I really want to understand how “two weeks to slow the spread” became “white collar workers should shelter in place for the foreseeable future and blue collar folks should wear masks.” Im still dumbfounded by why healthy young and middle aged people were willing to give up so much for so long to avoid such a small risk. Vaccines were developed faster and proved more effective than was expected. Last years risk calculations would look really silly if the vaccines had been 60% effective and the curve had exploded after delta came along. They would look equally silly if delta had hit five months earlier.
Why were young and middle aged people willing to live bleak and austere lives for a year or more to avoid a 1 in 2000 chance of death. Do they never drink alcohol or smoke pot? Do they have a scientifically ideal BMI? Do they always drive the speed limit? The extreme risk aversion was a collective mental illness.
I can totally understand why retirees might have chosen to stay home for a year, I can even understand why school districts might have let 60 year old teachers work from home and hired young people to monitor classrooms. I can also understand why grandparents might have avoided their grandchildren during Christmas 2020, though I can also understand taking a small risk of infection and a 3% chance of dying if infected to have a normal Christmas if you only have 10 or 15 Christmases left in you. Reasonable people can disagree on that one.
America was not built by timid men, it was built by people who threw up railroads and bridges and dug mines fully aware that some of the workers would die. The idea that life can be completely safe until old age, with the consequence that many peoples’ bodies outlast their brains and they spend years as senescent morons, is the essence of modern decadence.
America was built by all types of people. Rich cowards, slaves, the working poor and just about every stripe of moral character any of us can imagine. Reducing America's history to a PragerU picture book isn't helping anybody. There is a lot we still don't know about this virus and taking precautions is a reasonable thing to do. How we come to terms with it over the long haul will depend on a variety of factors but I would rather we listen to the medical community about what makes sense than a preacher or a fox business market analyst. Did some people overreact? Yes. Does it become easier to Monday morning quarterback the more we learn? Also, Yes. In the context of a country where over 1/3 of it's voting population think the last election was stolen (it wasn't) I don't know if we should get into "what's going on with these grand delusions?!" because we are obviously a society susceptible to all sorts of deception.
This is unfair. We didn't know what we were dealing with then, so taking the cautious approach was certainly advisable. Let's not forget the main reason: don't overwhelm the medical system. People taking up space in ICUs for COVID meant space not available for others kinds of life-threatening issues.
Armchair quarterbacking is easy. On the field, in the moment, and you have the ball? Not so much.
Uh, even that linked piece says we need more data before making decisions and that the true case fatality rate was unknown (with percentages all over the map).
And again, the primary reason for attempting to bend the curve was not overwhelming the medical system so that many more people didn't have to die than needed to (including people who did not even have COVID.)
bending the curve to avoid swamping hospitals made sense. keeping things closed or partly closed in april after the curve was bent did not. if not overwhelming hospitals were the goal, e would have wanted more infections during summer 2020 to build immunity before the winter flu season
Well, we were terrible at keeping the curve bent for long, so even though I disagree with your timeline, I do agree that in the long run, we'll have to strike some better balance. Until we figure out how, though, it's going to be a rocky ride with wave after wave overwhelming the hospitals.
If it's not quick from herd immunity through vaccination, it's going to be slow (and annoying) through waves of actual infection.
Without agreeing with your descent into jingoism, I would be interested in an long-form oral history kind thing about how literally every city, province, and nation on the planet somehow switched from "bend the curve" to "covid zero".
So much of the strategy and messaging seemed to change overnight and have unanimous consensus. It was baffling, and i think I’ll be the “crazy grandpa” sitting on the Thanksgiving table in 40 years ranting about it.
One side note. David Abbott often uses colorful language to elaborate and tie a bow on his points but as someone who enjoys reading his comments, I would not use the term “jingoist” to describe him. I’m not suggesting you’re calling DA a “jingoist” either but it’s a word that can pack some heat so I wanted to chime in.
my understanding is the term jingoist had its origins in patriotic appeals victorian Tories made to newly enfranchised working class voters. My comment was jingoist in that sense. But then there are snowflakes who think jingoist ds should be cancelled and screw that.
wait -- is "jingoist" really a heated term? I find it kind of charming and archaic. I mean, jingoism itself may not always be charming -- it's the pejorative of "patriotism" (I'm a patriot, you're a jingoist, he's an ethnic cleanser, or something like that).
But I had not known it was a fightin' word! That's news to me, by jingo!
"Why were young and middle aged people willing to live bleak and austere lives for a year or more to avoid a 1 in 2000 chance of death. Do they never drink alcohol or smoke pot? Do they have a scientifically ideal BMI? Do they always drive the speed limit? The extreme risk aversion was a collective mental illness."
'Are there no workshouses? Are there no prisons?'
I am absolutely willing to agree some people have overdone it on the covid freakout, but Covid-19 is a nasty, unpleasant way to die - or survive. I would also point out the last 40 years have featured a mass expansion of prisons (for 'safety reasons'), and just now ended 20 year war in which 240k non-Americans died to prevent a hypothetical event happening that features a much longer set of odds against.
To paraphrase Nathan Hale: "I only regret that I have but one 'like' to use for this comment".
We have become a nation whose rules are determined by the our most neurotic, safety-obsessed narcissists. Encouraged by a media who understands that fear sells. And government officials who rarely turn down an opportunity to expand their 'emergency' powers.
The moves toward requiring vaccines for interstate travel, masking children and instituting waves of restrictions every time a variant spreads through the populace further encourage the trend toward decadence. Time to repurpose the 2016-2020 phrase: #Resistance
Get a second subscription to the 'stack, and then you can give more likes under your other pseuds. Maybe MY can work out a group rate for you -- you could give likes by the dozen.
So long as we acknowledge that the same exact safety-obsessed neurosis is driving BOTH the right’s views of crime and incarceration, voting rights, immigration, military spending, and foreign affairs and the left’s obsession with “intangible harms”, bias in all its forms, sexual propriety, and Covid.
We have different definitions of the word "enjoy". And that is OK. With vaccines readily available, each person can choose their own level of risk tolerance, though I do wish the risk equation was treated more responsibly by the press.
I'm vaccinated and will get the booster when available. And I will enjoy my life largely in the same manner I did in 2019.
Sometimes it has to do more with whom else we're protecting.
My husband and I are vaccinated. So while I don't want to catch CoVID, I'm not particularly nervous about it - I also don't want to get the flu or a cold.
But...
1) My kids are not vaccinated yet because although the AAP recommends that the FDA approve it(EUA) without an extra-long trial, the FDA so far hasn't taken the bait. So, I am willing to reduce personal exposure risk to reduce giving it to them (that's different from sending them to school - sending them to school has a benefit _FOR THEM_ - eating indoors at a restaurant has a benefit _FOR ME_.).
(We actually did eat indoors during the summer when Delta wasn't a thing yet and the numbers were looking good)
2) We're still doing short-term precautions - we're about to go on a family vacation (school has a fall break) and I really don't want to catch CoVID before then and either know about it (and cancel the trip) or don't know about it (and risk infecting _other_ people, especially kids)
Mask usage for me is about protecting other people more than myself. I mean, there's still some element of _protect myself_ in there, but now that I'm vaccinated that's a much smaller part of the equation and I _am_ willing to do go "riskier" things, but I'm also worried about the kids.
And the restrictions regarding children are especially bizarre considering the Covid risk to them is statistically less than the flu. Vulnerable populations can protect themselves with the vaccine, so what is the point of masking children?
Fewer than 200 children under 12 have died of COVID in the US. I suspect those that did were unhealthy to begin with. Healthy kids are at much greater risk of dying in a car crash than from COVID.
Would the risk of dying in a car crash be greater if they didn't wear seatbelts? Until we know more about this virus (and the fall school semester is going to get us a lot of great data) why just declare victory and depart the field? This is cut and run Covid edition.
It also helps protect people who, for various reasons, can't be vaccinated, and it protects vaccinated people for whom the vaccine doesn't work sufficiently. There is a population for any vaccine for whom immunity is never conferred, for whatever reasons.
For example, I have been vaccinated multiple times against whooping cough. I have also had whooping cough more than once when it became an epidemic in my area (largely due to anti-vax sentiment weakening local vax rates), because it's extremely contagious. (It's also extremely unpleasant, particularly for adults.) So, the fact that I didn't gain immunity from the vaccine only became a problem for me when the herd immunity was weak enough to allow for more breakthrough epidemics.
Now, do other people owe it to me and others like me to get vaccinated? Not necessarily. But it might be nice if we viewed it as an honorable community duty to one other. As it stands, I'm vaccinated against many illnesses, besides whooping cough, for which I did gain immunity (or at least serious protection), and that's helping protect the people for whom *those* vaccines didn't work sufficiently, and so on, and so on, down the line.
[Deleted and reposted to consolidate my comments.]
You're making an unintentional argument for disbanding the US military, since we spend trillions on it to handle things like 9/11 for which the death rate was 1000x smaller.
Also, might as well open the border as well, since the security concerns with doing so are largely a thing that lives rent free in the heads of Fox News viewers.
This ignores deterrence. There's argument to be had over the size our military should be, but if we simply didn't have one, the likelihood of being severely attacked goes way up, because that fact would not be lost on America's enemies.
I mean, yes, have a military, but maybe we don't need one larger than every single other one combined. Especially since most of it is filled with graft and pork projects for politically connected districts.
Fair enough. I was mainly trying to point out that deterrence is always a factor that needs to be considered alongside the current rates of [insert whatever undesirable outcome is under discussion], because changing the incentives and disincentives of a thing will inevitably affect that rate -- it can't be presumed to remain constant under radically different circumstances.
I personally would welcome both a more pragmatic approach to COVID-19 and slashing the US military budget to probably about 20% or less of its current level.
No, that's a bad analogy because we spend all that time and effort on the military to prevent much greater levels of death and injury from things like 9/11. Oh, wait.
I stayed inside and avoided large gatherings to keep people I know in my community safe - I was worried less about my own health than I was about infecting others.
I ride a motorcycle (w/ a helmet, I'm not crazy) I'm not overly concerned with my own personal well-being. But it's extremely unlikely I would hurt *someone else* by getting into a motorcycle accident, whereas contracting covid could entail infecting other people and potentially killing them.
"...could entail infecting other people and potentially killing them..."
Yeah, this is an important point.
The issue for me is not, "am I willing to take a 1/x chance of dying".
Instead, the issue is, "there's a terrorist who has taken your fellow Americans hostage, and he is going to execute 10 million of them. What are you willing to do to save some of those lives? Will you get a shot? Will you wear a mask?"
And my answer, of course, is that my freedum to expose my nose is far more important than the lives of my fellow Americans. Who cares about millions of deaths? My freedums matter more!!!
10 million, when vaccines are readily available? Respectfully, that is a perfect example of how the risk from COVID - and the benefits from masking - are being wildly mis-represented.
There are vaccines available *now* and once vaccines became available I started living a *mostly* normal life again. I'm not going to go out of my way to protect the unvaccinated at even a minor inconvenience to myself. That wasn't the case for the first year+ of the pandemic though.
I don’t understand what you’re talking about. I’m out and about going to the gym, going out to dinner, I have a vacation conking up in a few weeks. Seriously, what on Earth are you going on about?
I'm required to wear a mask every time I go to court or visit a jail. Also, national parks were closed for months last year, and we didnt have jury trials for 15 months. My kid's school was closed for 2 months, and we put him in private school last year so he could attend classes in person.
Closing national parks was a stupid idea, and schools should have reopened earlier. But I just don’t see that being forced to wear shoes and underwear when you go to visit a jail is a problem, and a mask is no more uncomfortable than those.
Let me preface by saying that I'm fully vaccinated, that I understand why masking is a thing, that I wear a mask when required, and that I don't make a fuss about it.
That said, I have had sensory issues since childhood, and personally, I find masks much more uncomfortable and claustrophobic than the clothing you mention, especially in the heat. In particular, neither of those restricts breathing. Despite being very accustomed to masking at this point, significant downsides remain for me. I don't really want to explain further for privacy reasons, but hopefully, you'll take me at my word that this is true for me.
Considering masking necessary doesn't require us to pretend that it has no downsides or to overly minimize them. The case can still be made. In fact, most people will find a case more convincing if they think you're being straight with them. It's also worth keeping in mind that, even if an intervention has little or no effect on you, it may still be experienced quite differently by others who are unlike you in various dimensions.
It can also be very hard to understand people. Facial expressions are blocked and sounds are muffled. It's especially bothersome to non-native speakers and young children who just learning to communnicate.
false. i’ve gotten used to wearing shirts. and i don’t want new rules when life is already so regulated. finally, shoes don’t compromise non-verbal communication, and so find young women’s’ faces far more interesting than their feet
Masks are much worse than suits. But, in Gawgia, in the summer, there are plenty of courts where the lawyers wear short sleeves. I’m not that country, I prefer seersucker
No thanks. Maybe if you've signed up to live on the moon you can expect to wear a mask all the time. But not here on Earth. It's not human to walk around with your face always covered. And I'd object to wearing a burka too.
I suspect national parks close whenever because they generally close whenever they have a plausible excuse to do so. And never underestimate the ability for public school systems to overreact to anything that their worst members of the union demand.
It's the same stuff right leaning people are always going on about: "some people somewhere where I don't live are doing crazy things." I live in an educated bubble in DC, and we have house parties, dine indoors, I'm going to an Alabama football game in a few weeks for Pete's sake
Everyone has anecdotes. My sapphire-blue, big-city neighborhood is having block parties, folks are coming over for drinks and dinner, and everyone’s squeezed in at least one decent summer vacation.
Sure - but BronxZeeCobra's reply was as if David Abbot is living on another planet. I wasn't reading that LA county's covid response was extreme on Fox News, I was hearing about it from people living there who were either complaining about it or telling me it wasn't enough.
No country, even a basket case like Afghanistan, can be won/made by timid men. Nothing unique about America in that regard. More importantly, implicit in your argument there's an accusation that people who advocate for more vaccination/masks are actually asking for a 'zero covid' scenario. That's unfair. All people are asking for is some civic responsibility( e.g. wear masks and get the shot ) so that things can go back to normal. Contrary to the Right, no man is an island especially if the island is sneezing deadly air!
You misconstrue me. I want more vaccinations. I think virtually all adults should vaccinate. I think children should have the option. I'd take my 7 year old to get vaccinated this afternoon if I could.
I was very happy to wear a mask in grocery stores, pharmacies and post offices before I was vaccinated. Many vulnerable people have to go to those places. As an attorney, I gave my clients the option of meeting in my conference room with masks or meeting outdoors without masks. I didnt want to get my clients sick.
I avoided crowded restaurants and the gym until I was vaccinated. I avoided indoor dining altogether for a couple of weeks during the January spike. If everyone had displayed my degree of risk aversion, there would have been fewer COVID cases and deaths.
However, I never thought that low and moderate risk folks should wear masks while socializing in pairs or small groups. If people wanted to go to a restaurant and take the risk, that's their choice. And I certainly feel zero obligation to wear a mask to protect people who are too stupid to vaccinate.
"And I certainly feel zero obligation to wear a mask to protect people who are too stupid to vaccinate."
I'm with you on that one.
Unfortunately, I have no way of knowing which unvaccinated people I come into contact with are victims of Fox News brain-poisoning, and which ones have cancer, Crohn's disease, or impaired immune function, and which ones have parents or children with cancer, impaired immune function, and so on.
If I could be sure that my cavalier attitude was only endangering those who have willfully endangered themselves, then I would wear my mask far less often.
Those people are eligible for vaccination other than the child under 12. Those people were always vulnerable to respiratory viruses. Did you wear a mask for them in the past? Sorry I’m with DA here and always looked at the situation as bend the curve to prevent overwhelming the hospitals. Covid is likely here with us forever as MYs post explains. Are we masking for the vulnerable forever?
"Sorry I’m with DA here" no need to apologize: I'm sure DA is a good person to be with.
"Did you wear a mask for them in the past?"
In the past, I never wore masks, even at times when I now see I should have, e.g. when I was feeling ill but needed to keep working. In the future, I'm going to mask when I have symptoms. I understand this has been the norm in some Asian countries for a while, and it seems like a good norm for us to adopt.
I have every hope that one of the lasting good effects of this plague will be to normalize a higher level of mask-wearing in public.
"Are we masking for the vulnerable forever?"
How long will I mask as part of a suite of COVID responses? Probably until some combination of: vaccination rate is high enough + prevalence and spread is low enough. Additionally, I will mask or not it in a way coordinated with public policy and the actions of others. It's a behavior that, like many social behaviors, gains its efficacy in part by being widely adopted.
I remain baffled that people are so wrought up about masks. Why is it so hard? I even mask at the gym -- it's not comfortable, and it means that I am exercising in the Andes, but it's just not a big deal in the scheme of things.
Why do people have to be such babies about it? America used to be a land of brave, rugged pioneers, not timid people who fuss over wearing a mask.
Ok - quick response since I'm at work. I don't necessarily disagree about general masking in grocery stores, pharmacies, doctor's office, etc. (Neither did DA). I do somewhat disagree re: gym and work-out. My preferred exercise is a high-impact aerobic dance class (Jazzercise) that I've been doing 20+ years. Tried it with a mask and hated it. So now I'm back to online class which is not nearly as fun, but ok ... so be it.
Here is my larger point: life and risk calculation/preventative medicine is more than just Covid. We need to mask forever at stores? Ok, maybe ... I'm open to that. But I have a ton of patients that gained wt over the last year b/c they stopped going to the gym and were sedentary. And now are STILL afraid to go back to the gym despite vaccination. What is the morbidity /mortality of obesity from that wt gain and how does that compare to the risk of Covid, vaccinated?
Kids were out of school for the year. Poverty and homelessness increased from our collective demand for isolation. Depression, especially among my seniors, was severe from isolation. Those all have associated morbidity and mortality. We will not know the cost of this year for a generation to come and over-reaction by shutting down everything has a significant cost, just as under-reaction has a huge cost (Florida, recently). This is my point. There is a necessary balance. Think about everything in the larger, broader context : yes, Covid has been a huge tragedy, but there were and still are other health risk considerations besides just Covid.
I'm young, very healthy, and vaccinated with an mRNA dose. I don't want to get COVID just about as much as I don't want to get a common cold, plus some uncertainty about long covid (vaccines reduce my risk by half, some proportion have symptoms from ICU care which I am extremely unlikely to need- so, pretty low risk, maybe less than 5% given infection- but don't want it). That being said, my wife is a nurse, and I DEFINITELY don't want to be hospitalized. They're so understaffed and overdrawn right now. So, I mask up indoors around strangers, but don't care about masking with people I know well, because they are all vaccinated and they'd tell me if they tested positive. I travel, I see my older relatives. I'm an epidemiology grad student and quite liberal. I think you're overestimating how many people are living "bleak and austere lives" based on the crazies that get on the news- squeaky wheels get all the attention, but the silent majority of American adults are vaccinated and living pretty normal lives right now.
Social pressure and a fear of social shaming. Many of the young white collar workers I know absorbed the idea that covid was something you got because you did something you weren’t supposed to do. Healthcare workers got it, but they got it the good way.
I think there was also a lot of bad information out there. There was a survey a while back where a large percent of the population thought the half of people with covid ended up in the hospital. I know young people who truly believed that if they got covid there was a very high chance they would end up in the hospital.
Probably not. But as someone who has had to work onsite through the pandemic, plenty of people got infected at work despite everyone wearing masks. Many employers did not do a very good job of making workplaces safe. Even ones who took covid seriously because it made things inconvenient and was expensive.
If you’re spending 8 hours near someone in a poorly ventilated room talking and you have a high viral load there’s a very good chance of infecting the other person even if you’re both wearing masks. That really got lost in the messaging.
I don't have a strong opinion on this argument, but I think what is considered wrong with it is that it increases the chances of vulnerable people getting it, and it increases the risk of severe mutations.
"Two weeks to slow the spread" was total lockdown after we saw what was happening in New York. Literally no one went out at all. That's not been the case since Xmas, and now we see ICUs accross the south being overwhelmed.
The difference between a novel virus and drinking alcohol, speeding, etc. is the sense (which might be an illusion) of personal control. In other words, people can more easily convince themselves that they're the exception to the average risk factor for the latter activities, because they're more responsible / have better reflexes / etc. Some of them are right; many are wrong. But avoiding a novel virus that doctors didn't know how to treat and whose long-term effects were unknown is a fairly rational choice. Now we do know how to treat it, but the long-term effects still aren't so well understood. I think we'll see a gradual growth in acceptance of COVID risk as the situation matures.
i feel that covid mortality risk has consistently been exaggerated. it’s relatively hard to find center left news sources understating covid risk.
we’ve known the mortality risk within a factor of 2 or 3 for a while. i simply don’t see the level of restrictions people have accepted being justified by the risk. the better strategy is to shelter vulnerable people, who tend not to have full time, physically demanding jobs. very easy to isolate old people really. “wear masks around old people, except at christmas, but reduce your contact during the period two to six days before christmas” would have been a fine rule.
Part of my point is that we need to account for not just mortality risk, but also "Long Covid" risk.
The overall institutional response in the US has been a disaster, but mainly because of inconsistency and general incompetence. The right approach to containing a pandemic is to institute clear, consistent policies that are just a little too strict (keeping in mind that some people won't follow the policies and enforcement is always difficult).
In the US, we still barely even have a testing infrastructure, and contact tracing isn't even under consideration, let alone real support for quarantining. The next pandemic is really going to fuck us. I guess at this point, we might as well enjoy the world until then.
This does seem to have some relevance for the masks in schools debate doesn’t it? And just for covid prevention among young people in general. If my daughter is going to get variations on this virus dozens of times in her life why am I trying to prevent her from getting it now? Especially since, past the first year of life, it seems like the younger you get this thing the better.
I also know a few parents who are now saying “why don’t kids always wear masks” to prevent spread of flu and ‘common colds’. Which I do understand as it’s a big pain when your kid is sick! But if the common cold is not serious in mid life because we’ve all had it ten times while we were young then we’re not doing kids much of a favor by reducing their exposure to these coronaviruses and rino viruses at a time when their bodies seem most able to handle first exposure.
Yes, I think we need research into the question of whether suppressing youth cold infections is a good idea or a bad idea. You can see plenty of upside to it (kids getting colds is annoying!) but you could also imagine it being counterproductive.
Let's not forget that chicken pox (in the days before vaccination) was super mild for kids but terrible for teens and adults. If this is true for COVID and other respiratory diseases as well, then there is definitely a benefit to kids starting to build immunity to the various variants so that when they become adults, their immune systems aren't completely taken by surprise. If this can happen through vaccination rather than actual illness, all the better.
I remember a definition of "exception that proves the rule" in a book. (I don't remember the book - I think it defined various phrases, this was > 20 years ago)
If I make the statement:
"The kids can stay up past 8:00 tonight" I'm clearly implying an exception(I said 'tonight' implying an exception) and that suggests(proves?) the rule is that normally they must go to bed by 8:00.
Isn’t the answer pretty obvious? We’d need electronic medical records with a central database versus provider based to prove it out in a long term study.
...and so many reasons not to! I have no desire for the government, which has been under the control of LBJ, Richard Nixon, Bill Clinton and Donald Trump during my lifetime, to have access to my medical records.
Read up on what LBJ & Nixon did with information against their political enemies. And I wouldn't put anything beyond Trump. I think political actors use information as a weapon all the time, and I wouldn't want medical information to be part of their arsenal.
I actually think medical records should be held by insurers, rather than providers, not necessarily the government. Payers already have enormous claims databases that are very useful, but lack the details behind the claims, which limits their reliability and richness for research - though payers do already have the right to access the underlying medical records on demand. So if you're on Medicare that would be CMS, but if you're on private insurance it would be whatever private insurer you have. Then the insurance databases could be standardized to be useful for research, on the model of the FDA Sentinel project that links insurance claims databases, but for more than just FDA regulated products.
I don't think generalized privacy concerns about that come close to outweighing the public health benefits.
Nope as in they won't cover 90+% or nope as in that doesn't count as centralized EMR? I think EMR systems are likely too complicated for the government to run as a centralized system--like, realistically you need interconnections between EMR systems, but Epic is dominant because it's a very good system because it has had to slowly but surely crush other vendors.
I don't know what happens if they truly gain monopoly status (do they slump off?), but it strikes me that the process of creating a really good centralized EMR is the result of market competition and not something likely to be easily recreated by a public service. Even universal systems in Europe often have several different record systems.
You are really asking me, "why is notoriously slow-moving, inefficient, and sclerotic bureaucracy acting like a slow-moving, inefficient, and sclerotic bureaucracy?"?
They don’t want to make it obvious to the rubes that you test it by taking it and we have never done long term follow up. And the cost benefit is still a slam dunk even if there are long term consequences.
Yes, this is proving to be a problem with RSV, a not uncommon respiratory virus which effects very young children. It heavily effects their ability to breathe and is terrifying. With hospital oxygen treatment it's very survivable though. Normally it bounces around continuously with a heavy wave in winter and pediatric ICUs are set up to deal with it. But the anti-Covid measures and the relaxation thereof have compressed the RSV waves into new times of the year, which combined with Covid has put dangerous strains on some pediatric ICUs.
So yes, really thinking about the overall picture on immunological development in kids, on all illnesses, is going to be key for long term planning.
The immune system evolved to be exposed to many pathogens in early life. That early exposure is rather important in training the immune system. There’s evidence for something called the hygiene hypothesis that postulates that allergies and autoimmune diseases arise in part because we have less exposure to parasites and certain bacteria and so the immune system reacts against pollen, food and self.
I have no idea what happens if kids have less exposure to respiratory viruses in childhood, but the immune system is a wonderful, complex system that often surprises us.
I will also add that more exposure to respiratory pathogens may make stuff like colds and flu milder because each exposure or infection acts like a booster. Severe flu seasons generally happen when the strain of flu circulating is very different from the strains in past years so the immune system isn’t very good at recognizing it.
When kids get diseases from notoriously germ spreading schools, they aren't the only ones affected. They can easily spread it to grandparents and older teachers who are much more likely to have a serious case. And while their parents likely won't die from the disease (though they certainly can), having covid, which can include things like long covid, while you have small children at home does not sound fun.
At the beginning of Covid, one argument in favor of remote learning was that kids could bring the virus home and infect their grandparents. I am saying that those grandparents can now be vaccinated and protected from serious disease so that the author's concern is less of a factor now. I am definitely of the view that we need to emphasize the vaccine. I don't think Covid Zero is practical. I also question the idea that masks are necessary in all indoor places and definitely not outdoors. Yes, we need to update vaccines but also need to trust that they are doing a fine job.
Are you saying this in favor of masks all the time (or during cold and flu season) or just for covid? It seems like a ‘covid zero’ mentality or maybe a ‘all cold and flu zero’ mentality that doesn’t necessarily make sense if a certain number of infections in a lifetime are inevitable. Or maybe it does (I’m no expert) … I’d love to hear / know more about the protection provided by childhood viral infections. If I went my whole childhood cold and flu free would that put me in greater danger later in life?
Anyway I’m all for short term measures to protect grandparents / parents if something is coming that will make the problem better. Like a better vaccine that prevents all breakthrough infections or something. But it sort of seems like our vaccine is only going to get less effective (I dunno maybe there’s something new coming?) and maybe the thing to do now is get your shots and then get exposed and start to build that natural immunity as well.
My current thinking is that we shouldn’t aim for cold/flu/covid *zero*, but it would be a real benefit to human health if we get cold once a year, and covid or flu once every ten years, rather than cold multiple times a year, and flu or covid every couple years. We might be able to do that by having a weekly virus report, like the weather report, and wearing masks whenever the number gets above a certain point, just like we wear shorts or raincoats when the temperature or precipitation get above certain amounts.
My partner tells me that at least some of the creative executives at Coca Cola have said that Coke Zero is actually a more perfect realization of their flavor concept than Classic Coke. I think there are some people that prefer Diet Coke, but Coke Zero is actually worth drinking even for people that aren't specifically avoiding sugars.
When Coke Zero first came out, I still occasionally liked a real Coke over Diet. I felt at the time like Coke Zero was so close to the real thing that I dropped real Coke completely and have never looked back.
To that end, I actually think Pepsi Max (now Pepsi Zero Sugar) tastes even sweeter than Coke Zero (now Coke Zero Sugar), although to be fair, I haven't had the latest reformulation.
First cent: Regarding flu vs cold, we're generally pretty sloppy with language. I mean, we call it the "stomach flu." (Some people even misuse the term "flywheel.")
Second cent: Man, Matt must have been demon good at writing term papers the day before the deadline back in college.
I should have been clearer. I, too, wrote terms papers in the last few hours before the deadline. Unlike Matt's though, they were terrible as a result.
There’s a very thin line between utter bullshit and brilliant synthesis and analysis.
I was always good at staying on the right side of the line, and therefore could crank out 30-page term papers in a night. But I never figured out how to monetize it, which is key.
I am so excited for the trials of Moderna’s new cold and flu vaccines. Even if it just stops four cold viruses, four flu viruses, and Covid, that’s a significant improvement on past flu vaccines.
The question is whether the hospital system can handle ‘a little worse than usual because of a new virus’ for a decade. Here in LA, vaccine rates are better than they will likely get in a lot of states (80 percent of adults) and there was a large wave over the winter. But hospitalizations are still up enough to stress the system some, in a way that will cause nurses to quit. System didn’t have slack to begin with. If the 1889 theory is correct we need to find a way to raise the line.
I don't see those vax numbers reported for LA? The NYTs has the 18+ in LA county at 67%, with overall rates of vaccination lower in LA than in Miami or Harris (Houston) county, Texas. But to the larger point, why wouldn't each subsequent year get a little better, with more and more people building up their immunity through infection or vaccination as time moves on?
For first dose - it's 80% statewide, 74% in LA County as of a day or two ago, and increasing since the mandates are coming. But the point is that if 1889 led to a decade of increased stress on the public health system, even if the vaccine cuts that to five you still have doctors and nurses quitting, especially in places like Mississippi. Not clear how you solve for that.
Where are you seeing data on nurses and doctors quitting? I've seen a lot of retirement-age folks quit in my extended family and friend network for reasons loosely connected to covid. In other words, they were probably going to quit in a few years anyways, and the covid disruptions kind of pushed them over the edge. But that was as much about the huge amount of baby boomers in the generation that is now reaching retirement as it was about anything else, and not limited to those working in a medical environment.
On the one hand, yes -- Matt and typos go together like Hope & Crosby -- on the other hand, it does bother me when I makes big ones because I actually specifically asked him on Twitter if he was going to have a proofreader for this blog because I don't much mind typos in a free product, but do in something I'm paying for, and he said yes there would be a proofreader. That said, the 1889/1899 distinction I could see being missed even at a professionally edited magazine.
While poorly (deceptively?) communicated, flatten the curve is never a single time point strategy. It may need to be maintained or repeated until some immunity threshold is reached and the susceptible population remaining is unlikely to overwhelm a local healthcare system. Overall I think the public would have responded well to more mechanistic and transparent explanations throughout this pandemic.
The issue is that the systems aren't designed for that. Indoor dining is really bad for curve flattening, but repeated restaurant closures will just kill the industry. Claustrophobic close-in clubbing is horrible for curve flattening, but again, you can't open/close/open/close on industries like that. PPP and CARES help a lot, but the dimmer switch approach can't continue indefinitely. Red States have already decided they are done with it.
I wonder if there are economic structures that would help with this. Water parks and ski resorts have to deal with unexpected weather closures all the time - do they have insurance against that? If so, could we create a social insurance program for restaurants and nightclubs and occasional disease-related closures?
It's not just red states. I was up in Minneapolis last week and the world was capital-N Normal again. A few business had mask mandate signs posted, and people generally complied in a your-roof-your-rules framework, but that was it.
With exceptions, continued enthusiasm for NPI seems to be a coastal thing in a way that doesn't map very neatly onto red and blue.
For me the takeaway is that we just need more vaccines. More vaccines for covid, more vaccines for the flu and maybe vaccines for the common cold. And the more we suppress the prevalence of the virus in the population, the more we need vaccines to keep our immune system sharp because covid, the flu and the common cold all include a set of viruses for which elimination is not possible. But we can reduce the human cost with regular and varied vaccination.
But along these lines, we need vaccines that have fewer side effects, and not just deadly ones. I would be fine with taking a cocktail of 5-6 vaccines every year, but the symptoms should be mild not, you're going to spend next day in bed. So I think more research is needed and dosing needs to be experimented with.
There is enormous economic value here in improving daily human health if we can improve vaccine regimens - on the order of a large fraction of a percent or even a full percent of GDP. It would be great if we could actually unlock it.
I wonder if the coronavirus Matt writes about — or other, similar coranaviruses that cause common cold — are truly globally endemic in the main, or some are and some aren't, or do they exhibit regional differences in terms of endemicity.
Relatedly, I've wondered if certain populations — I'm thinking primarily in terms of East Asia — might possess a modicum of immunity (I know there's a more technical way to describe this but no time to research at the moment) vis-à-vis Covid19. I'm not even suggesting we have epidemiological evidence for this, although we may, in that China, Taiwan, Japan and Korea all have suffered a lot less sickness during this pandemic than most of the Americas or Europe.
One personal anecdote that got me thinking along these lines was that, during my first sting in Asia — I arrived in 2013 — I got slammed on a regular basis with nasty colds for the first eighteen months or so. I rarely suffered from them back in the States. And yes, these were quite unpleasant. At one point I was absolutely convinced my neighbor's cat's dander was blowing through the building ventilation and affecting me (the cold wouldn't let up for weeks). But he kept his cat and I eventually recovered.
I have zero idea whether or not these colds were caused by coronaviruses. My guess is that this is statistically not all that likely (non-coranavirus cold viruses outnumber coranaviruses by something like 4 to 1, if memory serves). But who knows?
But also, everything I've read about colds suggests that we know four coronaviruses, some number of rhinoviruses, syncytial viruses, and influenza viruses, but every time someone does a systematic study of several hundred people with colds, they find some new viruses that they hadn't cataloged before. We should try to learn more about that, and maybe do more surveillance to understand when and where a new one is emerging.
"Relatedly, I've wondered if certain populations — I'm thinking primarily in terms of East Asia — might possess a modicum of immunity (I know there's a more technical way to describe this but no time to research at the moment) vis-à-vis Covid19. I'm not even suggesting we have epidemiological evidence for this, although we may, in that China, Taiwan, Japan and Korea all have suffered a lot less sickness during this pandemic than most of the Americas or Europe."
It appears, in fact, that the descendants of the southern Chinese population circa 20,000 years ago did have immunity.
It would be very surprising to me if there's something that spreads easily from human to human, but isn't globally endemic (other than the things like measles and polio that we've eliminated from some places through vaccination). There are bacterial (cholera) or other parasite (malaria) diseases that are endemic only in some regions, but it's because those don't spread directly from one human to another, but go through some environmental factor that varies in different parts of the world.
However, if there are animal viruses that frequently get spread to individual humans, but only rarely spread from human to human, those could be endemic in the animal populations of some region. (You mentioned a cat, and covid is known to infect cats - maybe there are other animal coronaviruses endemic to East Asia that get to humans the way that covid gets to cats?)
Well, I guess specifically what I was wondering about was the regional *variance* in the frequency that a given virus causes illness, ie, perhaps a certain coronavirus causes (say) 1.3% of all colds in one region, but 14.8% of all colds in another. And so on. But maybe there are no substantive differences from region to region on this score. I haven't looked into it. But commenter Elm provides a link to an interesting NYT article about a study conducted by University of Arizona scientists that concludes a large-scale, long in duration (centuries) outbreak of coronavirus disease in China millennia ago has resulted in changes to the DNA of people in that region (actually my region) to this day — the implication being people here on average enjoy a greater degree of genetic protection from coronaviruses.
I’m a little surprised that no one has, since the papers suggesting this are fifteen or twenty years old. I had thought Svalbard was the only place they had frozen bodies from 1918, but it looks like Svalbard didn’t have much long term settlement until the 1890s. If there are frozen bodies elsewhere, that would be useful to know!
The Covid period has given me a lot of conversations where I’ve said “I’ve never heard that before.” This was the best of the batch.
Now… to be fair. MattY was competing with a cohort of mostly “COVID IS A PLOT BY THE ELITES TO DISTRACT AND DIVIDE US WHILE THEY POISON THE WATER SUPPLY!!!” and its homeomorphisms
But this would likely be the best novel take even if he wasn’t.
Frankly on the topic of covid policy I have no clue what anyone is doing anymore. it seems like the government is running in circles right now. we should have gone harder with mandates than we did, why do people have such a problem with vaccines anyway? I don't get it.
Off-topic: Matt, you've tweeted a lot recently about the crucial role played by the NYT's editorial judgment regarding *which news stories to promote with what angle*. First the Afghanistan editorializing, today the TX abortion decision:
"Always interesting to see which stories are seen as equally newsworthy as "new copies of old emails found on a laptop." Virtually nothing meets that high bar."
I've seen this argument laid out elsewhere and I agree that it's persuasive. But (even though I know this wasn't Matt's intention), I'm going to have to quibble with the "take the L" take home at the end. Assuming the COVID-1889 theory is true, you could logically argue that this is the mostly likely outcome for SARS-CoV2 IN THE LONG RUN. But when do we get there? If the world was still seeing serious issues with the disease 5-10 years later, that's a pretty long time! Moreover, giving as many people as possible (including "lower risk (but not no risk)" children) gives their immune systems a first exposure to this coronavirus, meaning they won't have to suffer the debilitating effects that much of the world has seen. Remember, again -- death is not the only negative endpoint... Long COVID and serious long-term respiratory effects are nothing to dismiss.
It's also worth raising again that Pfizer (and probably pretty much every other large pharmaceutical company) are working on a drug (NOT a vaccine) that will protect against not only SARS-CoV2 but also other future coronavirus threats.
"The oral antiviral clinical candidate PF-07321332, a SARS-CoV2-3CL protease inhibitor, has demonstrated potent in vitro anti-viral activity against SARS-CoV-2, as well as activity against other coronaviruses, suggesting potential for use in the treatment of COVID-19 as well as potential use to address future coronavirus threats."
5-10 years is a pretty long time, but vaccines should allow us to substantially curtail the window.
In terms of taking the L, I mean that things like DC's current indoor mask mandate are probably pointless. We're not close to overwhelming our hospital system here (enough people are vaccinated, hopefully, that that won't happen) but we're also nowhere near suppressing the virus or achieving Covid Zero. I'm not some kind of fanatical anti-masker who objects to using it in schools (where the vax rates are low because kids aren't eligible) or wants to make fun of people who choose to wear masks when they go to the store. But as a social objective, further suppression at this point doesn't make much sense to me.
If you accept the argument that there's some finite amount of political capital that can be spent on covid mitigation measures, it seems like about eight weeks after the 5-12s get an EUA, even a milligram of political capital spent on anything other than vaccinations is a stupid waste.
I'm with you on the indoor mask mandates and the idea that Covid Zero is not going to happen. I observe that everyone is getting so tired of them and not wearing them properly--and arguably many (cloth masks especially) aren't very good. We still in this country, I observe, view this as largely a "mask war." There are a number of possibilities we could explore more--like improved ventilation and more testing. By the way, in British schools I have read, the kids don't have to wear masks, but are tested frequently. And there is an 80% adult vaccination rate. We should concentrate more on getting people vaccinated--like young adults who don't bother or essential workers who don't want to take off work to get a vaccine.
"But as a social objective, further suppression at this point doesn't make much sense to me."
Still unhelpfully ambiguous. Which suppression methods are you advocating that we abandon?
Having separate hospital wards for COVID patients?
Having symptomatic carriers self-quarantine?
Testing people with symptoms?
Contact-tracing?
The "let it rip" model says "yes" to all of these. On that model, we should be having lollipop parties for our kids with the intubation equipment taking from the lungs of this morning's COVID death. Is that what you are advocating?
You've got to be more precise. Say what you mean. People listen to you. Don't let yourself be a vector for bad information and bad ideas.
I assume hospitals have to make decisions about whether to separate patients with infectious diseases all the time, and I don't normally know how they make those decisions, and I don't expect to be looped in in this case. Like normal.
We have no mechanism of 'having' symptomatic carriers self-quarantine, so public health authorities will make some recommendation, and maybe employers will have some policies, and then people will do what they're going to do. Like normal.
We also have no method of obligating people to get tested unless they are hospitalized. As long as there is a demand for tests I guess they will be available, but no need to force it. Like normal.
Contact tracing? When did you write this?
We shouldn't have lollipop parties because that wouldn't be normal. Act normal, instead of making weird concessions to the virus one way or the other.
“Act normal” is still ambiguous. Do we want to throw away everything we’ve learned about cold and flu this past year? Or can we have a new normal, where sick days are strongly encouraged, meetings are moved to Zoom when local illness rates are above some pre-determined threshold, etc? It seems like some very minor interventions can have a major impact, just as some major and painful interventions can have little or no positive impact. We shouldn’t throw the baby out with the bath water.
For sure! For corporate cultures to shift in response to events and technological developments and stuff is totally normal and we should do it. Different places will also respond and adapt differently, and this, too, is normal. These are organic processes, not something we can collectively control or make a decision about.
Aren't organic processes the same as things we collectively control and make decisions about? Who runs these organic processes except for us, collectively?
I live in a university town where the university has been very successful at quelling several outbreaks via contact tracing. They employ massive routine surveillance testing, and when they find positive cases they follow up with dorm-mates, team-mates, and so on and test them. It works, and it kept rates extremely low last year.
Does MY think that the university should not do that? He keeps saying vague things, and that's not a responsible way to be a public voice.
Well it would be cool if Matt would respond, but since I'm the one who's here:
Universities have all sorts of policies with respect to health and safety on their campuses, and if, within the law and the other constraints that it faces, the school in your town thinks that this is the way to go so they can operate in person, I think that's great.
Other schools no doubt will do different things, or nothing. I don't think that any government should either require or prohibit any particular response.
I don't mind what the school in your town does, and I don't think it's my business or Matt's. Of course you live there, so maybe *is* your business to some degree, and maybe they have a channel to receive your input, but I hope they don't care too much about the opinions of people like me who don't know what they're dealing with and aren't affected by their decisions.
I'm not trying to argue, I'm just trying to explain how my 'act normal' perspective applies to this example.
Also, we have done contact tracing for STDs for decades. It’s harder to do fully effective contact tracing when contacts are more fleeting than casual sex, but casual sex contact tracing is hard, and yet the bit we do still helps.
Also, on the last point about “making weird concessions” - I think over the last 20 years we learned the lesson that when there is a threat, the best thing to do is ignore it so that it can’t achieve its goals. That may be reasonable when the threat is a terrorist group trying to extract concessions. But the virus doesn’t care, so we shouldn’t be acting to spite it. That doesn’t deter it, the way it deters trolls and terrorists.
"On that model, we should be having lollipop parties for our kids with the intubation equipment taking from the lungs of this morning's COVID death. Is that what you are advocating?"
Given that the total viral load present in the air appears to impact the severity of Covid-19, I expect you want to expose kids to minimal amount possible of Covid-19.
It probably makes sense for people to continue wearing masks in grocery stores and other public settings where we don't really socialize. Could help suppressing all sorts of diseases.
Unless we get a variant that evades the vaccines. And seeing as how the people who study this can't agree on the likelihood of that, I wouldn't venture a guess.
So I would err on the side of caution (continuing to mask for the sake of my kids) but I do understand why other vaccinated individuals would choose otherwise.
Yeah, I think that MY's "take the L" kicker is unhelpfully ambiguous. Some people are going to read it as though MY is advocating for a Swedish-style "let it rip" policy: no vaccination, no mitigation, expose everyone as soon as possible and let the weak die.
But that's not what he said. "Take the L" here just means, accept that we will not be able to eliminate the pathogen from the population.
If we vaccinate as many people as possible, while accepting that we cannot eliminate the pathogen from the population, then we will spare a lot of deaths and misery.
It's a loss by comparison to a maximalist goal of total elimination. But it saves millions of lives compared to "let it rip."
I think it’s misleading to say Sweden did “let it rip”. They had few government-mandated interventions, but I would be shocked if the population didn’t do many things on their own.
That aside, I still think MY is saying things that will sound to some people like he is advocating a "let it rip" policy, from here out with COVID-19 and possibly from the get-go with COVID-24 or whatever the next pandemic will be.
Is he? Is he saying something different? I think it would be more responsible for him to make his position clear.
One advantage we have is vaccines. The thing vaccines do is give you exposure without giving you the disease. They're not perfect for building immunity – breakthrough infections do happen. But neither is being exposed to the actual disease – second infections also happen.
I really want to understand how “two weeks to slow the spread” became “white collar workers should shelter in place for the foreseeable future and blue collar folks should wear masks.” Im still dumbfounded by why healthy young and middle aged people were willing to give up so much for so long to avoid such a small risk. Vaccines were developed faster and proved more effective than was expected. Last years risk calculations would look really silly if the vaccines had been 60% effective and the curve had exploded after delta came along. They would look equally silly if delta had hit five months earlier.
Why were young and middle aged people willing to live bleak and austere lives for a year or more to avoid a 1 in 2000 chance of death. Do they never drink alcohol or smoke pot? Do they have a scientifically ideal BMI? Do they always drive the speed limit? The extreme risk aversion was a collective mental illness.
I can totally understand why retirees might have chosen to stay home for a year, I can even understand why school districts might have let 60 year old teachers work from home and hired young people to monitor classrooms. I can also understand why grandparents might have avoided their grandchildren during Christmas 2020, though I can also understand taking a small risk of infection and a 3% chance of dying if infected to have a normal Christmas if you only have 10 or 15 Christmases left in you. Reasonable people can disagree on that one.
America was not built by timid men, it was built by people who threw up railroads and bridges and dug mines fully aware that some of the workers would die. The idea that life can be completely safe until old age, with the consequence that many peoples’ bodies outlast their brains and they spend years as senescent morons, is the essence of modern decadence.
America was built by all types of people. Rich cowards, slaves, the working poor and just about every stripe of moral character any of us can imagine. Reducing America's history to a PragerU picture book isn't helping anybody. There is a lot we still don't know about this virus and taking precautions is a reasonable thing to do. How we come to terms with it over the long haul will depend on a variety of factors but I would rather we listen to the medical community about what makes sense than a preacher or a fox business market analyst. Did some people overreact? Yes. Does it become easier to Monday morning quarterback the more we learn? Also, Yes. In the context of a country where over 1/3 of it's voting population think the last election was stolen (it wasn't) I don't know if we should get into "what's going on with these grand delusions?!" because we are obviously a society susceptible to all sorts of deception.
Very well said.
This is unfair. We didn't know what we were dealing with then, so taking the cautious approach was certainly advisable. Let's not forget the main reason: don't overwhelm the medical system. People taking up space in ICUs for COVID meant space not available for others kinds of life-threatening issues.
Armchair quarterbacking is easy. On the field, in the moment, and you have the ball? Not so much.
This was published March 17, 2020. We had a good estimate of the mortality rate early on.
https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/
Uh, even that linked piece says we need more data before making decisions and that the true case fatality rate was unknown (with percentages all over the map).
And again, the primary reason for attempting to bend the curve was not overwhelming the medical system so that many more people didn't have to die than needed to (including people who did not even have COVID.)
bending the curve to avoid swamping hospitals made sense. keeping things closed or partly closed in april after the curve was bent did not. if not overwhelming hospitals were the goal, e would have wanted more infections during summer 2020 to build immunity before the winter flu season
Well, we were terrible at keeping the curve bent for long, so even though I disagree with your timeline, I do agree that in the long run, we'll have to strike some better balance. Until we figure out how, though, it's going to be a rocky ride with wave after wave overwhelming the hospitals.
If it's not quick from herd immunity through vaccination, it's going to be slow (and annoying) through waves of actual infection.
Without agreeing with your descent into jingoism, I would be interested in an long-form oral history kind thing about how literally every city, province, and nation on the planet somehow switched from "bend the curve" to "covid zero".
So much of the strategy and messaging seemed to change overnight and have unanimous consensus. It was baffling, and i think I’ll be the “crazy grandpa” sitting on the Thanksgiving table in 40 years ranting about it.
One side note. David Abbott often uses colorful language to elaborate and tie a bow on his points but as someone who enjoys reading his comments, I would not use the term “jingoist” to describe him. I’m not suggesting you’re calling DA a “jingoist” either but it’s a word that can pack some heat so I wanted to chime in.
my understanding is the term jingoist had its origins in patriotic appeals victorian Tories made to newly enfranchised working class voters. My comment was jingoist in that sense. But then there are snowflakes who think jingoist ds should be cancelled and screw that.
https://en.wikipedia.org/wiki/Jingoism
wait -- is "jingoist" really a heated term? I find it kind of charming and archaic. I mean, jingoism itself may not always be charming -- it's the pejorative of "patriotism" (I'm a patriot, you're a jingoist, he's an ethnic cleanser, or something like that).
But I had not known it was a fightin' word! That's news to me, by jingo!
"Why were young and middle aged people willing to live bleak and austere lives for a year or more to avoid a 1 in 2000 chance of death. Do they never drink alcohol or smoke pot? Do they have a scientifically ideal BMI? Do they always drive the speed limit? The extreme risk aversion was a collective mental illness."
'Are there no workshouses? Are there no prisons?'
I am absolutely willing to agree some people have overdone it on the covid freakout, but Covid-19 is a nasty, unpleasant way to die - or survive. I would also point out the last 40 years have featured a mass expansion of prisons (for 'safety reasons'), and just now ended 20 year war in which 240k non-Americans died to prevent a hypothetical event happening that features a much longer set of odds against.
elm
so
To paraphrase Nathan Hale: "I only regret that I have but one 'like' to use for this comment".
We have become a nation whose rules are determined by the our most neurotic, safety-obsessed narcissists. Encouraged by a media who understands that fear sells. And government officials who rarely turn down an opportunity to expand their 'emergency' powers.
The moves toward requiring vaccines for interstate travel, masking children and instituting waves of restrictions every time a variant spreads through the populace further encourage the trend toward decadence. Time to repurpose the 2016-2020 phrase: #Resistance
"I have but one 'like' to use for this comment"
Get a second subscription to the 'stack, and then you can give more likes under your other pseuds. Maybe MY can work out a group rate for you -- you could give likes by the dozen.
I actually agree with much of this…
So long as we acknowledge that the same exact safety-obsessed neurosis is driving BOTH the right’s views of crime and incarceration, voting rights, immigration, military spending, and foreign affairs and the left’s obsession with “intangible harms”, bias in all its forms, sexual propriety, and Covid.
We have different definitions of the word "enjoy". And that is OK. With vaccines readily available, each person can choose their own level of risk tolerance, though I do wish the risk equation was treated more responsibly by the press.
I'm vaccinated and will get the booster when available. And I will enjoy my life largely in the same manner I did in 2019.
Sometimes it has to do more with whom else we're protecting.
My husband and I are vaccinated. So while I don't want to catch CoVID, I'm not particularly nervous about it - I also don't want to get the flu or a cold.
But...
1) My kids are not vaccinated yet because although the AAP recommends that the FDA approve it(EUA) without an extra-long trial, the FDA so far hasn't taken the bait. So, I am willing to reduce personal exposure risk to reduce giving it to them (that's different from sending them to school - sending them to school has a benefit _FOR THEM_ - eating indoors at a restaurant has a benefit _FOR ME_.).
(We actually did eat indoors during the summer when Delta wasn't a thing yet and the numbers were looking good)
2) We're still doing short-term precautions - we're about to go on a family vacation (school has a fall break) and I really don't want to catch CoVID before then and either know about it (and cancel the trip) or don't know about it (and risk infecting _other_ people, especially kids)
Mask usage for me is about protecting other people more than myself. I mean, there's still some element of _protect myself_ in there, but now that I'm vaccinated that's a much smaller part of the equation and I _am_ willing to do go "riskier" things, but I'm also worried about the kids.
Wear a mask if you choose. But since I am vaccinated, I resist mandates.
Just curious, if a restaurant has a vaccine mandate, will you refuse to show them your proof as an act of principle?
“For one so concerned with others forcing their paranoia onto you, you have zero self-awareness of your own paranoia.”
Dunno what paranoia he possesses, but is he trying to force anyone to react to it?
And the restrictions regarding children are especially bizarre considering the Covid risk to them is statistically less than the flu. Vulnerable populations can protect themselves with the vaccine, so what is the point of masking children?
Preach it!
Fewer than 200 children under 12 have died of COVID in the US. I suspect those that did were unhealthy to begin with. Healthy kids are at much greater risk of dying in a car crash than from COVID.
Would the risk of dying in a car crash be greater if they didn't wear seatbelts? Until we know more about this virus (and the fall school semester is going to get us a lot of great data) why just declare victory and depart the field? This is cut and run Covid edition.
Looks like failure to use restraints accounts for about 1/3 of child deaths in auto accidents, still leaving ~400 who were wearing it (in 2018): https://www.cdc.gov/transportationsafety/child_passenger_safety/cps-factsheet.html
To protect those who choose to remain unvaccinated is the rationale I’ve heard. I don’t think that should be a goal. But that’s the rationale.
It also helps protect people who, for various reasons, can't be vaccinated, and it protects vaccinated people for whom the vaccine doesn't work sufficiently. There is a population for any vaccine for whom immunity is never conferred, for whatever reasons.
For example, I have been vaccinated multiple times against whooping cough. I have also had whooping cough more than once when it became an epidemic in my area (largely due to anti-vax sentiment weakening local vax rates), because it's extremely contagious. (It's also extremely unpleasant, particularly for adults.) So, the fact that I didn't gain immunity from the vaccine only became a problem for me when the herd immunity was weak enough to allow for more breakthrough epidemics.
Now, do other people owe it to me and others like me to get vaccinated? Not necessarily. But it might be nice if we viewed it as an honorable community duty to one other. As it stands, I'm vaccinated against many illnesses, besides whooping cough, for which I did gain immunity (or at least serious protection), and that's helping protect the people for whom *those* vaccines didn't work sufficiently, and so on, and so on, down the line.
[Deleted and reposted to consolidate my comments.]
You're making an unintentional argument for disbanding the US military, since we spend trillions on it to handle things like 9/11 for which the death rate was 1000x smaller.
Also, might as well open the border as well, since the security concerns with doing so are largely a thing that lives rent free in the heads of Fox News viewers.
This ignores deterrence. There's argument to be had over the size our military should be, but if we simply didn't have one, the likelihood of being severely attacked goes way up, because that fact would not be lost on America's enemies.
I mean, yes, have a military, but maybe we don't need one larger than every single other one combined. Especially since most of it is filled with graft and pork projects for politically connected districts.
Fair enough. I was mainly trying to point out that deterrence is always a factor that needs to be considered alongside the current rates of [insert whatever undesirable outcome is under discussion], because changing the incentives and disincentives of a thing will inevitably affect that rate -- it can't be presumed to remain constant under radically different circumstances.
I personally would welcome both a more pragmatic approach to COVID-19 and slashing the US military budget to probably about 20% or less of its current level.
No, that's a bad analogy because we spend all that time and effort on the military to prevent much greater levels of death and injury from things like 9/11. Oh, wait.
I stayed inside and avoided large gatherings to keep people I know in my community safe - I was worried less about my own health than I was about infecting others.
I ride a motorcycle (w/ a helmet, I'm not crazy) I'm not overly concerned with my own personal well-being. But it's extremely unlikely I would hurt *someone else* by getting into a motorcycle accident, whereas contracting covid could entail infecting other people and potentially killing them.
"...could entail infecting other people and potentially killing them..."
Yeah, this is an important point.
The issue for me is not, "am I willing to take a 1/x chance of dying".
Instead, the issue is, "there's a terrorist who has taken your fellow Americans hostage, and he is going to execute 10 million of them. What are you willing to do to save some of those lives? Will you get a shot? Will you wear a mask?"
And my answer, of course, is that my freedum to expose my nose is far more important than the lives of my fellow Americans. Who cares about millions of deaths? My freedums matter more!!!
10 million, when vaccines are readily available? Respectfully, that is a perfect example of how the risk from COVID - and the benefits from masking - are being wildly mis-represented.
There are vaccines available *now* and once vaccines became available I started living a *mostly* normal life again. I'm not going to go out of my way to protect the unvaccinated at even a minor inconvenience to myself. That wasn't the case for the first year+ of the pandemic though.
I don’t understand what you’re talking about. I’m out and about going to the gym, going out to dinner, I have a vacation conking up in a few weeks. Seriously, what on Earth are you going on about?
I'm required to wear a mask every time I go to court or visit a jail. Also, national parks were closed for months last year, and we didnt have jury trials for 15 months. My kid's school was closed for 2 months, and we put him in private school last year so he could attend classes in person.
Closing national parks was a stupid idea, and schools should have reopened earlier. But I just don’t see that being forced to wear shoes and underwear when you go to visit a jail is a problem, and a mask is no more uncomfortable than those.
Let me preface by saying that I'm fully vaccinated, that I understand why masking is a thing, that I wear a mask when required, and that I don't make a fuss about it.
That said, I have had sensory issues since childhood, and personally, I find masks much more uncomfortable and claustrophobic than the clothing you mention, especially in the heat. In particular, neither of those restricts breathing. Despite being very accustomed to masking at this point, significant downsides remain for me. I don't really want to explain further for privacy reasons, but hopefully, you'll take me at my word that this is true for me.
Considering masking necessary doesn't require us to pretend that it has no downsides or to overly minimize them. The case can still be made. In fact, most people will find a case more convincing if they think you're being straight with them. It's also worth keeping in mind that, even if an intervention has little or no effect on you, it may still be experienced quite differently by others who are unlike you in various dimensions.
It can also be very hard to understand people. Facial expressions are blocked and sounds are muffled. It's especially bothersome to non-native speakers and young children who just learning to communnicate.
false. i’ve gotten used to wearing shirts. and i don’t want new rules when life is already so regulated. finally, shoes don’t compromise non-verbal communication, and so find young women’s’ faces far more interesting than their feet
Is it possible that you're projecting "I don't want new rules" onto other people who might not feel that way, then?
maybe, but i’m not alone. a lot of the anti vax/hydroxchloraquin crowd are a lot rowdier than I.
Don’t you have to wear a suit to court? That seems far more burdensome.
Masks are much worse than suits. But, in Gawgia, in the summer, there are plenty of courts where the lawyers wear short sleeves. I’m not that country, I prefer seersucker
Suit to work every day or t-shirt and gym shorts and a mask. I’d go with mask.
disagree!
No thanks. Maybe if you've signed up to live on the moon you can expect to wear a mask all the time. But not here on Earth. It's not human to walk around with your face always covered. And I'd object to wearing a burka too.
Yep!
*shirt sleeves, not short sleeves
Right -- and neckties restrict oxygen to the brain.
https://link.springer.com/article/10.1007/s00234-018-2048-7
Only if they’re tight.
I suspect national parks close whenever because they generally close whenever they have a plausible excuse to do so. And never underestimate the ability for public school systems to overreact to anything that their worst members of the union demand.
My brother did the same thing with my nephew. Completely lost confidence in their town's public schools.
It's the same stuff right leaning people are always going on about: "some people somewhere where I don't live are doing crazy things." I live in an educated bubble in DC, and we have house parties, dine indoors, I'm going to an Alabama football game in a few weeks for Pete's sake
Exactly! Where is that coming from? Too much media consumption would be my guess.
I don't know, when I talked to friends in Los Angeles the lengths they were going to seemed pretty extreme, and they seemed to regard it as normal.
Everyone has anecdotes. My sapphire-blue, big-city neighborhood is having block parties, folks are coming over for drinks and dinner, and everyone’s squeezed in at least one decent summer vacation.
Sure - but BronxZeeCobra's reply was as if David Abbot is living on another planet. I wasn't reading that LA county's covid response was extreme on Fox News, I was hearing about it from people living there who were either complaining about it or telling me it wasn't enough.
No country, even a basket case like Afghanistan, can be won/made by timid men. Nothing unique about America in that regard. More importantly, implicit in your argument there's an accusation that people who advocate for more vaccination/masks are actually asking for a 'zero covid' scenario. That's unfair. All people are asking for is some civic responsibility( e.g. wear masks and get the shot ) so that things can go back to normal. Contrary to the Right, no man is an island especially if the island is sneezing deadly air!
You misconstrue me. I want more vaccinations. I think virtually all adults should vaccinate. I think children should have the option. I'd take my 7 year old to get vaccinated this afternoon if I could.
I was very happy to wear a mask in grocery stores, pharmacies and post offices before I was vaccinated. Many vulnerable people have to go to those places. As an attorney, I gave my clients the option of meeting in my conference room with masks or meeting outdoors without masks. I didnt want to get my clients sick.
I avoided crowded restaurants and the gym until I was vaccinated. I avoided indoor dining altogether for a couple of weeks during the January spike. If everyone had displayed my degree of risk aversion, there would have been fewer COVID cases and deaths.
However, I never thought that low and moderate risk folks should wear masks while socializing in pairs or small groups. If people wanted to go to a restaurant and take the risk, that's their choice. And I certainly feel zero obligation to wear a mask to protect people who are too stupid to vaccinate.
"And I certainly feel zero obligation to wear a mask to protect people who are too stupid to vaccinate."
I'm with you on that one.
Unfortunately, I have no way of knowing which unvaccinated people I come into contact with are victims of Fox News brain-poisoning, and which ones have cancer, Crohn's disease, or impaired immune function, and which ones have parents or children with cancer, impaired immune function, and so on.
If I could be sure that my cavalier attitude was only endangering those who have willfully endangered themselves, then I would wear my mask far less often.
Those people are eligible for vaccination other than the child under 12. Those people were always vulnerable to respiratory viruses. Did you wear a mask for them in the past? Sorry I’m with DA here and always looked at the situation as bend the curve to prevent overwhelming the hospitals. Covid is likely here with us forever as MYs post explains. Are we masking for the vulnerable forever?
"Sorry I’m with DA here" no need to apologize: I'm sure DA is a good person to be with.
"Did you wear a mask for them in the past?"
In the past, I never wore masks, even at times when I now see I should have, e.g. when I was feeling ill but needed to keep working. In the future, I'm going to mask when I have symptoms. I understand this has been the norm in some Asian countries for a while, and it seems like a good norm for us to adopt.
I have every hope that one of the lasting good effects of this plague will be to normalize a higher level of mask-wearing in public.
"Are we masking for the vulnerable forever?"
How long will I mask as part of a suite of COVID responses? Probably until some combination of: vaccination rate is high enough + prevalence and spread is low enough. Additionally, I will mask or not it in a way coordinated with public policy and the actions of others. It's a behavior that, like many social behaviors, gains its efficacy in part by being widely adopted.
I remain baffled that people are so wrought up about masks. Why is it so hard? I even mask at the gym -- it's not comfortable, and it means that I am exercising in the Andes, but it's just not a big deal in the scheme of things.
Why do people have to be such babies about it? America used to be a land of brave, rugged pioneers, not timid people who fuss over wearing a mask.
Ok - quick response since I'm at work. I don't necessarily disagree about general masking in grocery stores, pharmacies, doctor's office, etc. (Neither did DA). I do somewhat disagree re: gym and work-out. My preferred exercise is a high-impact aerobic dance class (Jazzercise) that I've been doing 20+ years. Tried it with a mask and hated it. So now I'm back to online class which is not nearly as fun, but ok ... so be it.
Here is my larger point: life and risk calculation/preventative medicine is more than just Covid. We need to mask forever at stores? Ok, maybe ... I'm open to that. But I have a ton of patients that gained wt over the last year b/c they stopped going to the gym and were sedentary. And now are STILL afraid to go back to the gym despite vaccination. What is the morbidity /mortality of obesity from that wt gain and how does that compare to the risk of Covid, vaccinated?
Kids were out of school for the year. Poverty and homelessness increased from our collective demand for isolation. Depression, especially among my seniors, was severe from isolation. Those all have associated morbidity and mortality. We will not know the cost of this year for a generation to come and over-reaction by shutting down everything has a significant cost, just as under-reaction has a huge cost (Florida, recently). This is my point. There is a necessary balance. Think about everything in the larger, broader context : yes, Covid has been a huge tragedy, but there were and still are other health risk considerations besides just Covid.
For me, it's fogging glasses. Despite ameliorative efforts, it continues to drive me crazy.
I still wear the damn mask, though.
Do what you want. But don't force others to adopt your risk tolerance level.
I'm young, very healthy, and vaccinated with an mRNA dose. I don't want to get COVID just about as much as I don't want to get a common cold, plus some uncertainty about long covid (vaccines reduce my risk by half, some proportion have symptoms from ICU care which I am extremely unlikely to need- so, pretty low risk, maybe less than 5% given infection- but don't want it). That being said, my wife is a nurse, and I DEFINITELY don't want to be hospitalized. They're so understaffed and overdrawn right now. So, I mask up indoors around strangers, but don't care about masking with people I know well, because they are all vaccinated and they'd tell me if they tested positive. I travel, I see my older relatives. I'm an epidemiology grad student and quite liberal. I think you're overestimating how many people are living "bleak and austere lives" based on the crazies that get on the news- squeaky wheels get all the attention, but the silent majority of American adults are vaccinated and living pretty normal lives right now.
Social pressure and a fear of social shaming. Many of the young white collar workers I know absorbed the idea that covid was something you got because you did something you weren’t supposed to do. Healthcare workers got it, but they got it the good way.
I think there was also a lot of bad information out there. There was a survey a while back where a large percent of the population thought the half of people with covid ended up in the hospital. I know young people who truly believed that if they got covid there was a very high chance they would end up in the hospital.
“ covid was something you got because you did something you weren’t supposed to do. ”
So crowding into a bar doesn’t help the spread?
Probably not. But as someone who has had to work onsite through the pandemic, plenty of people got infected at work despite everyone wearing masks. Many employers did not do a very good job of making workplaces safe. Even ones who took covid seriously because it made things inconvenient and was expensive.
If you’re spending 8 hours near someone in a poorly ventilated room talking and you have a high viral load there’s a very good chance of infecting the other person even if you’re both wearing masks. That really got lost in the messaging.
what’s wrong with crossing into a bar if you are healthy and not old?
I don't have a strong opinion on this argument, but I think what is considered wrong with it is that it increases the chances of vulnerable people getting it, and it increases the risk of severe mutations.
You’ll get infected and spread it to people who are not healthy and old.
"Two weeks to slow the spread" was total lockdown after we saw what was happening in New York. Literally no one went out at all. That's not been the case since Xmas, and now we see ICUs accross the south being overwhelmed.
The difference between a novel virus and drinking alcohol, speeding, etc. is the sense (which might be an illusion) of personal control. In other words, people can more easily convince themselves that they're the exception to the average risk factor for the latter activities, because they're more responsible / have better reflexes / etc. Some of them are right; many are wrong. But avoiding a novel virus that doctors didn't know how to treat and whose long-term effects were unknown is a fairly rational choice. Now we do know how to treat it, but the long-term effects still aren't so well understood. I think we'll see a gradual growth in acceptance of COVID risk as the situation matures.
i feel that covid mortality risk has consistently been exaggerated. it’s relatively hard to find center left news sources understating covid risk.
we’ve known the mortality risk within a factor of 2 or 3 for a while. i simply don’t see the level of restrictions people have accepted being justified by the risk. the better strategy is to shelter vulnerable people, who tend not to have full time, physically demanding jobs. very easy to isolate old people really. “wear masks around old people, except at christmas, but reduce your contact during the period two to six days before christmas” would have been a fine rule.
Part of my point is that we need to account for not just mortality risk, but also "Long Covid" risk.
The overall institutional response in the US has been a disaster, but mainly because of inconsistency and general incompetence. The right approach to containing a pandemic is to institute clear, consistent policies that are just a little too strict (keeping in mind that some people won't follow the policies and enforcement is always difficult).
In the US, we still barely even have a testing infrastructure, and contact tracing isn't even under consideration, let alone real support for quarantining. The next pandemic is really going to fuck us. I guess at this point, we might as well enjoy the world until then.
This does seem to have some relevance for the masks in schools debate doesn’t it? And just for covid prevention among young people in general. If my daughter is going to get variations on this virus dozens of times in her life why am I trying to prevent her from getting it now? Especially since, past the first year of life, it seems like the younger you get this thing the better.
I also know a few parents who are now saying “why don’t kids always wear masks” to prevent spread of flu and ‘common colds’. Which I do understand as it’s a big pain when your kid is sick! But if the common cold is not serious in mid life because we’ve all had it ten times while we were young then we’re not doing kids much of a favor by reducing their exposure to these coronaviruses and rino viruses at a time when their bodies seem most able to handle first exposure.
Yes, I think we need research into the question of whether suppressing youth cold infections is a good idea or a bad idea. You can see plenty of upside to it (kids getting colds is annoying!) but you could also imagine it being counterproductive.
Let's not forget that chicken pox (in the days before vaccination) was super mild for kids but terrible for teens and adults. If this is true for COVID and other respiratory diseases as well, then there is definitely a benefit to kids starting to build immunity to the various variants so that when they become adults, their immune systems aren't completely taken by surprise. If this can happen through vaccination rather than actual illness, all the better.
Um, it was far from "super mild" for me when I was about eight. I was covered from head to toe. It looked more like smallpox than chicken pox.
Exception that proves the rule (whatever that means).
https://www.thechildren.com/health-info/conditions-and-illnesses/true-or-false-its-better-get-chicken-pox-child-adult
Sort of off-topic:
I remember a definition of "exception that proves the rule" in a book. (I don't remember the book - I think it defined various phrases, this was > 20 years ago)
If I make the statement:
"The kids can stay up past 8:00 tonight" I'm clearly implying an exception(I said 'tonight' implying an exception) and that suggests(proves?) the rule is that normally they must go to bed by 8:00.
Isn’t the answer pretty obvious? We’d need electronic medical records with a central database versus provider based to prove it out in a long term study.
So many reasons to have centralized medical records!
...and so many reasons not to! I have no desire for the government, which has been under the control of LBJ, Richard Nixon, Bill Clinton and Donald Trump during my lifetime, to have access to my medical records.
What exactly would any of those people have done even if they had direct, unfiltered access to your personal medical records?
And that's ignoring the ability to set up a database inaccessible by elected officials
Read up on what LBJ & Nixon did with information against their political enemies. And I wouldn't put anything beyond Trump. I think political actors use information as a weapon all the time, and I wouldn't want medical information to be part of their arsenal.
I actually think medical records should be held by insurers, rather than providers, not necessarily the government. Payers already have enormous claims databases that are very useful, but lack the details behind the claims, which limits their reliability and richness for research - though payers do already have the right to access the underlying medical records on demand. So if you're on Medicare that would be CMS, but if you're on private insurance it would be whatever private insurer you have. Then the insurance databases could be standardized to be useful for research, on the model of the FDA Sentinel project that links insurance claims databases, but for more than just FDA regulated products.
I don't think generalized privacy concerns about that come close to outweighing the public health benefits.
I’ll compromise! Insurers hold the data under universal healthcare system.
Well, I don't expect it to happen in your lifetime.
Absolutely agree. The next thing that would happen is that there would be centralized tax records!
In another ten years will Epic EMR dominance be strong enough to approach the level of monopoly (thus: centralized EMR)?
Nope.
Nope as in they won't cover 90+% or nope as in that doesn't count as centralized EMR? I think EMR systems are likely too complicated for the government to run as a centralized system--like, realistically you need interconnections between EMR systems, but Epic is dominant because it's a very good system because it has had to slowly but surely crush other vendors.
I don't know what happens if they truly gain monopoly status (do they slump off?), but it strikes me that the process of creating a really good centralized EMR is the result of market competition and not something likely to be easily recreated by a public service. Even universal systems in Europe often have several different record systems.
"If my daughter is going to get variations on this virus dozens of times in her life why am I trying to prevent her from getting it now?"
Because she will be better off if she gets vaccinated before her first natural exposure.
Possibly a lot better off.
Young children sometimes die from COVID. I don't believe anyone has died from the vaccine.
So, hang in there. The vaccine is worth the wait.
Yes. The whole idea of vaccines is to give you exposure without getting the actual disease. It's a nifty cheat that also happens saves lives.
If the FDA thought that were true, and so believe they do, why haven’t they approved the vaccine for children?
You are really asking me, "why is notoriously slow-moving, inefficient, and sclerotic bureaucracy acting like a slow-moving, inefficient, and sclerotic bureaucracy?"?
I don't think we need to look for hidden motives.
They don’t want to make it obvious to the rubes that you test it by taking it and we have never done long term follow up. And the cost benefit is still a slam dunk even if there are long term consequences.
Yes, this is proving to be a problem with RSV, a not uncommon respiratory virus which effects very young children. It heavily effects their ability to breathe and is terrifying. With hospital oxygen treatment it's very survivable though. Normally it bounces around continuously with a heavy wave in winter and pediatric ICUs are set up to deal with it. But the anti-Covid measures and the relaxation thereof have compressed the RSV waves into new times of the year, which combined with Covid has put dangerous strains on some pediatric ICUs.
So yes, really thinking about the overall picture on immunological development in kids, on all illnesses, is going to be key for long term planning.
The immune system evolved to be exposed to many pathogens in early life. That early exposure is rather important in training the immune system. There’s evidence for something called the hygiene hypothesis that postulates that allergies and autoimmune diseases arise in part because we have less exposure to parasites and certain bacteria and so the immune system reacts against pollen, food and self.
I have no idea what happens if kids have less exposure to respiratory viruses in childhood, but the immune system is a wonderful, complex system that often surprises us.
I will also add that more exposure to respiratory pathogens may make stuff like colds and flu milder because each exposure or infection acts like a booster. Severe flu seasons generally happen when the strain of flu circulating is very different from the strains in past years so the immune system isn’t very good at recognizing it.
When kids get diseases from notoriously germ spreading schools, they aren't the only ones affected. They can easily spread it to grandparents and older teachers who are much more likely to have a serious case. And while their parents likely won't die from the disease (though they certainly can), having covid, which can include things like long covid, while you have small children at home does not sound fun.
Those older teachers and grandparents can get vaccinated now.
At the beginning of Covid, one argument in favor of remote learning was that kids could bring the virus home and infect their grandparents. I am saying that those grandparents can now be vaccinated and protected from serious disease so that the author's concern is less of a factor now. I am definitely of the view that we need to emphasize the vaccine. I don't think Covid Zero is practical. I also question the idea that masks are necessary in all indoor places and definitely not outdoors. Yes, we need to update vaccines but also need to trust that they are doing a fine job.
Are you saying this in favor of masks all the time (or during cold and flu season) or just for covid? It seems like a ‘covid zero’ mentality or maybe a ‘all cold and flu zero’ mentality that doesn’t necessarily make sense if a certain number of infections in a lifetime are inevitable. Or maybe it does (I’m no expert) … I’d love to hear / know more about the protection provided by childhood viral infections. If I went my whole childhood cold and flu free would that put me in greater danger later in life?
Anyway I’m all for short term measures to protect grandparents / parents if something is coming that will make the problem better. Like a better vaccine that prevents all breakthrough infections or something. But it sort of seems like our vaccine is only going to get less effective (I dunno maybe there’s something new coming?) and maybe the thing to do now is get your shots and then get exposed and start to build that natural immunity as well.
My current thinking is that we shouldn’t aim for cold/flu/covid *zero*, but it would be a real benefit to human health if we get cold once a year, and covid or flu once every ten years, rather than cold multiple times a year, and flu or covid every couple years. We might be able to do that by having a weekly virus report, like the weather report, and wearing masks whenever the number gets above a certain point, just like we wear shorts or raincoats when the temperature or precipitation get above certain amounts.
"we shouldn’t aim for cold/flu/covid *zero*,"
Can we all agree that Coke Zero was a mistake?
My partner tells me that at least some of the creative executives at Coca Cola have said that Coke Zero is actually a more perfect realization of their flavor concept than Classic Coke. I think there are some people that prefer Diet Coke, but Coke Zero is actually worth drinking even for people that aren't specifically avoiding sugars.
When Coke Zero first came out, I still occasionally liked a real Coke over Diet. I felt at the time like Coke Zero was so close to the real thing that I dropped real Coke completely and have never looked back.
To that end, I actually think Pepsi Max (now Pepsi Zero Sugar) tastes even sweeter than Coke Zero (now Coke Zero Sugar), although to be fair, I haven't had the latest reformulation.
"Coke Zero is actually a more perfect realization of their flavor concept than Classic Coke"
Did not know that!
So, we all agree the Uzbeks didn’t have a lab leak, right?
Just asking questions!
Their lab took appropriate safety steppes.
Sadly, there were descended from the four Mongolian horsemen.
elm
covid khan
Ken in MIA for the score!
I want to know how the cows collected bat specimens.
I suspect the cows did not have appropriate PPE. They probably got a bum steer on safety from camels that *MAYBE* got MERS from a bat reservoir.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356540/
props for "bum steer." veal lustig.
My two cents:
First cent: Regarding flu vs cold, we're generally pretty sloppy with language. I mean, we call it the "stomach flu." (Some people even misuse the term "flywheel.")
Second cent: Man, Matt must have been demon good at writing term papers the day before the deadline back in college.
How else would you write them?
I should have been clearer. I, too, wrote terms papers in the last few hours before the deadline. Unlike Matt's though, they were terrible as a result.
There’s a very thin line between utter bullshit and brilliant synthesis and analysis.
I was always good at staying on the right side of the line, and therefore could crank out 30-page term papers in a night. But I never figured out how to monetize it, which is key.
"(Some people even misuse the term "flywheel.")"
Unpossible.
No one could be that callously indifferent to the English language and basic mechanics, all at once!
I am so excited for the trials of Moderna’s new cold and flu vaccines. Even if it just stops four cold viruses, four flu viruses, and Covid, that’s a significant improvement on past flu vaccines.
That will be interesting.
The question is whether the hospital system can handle ‘a little worse than usual because of a new virus’ for a decade. Here in LA, vaccine rates are better than they will likely get in a lot of states (80 percent of adults) and there was a large wave over the winter. But hospitalizations are still up enough to stress the system some, in a way that will cause nurses to quit. System didn’t have slack to begin with. If the 1889 theory is correct we need to find a way to raise the line.
I don't see those vax numbers reported for LA? The NYTs has the 18+ in LA county at 67%, with overall rates of vaccination lower in LA than in Miami or Harris (Houston) county, Texas. But to the larger point, why wouldn't each subsequent year get a little better, with more and more people building up their immunity through infection or vaccination as time moves on?
For first dose - it's 80% statewide, 74% in LA County as of a day or two ago, and increasing since the mandates are coming. But the point is that if 1889 led to a decade of increased stress on the public health system, even if the vaccine cuts that to five you still have doctors and nurses quitting, especially in places like Mississippi. Not clear how you solve for that.
Where are you seeing data on nurses and doctors quitting? I've seen a lot of retirement-age folks quit in my extended family and friend network for reasons loosely connected to covid. In other words, they were probably going to quit in a few years anyways, and the covid disruptions kind of pushed them over the edge. But that was as much about the huge amount of baby boomers in the generation that is now reaching retirement as it was about anything else, and not limited to those working in a medical environment.
There are a couple of cases in this article of writing 1899 when you meant 1889.
When Matt's first book was released, his co-workers at Think Progress threw him a party where the cake had a deliberate typo.
All I'm saying is that I know what I signed up for.
They really ought to give him a column in the Grauniad.
On the one hand, yes -- Matt and typos go together like Hope & Crosby -- on the other hand, it does bother me when I makes big ones because I actually specifically asked him on Twitter if he was going to have a proofreader for this blog because I don't much mind typos in a free product, but do in something I'm paying for, and he said yes there would be a proofreader. That said, the 1889/1899 distinction I could see being missed even at a professionally edited magazine.
Proofreading is for the little people.
Google "fat finger wire transfer" and see how common typos are among supposedly careful, sophisticated parties.
While poorly (deceptively?) communicated, flatten the curve is never a single time point strategy. It may need to be maintained or repeated until some immunity threshold is reached and the susceptible population remaining is unlikely to overwhelm a local healthcare system. Overall I think the public would have responded well to more mechanistic and transparent explanations throughout this pandemic.
The issue is that the systems aren't designed for that. Indoor dining is really bad for curve flattening, but repeated restaurant closures will just kill the industry. Claustrophobic close-in clubbing is horrible for curve flattening, but again, you can't open/close/open/close on industries like that. PPP and CARES help a lot, but the dimmer switch approach can't continue indefinitely. Red States have already decided they are done with it.
I wonder if there are economic structures that would help with this. Water parks and ski resorts have to deal with unexpected weather closures all the time - do they have insurance against that? If so, could we create a social insurance program for restaurants and nightclubs and occasional disease-related closures?
There is business interruption insurance, but I can’t see anyone underwriting affordable policies for COVID lockdowns.
That's a good point, I didn't mean to imply the earliest interventions should be repeated. Interventions can and should be optimized over time
It's not just red states. I was up in Minneapolis last week and the world was capital-N Normal again. A few business had mask mandate signs posted, and people generally complied in a your-roof-your-rules framework, but that was it.
With exceptions, continued enthusiasm for NPI seems to be a coastal thing in a way that doesn't map very neatly onto red and blue.
For me the takeaway is that we just need more vaccines. More vaccines for covid, more vaccines for the flu and maybe vaccines for the common cold. And the more we suppress the prevalence of the virus in the population, the more we need vaccines to keep our immune system sharp because covid, the flu and the common cold all include a set of viruses for which elimination is not possible. But we can reduce the human cost with regular and varied vaccination.
But along these lines, we need vaccines that have fewer side effects, and not just deadly ones. I would be fine with taking a cocktail of 5-6 vaccines every year, but the symptoms should be mild not, you're going to spend next day in bed. So I think more research is needed and dosing needs to be experimented with.
There is enormous economic value here in improving daily human health if we can improve vaccine regimens - on the order of a large fraction of a percent or even a full percent of GDP. It would be great if we could actually unlock it.
"but the symptoms should be mild not, you're going to spend next day in bed."
If said vaccines can really prevent common colds, I'd much rather spend one day in bed rather than a couple weeks with a cold.
I wonder if the coronavirus Matt writes about — or other, similar coranaviruses that cause common cold — are truly globally endemic in the main, or some are and some aren't, or do they exhibit regional differences in terms of endemicity.
Relatedly, I've wondered if certain populations — I'm thinking primarily in terms of East Asia — might possess a modicum of immunity (I know there's a more technical way to describe this but no time to research at the moment) vis-à-vis Covid19. I'm not even suggesting we have epidemiological evidence for this, although we may, in that China, Taiwan, Japan and Korea all have suffered a lot less sickness during this pandemic than most of the Americas or Europe.
One personal anecdote that got me thinking along these lines was that, during my first sting in Asia — I arrived in 2013 — I got slammed on a regular basis with nasty colds for the first eighteen months or so. I rarely suffered from them back in the States. And yes, these were quite unpleasant. At one point I was absolutely convinced my neighbor's cat's dander was blowing through the building ventilation and affecting me (the cold wouldn't let up for weeks). But he kept his cat and I eventually recovered.
I have zero idea whether or not these colds were caused by coronaviruses. My guess is that this is statistically not all that likely (non-coranavirus cold viruses outnumber coranaviruses by something like 4 to 1, if memory serves). But who knows?
But also, everything I've read about colds suggests that we know four coronaviruses, some number of rhinoviruses, syncytial viruses, and influenza viruses, but every time someone does a systematic study of several hundred people with colds, they find some new viruses that they hadn't cataloged before. We should try to learn more about that, and maybe do more surveillance to understand when and where a new one is emerging.
"Relatedly, I've wondered if certain populations — I'm thinking primarily in terms of East Asia — might possess a modicum of immunity (I know there's a more technical way to describe this but no time to research at the moment) vis-à-vis Covid19. I'm not even suggesting we have epidemiological evidence for this, although we may, in that China, Taiwan, Japan and Korea all have suffered a lot less sickness during this pandemic than most of the Americas or Europe."
It appears, in fact, that the descendants of the southern Chinese population circa 20,000 years ago did have immunity.
https://www.nytimes.com/2021/06/24/science/ancient-coronavirus-epidemic.html
elm
keeping in mind that's based on a genetic clock so it could be off by orders of 2-4, maybe more
That's interesting. Thanks.
It would be very surprising to me if there's something that spreads easily from human to human, but isn't globally endemic (other than the things like measles and polio that we've eliminated from some places through vaccination). There are bacterial (cholera) or other parasite (malaria) diseases that are endemic only in some regions, but it's because those don't spread directly from one human to another, but go through some environmental factor that varies in different parts of the world.
However, if there are animal viruses that frequently get spread to individual humans, but only rarely spread from human to human, those could be endemic in the animal populations of some region. (You mentioned a cat, and covid is known to infect cats - maybe there are other animal coronaviruses endemic to East Asia that get to humans the way that covid gets to cats?)
Well, I guess specifically what I was wondering about was the regional *variance* in the frequency that a given virus causes illness, ie, perhaps a certain coronavirus causes (say) 1.3% of all colds in one region, but 14.8% of all colds in another. And so on. But maybe there are no substantive differences from region to region on this score. I haven't looked into it. But commenter Elm provides a link to an interesting NYT article about a study conducted by University of Arizona scientists that concludes a large-scale, long in duration (centuries) outbreak of coronavirus disease in China millennia ago has resulted in changes to the DNA of people in that region (actually my region) to this day — the implication being people here on average enjoy a greater degree of genetic protection from coronaviruses.
Now all we need to do is find some Russian who died from Covid-1889 and was buried in the Siberian permafrost, just as the 1918 flu was accurately identified from a burial in Alaska: https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus.html
I’m a little surprised that no one has, since the papers suggesting this are fifteen or twenty years old. I had thought Svalbard was the only place they had frozen bodies from 1918, but it looks like Svalbard didn’t have much long term settlement until the 1890s. If there are frozen bodies elsewhere, that would be useful to know!
Just so!
elm
better hurry, the big permafrost melt is on
The Covid period has given me a lot of conversations where I’ve said “I’ve never heard that before.” This was the best of the batch.
Now… to be fair. MattY was competing with a cohort of mostly “COVID IS A PLOT BY THE ELITES TO DISTRACT AND DIVIDE US WHILE THEY POISON THE WATER SUPPLY!!!” and its homeomorphisms
But this would likely be the best novel take even if he wasn’t.
So can we get a HCoV-OC43 vaccine, and have 5% less colds? I'd take that.
Frankly on the topic of covid policy I have no clue what anyone is doing anymore. it seems like the government is running in circles right now. we should have gone harder with mandates than we did, why do people have such a problem with vaccines anyway? I don't get it.
Off-topic: Matt, you've tweeted a lot recently about the crucial role played by the NYT's editorial judgment regarding *which news stories to promote with what angle*. First the Afghanistan editorializing, today the TX abortion decision:
"Always interesting to see which stories are seen as equally newsworthy as "new copies of old emails found on a laptop." Virtually nothing meets that high bar."
Will you write an essay on it?
I've seen this argument laid out elsewhere and I agree that it's persuasive. But (even though I know this wasn't Matt's intention), I'm going to have to quibble with the "take the L" take home at the end. Assuming the COVID-1889 theory is true, you could logically argue that this is the mostly likely outcome for SARS-CoV2 IN THE LONG RUN. But when do we get there? If the world was still seeing serious issues with the disease 5-10 years later, that's a pretty long time! Moreover, giving as many people as possible (including "lower risk (but not no risk)" children) gives their immune systems a first exposure to this coronavirus, meaning they won't have to suffer the debilitating effects that much of the world has seen. Remember, again -- death is not the only negative endpoint... Long COVID and serious long-term respiratory effects are nothing to dismiss.
It's also worth raising again that Pfizer (and probably pretty much every other large pharmaceutical company) are working on a drug (NOT a vaccine) that will protect against not only SARS-CoV2 but also other future coronavirus threats.
https://www.pfizer.com/news/press-release/press-release-detail/pfizer-initiates-phase-1-study-novel-oral-antiviral
"The oral antiviral clinical candidate PF-07321332, a SARS-CoV2-3CL protease inhibitor, has demonstrated potent in vitro anti-viral activity against SARS-CoV-2, as well as activity against other coronaviruses, suggesting potential for use in the treatment of COVID-19 as well as potential use to address future coronavirus threats."
5-10 years is a pretty long time, but vaccines should allow us to substantially curtail the window.
In terms of taking the L, I mean that things like DC's current indoor mask mandate are probably pointless. We're not close to overwhelming our hospital system here (enough people are vaccinated, hopefully, that that won't happen) but we're also nowhere near suppressing the virus or achieving Covid Zero. I'm not some kind of fanatical anti-masker who objects to using it in schools (where the vax rates are low because kids aren't eligible) or wants to make fun of people who choose to wear masks when they go to the store. But as a social objective, further suppression at this point doesn't make much sense to me.
If you accept the argument that there's some finite amount of political capital that can be spent on covid mitigation measures, it seems like about eight weeks after the 5-12s get an EUA, even a milligram of political capital spent on anything other than vaccinations is a stupid waste.
I'm with you on the indoor mask mandates and the idea that Covid Zero is not going to happen. I observe that everyone is getting so tired of them and not wearing them properly--and arguably many (cloth masks especially) aren't very good. We still in this country, I observe, view this as largely a "mask war." There are a number of possibilities we could explore more--like improved ventilation and more testing. By the way, in British schools I have read, the kids don't have to wear masks, but are tested frequently. And there is an 80% adult vaccination rate. We should concentrate more on getting people vaccinated--like young adults who don't bother or essential workers who don't want to take off work to get a vaccine.
“…not wearing them properly…”
The photo at the top of the essay made me laugh.
"But as a social objective, further suppression at this point doesn't make much sense to me."
Still unhelpfully ambiguous. Which suppression methods are you advocating that we abandon?
Having separate hospital wards for COVID patients?
Having symptomatic carriers self-quarantine?
Testing people with symptoms?
Contact-tracing?
The "let it rip" model says "yes" to all of these. On that model, we should be having lollipop parties for our kids with the intubation equipment taking from the lungs of this morning's COVID death. Is that what you are advocating?
You've got to be more precise. Say what you mean. People listen to you. Don't let yourself be a vector for bad information and bad ideas.
To me it means, 'act normal'.
I assume hospitals have to make decisions about whether to separate patients with infectious diseases all the time, and I don't normally know how they make those decisions, and I don't expect to be looped in in this case. Like normal.
We have no mechanism of 'having' symptomatic carriers self-quarantine, so public health authorities will make some recommendation, and maybe employers will have some policies, and then people will do what they're going to do. Like normal.
We also have no method of obligating people to get tested unless they are hospitalized. As long as there is a demand for tests I guess they will be available, but no need to force it. Like normal.
Contact tracing? When did you write this?
We shouldn't have lollipop parties because that wouldn't be normal. Act normal, instead of making weird concessions to the virus one way or the other.
“Act normal” is still ambiguous. Do we want to throw away everything we’ve learned about cold and flu this past year? Or can we have a new normal, where sick days are strongly encouraged, meetings are moved to Zoom when local illness rates are above some pre-determined threshold, etc? It seems like some very minor interventions can have a major impact, just as some major and painful interventions can have little or no positive impact. We shouldn’t throw the baby out with the bath water.
For sure! For corporate cultures to shift in response to events and technological developments and stuff is totally normal and we should do it. Different places will also respond and adapt differently, and this, too, is normal. These are organic processes, not something we can collectively control or make a decision about.
Aren't organic processes the same as things we collectively control and make decisions about? Who runs these organic processes except for us, collectively?
"Contact tracing? When did you write this?"
I live in a university town where the university has been very successful at quelling several outbreaks via contact tracing. They employ massive routine surveillance testing, and when they find positive cases they follow up with dorm-mates, team-mates, and so on and test them. It works, and it kept rates extremely low last year.
Does MY think that the university should not do that? He keeps saying vague things, and that's not a responsible way to be a public voice.
Well it would be cool if Matt would respond, but since I'm the one who's here:
Universities have all sorts of policies with respect to health and safety on their campuses, and if, within the law and the other constraints that it faces, the school in your town thinks that this is the way to go so they can operate in person, I think that's great.
Other schools no doubt will do different things, or nothing. I don't think that any government should either require or prohibit any particular response.
I don't mind what the school in your town does, and I don't think it's my business or Matt's. Of course you live there, so maybe *is* your business to some degree, and maybe they have a channel to receive your input, but I hope they don't care too much about the opinions of people like me who don't know what they're dealing with and aren't affected by their decisions.
I'm not trying to argue, I'm just trying to explain how my 'act normal' perspective applies to this example.
Also, we have done contact tracing for STDs for decades. It’s harder to do fully effective contact tracing when contacts are more fleeting than casual sex, but casual sex contact tracing is hard, and yet the bit we do still helps.
Also, on the last point about “making weird concessions” - I think over the last 20 years we learned the lesson that when there is a threat, the best thing to do is ignore it so that it can’t achieve its goals. That may be reasonable when the threat is a terrorist group trying to extract concessions. But the virus doesn’t care, so we shouldn’t be acting to spite it. That doesn’t deter it, the way it deters trolls and terrorists.
"On that model, we should be having lollipop parties for our kids with the intubation equipment taking from the lungs of this morning's COVID death. Is that what you are advocating?"
Given that the total viral load present in the air appears to impact the severity of Covid-19, I expect you want to expose kids to minimal amount possible of Covid-19.
elm
not an experiment anyone wants to conduct
It probably makes sense for people to continue wearing masks in grocery stores and other public settings where we don't really socialize. Could help suppressing all sorts of diseases.
Unless we get a variant that evades the vaccines. And seeing as how the people who study this can't agree on the likelihood of that, I wouldn't venture a guess.
https://www.statnews.com/2021/08/30/inside-pfizer-labs-variant-hunters-race-to-stay-ahead-of-pandemic-2/
So I would err on the side of caution (continuing to mask for the sake of my kids) but I do understand why other vaccinated individuals would choose otherwise.
Yeah, I think that MY's "take the L" kicker is unhelpfully ambiguous. Some people are going to read it as though MY is advocating for a Swedish-style "let it rip" policy: no vaccination, no mitigation, expose everyone as soon as possible and let the weak die.
But that's not what he said. "Take the L" here just means, accept that we will not be able to eliminate the pathogen from the population.
If we vaccinate as many people as possible, while accepting that we cannot eliminate the pathogen from the population, then we will spare a lot of deaths and misery.
It's a loss by comparison to a maximalist goal of total elimination. But it saves millions of lives compared to "let it rip."
I think it’s misleading to say Sweden did “let it rip”. They had few government-mandated interventions, but I would be shocked if the population didn’t do many things on their own.
Fair point. I apologize to the Swedes.
That aside, I still think MY is saying things that will sound to some people like he is advocating a "let it rip" policy, from here out with COVID-19 and possibly from the get-go with COVID-24 or whatever the next pandemic will be.
Is he? Is he saying something different? I think it would be more responsible for him to make his position clear.
One advantage we have is vaccines. The thing vaccines do is give you exposure without giving you the disease. They're not perfect for building immunity – breakthrough infections do happen. But neither is being exposed to the actual disease – second infections also happen.