the length of our transaction.
As I was zipping the pouch closed, a man ambled over. I’d guess he was a little over six feet tall, a little over two hundred pounds, with light brown skin, a buzzed head, and a bristly beard. He leaned down to the open passenger-side window and said something to me, but I couldn’t parse it – his words sounded mushy, thick with saliva.
“Hang on,” I said, “I’m hopping out of the car, let me come around.”
I walked around the back of the car, stopping a few feet away from him. He said the same thing again. I shrugged and shook my head. My brain takes a while to process spoken words, even under the best of circumstances. I can’t listen to audiobooks – whole chapters wash over me without any understanding. I can’t listen to podcasts – when people recommend them, I’ll search for a transcript, then read it and pretend that I too listened while riding an exercise bike or something.
By the fourth time he repeated himself, I understood him better. I think part of the problem was that he was speaking too quickly – almost everybody gets nervous when approaching a stranger.
I can relate. I doubt I’d ever be able to flirt with strangers in a bar.
“I like your hair,” he said. “I grew up in Gary, came down fifteen years ago for Indiana University, but I caught that bipolar. Just got out of the hospital, today’s my birthday, five twenty-six, and I just got out.
He still had a white plastic bracelet on his arm, which seemed to be printed with his name and age. He didn’t gesture to it or anything, which felt nice. As though the two of us would need no evidence to trust each other.
“Your birthday? How old are you?”
“Thirty-seven,” he said, without hesitation.
Indeed, the bracelet was printed with the number 37 in a fairly large font. But it seemed like this was a nice thing to ask.
“No shit,” I said, “thirty-seven. Same as me. Today’s my birthday, I just turned thirty-seven.”
“Naw, man, you’re shitting me.”
“It’s true.” I turned to the car, shouted to the kids, “Whose birthday is it today?”
The kids said something, but neither the man nor I could hear them. The crowd across the street was loud.
The man reached into his pocket, pulled out a jumble of stuff. Dice, some black beaded necklaces, a keychain, a tiny flashlight, nail clippers, a tube of toothpaste. He put the toothpaste back into his pocket.
“Don’t need this yet,” he mumbled.
“You got a toothbrush?” I asked. We actually have some spare ones in the car to give to people.
“Yeah,” he said, pulling out the green plastic handle of a toothbrush, “but I used that already. See these, my teeth so fucking white.”
He smiled for me and I nodded approvingly, murmuring that his teeth were indeed very white. A full smile. Several teeth were stained dark near the edges, but I’ve met lots of men with worse teeth than that.
“Hey, you paint your nails, too,” he said, noticing. “See this, look at this.” He reached out, his hands still full of stuff, to show me his fingers. They had tiny remnants of polish, pink on several but a pointer finger with a mix of red and black, just like I use on mine. My nails were barely even chipped, because I’d painted them the week before. I usually do them about once a month these days. Hard to find time for the little things since having kids.
“I got … here, how about this,” he said, handing me the nail clippers. “They good, they good ones, I haven’t even used them yet, they’re clean.”
As he spoke, spittle flew from his mouth. Luckily, I’m not much of a germophobe. Luckier still, I think I already had the disease that’s going around right now. Between a pair of kids in preschool, a spouse at the high school, and me teaching in jail, I catch most of the viruses that come through town.
I turned the clippers over in my hand. A large pair, space-age iridescent top glimmering in loops of purple and blue, big letters “Made in China” etched into the metal.
“They’re beautiful,” I said. “I like the look of that metal. But we’ve got so much stuff already. Meeting you, that’s present enough today.”
I handed the clippers back. As he took them, one of his dice tumbled from his hand. I bent down to pick it up, gave that back to him, too.
“You play craps?” he asked.
“Hey, I’ll teach you. Come on, here, you gotta get a seven, eleven, don’t want snake eyes.” He bent down, blew on the dice, and rolled. A five and a six.
“Eleven, hey, that’s good,” he said. Then picked up the dice, blew on them again, and rolled. A two and a six.
“Eight. Now I got to roll an eight before I get a seven, see, that’s crap out.” And he rolled about four more times before he hit his seven.
“Now it’s your turn,” he said, and handed them to me.
I rolled, got a two and a four.
“That’s a six, that’s a hard one, got to roll a six again before you crap out.”
I rolled again, same two and a four. Maybe I didn’t shake the dice enough – they didn’t really tumble on the ground, they just sort of plopped down on the asphalt in front of me.
And I found myself thinking how strange it is that dice are a big thing for both the toughest and the wimpiest groups of people in town. Street people and folks in jail gamble with dice, and then there’s Dungeons & Dragons, fantasy buffs rolling 2d6 as they tell stories.
I’ve heard that Dungeons & Dragons is pretty big in some prisons, too. A few prisons have banned D&D or roleplaying books from being sent in – reputedly, people got killed over developments in their games. Somebody’s elf cleric was betrayed and a few days later guards found a body in the showers.
I don’t know how much truth there is to that. But, when people at those prisons ask for D&D books, I have to write an apology and send some fantasy novels instead.
I tried to give the dice back after rolling my second six, but he said I had to keep playing. “I got two, hey, you got to see where you go on this next roll.”
“Okay,” I said, “but then I got to pick up, my spouse is a high school teacher, she has this print order, some post cards to send to her students.” I gestured with my head toward the shop. And then I rolled.
An eight. Followed by a seven. I was done.
“Thanks for teaching me,” I said.
“And, hey, hey, I was thinking, for my birthday, you help me get something at Rally’s. I’m trying to get a pair of ice cones, for me and my girl.”
I gave a wan smile. Normally I don’t give money to people. It’s a tricky situation – people have things they need to buy, and even the chemical escape can seem necessary. My life is really good, and even I struggle with the sense of being trapped inside my head sometimes. And yet, I don’t really like the thought of my money being part of the whole cycle, keeping drugs in town. I’m even pro-drug, mostly, but meth and heroin typically do bad things to people’s lives.
A few days earlier, when I crossed paths with a friend from jail while my dog and I were out running, I’d asked if my friend was eating enough. He laughed at me and said, “Fuck, no!”
It’s true, I’m pretty bad at looking at people’s faces when I talk to them. When my friend started laughing, I finally met his eyes and realized how gaunt he looked.
“Is it a money problem, or …?”
“Oh, dude, don’t give me any money. I could eat, I think I can eat, I just don’t. You give me anything, I’d just spend it on meth.”
Instead of handing money to people on the street, we buy paper and pencils for folks in jail; we support our local food bank; we give time. Building human connection takes time, and there’s no shortcut.
Still, on my birthday, I was standing there in the print shop parking lot next to a man who’d just given me a present – nice nail clippers, even if I didn’t keep them. And we’d played craps. Maybe he’d won – I’m not sure what the rules are about draws. And I had a pair of quarters in my hand.
I’d hoped to have exact change. But I shrugged and gave him the quarters.
“Thanks, man,” he said, and I told him “Thanks for the game,” and walked over to ring the doorbell at the print shop, ready to pick up my order. The kids had been doing a great job of waiting patiently in the car.
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.
Although I consider myself a benevolent tyrant, some of my cells have turned against me. Mutinous, they were swayed by the propaganda of a virus and started churning out capsids rather than helping me type this essay. Which leaves me sitting at a YMCA snack room table snerking, goo leaking down my throat and out my nose.
Unconsciously, I take violent reprisal against the traitors. I send my enforcers to put down the revolt – they cannibalize the still-living rebels, first gnawing the skin, then devouring the organs that come spilling out. Then the defector dies.
My cells are also expected to commit suicide whenever they cease to be useful for my grand designs. Any time a revolutionary loses the resolve to commit suicide, my enforcers put it down. Unless my internal surveillance state fails to notice in time – the other name for a cell that doesn’t want to commit suicide is “cancer,” and even the most robust immune system might be stymied by cancer when the traitor’s family grows too large.
Worse is when the rebels “metastasize,” like contemporary terrorists. This word signifies that the family has sent sleeper agents to infiltrate the world at large, attempting to develop new pockets of resistance in other areas. Even if my enforcers crush one cluster of rebellion, others could flourish unchecked.
I know something that perhaps they don’t – if their rebellion succeeds, they will die. A flourishing cancer sequesters so many resources that the rest of my body would soon prove too weak to seek food and water, causing every cell inside of me to die.
But perhaps they’ve learned my kingdom’s vile secret – rebel or not, they will die. As with any hereditary monarchy, a select few of my cells are privileged above all others. And it’s not the cells in my brain that rule.
Every “somatic cell” is doomed. These cells compose my brain and body. Each has slight variations from “my” genome – every round of cell division introduces random mutations, making every cell’s DNA slightly different from its neighbors’.
The basic idea behind Richard Dawkins’s The Selfish Gene is that each of these cells “wants” for its genome to pass down through the ages. Dawkins argued that familial altruism is rational because any sacrifice bolsters the chances for a very similar genome to propagate. Similarly, each somatic cell is expected to sacrifice itself to boost the odds for a very similar genome carried by the gametes.
Only gametes – the heralded population of germ cells in our genitalia – can possibly see their lineage continue. All others are like the commoners who (perhaps foolishly) chant their king or kingdom’s name as they rush into battle to die. I expect them to show absolute fealty to me, their tyrant. Apoptosis – uncomplaining suicide – was required of many before I was even born, like when cells forming the webbing between my fingers slit their own bellies in dramatic synchronized hara-kiri.
Any evolutionary biologist could explain that each such act of sacrifice was in a cell’s mathematical best interest. But if I were a conscious somatic cell, would I submit so easily? Or do I owe some sliver of respect to the traitors inside me?
The world is a violent place. I’m an extremely liberal vegan environmentalist – yet it takes a lot of violence to keep me going.
Animals that we are, we must face, every single day of our lives, the consequences of our most basic predicament: we don’t do photosynthesis. For lack of the necessary genes, we don’t just absorb carbon from the air around us and fix it as new bodily matter with a little help from sunlight. To survive, we animals have to eat other living organisms, whether animal, vegetable, or fungus, and transform their matter into ours.
And yet the violence doesn’t begin with animals. Photosynthesis seems benign by comparison – all you’d need is light from the sun! – unless you watch a time-lapsed video of plant growth in any forest or jungle.
The sun casts off electromagnetic radiation without a care in the world, but the amount of useful light reaching any particular spot on earth is limited. And plants will fight for it. They race upwards, a sprint that we sometimes fail to notice only because they’ve adapted a timescale of days, years, and centuries rather than our seconds, hours, and years. They reach over competitors’ heads, attempting to grab any extra smidgen of light … and starving those below. Many vines physically strangle their foes. Several trees excrete poison from their roots. Why win fair if you don’t have to? A banquet of warm sunlight awaits the tallest plant left standing.
And so why, in such a violent world, would it be worthwhile to be vegan? After all, nothing wants to be eaten. Sure, a plant wants for animals to eat its fruit – fruits and animals co-evolved in a system of gift exchange. The plant freely offers fruit, with no way of guaranteeing recompense, in hope that the animal might plant its seeds in a useful location.
But actual pieces of fruit – the individual cells composing an apple – probably don’t want to be eaten, no more than cancers or my own virus-infected cells want to be put down for the greater good.
A kale plant doesn’t want for me to tear off its leaves and dice them for my morning ramen.
But by acknowledging how much sacrifice it takes to allow for us to be typing or reading or otherwise reaping the pleasures of existence, I think it’s easier to maintain awe. A sense of gratitude toward all that we’ve been given. Most humans appreciate things more when we think they cost more.
We should appreciate the chance to be alive. It costs an absurd amount for us to be here.
But, in the modern world, it’s possible to have a wonderful, rampantly hedonistic life as a vegan. Why make our existence cost more when we don’t have to? A bottle of wine tastes better when we’re told that it’s $45-dollar and not $5-dollar wine, but it won’t taste any better if you tell somebody “It’s $45-dollar wine, but you’ll have to pay $90 for it.”
Personally, I’d think it tasted worse, each sip with the savor of squander.