How Do We Move Forward with Covid?
A New Calculation of Risk and Social Losses is Needed for the Vaccinated
Yesterday this tweet went strongly viral, hitting over 1200 likes and 260 retweets - and the question is why? What resonated with people?
Partly, it was no doubt the core public health statement that vaccines are saving lives, that after the horrors of March and April 2020, this new assault by Omicron is being largely deflected due to the success of New York City in getting almost all adults vaccinated.
But part of the response is no doubt the desire of many to have evidence that we as a society can move forward even in the face of new variants, that we don’t have to return to lockdowns and closed restaurants and remote learning. That vaccinations are a way through the inevitable generations of new variants and mutations of Covid and likely successor pandemic viruses.
Many comments challenged that hope, noting that deaths lag any spike in cases and spiking hospitalizations will have spillover effects in blocking access to hospital care for many non-Covid medical needs that may have fatal impacts. Now, I only posted the tweet after tracking rising caseloads in NYC even before the insane Omicron spike - and seeing no commensurate spike in fatalities - but caution is always a reasonable response in the face of a pandemic that has killed over 800,000 Americans.
One thing I have wanted to emphasize over and over again: most people and most political leaders have good faith reasons for different responses and views on what to do in the face of the pandemic because we have incomplete information and differing levels of risk tolerance about the impacts from the tradeoff between social interaction versus personal safety. The pure malevolence of a minority of political leaders manipulating misinformation on the pandemic for political gain has rippled through our social interactions, making many distrust honest disagreements as a stalking horse for political agendas. No one of good faith evaluating the evidence in 2020 should have opposed basic social protection measures like mask mandates and limited indoor interactions - but the fact we had large numbers doing so poisoned our whole public debate going forward.
If I have shifted towards a more optimistic view of keeping our communities functioning, at least for those who are vaccinated, it’s not from a Panglossian impulse from the beginning of the virus. Even this past Spring, before Delta and Omicron had even exploded in the US, I was skeptical that we could move quickly to normalcy since I doubted a voluntary vaccination regime would be enough, as many hoped then, especially with Covid variants continuing to evolve that might make vaccinations irrelevant.
So any optimism I now have is based on overcoming significant fears that new vaccines would fail in the face of an implacable biological enemy.
And they still may.
But so far, vaccines have been wildly successful in radically reducing mortality rates for the vaccinated not just from the old alpha variant but from Delta and now Omnicron. Not 100% safety but a radically reduced vulnerability for ourselves and our families.
Which is where good faith differences in risk tolerance and evaluation of evidence come in. Some people see a single unneeded death from Covid as one death too many and see returning to remote schools and shutting down in-door dining and theaters as a tiny price to pay to save lives. Which is not an unreasonable view to have.
But there are real costs to blocking a return to a more normal social life. It’s harder to have this discussion in a nation where so many state leaders are encouraging the unvaccinated to socialize and kill each other. But in a sane polity - and I consider New York City with its vaccine mandates and 91% adult vaccination rates to have achieved that status - we can approach the issue with a different lens.
From a personal perspective, I have two public school kids who emotionally suffered tremendously from Covid lockdowns and even with the partial in-person schooling that they participated in during the 2020-2021 school year, the emotional scars are clear and ongoing. They are hardly alone in this and my spouse, who teaches in a Harlem public school, has seen the impact on her students as other teachers report here and across the country. Both adults and children suffer in social isolation and the breaking of community bonds and those have broad-based human costs.
We see that social impact in the triple spike in homicides, car crash fatalities, and drug overdoses. That’s an increase in deaths from murder of 4900, an increase in car crash deaths of 2,580, and 22,250 additional drug overdose deaths. The car fatality increases are particularly striking since so many fewer car miles were driven in 2020. Accounting for that, car fatalities were up 23% on a per-mile driven basis.
All three of these spikes in deaths reflect reckless, self- and other- harm-inducing behavior no doubt reflecting the disruptions, social isolation, and anxiety of the pandemic. While there are long-term forces underlying each of these areas, it is hard to believe that their simultaneous extreme increases are not related to the pandemic.
Which means, at least among the vaccinated, even a pure calculation based on saving the maximum lives possible require a calculus balancing lives saved from viral death due to restricting social interaction compared to lives likely lost due to harm-inducing behaviors related to those same restricted social interactions.
It’s a hard and uncertain calculus but my general switch to supporting as full return to normalcy as possible (caveat: for the vaccinated) is based on my calculation that doing so will maximize lives and mental health saved.
The dead bodies filling hospital ICUs will rightly be cited by many as an alarm bell calling for more restrictions on social interaction, but I will argue that bodies being delivered to morgues from crime, car crashes, and drug overdose sites need to be treated as alarm bells as well. And the non-fatal but real damage of social isolation has to be in our ongoing public health calculations as well.
To repeat, people of good faith will differ in these calculations and we will make all our lives better if we recognize that as we argue through these social choices. Save denunciations and anger for the monsters feeding lies and hate into our public health debates - and let’s try to model a more gentle and humane debate among ourselves.