This piece by Susan Matthews is really helpful for those of us who are vaccinated and trying to figure out what their risks are regarding the much more transmissible delta variant of SARS-CoV-2. Covid-19 is endemic now — how do we live with that? What reasonable actions should we take to keep ourselves, our communities, and our loved ones safe?
All of this is making people — yes, probably mostly vaccinated people — rethink the basic questions they thought their vaccine had answered for them: Can I go to restaurants and bars unmasked? Can I go back to the office? Can I see my grandma? Can I go on vacation? Can I unmask at my people-facing job? Can I have a wedding, or a party? The answer to those questions is not quite as easy as “yes, if you’re vaccinated.” It depends partly on how many in your group are vaccinated, but the actual answer is basically the same as it’s been all pandemic: It depends on your risk tolerance, it depends on what is happening with case counts locally (though, as more people travel, this might become a less reliable tool), and it depends on any unique risk factors in your group. Kass’ perspective felt novel to me: She said she suspects that in the end, a lot of people are going to end up boosting their immunity by suffering through a mild case of COVID. So no one should feel that bad about getting sick after they’re vaxxed. What matters is getting the order right: “If everyone who gets vaccinated still gets COVID but doesn’t die, that’s a success,” she said. The issue is that it doesn’t feel like a success for vaccinated people. Plus, “if you get infected after you’re vaxxed, it’s all you talk about,” she said. And right now, that’s understandably freaking out a lot of vaccinated people who thought they were in the clear.
Dr. Brytney Cobia treats Covid-19 patients at the Grandview Medical Center in Birmingham, Alabama, a state that ranks last in the US in fully vaccinated adults. In a recent Facebook post, Cobia shares that people are willing to get vaccinated after having to watch an unvaccinated member of their family die from Covid.
I’ve made a LOT of progress encouraging people to get vaccinated lately!!! Do you want to know how? I’m admitting young healthy people to the hospital with very serious COVID infections. One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late. A few days later when I call time of death, I hug their family members and I tell them the best way to honor their loved one is to go get vaccinated and encourage everyone they know to do the same. They cry. And they tell me they didn’t know. They thought it was a hoax. They thought it was political. They thought because they had a certain blood type or a certain skin color they wouldn’t get as sick. They thought it was ‘just the flu’. But they were wrong. And they wish they could go back. But they can’t. So they thank me and they go get the vaccine. And I go back to my office, write their death note, and say a small prayer that this loss will save more lives.
After an inept coronavirus response, will the United States do better when the next pandemic strikes? Experts generally agree that America learned from the past year, and that the next public-health crisis won’t be quite as bewildering. But America’s pandemic preparedness still has major gaps, some of which are too big for any one administration to fix. In recent weeks, I’ve called back many of the experts I interviewed over the past 18 months about masks, testing, contact tracing, quarantine, and more. I asked them, “Are we ready for another one?” The short answer is “Not quite.” The long answer is that being truly “ready” will be harder than anyone realizes.
The Trump administration mishandled the American response to Covid-19 so completely that it’s tempting to pin most of the pandemic carnage on him. But the more I read about the pandemic (Michael Lewis’s The Premonition is a recent example), the more I have come to believe that the majority of the American pandemic deaths were baked in, no matter who was President. Trump was definitely a worst-case scenario, but even a more competent person in the White House in Jan 2020 (like Clinton or Sanders or Romney) would not have done so much better. Poor public health infrastructure, politicized government agencies, no mandatory paid leave, an overpriced healthcare system that only works for some, uncoordinated national response (+ federalism), years of defunding government programs, a reactive (rather than proactive) CDC, unhealthy populace, poverty, systemic racism in medicine, entitled individualism, high rate of uninsured people, growing anti-science sentiment — the pandemic was destined to race through the United States like a brush fire no matter what.
Even the European Union, whose member nations do not share many of America’s aforementioned challenges (but have other issues), did only marginally better than the US in preventing Covid deaths. The UK did worse:
While the Chinese government’s obstruction may keep us from knowing for sure whether the virus, SARS-CoV-2, came from the wild directly or through a lab in Wuhan or if genetic experimentation was involved, what we know already is troubling.
Years of research on the dangers of coronaviruses, and the broader history of lab accidents and errors around the world, provided scientists with plenty of reasons to proceed with caution as they investigated this class of pathogens. But troubling safety practices persisted.
Worse, researchers’ success at uncovering new threats did not always translate into preparedness.
Even if the coronavirus jumped from animal to human without the involvement of research activities, the groundwork for a potential disaster had been laid for years, and learning its lessons is essential to preventing others.
Is it possible that SARS-CoV-2 came from a lab? Yes. Is it probable? We can’t know that right now. It’s a tantalizing puzzle involving a possible cover-up, but irresponsibly assigning certainty to the situation does no one but attention-seeking pundits any good.
For many of us in the US and other parts of the world, with Covid-19 on the decline because of vaccinations, the last month or two has seen people getting back into the world for the first time since the pandemic began in early 2020. XKCD’s Randall Munroe plotted out some of these experiences on a scale from “normal” to “alarming”:
From its founding, the United States has cultivated a national mythos around the capacity of individuals to pull themselves up by their bootstraps, ostensibly by their own merits. This particular strain of individualism, which valorizes independence and prizes personal freedom, transcends administrations. It has also repeatedly hamstrung America’s pandemic response. It explains why the U.S. focused so intensely on preserving its hospital capacity instead of on measures that would have saved people from even needing a hospital. It explains why so many Americans refused to act for the collective good, whether by masking up or isolating themselves. And it explains why the CDC, despite being the nation’s top public-health agency, issued guidelines that focused on the freedoms that vaccinated people might enjoy. The move signaled to people with the newfound privilege of immunity that they were liberated from the pandemic’s collective problem. It also hinted to those who were still vulnerable that their challenges are now theirs alone and, worse still, that their lingering risk was somehow their fault. (“If you’re not vaccinated, that, again, is taking your responsibility for your own health into your own hands,” Walensky said.)
The pandemic demonstrated, in plain and easily understandable numbers of Covid deaths, that America is a place where the swift leave the stragglers to the wolves. I hope against hope that’ll change for the better in the future.
After watching this short film on how much data private companies are able to gather about you (data that we willingly give them in some cases), you might be forgiven for thinking that, never mind some far flung future, we are living in a full-on dystopia right now. The set design, the acting, the positioning of the tables, the see-through table tops, the laptop vs. notebook…this was really well done. When the interrogator got up from his desk, I viscerally felt the invasion of privacy.
Because of the remarkable Covid-19 vaccines, the pandemic is easing in America. In many parts of the country, things are returning to some semblance of normal, whatever that means. But many will continue to struggle and come to terms with what happened for awhile longer. Ed Yong, What Happens When Americans Can Finally Exhale:
But there is another crucial difference between May 2020 and May 2021: People have now lived through 14 months of pandemic life. Millions have endured a year of grief, anxiety, isolation, and rolling trauma. Some will recover uneventfully, but for others, the quiet moments after adrenaline fades and normalcy resumes may be unexpectedly punishing. When they finally get a chance to exhale, their breaths may emerge as sighs. “People put their heads down and do what they have to do, but suddenly, when there’s an opening, all these feelings come up,” Laura van Dernoot Lipsky, the founder and director of the Trauma Stewardship Institute, told me. Lipsky has spent decades helping people navigate the consequences of natural disasters, mass shootings, and other crises. “As hard as the initial trauma is,” she said, “it’s the aftermath that destroys people.”
And it wasn’t just the pandemic:
Not everyone will feel this way. Perhaps most Americans won’t. In past work, Silver, the UC Irvine psychologist, found that even communities that go through extreme traumas, such as years of daily rocket fire, can show low levels of PTSD. Three factors seem to protect them: confidence in authorities, a sense of belonging, and community solidarity. In the U.S., the pandemic eroded all three. It reduced trust in institutions, separated people from their loved ones, and widened political divisions. It was something of a self-reinforcing disaster, exacerbating the conditions that make recovery harder.
Also, let’s not forget: “Globally, the pandemic is set to kill more people in 2021 than in 2020.”
Since yesterday’s announcement, I’d been feeling uneasy about the CDC’s decision to update its guidance to state that fully vaccinated people don’t need to wear masks in most situations indoors or out. Zeynep Tufekci’s piece in the Times nails why.
It’s difficult for officials to issue rules as conditions evolve and uncertainty continues. So I hesitate to question the agency’s approach. But it’s not clear whether it was responding to scientific evidence or public clamor to lift state and local mandates, which the C.D.C. said could remain in place.
It might have been better to have kept up indoor mask mandates to help suppress the virus for maybe as little as a few more weeks.
The C.D.C. could have set metrics to measure such progress, saying that guidelines would be maintained until the number of cases or the number vaccinations reached a certain level, determined by epidemiologists.
The vaccine is on its way to controlling Covid-19 in the US — but we’re not there yet. We’re not the UK or Israel…they’re further along in their vaccination campaigns and their daily cases and deaths are way down, warranting behavioral changes. In the US, over 600 people/day are still dying of Covid-19 and our case positivity rate is still above 3%. Too many people, including almost all children, are still vulnerable and as Tufekci says, the CDC could have waited a few more weeks to more quickly drive down the virus levels.
Update: The CDC’s move has been sharply condemned by National Nurses United, the nation’s largest union of registered nurses:
“The union noted that more than 35,000 new cases of coronavirus were being reported each day and that more than 600 people were dying each day. “Now is not the time to relax protective measures, and we are outraged that the C.D.C. has done just that while we are still in the midst of the deadliest pandemic in a century,” Ms. Castillo said.”
And Ken Schultz notes that the needle the CDC is trying to thread here might not work out the way that they’d hoped.
Imagine the social preference ordering is:
1. Unvaccinated wear masks, vaccinated don’t.
2. Everyone wears masks.
3. No one wears masks.
Selfish, short-sighted behavior and the inability to monitor vaccination status mean that, in trying to get #1, you can end up at #3.
So I trust the CDC’s position that #1 is socially desirable from a scientific perspective. But by undermining mask mandates, they have made it more likely that we end up in #3, which science says is still risky. Living with #2 for now respects both science and social science.
When large, seemingly sudden systemic failures occur, Michael Lewis is one of those writers who’s just waiting to pounce on it and tell us all about it. So it’s not a surprise to see that his new book comes out tomorrow: The Premonition: A Pandemic Story (ebook). From a Time interview with Lewis:
The Premonition makes sense of the COVID-19 pandemic through three people, each of whom knows a great deal about how to stop it-and none of whom is ever approached by the U.S. government: A “redneck epidemiologist” named Carter Mercher who had written the closest thing the government had to a pandemic strategy; Joe DeRisi, a McArthur Fellow who once built a chip containing all the world’s viruses; and Dr. Chastity Dean, an obscure local health official in California.
True to form, Lewis makes few grand claims for what he finds, preferring instead to let the curated details speak for themselves. “I like to think that my job is mainly to find the story in the material,” he writes in the prologue. “I think this particular story is about the curious talents of a society, and how those talents are wasted if not led. It’s also about how gaps open between a society’s reputation and its performance.”
The main question running through “The Premonition” is how, when it came to the initial Covid response, a very rich country that was ranked first globally in pandemic readiness in 2019 managed to incentivize almost all the wrong things.
Of course, this is the reality that all of us have been living for the past year, so the failures of the system don’t come as much of a surprise. Still, Lewis finds ways not just to showcase the brokenness of the system writ large but to zoom in on the sand in the gears.
But Szalai also notes the drawback of most of Lewis’s books:
This method of hewing so tightly to his characters’ perspectives gives Lewis’s narrative its undeniable propulsion, but it also comes at a cost. He doesn’t supply any endnotes, or even a sense of how many people he talked to. His main characters are presented to us as they would undoubtedly like to appear: charmingly obsessive, unwaveringly principled and unfailingly right.
Anne Helen Peterson noticed a bunch of reports about fast food & retail businesses around the US having trouble finding employees, which difficulty the business owners are blaming on lazy American workers whose unemployment benefits have been extended/expanded during the pandemic. But what if, she writes, those benefits are actually providing a safety net to American workers so that they do not need to take terrible jobs for low wages at terrible companies under terrible management? The ‘Capitalism is Broken’ Economy:
Stick with me here, but what if people weren’t lazy — and instead, for the first time in a long time, were able to say no to exploitative working conditions and poverty-level wages? And what if business owners are scandalized, dismayed, frustrated, or bewildered by this scenario because their pre-pandemic business models were predicated on a steady stream of non-unionized labor with no other options? It’s not the labor force that’s breaking. It’s the economic model.
Unemployment benefits have offered a steady paycheck while you figure out your options. Put differently: a version of the safety net that’s been missing from most American employment, and, by extension, the ability to say no. No, I don’t have to work for a restaurant that only gives me my hours three days ahead of time, thus making it nearly impossible to find reliable childcare. No, I don’t have to work clopen shifts. No, I don’t have to expect a job without sick leave or paid time off. No, I don’t have to deal with asshole customers or managers who degrade me without consequence. No, I don’t have to work in a job with significant, accumulating health risks.
Her question near the end of the piece is worth considering: “If a business can’t pay a living wage, should it be a business?”
The second cover down, by Katrina Catacutan, is probably my favorite (the body language of the woman answering the door is just perfect) but the last image by Amy Young hit me like a ton of bricks. The New Yorker should run all of these covers for an issue of the magazine in a few weeks — collect them all!
In a letter published in The Lancet, a group of scholars argue, with an extensive review of the available evidence, that the primary mode of transmission from human to human of the virus responsible for Covid-19 is via aerosols, not through larger particles called droplets or through fomites (transfer from surfaces). Here are three of their ten reasons why:
Third, asymptomatic or presymptomatic transmission of SARS-CoV-2 from people who are not coughing or sneezing is likely to account for at least a third, and perhaps up to 59%, of all transmission globally and is a key way SARS-CoV-2 has spread around the world, supportive of a predominantly airborne mode of transmission. Direct measurements show that speaking produces thousands of aerosol particles and few large droplets, which supports the airborne route.
Fourth, transmission of SARS-CoV-2 is higher indoors than outdoors and is substantially reduced by indoor ventilation. Both observations support a predominantly airborne route of transmission.
Fifth, nosocomial infections have been documented in health-care organisations, where there have been strict contact-and-droplet precautions and use of personal protective equipment (PPE) designed to protect against droplet but not aerosol exposure.
The letter concludes with a plea by the authors for public health officials to finally embrace this reality: “The public health community should act accordingly and without further delay.”
I can’t believe we’re actually still arguing about this. One of the authors, Jose-Luis Jimenez, wrote this seminal Time magazine piece that provided the smoke analogy that is the mental model I’ve been using to think about potential risks during the pandemic.
When it comes to COVID-19, the evidence overwhelmingly supports aerosol transmission, and there are no strong arguments against it. For example, contact tracing has found that much COVID-19 transmission occurs in close proximity, but that many people who share the same home with an infected person do not get the disease. To understand why, it is useful to use cigarette or vaping smoke (which is also an aerosol) as an analog. Imagine sharing a home with a smoker: if you stood close to the smoker while talking, you would inhale a great deal of smoke. Replace the smoke with virus-containing aerosols, which behave very similarly, and the impact is similar: the closer you are to someone releasing virus-carrying aerosols, the more likely you are to breathe in larger amounts of virus. We know from detailed, rigorous studies that when individuals talk in close proximity, aerosols dominate transmission and droplets are nearly negligible.
Another of the authors, Zeynep Tufekci, has been arguing the case for aerosols (and masks & overdispersion) since early in the pandemic, and she succinctly explained in a Twitter thread how predominantly aerosol transmission fits with the mitigation methods that have really worked around the world:
Airborne transmission unites three things crucial to recognize for effective COVID-19 mitigation: transmission without symptoms (thus aerosols), clusters driving the epidemic (also aerosols) and masks/ventilation indoors being key (hey, also aerosols). This framework is coherent.
Her whole thread is worth a read — like this bit about how other respiratory pathogens are likely spread by aerosols and not droplets (as commonly believed):
Fascinatingly, you search the scientific record high and low, but there really is little to no direct evidence for gravity-sprayed droplets being predominant mode of transmission for respiratory illnesses outside of coughing/sneezing. It’s many… assumptions. Like a tradition.
If any good comes out of the pandemic at all, a better and more useful scientific understanding of how respiratory pathogens are transmitted would be a good start.
Update: One of the authors, Trisha Greenhalgh, responds succinctly to criticisms of the paper in this Twitter thread.
Criticism 1: “The paper is just opinion, and several authors aren’t even doctors.”
Response: No. It’s well-researched scholarly argument, produced by an interdisciplinary team of 6 professors including 3 docs, 2 aerosol scientists and 1 social scientist.
In 1955, epidemiologist Thomas Francis Jr. announced the results of a field trial of the polio vaccine that Jonas Salk had developed. America erupted in joy.
Now a phalanx of bulky television cameras focussed on Francis as he prepared to report on the efficacy of the vaccine. He had good news to share: to cheers from the audience, he explained that the Salk vaccine was sixty to seventy per cent effective against the most prevalent strain of poliovirus, and ninety per cent effective against the other, less common strains. All this had been shown through what was, at that time, the largest vaccine trial ever conducted.
All afternoon and evening, church bells rang out across America. People flooded into the streets, kissing and embracing; parents hugged their kids with joy and relief. Salk became an instant national hero, turning down the offer of a ticker-tape parade in New York City; President Dwight D. Eisenhower invited him to the White House and, later, asked Congress to award him a Congressional Gold Medal. That night, from the kitchen of a colleague’s house, Salk — whose name was being touted in newspapers, magazines, radio reports, and television news broadcasts around the world — gave his first network-TV interview to Edward R. Murrow, whose show “See It Now” had exposed the tactics of Senator Joseph McCarthy a year earlier. Blushing in admiration, Murrow asked the doctor, “Who owns the patent on this vaccine?” “The people,” Salk said, nobly. “There is no patent. Could you patent the sun?”
In the days that followed, schoolchildren were instructed by their teachers to write thank-you notes to Salk. Universities lined up to offer him honorary degrees. Millions of American doctors, nurses, and parents got down to the serious business of vaccinating their children against polio, using a shot they’d been anticipating for seventeen years.
But the polio vaccine rollout had its challenges, including a manufacturing negligence & oversight failure that resulted in tens of thousands of polio cases in otherwise healthy children.
In May, the polio vaccination drive was temporarily suspended. Leonard Scheele, the U.S. Surgeon General, inspected the facilities of all six vaccine companies and fired the government officials he considered to be culpable; the director of the N.I.H. and the Secretary of Health voluntarily resigned. New safety procedures were developed, including an improved means of filtering the viral mix just before the formaldehyde was added. Better tests were developed to detect live virus, and stricter record-keeping was instituted. The incident could have created a vaccine-hesitancy crisis. But, incredibly, the American public readily accepted the medical establishment’s explanation for the failure, and its pledges to right the situation. The nation’s trust in medical progress and in Dr. Salk was so resolute that, when it was announced that a new, safe polio vaccine was available, parents pushed their children back to the head of the line. It’s hard to imagine such an outcome today.
This is a very good and bracing essay from David Roth for Defector about a certain type of knee-jerk libertarian response to the pandemic in the US.
In place of any actually ennobling liberty or more fundamental freedom, contemporary American life mostly offers choices. But since most of these are not really choices at all in any meaningful way, it might be more accurate to say that we’re offered selection. The choice between paying for health insurance and running up six figures of non-dischargeable debt because you got sick, for instance, is honestly less a choice than a hostage situation. But because the second outcome is still extremely possible even if you choose to pay for health insurance, it’s more correct to say that the choice is already made, and that the decision is more about choosing from an array of variously insufficient and predatory options the one whose name or price or risk you like most. Sometimes there isn’t even that, and the choice is a binary one between something and nothing. None of this is really what anyone would choose, but these ugly individuated choices are what we get.
And then:
The broader complacent and unreasoned acceptance that props up our otherwise untenable status quo is shot through all these facile “it’s a private matter and a personal choice” formulations; if you have accepted that mostly useless choices between dreary outcomes are all you could ever get as a citizen in the wealthiest and most powerful country on earth, then you have also accepted that these choices are actually very important, and that making them is the thing makes you free. None of these personal choices actually make anything better for the person making them. In the case of the vaccine, those choices have devastating downstream impacts for all the people who glance off the choice-maker as they carve their personal hero’s journeys through the world. None of this matters as much as the idea that the choice is theirs to make.
The NY Times has a profile of Dr. Katalin Kariko, who struggled for decades against a system unwilling to consider and fund her ideas about how messenger RNA could be used to instruct cells inside human bodies to “make their own medicines”. Her work has culminated in two highly effective vaccines for Covid-19 and is being extended to produce possible vaccines for HIV, the flu, tuberculosis, and malaria.
Now Katalin Kariko, 66, known to colleagues as Kati, has emerged as one of the heroes of Covid-19 vaccine development. Her work, with her close collaborator, Dr. Drew Weissman of the University of Pennsylvania, laid the foundation for the stunningly successful vaccines made by Pfizer-BioNTech and Moderna.
For her entire career, Dr. Kariko has focused on messenger RNA, or mRNA — the genetic script that carries DNA instructions to each cell’s protein-making machinery. She was convinced mRNA could be used to instruct cells to make their own medicines, including vaccines.
Stat also wrote a piece about Kariko and the development of the mRNA vaccines. It seems like Kariko will be strongly considered for a Nobel Prize in Chemistry for her achievements. The Covid vaccines will save hundreds of thousands of lives alone, and if mRNA can indeed be harnessed to protect against HIV and malaria, the effect on the world will be immense. Give Kariko all the prizes and whatever she wants to be happy in life — she’s earned it and more.
But mRNA’s story likely will not end with COVID-19: Its potential stretches far beyond this pandemic. This year, a team at Yale patented a similar RNA-based technology to vaccinate against malaria, perhaps the world’s most devastating disease. Because mRNA is so easy to edit, Pfizer says that it is planning to use it against seasonal flu, which mutates constantly and kills hundreds of thousands of people around the world every year. The company that partnered with Pfizer last year, BioNTech, is developing individualized therapies that would create on-demand proteins associated with specific tumors to teach the body to fight off advanced cancer. In mouse trials, synthetic-mRNA therapies have been shown to slow and reverse the effects of multiple sclerosis. “I’m fully convinced now even more than before that mRNA can be broadly transformational,” Özlem Türeci, BioNTech’s chief medical officer, told me. “In principle, everything you can do with protein can be substituted by mRNA.”
Produced by BBC Studios Natural History Unit and narrated by David Attenborough, The Year Earth Changed is an upcoming documentary that looks at what happened to the natural world when much of the world’s human population stayed indoors for a few months.
From hearing birdsong in deserted cities, to witnessing whales communicating in new ways, to encountering capybaras in South American suburbs, people all over the world have had the chance to engage with nature like never before. In the one-hour special, viewers will witness how changes in human behavior — reducing cruise ship traffic, closing beaches a few days a year, identifying more harmonious ways for humans and wildlife to coexist — can have a profound impact on nature. The documentary, narrated by David Attenborough, is a love letter to planet Earth, highlighting the ways nature bouncing back can give us hope for the future.
The Year Earth Changed debuts on Apple+ on April 22, aka Earth Day. (I can’t believe they resisted calling this Nature Is Healing though…)
Related to my post from last month about what a 95% or 66% efficacy rate of a vaccine even means, Vox made a clear and concise video about why comparing vaccine efficacy rates is difficult — trials were done in different countries with different variants under different conditions with different levels of disease — and why protection against severe illness, hospitalization and death is a better way to compare and evaluate these vaccines. As this chart from Dr. Eric Topol shows, all of the major vaccines show strong protection against severe illness.
I thought this interview with Dr. Ashish K. Jha, dean of the Brown University School of Public Health, was really good and useful in terms of calibrating expectations with regard to the “end” of the pandemic, vaccines, and variants. On the guidance that vaccinated people should be getting:
I think it is essential that we give guidance to people. And I think we should give guidance to people on what they can do safely once they are vaccinated. People say, “Can your behavior change?” My answer is: absolutely! That’s a major motivation for getting vaccinated. First of all, what’s very clear to me is vaccinated people hanging out with other vaccinated people is pretty darn close to normal. You don’t have to wear a mask. You can share a meal. The chance that a fully vaccinated person will transmit the virus to another fully vaccinated person who then will get sick and die … I mean, sure, people get struck by lightning, too. But you don’t make policy based on that. And we need to remind people that there is a huge benefit to getting vaccinated, which is that you are safe enough to do the things you love with other vaccinated people.
After getting his second dose of the Covid-19 vaccine at a clinic at Berkshire Community College, Yo-Yo Ma got out his cello and performed a 15-minute impromptu concert for the others folks at the clinic.
When Ma had first visited the clinic for his first shot, he did so quietly, taking in the surroundings, staff said. But brought his cello when he returned for the second shot.
Staff described how a hush fell across the clinic as Ma began to play. “It was so weird how peaceful the whole building became, just having a little bit of music in the background,” said Leslie Drager, the lead clinical manager for the vaccination site, according to the Washington Post.
Why is it weird? Music is amazing. I know you could never get such a “frivolous” spending measure through an American deliberative body these days, but how awesome would it be for the government to commission out-of-work musicians to play at vaccination clinics? Ok maybe you couldn’t have anyone sing and the brass & woodwinds would probably have to sit this one out, but you could have strings, guitars, percussion, pianos, DJs, etc. there to play some relaxing, uplifting, or energetic music, according to local custom & culture. Bring back the WPA!
According to a study conducted by the Pew Research Center, among those people who said they probably or definitely won’t get a Covid-19 vaccine, the top two reasons given were “concern about side effects” and “the vaccines were developed and tested too quickly”. For our purposes here, I’m going to ignore the first concern — the data is pretty conclusive that, on average, the vaccine side effects are minimal when compared to the effects of actually contracting Covid-19 — and focus on the quick development timeline. If you’re among those who are apprehensive about the unprecedented speed at which the world’s governments and scientific community mobilized to create several effective Covid-19 vaccines, I hope the following will help you make a good decision.
In reading a bunch of different resources (linked below throughout), I identified six main reasons why the Covid-19 vaccines were developed so quickly compared to past efforts.
1. The need was urgent. Covid-19 changed the entire world in a very short span of time and it was evident in the absence of an effective vaccine, tens of millions more people would unnecessarily die and/or suffer and the rest of us would be living in fear of disease and death. This urgency drove several of the other factors here: the availability of funding, resources, and collaboration.
2. Funding & focus. Companies and governments threw billions and billions of dollars at this. Companies, research centers, and scientists dropped other stuff they were working on to study SARS-CoV-2 and Covid-19. Governments prioritized regulatory approval for trials, etc. From a thread by Dr. Kat Arney:
Relatively few in the scientific, pharma & policy worlds care about vaccines compared w/ drugs. Most vaccine programmes are underfunded as they’re perceived as not profitable, only relevant to LMICs, & have few research groups/companies working on them. Getting funding & research capacity for vax usually takes months/years. COVID-19 vaccine was a massive global research effort w/ $millions for multiple groups/projects in weeks. Years of funding cycles & lab research happened in months, huge amount of time saved.
We proceeded at risk. So people say, what do you mean by “at risk”? Are you risking safety? Are you risking scientific integrity? No, it’s a financial risk. In other words, you invest in things that cost a lot of money before you even have an answer to whether the prior step worked.
And a classic example is the production of large scale amounts of clinical lots, which have been produced and are being produced before you even know that your vaccine works, so that you have hundreds of millions of doses ready to go. If the vaccine works, you’ve saved many months. If the vaccine doesn’t, you lost a lot of money, to the tune of hundreds of millions if not billions of dollars. But it was felt it was worth that investment and that risk financially in order to save time.
3. Availability of volunteers & high incidence of disease. In order to statistically show the vaccine works, you need people to test it on and you need enough people in the studies to get sick. Kat Arney again:
To show vax effectiveness, you need a high number of people with the disease in the population — big problem with the Ebola vax is that it took so long to develop the outbreak was over & the couldn’t get enough numbers to conclusively show it worked
We’re in a global pandemic — the vaccine is being tested in places with very high community prevalence, so trials can hit pre-determined statistical milestones very quickly. Huge amount of time saved.
Hundreds of thousands of people around the world volunteered to test these vaccines — without them, we’d be months and years away from a safe, tested vaccine.
4. International & corporate collaboration. Countries and companies shared research, data, and resources because the primary goal was to develop effective vaccines and save lives, not make a profit. For instance, Chinese researchers posted the genome for SARS-CoV-2 on January 11, 2020, allowing the effort to develop a vaccine to begin.
5. We knew a lot about coronaviruses from previous work. This wasn’t an effort that started from scratch. From Bloomberg:
The Pfizer-BioNTech and Moderna vaccines may seem brand new, but they are the culmination of more than a decade of work that started during the SARS and MERS outbreaks. Vaccines were even developed against MERS but were never needed. Nevertheless, scientists learned a huge amount from working with that virus, which is from the same family as the one that causes Covid-19.
Really, most of the vaccine platform development work is already done. You just have to do the remaining part, which is adding the right viral antigens to the already-proven platform and making sure it’s safe and effective in humans. Even in just the last five to 10 years, we’ve made big leaps in developing new kinds of vaccine platforms like those being tested for SARS-CoV-2.
6. Scientific and technological capability. Ok, we know a lot about coronaviruses but humanity’s general scientific and technological abilities have never been stronger or more powerful. Again from Bloomberg:
Remember also that technology has evolved rapidly — for example, we’re now about able to sequence the genomes of every mutant version of the virus in less than a day. That helps in speeding up vaccine development.
However we have collectively now shown that with money no object, some clever and highly motivated people, an unlimited pool of altruistic volunteers, and sensible regulators that we can do amazing things.
Several things happened on 3/11 that made Americans and their government finally realize that our lives were about to significantly change: the stock market plunged, the NBA suspended its season after a player tested positive, the WHO called it a “pandemic” for the first time, Trump addressed the nation and announced a ban on travel from Europe, and Tom Hanks & Rita Wilson announced that they had tested positive for the virus.
Claudia Sahm: Frankly, the night before, the 10th, I was in a bit of a panic because I was worried that I was overreacting. It was like gaslighting the way Trump and Republicans and Fox News would talk about the coronavirus. Like, “We’ve got this one, it’s not a big deal. It’s like the common flu.” Listening to that, I was saying, “We need to get going.” Congress needs to do real things. That morning, I stood in front of the House Democrats at the minority whip breakfast and told them what they needed to do with a relief package. I told the House Democrats that the $8.3 billion package that they had passed the week before was an insult.
DANIEL MERTZLUFFT, director of Ratatouille: The TikTok Musical, who was then in a Broadway theater audience: In the three hours I was seeing Company, the world had changed. I went to drinks after work with friends, one of whom is a business owner that works in theater marketing, and I remember him arriving at the bar and sort of realizing for the first time what it must have been like on the day the Great Depression started. What he said was, “This is not a month; this is going to be months. My business no longer exists. I have to fire my entire team.”
The Trump, Hanks, and NBA news all hit within a period of 30 minutes — I vividly remember being on Twitter and texting w/ friends as the news rolled in that evening. I’d stocked up on food & such during the last week in February and had been fully convinced the day before by this video on the exponential growth of epidemics that this was going to be a world-changing event, but the pace of events that evening was unprecedentedly dizzying. (via the morning news)
Conditions may be ripe for a better summer, however. Vaccine supplies should be flowing more freely, at least in the U.S.; the Biden administration now expects enough vaccine doses in hand for all adults by the end of May. With most vulnerable populations protected, there should be fewer hospitalizations and deaths. And with warmer weather, people can return to outdoor life.
Widespread transmission of the virus could be replaced by more sporadic and localized outbreaks. There’s also growing evidence that vaccines don’t just protect people from getting symptomatic Covid-19, but can reduce transmission.
And in the long-term, well, SARS-CoV-2 will be around for years and even decades to come:
Years from now, SARS-CoV-2 could join the ranks of OC43, 229E, NL63, and HKU1 — the four endemic, seasonal coronaviruses that cause a chunk of common colds every year. Essentially, our immune systems — primed by vaccines, boosters, and previous encounters with the coronavirus — will be ready to knock back SARS-2 when we see it again, potentially blocking an infection or leading to one that causes no symptoms or maybe just the sniffles.
It’s good to read stuff like this — it provides a basis to use when calibrating your optimism or pessimism for future activities and desires.
After the Biden administration announced they will have enough Covid-19 vaccine supply to cover every single adult in the country by the end of May, I got to wondering about what they were going to do with the tens & hundreds of millions of surplus doses already procured for the remainder of the year. “Oh,” I thought, naively, “We’ll be able to distribute it to countries that can’t easily procure or manufacture vaccines of their own!” And I’m sure some of that will happen, if only for PR purposes. But it’s perhaps more likely that America will practice vaccine diplomacy and use the stockpile to reestablish its global leadership.
The United States has backed away from the world. This isn’t a Clinton thing or a W Bush thing or an Obama thing or a Trump thing or a Biden thing, but instead a United States thing. The American people lost interest in playing a constructive role in the world three decades ago, and America’s political leadership has molded itself around that fact. Trump may have been instinctually and publicly hostile to all things international, but Biden is only different in tone. Biden’s Buy-American program is actually more anti-globalization than Trump’s America-First rhetoric as it is an express violation of most of America’s international trade commitments. TeamBiden says it wants to reestablish America’s global leadership…but it plans to do so without any troops or money. Sorry, but that’s not how it works.
Which makes the possibilities for vaccine diplomacy wildly interesting. The United States has no responsibility to provide COVID vaccines to the world. It can — it will — distribute them, but it will want something in return.
Even if you disagree with some of the analysis here, it will be interesting to watch where America’s stockpile ends up. Given Biden’s rhetoric of “listening to the science” when it comes to the pandemic, I hope that at least some of that supply goes to places that need it most to make certain the pandemic doesn’t sputter on for years, generating potentially dangerous new variants, even if it’s politically disadvantageous.
Like three dozen other countries, the United States contracted with multiple vaccine companies for several times the number of doses needed to cover its population. No one knew at the time which, if any, of the candidate vaccines would work or when they might prove safe and effective. But by now, most of the prepurchased vaccines appear to offer solid protection — which means many countries will receive far more vaccine than they need. The excess doses the United States alone may have by July would vaccinate at least 200 million people.
A chart in the article notes that the US has procured enough vaccine to cover almost 1.5 billion people after fully vaccinating its entire population.
Zeynep Tufekci has written an important piece for The Atlantic on the mistakes that the media, public health officials, and the public keep making during the pandemic and how we can learn from them. A big one for me is how scientists & other public health officials and agencies communicate their knowledge to the public and how the media interprets and amplifies those messages.
Thus, on January 14, 2020, the WHO stated that there was “no clear evidence of human-to-human transmission.” It should have said, “There is increasing likelihood that human-to-human transmission is taking place, but we haven’t yet proven this, because we have no access to Wuhan, China.” (Cases were already popping up around the world at that point.) Acting as if there was human-to-human transmission during the early weeks of the pandemic would have been wise and preventive.
Later that spring, WHO officials stated that there was “currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection,” producing many articles laden with panic and despair. Instead, it should have said: “We expect the immune system to function against this virus, and to provide some immunity for some period of time, but it is still hard to know specifics because it is so early.”
Similarly, since the vaccines were announced, too many statements have emphasized that we don’t yet know if vaccines prevent transmission. Instead, public-health authorities should have said that we have many reasons to expect, and increasing amounts of data to suggest, that vaccines will blunt infectiousness, but that we’re waiting for additional data to be more precise about it. That’s been unfortunate, because while many, many things have gone wrong during this pandemic, the vaccines are one thing that has gone very, very right.
This pair of statements she highlights — “no clear evidence of human-to-human transmission” and “There is increasing likelihood that human-to-human transmission is taking place, but we haven’t yet proven this, because we have no access to Wuhan, China” — are both factually true but the second statement is so much more helpful, useful, and far less likely to be misinterpreted by people who aren’t scientists that making the first statement is almost negligent.
A film crew from the NY Times recently spent several days in the Covid-19 ICU in Arizona, at the time one of the hardest hit places in the world. Two of the nurses wore GoPro cameras while working to witness what they did on a daily basis — the 12-hour days, the grief, the care, the constant death. This video is incredible and incredibly difficult to watch — you actually see a patient die on camera, surrounded by nurses and family (virtually).
So many Americans have died in hospitals without family by their side, but they were not alone. Nurses brush patients’ teeth, change their catheters and hold their hands in their final moments.
At the beginning of the video, one of the nurses says, “Unless you’re actually in there, you have no idea.” Thanks to their willingness to share their experiences, now we at least have some idea.
Update: Vox talked to some ICU doctors about what it’s like for their patients when they die from Covid-19. Because of patient confidentiality and the contagious nature of the disease, society (and even the families) has been “protected and sheltered from seeing the worst of this disease”.
Imagine trying to breathe through a very narrow straw, says Jess Mandel, chief of pulmonary, critical care, and sleep medicine at UC San Diego Health. “You can do that for 15 to 20 seconds, but try doing it for two hours.” Or for days or weeks.
Patients struggling through low oxygen levels like this have told Kenneth Remy, an assistant professor of critical care medicine at Washington University School of Medicine in St. Louis, that it feels like a band across their chest or that their lungs are on fire. Or like a thousand bees stinging them inside their chest. Others might have thick secretions in their lungs that make it feel like they are trying to breathe through muck. Many people say it feels like they’re being smothered.
The ordeal is so taxing that many wish for death. “You hear the patients say, ‘I just want to die because this is so excruciating,’” Remy says. “That’s what this virus does.”
In popular press and social media, there’s been a misunderstanding of what is actually meant when scientists say that the Pfizer and Moderna Covid-19 vaccines have an efficacy of 94-95%. It does not mean that 95% of vaccinated people are protected from infection — these vaccines are better than that. Dr. Piero Olliaro explains in a letter to The Lancet:
The mRNA-based Pfizer and Moderna vaccines were shown to have 94-95% efficacy in preventing symptomatic COVID-19, calculated as 100 x (1 minus the attack rate with vaccine divided by the attack rate with placebo). It means that in a population such as the one enrolled in the trials, with a cumulated COVID-19 attack rate over a period of 3 months of about 1% without a vaccine, we would expect roughly 0.05% of vaccinated people would get diseased.
Another way to put it: you’re 20 times less likely to get Covid-19 with a vaccine than without. (And again, data indicates these are safe vaccines.) Olliaro explains with some simple math:
If we vaccinated a population of 100,000 and protected 95% of them, that would leave 5000 individuals diseased over 3 months, which is almost the current overall COVID-19 case rate in the UK. Rather, a 95% vaccine efficacy means that instead of 1000 COVID-19 cases in a population of 100,000 without vaccine (from the placebo arm of the abovementioned trials, approximately 1% would be ill with COVID-19 and 99% would not) we would expect 50 cases (99.95% of the population is disease-free, at least for 3 months).
And of course if you vaccinate widely, it becomes a compounding situation because the virus just runs out of people to infect.
Over the past week or two, I’ve read a number of articles and threads about why Covid-19 cases are falling so rapidly in the US. The explanations have all been somewhat unsatisfying to me. Cases have indeed dropped off quite quickly and it happened pretty uniformly all over the country. Look at the mini state graphs on the NY Times Covid page — they all look about the same. Hospitalizations and positivity rates have dropped too, so while the number of daily tests has fallen too, this appears to be a real drop and not just an artifact of a lack of testing. Which is great news! Imagine a February and March that looked like December — a disaster compounded.
The vaccine explanation is the weakest one for me: not enough people outside of healthcare workers had gotten them early enough to start bending that curve sharply downward in early January. But as Thompson notes, it could be having more of an effect on hospitalizations because the folks getting shots (and therefore immunity against severe infection) are those most likely to end up in hospitals due to infection. And obviously, vaccines are going to become the dominant factor in falling case numbers as more and more people get jabbed.
I’m also skeptical of the seasonality argument, but (again, as Thompson notes) there’s a lot we don’t know about how temperature, sunlight, humidity, and this specific coronavirus interact. Obviously Covid-19 is a seasonal thing and that’s definitely a contributing factor here, but that sharp of a drop in early January? I don’t know if it’s the primary driver here. Also, the seasonal flu typically peaks in February in the US.
I think the most logical explanation is one proposed initially by @mgmgomes1 and others — namely that we are seeing the effects of population immunity with heterogeneous mixing + strong behavioral effects. Take a(n overly) simple example. Assume 60% of a population has zero respiratory contacts, while the other 40% lives life as normal. If 75% of that high-mixing group has immunity (e.g., 30% population seroprevalence), you could easily see herd effects.
Basically, a large percentage of the folks at the greatest risk of getting Covid-19 in the US (i.e. folks who aren’t able or willing to keep from seeing other people and/or take proper precautions) have gotten it, resulting in a sort of localized “herd immunity” among those folks. After the massive holiday surge in cases (more on that in a sec), this hypothesis suggests, the virus started running out of people to infect and rates dropped quickly. This is the first explanation I read that really made sense to me.
Thompson leads off his piece with the behavioral explanation: “Maybe Americans finally got the hang of this mask and social-distancing thing.” I do not buy that people who previously weren’t doing so before suddenly started wearing masks (or better masks), keeping distant, spending less time indoors with others, and staying home from work started doing so in numbers large enough to cause such a sharp downturn. But you can’t consider the decline without also looking at how cases got so high in the first place. Here’s Steven Johnson on Twitter, zooming out a few months:
[It’s] not so much that people got the hang of social distancing, but rather that the holiday season compelled people to relax social distancing for in-person family gatherings. So the current decline is mostly reversion to where we were in Oct-Nov.
Yes, this. Without these holidays, we may have seen much more of a winter plateau than a spike. So here’s what seems plausible to me. As the cold weather made the coronavirus more effective at infection, people gathered for Halloween, Thanksgiving, Hanukkah, Christmas, and New Year’s — each subsequent holiday building on the previous one — and it pushed cases much higher than they would have been without those major gatherings. After two months of massive infection rates, the virus burned itself out among the high-mixing group and everyone else retreated back into their homes and pods to hunker down, resulting in the steep decline we’re seeing.
Obviously, careful scientific study will be necessary to tease out how significant each of these (and other!) causes were to the holiday spike and subsequent decline. But for now, the way forward is continuing to social distance, wear (better) masks, limit close contacts, and get people vaccinated — before B.1.1.7 and the other variants hit.
This guide to Covid-19 variants (SARS-CoV-2 viruses that have evolved changes to meaningfully alter their behavior) by Michaeleen Doucleff and Meredith Rizzo at NPR cleverly visualizes how mutations of the virus’s spike proteins help bind it more easily to ACE2 receptors on human cells. The key to the visualization is Meredith Miotke’s illustrations of the viruses using Lego pieces to represent the virus spikes and cell receptors. The usual SARS-CoV-2 has 1x1 Lego pieces that can bind with 1x2 pieces, like so:
But, as everyone who has ever worked with a Lego set knows, a 1x1 piece stuck to a 1x2 piece is not super stable. So when a version of the virus with a 1x2 piece shows up, it’s able to form a better connection to the 1x2 receptor:
The analogy breaks down if you look too hard at it1 but for many people, it can be a quick way to get the gist of the mechanism at work here. (via @EricTopol)
This is a huge pet peeve of mine when people try to poke holes in analogies: by definition, all analogies break down if you examine them too deeply. An analogy is a comparison of two different things that are similar in significant respects. If they were the same in every respect, it’s not an analogy…you’d just be describing one thing.↩
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