I have been (and continue to be) a bit doomy about the pandemic, so I feel I should make a little bit of a big deal about the number of deaths from COVID in the US last week falling below 1400, the first time it has been below 200 dead Americans a day since the start of the pandemic three years ago. Similarly, while we are not quite at the low point for hospitalization (which was last April) there are only (only!) around 12,000 people currently hospitalized with COVID in the US, and the trend is still in the good direction at the moment.
I don’t, alas, believe that it’s “over”. We seem to be heading toward treating COVID-19 like the flu, by which I mean that there will be an annual booster that will not be required and that most people won’t get; that we will not for the most part test for the specific virus unless a person is sick enough to see a doctor; that people who get sick will not quarantine, other than those with very severe symptoms who can’t simply carry on; that very few people will wear masks or take other preventive measures, and those who do will be tolerated but not respected; that most of the people who die will be the people already most vulnerable to illness; and that planning for contingencies if it gets worse, or for pandemics generally, will be underfunded and deprioritized.
And that means a few things: first of all and the thing that I’m upset about the most right now, that most of us will be able to stop thinking about it much at the expense of a few million people who will have to permanently stop doing things in-person, except at very high risk of very serious illness or death. If America generally starts treating COVID like the flu, then people with immune problems or other health issues will simply never be able to safely go to a concert or a religious service again. They may have a choice: isolate your children or risk orphaning them. Many occupations will be closed to them. And of course, the 75,000 Americans who will likely die with COVID this year and the 75,000 Americans who will die with COVID next year, and again the year after, will be mostly people who are already pushed outside of the mainstream. I have a problem with that.
But also, given that COVID is not the flu, it seems at least fairly likely—perhaps not probable but not unlikely—that there will be new variants of concern, or new patterns of vulnerability. If six thousand Americans will die with COVID in a “good month” like this last one, it doesn’t take many “bad months” to put the butcher’s bill for the year past 100,000 again.
This is, of course, on top of any long-term problems caused by vast quantities of us getting COVID-19 again and again. I don’t know if I’ve said it here, but I have been saying pretty often that in the 2060s, there will be a ton of Gen Z folk who have their doctors tell them Ah, yes, I see, you had COVID back in the twenties. In my optimistic moments, I imagine the doctors going on to say we have a treatment for that.
Tolerabimus quod tolerare debemus,
-Vardibidian.
I am reminded, in discussion of the butcher’s bill, that the “excess deaths” figure is much lower than the “dead with COVID” number—it is wrong to think of the 75,000 people who will die with COVID in 2023 as being, absent COVID, all alive in 2024. On the other hand, of the 200 or so Americans who will die with COVID today, even among those whose deaths are not “excess” to expectation, there will be some who would have lived a bit longer, maybe even with joy, if they hadn’t contracted this particular virus.
Thanks,
-V.
Okay, so what’s the plan?
We create the culture we live in as well as suffering under it, and so let’s take the action we can take as individuals, and go about the business of normalizing moderate precautions to protect against communicable illness.
The visible-to-me discourse about individual precautions during the pandemic has been super judgmental, in the “anyone who is not doing precisely what i am doing is doing it wrong” sense. And i understand why: (A) on the face of it, if you’re doing the right thing and i’m not, then i’m risking your life, and it’s not unreasonable for you to disapprove of that. Also (B) we’ve all been scared out of our minds, and fear makes us judgy.
But, like, suppose my position is that i’ve made active changes to my behavior and lifestyle to reduce the risk that i will spread COVID (and other airborne communicable diseases), and i expect to make those changes for the rest of my life, but i don’t expect to reduce that risk to zero. Right now, i do A, B, and C things, and i don’t do X, Y, and Z things, and i’m on the fence about C and Z long-term, but for the most part i’m planning to do what i’m doing indefinitely. (After some variable substitution, this is in fact my position.)
Given the background level of covid-behavior-judgment in which we live, it doesn’t feel very appealing to me to describe my particular set of behaviors on the internet, because i am *both* the worst person on earth because i do some risky things, *and* the most contemptible person on earth because i do some risk mitigation, and i expect to hear about it! So i’m probably not going to be vocal; i’m probably going to quietly do whatever i’m doing. And in practice, i do feel like the discourse i hear is dominated by the 0% and 100% arguments. Despite the fact that almost all of us are actually living somewhere in the space between how we lived in April 2019 and how we lived in April 2020.
So, like, i think we gotta normalize being open and non-defensive about our risk tradeoffs, so that the Overton window gets some input data. We’re used to this in other arenas, right? We all have some combination of lifestyle tradeoff behaviors around how we drive our cars, and whether we recycle, and how much we tip, and how long the food can be on how dirty of a floor before we won’t eat it, and what kind of areas we walk around late at night. And for the most part, we all make choices, and implement those choices, and gather data from other people’s self-reported and observed choices over time.
That’s where we’re going, right? I think it’s no longer a very helpful framing to talk about whether the pandemic is “over,” especially as a proxy for “… once it’s over, we’ll never talk about COVID again.” I think both we should still talk about COVID (i.e. “the pandemic is not over”), and also that there is no known phase change on the horizon which will cause us to no longer need to talk about COVID (i.e. “the pandemic is over”). So i vote no on that boolean.
I wear a mask when i go into indoor locations that are not my house. I don’t wear a mask outdoors, but i keep one handy in case i encounter a crowd or an indoor location. I consider indoor restaurants, especially crowded ones, to be a significant health risk. I support requiring masking as a good way to lower the risk profile of crowded indoor gatherings of strangers, like dances and conventions. I freely cancel plans if i’m not sure i’m feeling well, and i expect people i make plans with to do likewise. I own an air filter, and i run it when people who don’t live in my house are present in my house. If i’m hosting a gathering larger than a couple of people, i invent and communicate some kind of additional communicable illness policy (e.g. testing). Everything in this paragraph is something i didn’t do in 2019, and currently expect to do forever. I think it is socially appropriate for people who have the means to do so, to make a similar list. No one else’s list will be identical to mine, and i think it’s socially appropriate for that to be mostly fine.
I dunno that any of that helps your post — possibly i’m ranting about social pressures that aren’t actually bothering anyone else, while ignoring the Big Questions. But i’ve had it rattling around in my head for awhile, and this was an excuse to actually post it.
Chaos–
Thank you for the post! I think it’s tremendously valuable, and I really like the idea of normalizing being open and non-defensive about risk tradeoffs. Although it’s very difficult not to be defensive, and it’s very difficult not to judge. Particularly since these sorts of things do wind up making real problems for other people, not just ourselves. And many of our choices are restricted (or at least affected) by our workplaces, our families, and our communities, sometimes in ways that make it difficult to be open and non-defensive.
Thanks,-V.