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I read the comments on your NYT just to get a sampling of how the general public reacted, and I’m really disturbed - but I can’t put my finger on why.

What disturbs me is the seemingly unanimous call to make unvaccinated people so miserable and/or cut off from society that they’ll effectively be forced to comply. What confuses me is that earlier in the pandemic I felt this way too - make deniers suffer until we break them and they comply - but I’ve since stopped devoting my energy to that. I just categorically refuse to wish suffering on others. But I wouldn’t know how to respond to charges that “people don’t have the right to endanger others” or “if it comes down to your family or theirs, you’d protect your own first, so it should be natural to want to harm others before they have a chance to harm you.” The forced binary of bullying vs. cajoling is garbage. I know that empathy isn’t a scaleable public health strategy, but I also know how people behave in response to a perceived threat. It doesn’t matter whether the threat is objective or subjective, one of literal death or a wound to the ego. The brain responds the same regardless.

Collective action problems are infuriating by their nature. Combine that with the utter impotency and despair of a polity that has lost faith in every civic institution and I suppose it’s a natural recipe for sadism. I know how much work it takes to resist being dominated by our worst cognitive biases and emotional impulses, mechanisms forged by evolutionary imperatives that became functionally maladaptive in modern society. It’s just heartbreaking that more people aren’t able to join me in doing that work for themselves, because I know how much happier it’s made me to develop that skill set. And it is a skill set; I truly don’t believe it’s some innate moral disposition or intellectual superiority.

I was really surprised by my own distaste in response to people’s calls to impose suffering. Some people started out describing limiting a person’s choices - say, if you don’t get a vaccine, you can work some places but should not be allowed to keep your job at a nursing home. Fair, reasonable. But often it devolved into “maybe if their families starve they’ll reconsider their selfishness.”

I hope we haven’t lost our ability to see fellow humans in terms other than selfishness, craven self-interest, and malice. I try to remind myself that we did indeed evolve as a cooperative species. But cooperation that promotes the survival of the species as a whole is altogether different from cooperation that makes modern life livable.

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I think the social media/media polarization has made it worse. We tend to see the worst of the “other” side and then extrapolate it to everyone. There is a larger number of people in this country who are unvaccinated because a lot of things are dysfunctional, and have been for a while. And then there’s the puritanism and moral/sin framing that’s really dominated the way we think about a lot of things. (See: beach shaming). I’m not saying there aren’t really irresponsible people—especially the grifters—that deserve all the scorn, but a lot of people are truly lost and confused about the vaccines. We haven’t even approved them properly yet! Our messaging has been confusing and defensive. Public health authorities and scientists may not like me saying this, but there was so much confusing and conflicting messaging that the lack of trust isn’t just because Tucker Carlson is spewing nonsense (or: he is, of course, making things worse but the environment that allows him to prosper is what we should worry about). And so on…

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There’s another aspect to the shaming/lack of compassion: I’ve heard several people—friends!—say something along the lines of fine, let them die then, which is just as frustrating as it was through the main surges because of course most people *won’t* die but we are still swimming around in risks to the vulnerable, overwhelming hospitals unnecessarily, and the fact that we simply don’t know what the long-term individual health aspect is even of mild cases.

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It seems almost like a rhetorical flourish rather than a coherent eugenics plan. It's not actually addressing the circumstances and consequences; it's just announcing rage and contempt. It would be nice if we could explore ways not to force society to have to work around the non-vaccinated constantly and bear 100% of the burden while increasing incentives to get vaccinated, without making *any* of this about morality, character or desert.

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Indeed it would. I heard a line four years ago or so that really stuck with my and I find myself running into it a lot, about how every ideology leads to eugenics. Wish I could remember where I heard it.

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Or maybe here, smug eugenics-speak leads to bullshit ideologies!

You should check out David Livingstone Smith on ideology and dehumanization (he writes mostly in the context of race but you can apply some of his ideas more generally). He suggests the explicit function of all ideologies is to oppress, not just a side effect. His recent book was awesome but this is a nice blog post:

http://blog.apaonline.org/2017/03/30/philosophy-in-the-contemporary-world-thinking-about-ideology/

https://www.davidlivingstonesmith.com/

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"Ideologies have us" is a good one. I haven't read his stuff before, but that makes sense.

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Going to the comments section is like those bad horror movies where someone hears a noise and ventures into the basement to check it out, and you're like DON'T GO INTO THE BASEMENT.

But this is the New York Times, so it's more like arthouse psychological horror.

Anyway, you expressed these sentiments very eloquently. People can be mean; especially when they feel morally entitled. And the forced binary of bullying vs. cajoling is garbage. There is a distinction lost between behaviors and choices having indirect moral implications (voting, not participating in public health measures like vaccination), and those that are actually *immoral*. And then a second distinction lost between immoral actions and immoral people who "deserve their fate." And then a third distinction between feeling they are "bad people who deserve their fate," and actually preaching these publicly! I think one of the complicating things is that while this may begin with cognitive biases and human nature, it eventually gets bound up with a person's values and identity, so the "biases" are no longer just biases but deep commitments. Then when you represent these commitments publicly you're, well, committed.

In this sense much of the online verbal cruelty you witnessed could also be understood as highly performative, and ultimately based on fantasy - a kind of venting or catharsis protected by anonymity and distance. I bet most of those people go about their day encountering others they know who declined the vax and never say this to their face, or maybe even view them as exceptions. So along with cognitive biases and knee-jerk emotional moralized responses, it's important to consider the gap between what people say in public, what they actually do, and what they actually believe. 

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Ah, you are truly a kindred soul!

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Really appreciate this piece, especially as there’s been a consistent lack of guidance for those of us with kids under 12. I also live in a county that topped out at 38% vaccination rate (of those eligible for vaccine), and while strong anti-vaxx sentiment is the biggest factor, I know a lot of people hesitant for the other, more nuanced reasons.

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Indeed. There should be better data and guidance then kids will probably be okay. Which may be true, but that’s just not enough to tell a parent going into the third school year of a pandemic.

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Exactly!

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As someone whose wife is now burdened with "Long COVID", I continue to be disappointed by the focus exclusively on mortality by both the media and the CDC. The morbidity associated with this virus will be tremendous and should be made another key point in the communication to those that are vaccine-hesitant, especially those that already have access to the vaccine. I realize that "we don't have all the data yet" but if we wait until every nuance is ascertained, we will have missed many opportunities. Preliminary statements could be issued tomorrow. There is enough anecdotal testimony out there that it now qualifies as anecDATA.

I cannot imagine that anywhere on our planet will be better off with a decline in our collective intelligence: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00324-2/fulltext

For those that have made it part of their personal identity that no science or fact or reasoning will "make them" get an "imposed" vaccine when there is a vaccine available, punitive social measures may be required. As my wife asked recently, "What if the insurance companies were allowed to deny coverage of COVID expenses to people that chose to not get the vaccine?" Seems harsh. In the past, how would a small community have handled a member that endangered the water supply? Shunning? Expulsion? Seems harsh. We still live in a time where a few people can represent a threat to a much larger community. Changing the structure of the community such that it mitigates or removes the tendency to be recalcitrant will take a long time. What do we do until then?

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Thank you so much for this. I don't know if it's your best piece yet - that's a bar so high I can't see it - but it might be the most important.

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I especially appreciate the remarks about getting past disdain and anger as a response to the vaccine-hesitant. For sure those folks should be making better decisions - absolutely. But stopping there is like a football team excusing a loss by complaining about good play on the other side. There was nothing we could do, Coach! More Heidi Larson and less Daniel Uhlfelder please.

Your comments re full FDA approval are right on target as well imho.

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Thank you!

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Collective lack of curiosity seems to be a recurring and concerning theme throughout this pandemic. Zeynep has pointed to examples like CDC's stopping their tracking of breakthroughs; lack of polling and ethnographic research to address vaccine hesitancy; resistance to studying airborne transmission; the early absence of journalistic investigation into possible lab leak scenarios. This may be tangential to the other issues we're discussing, but if scientists (!) and journalists (!) have lost their spirit of curiosity, that could be a big cultural problem. I can't think of anything more anti-science than incuriosity.

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Indeed! There are so many trials and experiments, as well as surveilllance, that we should be doing that we are not.

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@zeynep is on point, per usual. My partner, a few friends, and I are all vaccine breakthrough cases from a shared event 2 weeks ago. Despite being symptomatic, most of us didn't get tested until a week later, driven by our ignorance of the probability of a breakthrough case. While we're all okay, we sadly contributed to transmission within our communities 😢

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We should track these things so we know! Lack of information on what these things mean just feeds misinformation. I think the vaccinated and immunocompetent are mostly or completely fine, but that’s too broad.

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Zeynep, what is your reaction to the interview with Ralph Baric that just appeared in MIT Tech Review?

Two things that I noticed were: that he links his apparent change of mind on directing closer scrutiny at WIV to his concern over their habit of working at B2 levels of security; and that the tiptoeing around what is and what is not "gain of function" research is all so much weasel words. He elaborates that each country is perfectly entitled to have its own definition, and in fact there appears to be no common definition. I think his defense of the practical value of his own chimerical studies is quite compelling. And he states that no known virus with published sequence is close enough to the pandemic strains to have been the result of an experiment that took a natural bat strain, then hooked on super spikes for human attachment.

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Attempting to answer my own question, here's my napkin scribble so far:

Full vaccination provides ~20x reduction in hospitalization risk (link 1).

Delta 85% more likely to cause hospitalization (link 2).

So, in presence of Delta, full vaccination provides ~10x reduction in hospitalization risk compared to pre-Delta pre-vaccination.

All-cause mortality increase in US peaked at 40% higher than baseline (link 3).

So for vaccinated people in the Delta age, ~4% increase in death risk over baseline.

Links:

1 https://www.cdc.gov/mmwr/volumes/70/wr/mm7018e1.htm

2 https://www.thelancet.com/.../PIIS0140-6736.../fulltext...

3 https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

Corrections / feedback / refinements / alternate models super welcome and appreciated.

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"I continue to believe that our vaccines have brought back the risk essentially to baseline for healthy, immunocompetent individuals."

Seems reasonable, but — have you seen anyone run the numbers on this? I am trying / starting to and it's daunting.

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Why do the vaxed need to mask, if they are otherwise healthy? We're all going to get this endemic bug. Vaxed will get it, too, but not too bad. Mostly. What amount of restrictions will shut down delta? If that is not possible, what are we even doing, other than delaying the inevitable?

Why do kids need to mask? Is delta able to infect them at rates much higher than the earlier variants, which could barely do so? If they are getting it, but not getting sick, what are we doing? Still trying to protect others? Isn't the vax the proper and effective way to do that?

Why do we think that masks and mask mandates are effective? In state after state, mask mandates, etc., show no particular relationship to spread, to an almost comical extent.

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I agree vaccination is key. But we haven’t even approved the vaccine fully yet, and honestly, we haven’t done the proper outreach everywhere. There’s just too many unknowns, especially with the immunocompetent. By the way, the Delta wave won’t be forever, but while it’s here, it will probably catch a lot of people. Seems wrong for a country to stop too early.

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Thanks for responding. Hope you keep up the amazing work.

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I love this question! When masks were mandatory in stores, everyone wore a mask, or you were a known, visible rule-breaker. I have seen a few people skirting the edges of compliance, but never encountered a true jerk. I'm sure store workers ALL have had such encounters.

But now that masks are only required for the unvaccinated, masks, and the people displaying unhappiness about wearing them, have roughly disappeared where I live. The people who wear masks that I see are 1. Children, 2. some mature and elderly women. It in no way represents what I know of the statistical make-up of the unvaccinated adult cohort.

Ergo, the only way to get unvaccinated people to mask, is to ask the vaccinated people to mask along with them. Yes, the burdens of promoting responsible behavior fall upon those who are the most responsible, i.e. vaccinated. And I say this without any rancor or discouraging words or thoughts about those that aren't quite ready or willing to vax-up.

This is why mack mandates will return. Also, seems like the only way to ensure in-person schooling for the maximum number of students.

This sucks!

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I am vaccinated and back to wearing a mask indoors when grocery shopping and not eating in restaurants. First, you are right that cases among the vaccinated are usually much milder than among the unvaxed. However, this does not mean not disruptive, at any age. My reason is that I am in a much older age group, so the mask should provide some protection (I'd love to see some data on this; I'm using KN95 masks) any illness is likely to hit me harder too. I don't expect younger people to feel the same urgency about masks.

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I'm glad to see workplace testing mentioned in the New York Times article, but it's not really emphasized. Why is there so little discussion of this?

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I don’t know… So many things we don’t do. It’s baffling.

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I think it has to do with the extremely weak worker protections here and the toothlessness of OSHA. It is too easy to mistreat and fire people, too difficult to get recompense for unjust termination, and OSHA is woefully understaffed, needs a much more punitive fine/penalty structure, and there may not be the political will to empower them, even under this administration.

Essentially, there’s no one to complain to if an employer fails to take adequate safety precautions or fails to enforce them. So if workplace mandates do become enacted public policy, what do I do if my employer simply won’t implement one, or puts it on paper and doesn’t bother to enforce it? We saw what a nightmare 2020 was in terms of defiant business owners and powerless employees.

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It seems like there hasn’t even been much of an attempt to ask nicely for employee testing? Many businesses would probably follow the recommendations if there were some.

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You’re 100% correct here; I just sense a sort of exhausted defeatism that would rather not try something if *any* friction is anticipated. (Not universal by any means, more of a nebulous observation on my part due to living in DC.)

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That feels like an apt assessment of a lot of things, from where I am sitting in a rural area across the country from you.

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And testing in schools seems important too, to keep them open?

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Any thoughts on the recent Israeli Health Services data that purports to show Pfizer down to 39% effectiveness versus the Delta variant? How does this data compare to the UK-based study just published in New England Journal of Medicine that showed Pfizer at an 88% effectiveness versus Delta? Are there important differences in the data sets that we should consider? Also what is the latest information on whether or not Delta has had an effect on outdoor transmission?

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Back in what seems a lifetime ago, December 8th, you and your Counter asked whether the U.S. should best be seen through Turkish or Polish eyes. Any new thoughts?

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I think we are our unique dysfunction here! :-D

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