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We Have PTSD About COVID Reality
We don't have to undersell our COVID future now just because people oversold it in the past.
Half a million dead Americans. Does that even register for people?
I want to show a couple tweets from a conservative gentleman who has fancied himself a sophisticate throughout the pandemic, not because I want to dunk on him for being wrong, but because it highlights how the enormity of this crisis changed our perceptions.
In mid-March he said this:
Three weeks later, he had amended his position:
Imagine shifting from:
100,000 deaths would be criminal.
100,000 - 250,000 would be bad, sure. But it probably won’t happen.
500,000 and counting? Whatevs.
But that’s what he did. And in some way, that’s what all of us have done. We’ve had to. Because to truly grasp the enormity of this catastrophe would be emotionally incapacitating.
Imagine the total number of Americans killed in both World War 1 and World War 2—all dying at home in America, in a single year.
Because that’s what we’re talking about. Our brains and hearts aren’t wired to process that level of tragedy in detail. Which is why we retreat to abstractions and shift goalposts.
I said I wasn’t going to dunk on Mr. Calvinball but I have to. Sorry. Because this guy has been wrong over and over and over, all while posing as a just-asking-questions data nerd throwing cold math on the idiot alarmists. Here he is on December 1 saying “The COVID surge in the US will almost certainly start trending down in the next month.”
Spoiler: It did not.
And it did not take any special expertise to understand that this is where the virus was heading.
Also: Thursday Night Bulwark this week is going to be me, Tim Miller, Sarah Longwell, and Bill Kristol. Between CPAC, COVID, 95-year-old Nazis, and Trump’s “show of force,” it’s going to be lit.
It’s also important to understand that even with 500,000 dead, this virus is not done with us yet. Back of the envelope math suggests that even as cases decline, the next month will see something like 60,000 additional deaths.
That is an enormous number—a tragedy of epic proportions.
Remember: At the beginning of this there were lots and lots of people who insisted that it was unlikely 60,000 Americans would die during the entirety of the pandemic.
And now we’re looking at that number just as part of the tail.
Only a situation of absolute horror could numb us to the point where another 60,000 dead neighbors feels like an afterthought.
But here is what I want you to take away from today’s discussion:
The end is in sight. Despite everything, there are good reasons to be hopeful.
2. Normal Is Coming
I remind readers that for a solid year I’ve been a COVID hawk. I warned about COVID early. When we passed the death toll from 9/11 and then Vietnam I kept warning that the magnitude of deaths could be almost unimaginably large.
I argued that there was no way to “re-open” America during the pandemic. That mask usage was really important. That there were valid reasons for some schools to be doing remote learning. And on and on and on.
I’m nobody’s Pollyanna.
And today my concern is that the public health establishment is not conveying an appropriate amount of optimism about what the post-vaccine future is going to look like.
We are suffering from something like public health PTSD, where the happy-talk lies told to us during 2020 have made us unable to accept genuine good news in 2021.
We were told COVID would “disappear” like a miracle. Well, you cannot eradicate COVID. This isn’t smallpox; COVID isn’t going all-the-way away.
But that doesn’t mean that the spread of COVID can’t be reduced to an extremely low level.
We were told that hydroxychloroquine was a “miracle” cure. It wasn’t. There is no “miracle cure” for COVID. But the vaccines are incredibly effective at preventing serious illness related to COVID.
A huge number of stupid people refused to wear masks. This stupidity cost other people their lives. But that stupidity then, doesn’t mean that the best answer is for everyone to wear masks indefinitely.
If I were going to psychoanalyze America, I’d say that we were lied to for so long by people in positions of authority that we started reflexively taking the other side of every piece of good news on COVID and distrusting it. Because all of the previous “good news” was flim-flam.
But what we’re seeing right now in the efficacy of the vaccines, their impact on transmission, and the ramp-up in production is genuinely good news.
Genuinely great news.
We should accept it. Celebrate it, even.
The COVID vaccines function like a pincer movement on the virus:
The vaccine prevents people who contract COVID from getting seriously sick.
The fewer people who get sick, the slower the spread of the virus in the population.
The slower the spread, the fewer people who contract COVID.
I’m generalizing here, but I get the sense that the messaging from the public health community about our near term future is more or less:
Don’t get too excited. The vaccines aren’t magic. Bad things can still happen.
Which is true in the sense that our world is a fallen place and bad things can always happen. As Vincent Hanna once said, You can get hit by a bus while walking your doggie.
But it seems to me that the better message would be:
We get the shot. We get our lives back. Let’s go, America!
Because that’s where we’re heading. Unless something changes (more on this below), by late summer we should be doing lots of normal-ish stuff. Seeing family. Hanging out with friends. Going to baseball games.
Any school that’s not back in session come September will probably be either an extreme outlier or will have done something wrong.
There’s another PTSD issue here: For a long time, the people who kept saying “Go live your lives! It’s not a big risk!” were liars and fools who did not understand how dangerous COVID was. They insisted that it was “the common cold” or “the flu”—which is most certainly was not. Or they’d say that old people should be willing to die in order to “get the economy going again.” Or that if granny had to kick it in order for them to go out to a bar, then so be it. Or that the churches needed to be full by Easter Sunday or the virus would have won.
So I understand why you might be a little squirrelly hearing phrases like “really low risk.”
But we are heading to a place of genuinely low risk with COVID. Once a large majority of the country is vaccinated, we won’t have zero cases, but the chances of a person both contracting COVID and then having a serious health outcome will be really, really, reallllllyyyy small.
I can’t give you exact figures yet, but I can give you some context: The case fatality rate for COVID has been a pretty steady 1.6 percent. It varies by age and risk factors, of course. But for every 1,000 people diagnosed with COVID, about 16 of them die.
This is why it was always crazy not to take this virus seriously. You would not get on a plane that had a 1.6 percent chance of killing you.
But with the vaccines in wide adoption, not only is the number of cases in the population going plummet, but the CFR is going to drop significantly, too.
It’ll be a while before we can quantify it. It’ll require surveillance testing and study and comparisons with outcomes in other countries. But I’m at a high level of confidence that we’ll be at a place where we can go about our normal lives with truly minimal risk from COVID.
George Will used to have a line about how you can always make the world safer. If we mandated that everyone had to wear a football helmet when they left the house, we’d save lives. Will’s point was that there has to be a balance point where society says, “We’re safe enough. Everybody go about your business. The costs to quality of life for the next marginal returns on safety are too much to make sense.”
I want to repeat this: A lot of people made that same argument when 3,000 people were dying from COVID every day. That was nuts. Utterly insane.
Those same people also frequently said, “Then that means you want lockdowns forever!”
To which the reasonable response was: “No. We want to be smart about this virus, pick all of the low-hanging fruit in terms of mitigation, and then get back to normal as soon as the risk profile changes in a meaningful way.”
And that’s where it looks like we are finally headed with COVID. Come September would everyone be made some small amount safer if they wore masks all the time? Sure. Mask usage will always make communities safer from respiratory infections. But come September we should be at (or near) a place where the gains from mask usage are marginal enough that they don’t make sense for most people.
At that point, we’ll actually have to turn our attention to clawing back some of the zombie health-security theater that has crept into our lives—things like the obsession with transmission from fomites. (Which turn out not to be a concern.)
Let’s stop selling the future short. Let’s be willing to accept the good news. Let’s attack these next 20 weeks not like we’re grinding out another mile in the long war against COVID, but like we’re finishing the fight and getting our lives back.
I understand that nobody in public health wants to over-promise and under-deliver. We’ve seen that movie before.
But we also don’t have to distort reality just because the reality looks good.
3. The Caveats
In fairness to the public health community, you can understand why they’re cautious. There are variables that could change this outlook for worse. Some of them we know. Some of them we don’t.
Here are some of the known-unknowns:
Vaccinations lag. Either because production does not materialize, because one or more of the vaccines develops problems and gets pulled, or because people don’t get the shot once it’s available.
New strains are vaccine resistant. RNA viruses mutate at a relatively rapid pace. If new strains are less impacted by existing vaccines, that could cause problems, raising death and transmission rates from where we think they are now.
A new strain emerges that is particularly virulent for children. We still don’t have a vaccine approved for kids. It’s possible we’ll have one by September. This is lowest current priority, since kids (especially young kids) do very well with COVID, in terms of morbidity, mortality, and transmission. If a new strain developed that hit kids especially hard, that would change a lot of our calculus for the medium-term future.
So there are reasons to be cautious.
But if we take any lessons from the last year of public health messaging, it should be this: Just tell people the truth.
Tell them all of the truth. Even when the truth is complicated. Trust that the public can understand both a top-line message and the caveats that come with it.
If you’ve read this far, then you understand how big a deal the truth is to us. And I hope you’ll join us for more of it.