Issue 52: A Feeling of Impending Doom
4.3.21 | "Don't let the virus get to you before the vaccine does."
Hello,
The spring gambit is on its way to failure, and the main question is how steep the losses will be. A resurgence of the virus is well under way in Michigan and across the Northeast, while early reopenings in Texas and Florida have bent the curve back up in those two states as well. Nationwide, hospitalizations are on the rise again, and the daily death toll has started drifting higher after dropping steadily over the first few months of the new year.
This is exactly what public health experts predicted would happen when states began rescinding mask mandates and relaxing restrictions on indoor dining and other high-risk activities back in March, just as the more contagious and more lethal B.1.1.7 variant began to take hold and spread exponentially. Rather than backing off on reopening, states have responded by slamming the throttle open on vaccination in hopes of heading off the worst harms of a self-inflicted fourth wave.
The dashboard is starting to blink red, just as the epidemiological models suggested it might, and there’s a narrow window to act before the effects of mass vaccination really kick in, a window in which roughly a thousand people die each day. The White House has pleaded with governors to keep restrictions in place just a bit longer, and the president has appealed to citizens directly to keep masking and social distancing until most everyone is vaccinated (hopefully by the Fourth of July holiday). But the coupling between the urgent recommendations of the Biden administration and action at the state and local level is remarkably loose. There’s just not a lot more that can reasonably be done from the federal level at this point to quash what could end up being a fairly significant fourth wave before mass vaccination begins to—as epidemiologist Ronald Scott Braithwaite phrased it to the New York Times—“win the tug of war” against the virus in mid-to-late May.
You got a sense of this feeling of helplessness when the new CDC director at a Monday press briefing tossed her talking points and said something you really would prefer not to hear from someone in her position: “I’m going to pause here … to reflect on the recurring feeling I have of impending doom.” She continued, audibly shaken:
We have so much to look forward to, so much promise and potential of where we are and so much reason for hope, but right now I’m scared. … I so badly want to be done. I know you all so badly want to be done. We are just almost there, but not quite yet. And so I’m asking you to just hold on a little longer, to get vaccinated when you can so that all of those people that we all love will still be here when this pandemic ends. … I’m calling on every single one of you to sound the alarm, to carry these messages into your community and your spheres of influence. We do not have the luxury of inaction. For the health of our country we must work together now to prevent a fourth surge.
(You can watch the briefing in full below)
The fourth surge almost certainly won’t be as severe as the winter wave, because of the number of people who’ve been vaccinated or already infected. But each new infection brings with it some risk, either to an individual or to the people they interact with, of hospitalization, long-term disability (this recent episode of The Daily on Covid-induced psychosis is revealing), or death.
So for the 70 percent of U.S. adults who have yet to receive their shots, the race is on: “Don’t let the virus get to you before the vaccine does,” as former CDC director Tom Frieden put it recently.
And the vaccines do work, remarkably well. A new report from the CDC out this week showed that under real-world conditions people who had received either the Pfizer or Moderna vaccines were 90 percent less likely to develop SARS-CoV-2 infections of any kind (either asymptomatic or symptomatic), with substantial protection coming within two weeks after receiving the first dose. Vaccinated people are far, far less likely to transmit the virus to others, though the protection is not foolproof. This means that it will still be advisable to wear a mask in public, especially in enclosed spaces, even after you’re vaccinated, until case counts come under control.
More encouraging vaccine news came this week about kids — trial data shows that the Pfizer vaccine is highly effective at generating an immune response in adolescents age 12 to 15, with no serious side effects. The trial was designed to measure the production of anitbodies, not whether or not the shot was effective at preventing infections, so it may still be a few months before the vaccine is cleared for the under-16 set.
There are problems with the vaccine rollout — crappy websites and insufficient capacity mean that as many as half of people who’ve tried to get a vaccine appointment recently have been unable to sign up; a manufacturing problem spoiled millions of doses of the Johnson & Johnson vaccine, which may cause a dip in the available supply — but the pace of vaccination has only increased in recent weeks, nearing an average of three million shots a day this week, which would mean that nearly every eligible American should have a shot in the arm by the end of July.
Soon enough, the center of gravity in problem-solving around vaccination will shift from getting the vaccine to people who want it to overcoming the hesitancy of people who don’t. This is a fight that will get harder over time. Polling shows that vaccine hesitancy is melting away, but that’s mostly coming from people who wanted to “wait and see” having… waited and seen. There’s a hard core of about 20 percent of Americans who would simply prefer not to get vaccinated, and those numbers have not budged over the last four months.
Some of this will be a fight against misinformation — another recent poll shows that people who have mistaken beliefs about the vaccines are dramatically less likely to get their shots:
And when it comes to misinformation, there’s certainly some effort by extremists to deliberately undermine confidence in vaccination, as this reporting shows.
But far more often what stands in the way is the clustering of people with similar anti-vaccine beliefs in “pockets of homogeneity,” as sociologists Kevin Estep and Pierce Greenberg put it in a recent paper. Sometimes people in groups convince each other that Covid isn’t a big deal, even if they’ve personally lost people to the virus, as this spectacular piece from Kaiser Health News illustrates.
Other people hesitate to get the vaccine because they simply don’t know enough about it, and worry more about the risks from intentionally injecting a to-them-unknown substance into their bodies — or their children’s — than they worry about the speculative risk of contracting the virus, which they feel they can control. That’s a major upshot of ongoing research by sociologist Jessica Calarco.
It’s also illustrated by this in-depth look at efforts by nursing homes to get their staff to accept vaccinations. The major lesson is that “everyone’s fears are real, whether or not they are grounded in science or in something they believe right now,” one nursing home executive told The New York Times: “Beliefs change with time or new knowledge, so we have to ride it out. Listen hard, don’t judge and let them move at their own pace.”
// Link Roundup
The toll of Covid: Mortality data from last year is still provisional, but the CDC reports that Covid-19 was the third leading cause of death for 2020, driving a staggering 15.9 percent increase in the age-adjusted death rate over 2019. Only cancer and heart disease killed more Americans last year than Covid-19 did.
— “Covid-19 Pushed Total US Deaths Beyond 3.3 Million Last Year.” Carla K. Johnson, The Associated Press.
— “Provisional Mortality Data — United States, 2020.” Farida B. Ahmad et al, CDC MMWR.Surprise! Governance matters! The 2018 Clade X pandemic tabletop exercise continues to loom large as a foreshadowing of the Covid-19 pandemic in the U.S. It predicted some of the inter-state tensions we experienced under the pandemic, issues with repatriating Americans from hotspots abroad, problems around quarantine at home, and the difficulty with rapid vaccine manufacturing, prioritization, and deployment. Two things it failed to simulate: the grave effect of social media disinformation and failures of political leadership at the highest levels of the government. Epidemiologist Christopher T. Lee and former CDC director Tom Frieden argue the Covid pandemic shows how bad national leadership can undermine even well-resourced and well-functioning public health systems.
— “Why Even Well-Prepared Countries Failed the Pandemic Test.” Christopher T. Lee and Tom Frieden, Foreign Affairs.
— “Association Between Preparedness and Response Measures and Covid-19 Incidence and Mortality.” Christopher T. Lee et al, medRxiv.War and pestilence: This review of a new book by tropical disease and vaccine specialist Peter Hoetz highlights the role of geopolitical instability in the emergence of deadly disease outbreaks.
— “The Politics of Stopping Pandemics.” Jerome Groopman, The New Yorker.GATACCACAGACG: Researchers at Stanford, using discarded residue from vaccine doses, sequenced the spike protein-encoding mRNA that powers the Moderna vaccine, and posted the genetic code on Github.
— “Stanford Scientists Post Entire mRNA Sequence for Moderna Vaccine on Github.” Tom McKay, Gizmodo.“The Secretariat of being wrong”: Sociologist Robert Merton theorized that some behaviors we consider deviant arise from the strain when a person becomes fixated on socially desirable goals but is disillusioned with the socially acceptable means of achieving them. “Frustration and thwarted aspiration lead to the search for avenues of escape from a culturally induced intolerable situation,” he wrote, “or unrelieved ambition may eventuate in illicit attempts to acquire the dominant values.” Writing in 1938, he used Al Capone as a textbook example. But social strain theory is the motor under the hood of most modern anti-hero drama (think Walter White). Anyway Merton didn’t think this kind of behavior was limited to actual criminal activity, but showed up in any pursuit in which people could come to value winning over the rules of the game. In journalism today, one of the ways this plays out is when people who’ve washed out of the legitimate path to media prestige pursue an audience instead by becoming say-anything contrarians. In The Atlantic this week, Derek Thompson profiles one of them.
— “The Pandemic’s Wrongest Man.” Derek Thompson, The Atlantic.
Commutelands: Many of us haven’t made our pre-pandemic commutes to work in more than a year, and the distance of time might have made you rethink a practice you used to take for granted. Writer and filmmaker Beau Miles got a new perspective on commuting, and the barren landscapes our roads and rails produce, by walking what is typically a 75-minute drive, foraging everything he needed along the way. It resulted in this fascinating short film below. You can find many more like it on his YouTube channel.
That’s it for this week! Share the newsletter with your soon-to-be-vaccinated friends and family, subscribe through the button below, and I’ll see you in your inbox next Saturday.