Wednesday, July 21, 2021

No way out except through

Something strange is happening here in England, watched anxiously by many of my friends in North America. Despite rising numbers of cases of COVID-19—largely, but not completely, disassociated from numbers of hospitalizations and deaths—the Conservative government has finally removed all legal restrictions that, to one degree or another, have imposed on residents’ lives for almost a year and a half. Many people are anxious, not yet ready to board a train or enter a shop where they fear they will be the only people wearing masks (although, anecdotally, people’s actual behavior is changing only gradually, if at all). This in a country where all adults have had the opportunity for at least a first dose of vaccination and, in the over-50s (the age group in which 99% of U.K deaths have occurred) more than 90% have been fully vaccinated.

The government’s logic is that infections are going to peak sometime—hopefully in mid-August, though as with all models, no one knows for sure—and that the longer a full reopening of society is delayed, the longer that peak will simply be put off, rather than squashed. If we don’t do it now, when schools are out for the summer (and thus children not spreading infection through schools) and many social activities can be done outdoors where the risk of infection is minimal, what is the alternative? Push it into colder weather and the dreaded “flu season”? But it is a gamble, some are saying a reckless experiment. There is another alternative: to live with restrictions forever, wear masks out of habit, and allow an unprecedented taking of government power in an emergency to lapse into permanence, as previous attempts to increase our safety and “security” have done. (See U.S.A., “Patriot Act.”)

 

I think the strangeness is due to a crucial preposition. We, that is to say I too, have long been in the habit of saying that vaccines would be our way out of the pandemic. I said this before the vaccines were invented, and I’ve been saying it since, jubilant with the (still remarkable) degree of effectiveness the vaccines show and the speed with which they were developed. But I am finally grasping something which, for all its failings, the British government seems to have grasped too. As Isabel Miller wrote in Patience and Sarah, there will be no way out except through.

 

As far as I can determine, no country and no locality has gotten everything right during this pandemic, nor am I aware of any that has gotten everything wrong. There has been authoritarianism, the weaponizing of science as a belief rather than educated guesswork, the inappropriate use of scientific experts to make decisions that elected politicians should be making, or blaming them when things go bad. Meanwhile, SARS-CoV-2 goes on mutating into new variants and spreading more easily, as viruses have always done. There is no way out of the COVID-19 pandemic. There is only how we will get through it, and how soon, and at what cost.

 

Around a disease which, exceptionally (compared to influenza, for example) affects the oldest people in society while leaving the youngest members almost completely unscathed, much of the rhetoric has revolved around protecting the lives of the old and otherwise vulnerable members of society. While it is true that the life of an older person is no less valuable than the life of a child, nor should it be seen as more valuable. Yet the uncomfortable truth is that such calculations have to be, and have been, made. The U.S. National Bureau of Economic Research estimates that "in poor countries, where the population is relatively young, the economic contraction associated with lockdowns could potentially lead to 1.76 children’s lives being lost for every COVID-19 fatality averted, probably because wellbeing suffers as incomes decline." It may not be possible ever to prove such a sobering statistic, but it would not surprise me: these costs—in contrast to the harm caused by COVID-19 directlyare disproportionately borne by other people in other places, whereas in rich countries, we have been focused almost exclusively on ourselves.

 

Accusations of selfishness? How many of those I have heard in the course of this pandemic. In the debate over mask-wearing, fierce in the U.S. and, now that masks are no longer a legally enforced requirement in the U.K., threatening to spill over here, sometimes I wonder if face coverings have become more a signal of where one stands in a political debate than a rational choice. If I don’t wear a mask, I am selfish and want to kill Grandma. If I do wear a mask, I am a member of a cowed population that no longer has to be told what to do, as fear has been so deeply instilled that I will voluntarily give up my personal freedoms. Both of these stereotypes contain grains of truth.

 

I can adhere to mandates in my locality, or bow to the will of a place I want to do business with, without necessarily agreeing with them. I can and do care about personal liberties—hard fought liberties that are supposed to be basic to societies like America’s, Canada’s, and Britain’s—and I will not accept that such a position is unique to the right. Indeed, in this country it is the only position that has been truly critical of government incursions throughout; the official opposition, the Labour party, has seen fit to criticize the government only for not mandating more restrictions, and for longer, possibly forever. In a recent poll, a majority of Britons responded—perhaps exaggerating, in the grip of pandemic fear—that they would be happy for many restrictions to go on until COVID-19 is controlled worldwide. In other words, for years. Almost 20% said they would support the astonishing (and wholly unscientific) measure of an evening curfew, while a quarter said that some businesses, such as nightclubs and casinos, should never reopen.

 

What is going on here? Leaving aside whether it is a matter of vice for someone to celebrate at a nightclub or casino, the people responding to this survey are, I presume, just not interested in going to casinos or nightclubs themselves. But it is a big leap from that to say that no one else should do so—or, rather more pertinently, that no one should make a living working there. This looking down at activities that tempt or employ people, in many cases, younger than ourselves is uncomfortably close to the age-old scapegoating of homosexual people. Most people are not attracted to their own sex, so it costs them nothing to condemn behavior they don’t happen to find tempting.

 

The vaccines were supposed to be the good news. And it is utterly absurd that anyone, for political reasons, is now refusing vaccines that the Trump administration did as much as anyone to develop swiftly and successfully.* (Despite all the other things the previous U.S. administration got wrong, this was not one of them.) Vaccines mean freedom. Vaccines enable, or should enable, people to dispense with mask wearing and social distancing and being unable to make a living or, indeed, enjoy most of the things that make live worth living. Yet sometimes, I feel I am living in a funhouse-mirror world, in which vaccinated people fear the virus as much as they did in 2020, while the foolishly unvaccinated skip merrily on their way. 

 

While all approved vaccines are excellent at reducing the risk of hospitalization or death, they are slightly less effective at preventing people from being infected altogether. And logically, the higher percentage of people in a population are fully vaccinated, the greater the percentage of those who are hospitalized will have been vaccinated. (If the percentage of the population vaccinated ever reached 100%, for example, by definition everyone who was nonetheless hospitalized would be a vaccinated person.) The difference from 2020 is that even people unfortunate enough to be hospitalized are usually spending less time in hospital, and are much less likely to be ill enough to be put on a ventilator. There are treatments to mitigate the effects of severe COVID that we did not have a year ago.

 

All of this is what the U.K. health secretary meant when he, correctly, compared COVID-19 to the flu. Labour opponents quickly pounced on the health minister for “thinking COVID is the flu” but this is a willful misunderstanding, which totally ignores the changed landscape that the vaccines have given us in 2021. Those who thought COVID was like the flu last year were tragically wrong, but it is entirely reasonable to make the comparison now. Influenza can cause and has caused deadly pandemics. Tens of thousands of people die with the flu every winter in this country alone (I don’t say “of the flu” because, as with COVID, we only know that people have died within a certain period of being positively diagnosed with the disease; we cannot know, in every case, if the disease caused their death). Some would argue that there are many worse ways to die than flu. When, earlier this year, COVID-19 ceased to be the leading cause of death in England, news reporters jubilantly stated that the leading cause was once again dementia. Hardly a reason for rejoicing. But the point is that, as much as none of us want to catch flu, we do not shut down society every flu season, destroying livelihoods and preventing people from attending their parents’ funerals or hugging their kids. We give booster shots to the most vulnerable, wash our hands, don’t commute into work sick. We can even cover our faces if we think it will keep us from touching them.

 

It is unfair that, as with COVID-19, some people are more vulnerable to flu than others. Flu is a real danger to the very young as well as the very old members of society, in stark contrast to COVID, which almost never affects children badly. As with everything about COVID, the risk is not zero, but it is worth bearing in mind when people start to panic about children too young to be vaccinated. Children are much more likely to be badly affected by disruption to their education, the inability to socialize with others, and even mask wearing than they are to get seriously ill with the disease. It has become a confession of faith that mask wearing costs little or nothing, but this ignores the importance of seeing others’ faces, not only for anyone who has a hearing impairment, but for the emotional cues that all sighted people rely on and that children need to learn. The fact that children have responded with such resilience to all we have imposed upon them should make us all the more determined to bring such impositions to an end.

 

Our little goddaughter’s daddy and I used to enjoy taking her to church; she doesn’t even remember church now. With churches’ reluctance to open up fully to in-person participation, how many children will never get back into the habit of Sunday school? A year and a half is not a big proportion of a middle-aged person’s life, but to children, it is colossal. The mental and spiritual costs will last much longer for them than for someone whom interventions have saved a year of life. That calculation sounds harsh, but there are no harm-free interventions.

 

I feel more optimistic than many other people who, like me, are fully vaccinated now. We were never going to get everyone in the population to be vaccinated, but we don’t need to. “Herd immunity” is not only elusive, but an arbitrary number. What we needed was a substantial reduction in the chances of getting severe illness, and we’ve got that. When we say we have to learn to “live with COVID,” we are not talking about 2020’s COVID, but a coronavirus that will run out of people to infect, because such a high proportion of the population has antibodies (9 in 10 adults in the U.K.) Obviously, it would be better if most of the population got antibodies through vaccination, rather than infection. 

 

Vaccination,” wrote Jonathan Sumption, “is an impressive achievement. It represents the best that humanity can do about COVID.” I do not go as far as Lord Sumption in my skepticism of what lockdowns have accomplished, but it is time for them to end, and never to return. Disposable masks litter the streets, the blue cigarette butts of our time. Society has taken a step back in terms of plastic trash, while record heat waves and deadly floods worldwide make clear the vast emergency of the climate. If humanity keeps abusing the planet in this way, one more coronavirus will hardly matter.


Mutating is what viruses do; we will never be free of this pathogen, as we have never conquered any other, with the single exception of smallpox. We have feared COVID rationally because it was new and not much was known about it. Now we know, and while there is a healthy place for caution around this disease, so is there around not using a cellphone while driving, or other things that are far more likely to kill us and, for that matter, other people. Yet how many people still do such dangerous things, routinely and thoughtlessly, purely because they are used to them?

 

I didn’t get vaccinated because of the (vanishingly small, though still existent) chance that I would become seriously ill if I contracted COVID. I still might test positive at some point. I got vaccinated so that I could be free of this fear. So that I could be part of a society in which, while not everybody is vaccinated, everyone vulnerable has had the opportunity to get vaccinated. So that I would not be afraid of catching the disease or communicating it to those people. So that I could travel, attend events, sing in a congregation, and do any number of other things which, frankly, I never imagined a free country could deny my right to do, even temporarily. That does not make me a conservative or a liberal (except in the classical sense). It makes me human.




*If you live in the U.S. and happen to know anyone who is, for whatever reason, reluctant to get vaccinated, you may be encouraged to know that people in their lives talking to them is a bigger factor in getting vaccinated than political affiliation. It may be tempting to be angry at vaccine-hesitant people or write them off as stupid, but it doesn’t actually help them get vaccinated.

1 comment:

Unknown said...

Thank you for a very thoughtful analysis of the most significant world health crisis in the last 100 years--possibly since the small pox epidemic of the 1830's. Your critique is balanced, filled with insights, and well-argued from first to last! P & G