Issue 10: What We Knew From The Start
5.17.20 | Ten weeks later, a look back at what we got right and wrong
Hello,
It’s been ten weeks since I launched this newsletter. In that time, the confirmed count of Covid-19 cases in the U.S. went from barely 3,000 to more than 1.4 million; from barely 200 Covid-related deaths to nearly 90,000. There have been some surprises along the way — how quickly the country would fully lock down to slow the spread of the virus, and the confusion around mask wearing. The virus itself has produced some surprises — the shifting list of symptoms associated with Covid, the importance of asymptomatic spreaders, the toll of Covid’s long term effects on people who have recovered, and disturbing reports of serious or fatal complications in children.
But it’s striking to look back and see how much of what we’ve experienced was forecast or understood in March or even earlier. So for this issue, I want to look back at what we knew from the start, and what that might be able to tell us about what we can expect in the future.
[Masked bicyclists in Milan on May 7. Carlo Cozzoli for Shutterstock.]
// Link Roundup
What does it mean to say the virus is “airborne”?: Here’s a great digest of recent scientific work on what we know and what we don’t about how SARS-CoV-2 spreads through the air. One important takeaway is that the virus seems to follow the “20/80 rule,” meaning about 80 percent of disease transmission events are caused by about 20 percent of the people who are infected. So, if we say the virus has a basic reproduction number of about 2, meaning each person infects on average two other people, that’s concealing a really uneven distribution — many people infect one other person or nobody at all, but about 20 percent of people are super-spreaders and infect lots of others. The problem is, we don’t know who is likely to be in that 20 percent, and what combination of biology and sociology creates the conditions for that spread. Figuring this out will be a major advance in controlling the pandemic.
— “How Coronavirus Spreads through the Air: What We Know So Far.” Tanya Lewis, Scientific American.Ten-day weekends: Two biologists and an economist walk into a pandemic and come up with a plan to radically reorganize the rhythms of social life to defeat SARS-CoV-2. Instead of society-wide lockdowns, simply have people work and attend classes for four days, then take ten days at home to wait out any infection they’ve acquired while out in the world, and then do it all over again.
— “10-4: How to Reopen the Economy by Exploiting the Coronavirus's Weak Spot.” Uri Alon, Ron Milo, and Eran Yashiv, The New York Times.The class politics of Covid: In its early days the pandemic spread around the world on the backs (well, in the lungs) of relatively wealthy international travelers, which at first led people to believe Covid-19 was a disease of the rich. But once it gets into a country, the disease visits its worst harms on the poor.
— “How Coronavirus — A ‘Rich Man’s Disease’ — Infected The Poor.” Shashank Bengali, Kate Linthicum, and Victoria Kim. The Los Angeles Times.The wealthiest were likeliest to flee New York City when the virus hit, according to an in-depth analysis. Some 420,000 people are estimated to have left the city between March 1 and May 1, most of them having left from the city’s highest-income neighborhoods.
— “The Richest Neighborhoods Emptied Out Most as Coronavirus Hit New York City.” Kevin Quealy, The New York Times.“The poor, having no choice, remained.” But the pattern is nothing new, as this round-up of scholarly material from JSTOR shows.
— “In Epidemics, the Wealthy Have Always Fled.” Allison C. Meier, JSTOR Daily.Communities in crisis tend to come together in the form of loose-knit mutual aid networks. What lasting changes might a crisis of this magnitude bring?
— “What Mutual Aid Can Do During a Pandemic.” Jia Tolentino, The New Yorker.Other disasters are not on hold. Emergency managers are planning against the earthquakes, wildfires, tornadoes, floods, and hurricanes that will inevitably strike in the middle of the pandemic.
— “What Happens If a ‘Big One’ Strikes During the Pandemic?” Robin George Andrews, The Atlantic.“Our window of opportunity is closing.” Rick Bright, the infectious disease expert and federal official who was ousted from his role leading vaccine development, testified before the House this week. He detailed shortcomings in the federal government’s early response to the pandemic and warned that, as a resurgence of Covid-19 is likely this fall, without significant improvement in our response efforts, “2020 could be the darkest winter in modern history.”
// What We Knew From the Start
I went back to re-read the first issue of this newsletter and it was reassuring, in a way, how well the basic outlines of what we knew about this virus from the early weeks have held up. We knew from the data on the outbreak in Wuhan that the disease would strike the oldest hardest, and mostly spare children. We knew, too, that most spread happened in prolonged close contact. We knew it was much deadlier than the seasonal flu. And we knew locally serious outbreaks would overwhelm hospital systems.
The initial epidemiological projections weren’t terribly far off, either, considering they were forecasting a novel virus under novel conditions. The initial CDC modeling back in February estimated between 200,000 and 1.7 million deaths over the course of the pandemic. It was unclear at the time how and to what extent the models took physical distancing and other non-pharmaceutical interventions into account, and we’re now well on our way to meeting the lower bound of those estimates.
As much as we worried at the outset that the U.S. would never be able (or willing) to match the tight movement restrictions the Chinese government instituted, the physical distancing measures that we did put into effect — as unimaginable as they were at the time — really did work. A new study estimates that shelter in place and other distancing orders in the U.S. prevented between 9 million and 34 million additional cases of Covid-19 between March 1 and April 27.
There were things we didn’t know, of course, or got wrong.
One blind spot concerned the long-term effects of the virus. Some survivors of the disease who were hospitalized have continued to suffer impaired liver, heart, and lung function. Their health may never fully recover — people who survived SARS, for example, were much likelier to contract other illnesses years after they recovered. The potentially large lasting burden of the pandemic has drawn comparisons to the generational challenge of Polio.
The other mistake, and maybe the most consequential, is the confusion around masks. While the science around mask wearing was uncertain at first, it’s now becoming clear that widespread adoption of face coverings dramatically reduces the spread of disease by reducing the amount of virus-laden droplets people project when sneezing, coughing, talking, or even just breathing. One study suggests widespread adoption of masks could dramatically reduce the amplitude of Covid-19 waves in the U.S., but only if big majorities of the population actually do it — upwards of 80 percent.
// What We Know for Next Time
We know that physical distancing measures work. We know that mask wearing works. But most of all, we know the price of not taking seriously the risks posed by SARS-CoV-2. The first wave of the pandemic has begun to recede in most of the United States, though we risk reopening too quickly and allowing local outbreaks to flare back up. Globally and here in the U.S., a second and possibly deadlier wave of the pandemic is understood as likely by most epidemiologists by the autumn and into the winter. We were caught off guard by the first wave. There’s no excuse not to be ready for the second.
Thanks to all of you who’ve been reading and sending comments throughout this coronavirus odyssey! Sending you all best wishes for good health.
— R