The United States Update
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.
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.
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?
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.
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.
@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 😢
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.
Zeynep, have you written are linked to writing on why with a 1,000 times the viral load the delta variant is only seen as 2-3 times as infectious as earliest variant?
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.
Corrections / feedback / refinements / alternate models super welcome and appreciated.
"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.
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.
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?
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?
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?