I just put up a post on my personal FB page reminding my friends and family to continue to take this COVID thing seriously and shared with them an article that I thought was excellent by Ed Yong at the Atlantic.
I’m in the United States and I’d say that to most people it’s pretty clear that we have not handled this whole thing well. We’re closing in on 200,000 deaths from this (perhaps higher when you look at excess mortality) and the truth is we could’ve probably had only a few thousand deaths if we’d handled it differently.
Things like acknowledging the fact that a virus does not care what country you are from so a travel ban that does not prevent or isolate Americans coming from a geographic region with high-risk is going to fail to contain spread of the illness.
Or really locking down for a short period of time to prevent spread instead of what my state at least did which was still have takeout delivery and road construction and all sorts of other activities that were not in fact essential but did allow for potential spread.
(My state has actually done fairly well but I think that’s more down to population density and travel patterns than anything else.)
But what I wanted to throw out there in this post is how this illness plays into a number of human weaknesses and how we really have to actively fight against them to understand what we’re dealing with and to do so effectively.
For example, it’s very hard to see what isn’t there. So when a health measure, like a temporary lockdown, works we can’t see that it worked. Because the fact that it worked creates an absence of the event it was trying to prevent. I know some people, for example, argue that MERS wasn’t that big a deal. But perhaps it wasn’t that a big a deal because all of the health measures that were meant to contain it actually contained it.
Because those measures worked, we don’t see what they prevented. And we then inaccurately draw a conclusion that whatever measures were used to prevent that spread were not needed.
This has happened with the lockdowns. They were needed. They helped slow things down so that we didn’t have five NY/NJ/CT-style outbreaks going on at the same time early on.
That leads to the second issue most of us face with this illness. And that’s the issue of exponential spread. I pointed out on FB a few weeks ago that while it wasn’t making the news Hawaii was experiencing the highest growth rate in infections based on reported data. But that was at 50 cases a day so no one much cared. But they were doubling cases every two weeks at the time. Unchecked that 50 becomes 100 becomes 200 becomes 400 becomes 800 becomes 1600 becomes 3200.
It’s very hard to look at a low number and think that if you do nothing it will become a very big number. We can understand doubling. But get much past that, and we just don’t go there naturally.
It’s also very hard to understand the delay between cause and effect with this illness.
Recently some idiotic Stanford professor said that the U.S. fatalities were going to hit 170K and then just stop. I posted on FB that I wished the man would shut up and stop devaluing my degree because it was clear that he was wrong.
Why was it so clear when we were sitting around 150K fatalities at the time? Because, given the number of daily cases that had been reported prior to that point in time we already had enough infected people who were going to die to bring that number above 170K.
And we were infecting 50K new people a day still. Some of whom were going to become ill, get hospitalized, and die.
That man was completely missing the delay between infection and death that comes with this illness. I’d bet that delay can be as long as 45 days in some cases but is probably more like 25 days in a more typical case. So anyone focused on case numbers instead of death numbers is a month behind reality.
Also, most of the models being used fail to account for the interaction between human choice and disease spread. People are trying to use a basic regression approach to something that is more like game theory. (And I’m not a stats person so I may have just phrased that very wrong. But basically the idea is we can’t take what’s happened over the last two months, plug it into a model, and say this is where we’ll be two months from now without factoring in psychology. Because the outcome two months from now is driven by the actions of millions of individual actors making personal choices. Any good model of future outcome needs to factor in human behavior choices not just disease metrics, something that is very challenging to do.)
I also think most humans tend to approach crises in a linear fashion. A hurricane hits, it’s destructive, we rebuild, done. A wildfire burns, it’s destructive, we put it out, we rebuild, done. But that’s not how this illness works. It’s not: illness strikes, we lockdown, it goes away. It’s ongoing and cyclical.
I have yet to come up with the perfect imagery on this one but on FB I mentioned it’s like having a leaky water balloon and every time you take your finger off the hole in the balloon it starts leaking again. Until we can get this disease to low enough levels within the population, every single time we let up too much there will be a flare up.
That’s why we’re seeing rolling outbreaks across the country. Because one area gets an outbreak, takes the steps to get it under control, and gets things back down to something manageable but at the same time another area that hasn’t been seeing much of a problem lets up on its controls and gets a surge in cases.
That’s going to continue as long as there’s enough of the disease in the population to spread easily across geographies.
Which leads to another issue we’re all facing. It’s hard to give up your old habits for something so nebulous. Like a summer vacation. I had multiple friends on FB take out-of-state vacations this summer. They just couldn’t give up what they were used to doing for something that they weren’t experiencing personally. Here in Colorado they’re talking about having fans in the stands for Broncos games this winter. Football is more important than containing this illness.
I mean, really? Is it so hard to let go of something non-essential that you’d risk endangering your entire community for it? (Answer: Obviously in America it is.)
And that’s a big part of the problem. Even though almost 200K people have died this year that didn’t need to, this illness is very nebulous for most of us.
I don’t have friends in healthcare. I don’t have friends who work grocery store or meat packing jobs. My social circle is one that has a fair amount of privilege. Meaning that most of the people I know are working from home, able to order in grocery delivery, and hiring au pairs or tutors to homeschool their children.
They (and I) do not personally know the people who are dying. Because society is stratified enough that it’s not obvious to the average suburban upper middle class white person that this illness is killing as many people as it is. It doesn’t seem real. It doesn’t seem significant unless you are the one treating the ill patients or in a community that has been significantly impacted.
And that brings me to the final issue. Which is that people are too focused on deaths and not focused enough on long-term health consequences. We aren’t considering what happens in a society where millions become infected and perhaps as many as 1/3 of those people have lasting heart damage or lung damage or kidney damage or brain damage. We aren’t understanding what happens to a society where that many survivors struggle with long-term fatigue that impacts their ability to work.
It’s like what I said in an earlier post about skydiving. I thought it was die or have fun. Only when I realized the far bigger risk to me personally was a significant injury with long-term consequences did I truly understand the risk I was taking every time I jumped out of that plane.
So, bottom line here. We’re not naturally equipped to mentally understand the scope of what we’re dealing with. It requires concerted and ongoing effort to grasp the potential effects and the impact. And it’s a challenge to remain vigilant for as long as we’re going to need to remain vigilant. But we need to try. Because letting this thing burn out of control is going to create the type of damage that lasts for generations.
M.L. Humphrey 