What we’ve done.  And what lays ahead. Covid in 2022, Part 3 – Michael Fine

by Dr. Michael Fine, contributing writer, opinion

© Michael Fine 2021 

Introduction

This is the second of four essays about Covid, our culture, our time, and the moral responsibility we share for what we have, where we are, and what we’ve done.

Thanks, as always for reading.  And thanks as always to Nick, Deborah and Kendra for their help, wisdom and support.

Part 3

There are three disinformation campaigns I want to take a moment to debunk, because they all have the potential to cause a fair amount of chaos and distract us from being one people focused on saving lives by beating this virus into submission.  The idea that the risk of dying from the virus isn’t any greater than the risk of dying from the flu; the idea that Omicron was milder so we can throw the masks away and start dancing in the streets; and the idea that lockdowns don’t work. These are all false beliefs, and I can’t believe that our friends in the Kremlin aren’t licking their chops over the way the disinformation campaigns have been spread around in the U.S. and are widely believed, so we have something new to fight over. 

The notion that most people’s risk of dying is no greater than the risk of dying from the flu is part of this disinformation campaign. Most people’s risk of dying from Covid-19 was always no greater than the risk of dying from seasonal flu — or of dying from a car accident. The problem isn’t most people. Most deaths occur in people over 80 and those with chronic disease, for whom the vaccine isn’t very good protection, and whose protection from the vaccine wanes quickly.  And every day, a small but significant cohort of people cross over into the category of significant risk, because guess what? We all age and develop chronic disease over time. The number of deaths we’ll have is, and will stay, a function of the rate of community spread until we have enough effective antivirals and monoclonal antibodies and have a way to identify everyone who gets infected and can get them on treatment as soon as they develop symptoms. Period. We don’t have enough of the antivirals and monoclonal antibodies yet, and probably won’t until late March or April, so until them, our best way to reduce hospitalization and death is still to control community spread. Which means masking, avoiding public places, not having large events and rational testing. Sorry.

The idea that Omicron is milder than other variants is itself ludicrous. Omicron spreads quicker than other variants – it hit us hard and is now receding but still circulating. But Omicron is likely at least as virulent is the original strain, which killed millions of people – it’s just less virulent than Delta.  Of course, most of us were immunized before Omicron hit, thank-goodness, and many of us have been infected so we had antibodies, and that made Omicron look more benign, compared to Delta.  But Omicron also killed more people than Delta did, because it infected so many people. The danger of the ”Omicron is less virulent” trope is that people will lower their guard, stop masking and other social distancing, which will allow Omicron to spring back into the population and keep killing the vulnerable, whose risk is a function of community spread more than vaccination rate, especially because the effectiveness of the vaccine boosters is likely waning in that group. Politicians, pandering to the desire of most of us to be done with Covid already, are likely to pick up the “Omicron is less virulent” refrain, and liberalize or are liberalizing restrictions too early, and so enable yet more preventable deaths.

The study from the Johns Hopkins Department of Economics (not their great schools of Public Health or Medicine) that suggests lockdowns don’t work is a classic example of disinformation, one that is sure to cause the kind of public health chaos that does Vladimir Putin proud and shows great return on his investment in social media. The study itself is a meta-analysis, not an actual study, and is not peer-reviewed (one of the authors is also its publisher) and has several methodological problems so can’t be taken to be authoritative.

It’s going to take a few years and many studies to sort out when to use population movement restrictions to control the pandemics, and this is just a meta-analysis of studies of the impact of population movement restrictions on Covid-19, which is a rapidly spreading but relatively low virulence virus. It is likely that the effectiveness of movement restriction is a function of virus virulence, and transmissibility but also of the population density, age, and underlying health status. When you’ve seen one virus, you’ve seen one virus, and when you’ve seen one pandemic, you’ve seen one pandemic, just like when you’ve seen one study, you’ve seen one study. It takes patience, experience, and a little wisdom to sort it all out.

And in the meantime, if we get a bad variant or a new very virulent virus, which we will, population movement restrictions are public health tools that are critical, if used briefly, in a focused way. Publishing and disseminating this study weakens public support for that tool if and when we need to use it. Which we will, unfortunately, eventually, to save lives.

(I thought our prior lockdowns were too long and too broad. No need for them in rural areas while community transmission was low. And they were too permissive in densely packed urban areas because everyone there went out to work. Which was where they got infected and then brought those infections home.)

But politics and ideology messed up our public health practice. Teachers’ unions kept schools closed too long. Poor policy got us inadequate testing of the wrong populations, so we had no good data to steer by. Incomplete ideas about fairness kept us from keeping rural and suburban areas open. And business interests kept the factories, slaughterhouses, and fish-houses open inappropriately, when they should have closed when infected, and still should be. But for two or three weeks, which is all that is needed to stop spread in a place, not four months.

(I won’t spend any time on the false belief that Dr. Fauci is the incarnation of evil. We’ve never met – he seems a reasonable guy for someone who has spent most of his life in the lab, and he’s done a good job translating the science into language that people can understand. He isn’t always right, but neither am I. But there is something to be said for his integrity, for the way he told people what he understood when he understood it. We need more people like him, and the politically motivated campaign to impugn and threaten him is disgusting and cynical, and that campaign itself should make us disgusted and ashamed. Okay, maybe I did spend a little time on it. But it is the ethical and moral aspects of our culture that matter most now, and those ideals are what we all must be working to restore.)

The sad thing is that we are no better prepared now than we were in February of 2020. Intellectually, morally, or politically.

We are still a divided people, a division all of us must own, and all of us together must fix, if we can fix it, in fact.

I’m back to prayer and repentance and charity as the way forward. Get the prayer, repentance, and charity pieces straight, and the science, politics, ethics, and moral posture will follow, and we will save lives and bring back democracy.  And our sense of decency, compassion, and self-respect, all at the same time.

Thanks for reading.

Michael Many thanks again to Nick Landekic, who provided me with tons of data and publications over the last twenty months, and whose knowledge of Covid-19 is encyclopedic; to Deborah Faith, MPH, for her unending editorial support and great editorial suggestions, and to Kendra Tanquay, for her support of my writing over many months.  Thanks as well to the many readers who respond to these emails and help keep me honest.  Part one of these emails was written in response to a very good question.  Thanks for that question, Matt.