We May Be Done With the Pandemic but the Pandemic Isn't Done With Us
And by "us" I mean ALL of us
During a primetime address back in March, President Biden told the country that come Independence Day, we as a nation would “begin to mark our independence” from the coronavirus. Since that speech, tens of millions of Americans have received the coronavirus vaccine and the country has almost fully reopened. With the Fourth of July two weeks behind us, most Americans are treating the pandemic as a thing of the past.
Turns out viruses, uh, find a way.
Not that it was that hard. Since Independence Day, cases are clearly on the rise nationally. Last Friday, the country reported over 51,000 new cases, which is where we were last October. Every state has seen their number of new cases climb, with all but eight reporting at least a 50% increase over the past two weeks and thirty states reporting a triple-digit increase. Hospitalizations these past two weeks have also curved upward by 34%. There are full-blown outbreaks in 40% vaccinated Missouri and 35% vaccinated Arkansas (where the current surges are exceeded only by last winter’s spike) and 48% vaccinated Florida (where cases are back to April’s peak; the state alone accounts for 20% of the nation’s new cases.) Los Angeles County, California, recently reinstituted its indoor mask mandate.
One way to look at these higher numbers is that a surge of new coronavirus cases was expected after the country reopened. This might be one final bump in the stats before the pandemic recedes from view. And so far, the bump has been relatively mild…or at least mild by 2020’s standards, which even on its best day was still pretty awful. That’s a hell of a place to be with a highly effective and readily available vaccine at our disposal.
The good news, of course, is that the vaccines work. A lot has been written about this, but I don’t think the country still fully appreciates how amazing it is that these vaccines proved to be so effective and were developed so quickly (although the next time the Joker releases a toxin on Gotham City and Batman rushes back to the Batcave and whips up an antidote in, like, half-an-hour, yeah, I ain’t buying that.) I am a little worried about breakthrough cases not because I didn’t expect that—the vaccine isn’t 100% effective even if it is highly effective—but because I’m hearing about more cases like those involving players from the New York Yankees or members of the Texas Democratic legislative delegation hiding out in Washington DC who all have breakthrough cases at the same time. That suggests to me there’s something more potent about the strain of virus they were exposed to. Still, the breakthrough cases have produced mild symptoms and there really haven’t been that many and I’ve read I’m not supposed to worry about them too much so, yeah, I’m not going to worry about them too much. (Fingers crossed.)
What we’re left with, then, is what CDC director Rochelle Walensky calls a “pandemic of the unvaccinated,” with the unvaccinated accounting for 97% of all COVID-related hospitalizations and 99.5% of all COVID-related deaths. So, who hasn’t gotten the vaccine yet? According to a Kaiser Family Foundation poll published at the end of last month, over half the respondents in nearly every subgroup they measured reported getting at least one shot; the only group that didn’t was uninsured Americans under the age of 65 (48%). The groups with the lowest vaccination rates were Republicans (52%), rural residents (54%), 18-29-year-olds (55%), white evangelical Christians (58%), 30-49-year-olds (59%), and adults without a college degree (59%). In other words, those Americans who are least likely to be vaccinated are those who are perhaps worried about costs associated with getting the vaccine (uninsured Americans), those with a sense of “invincibility” or a feeling that should they catch the virus they won’t get too sick (young people), those who live in less populated areas with low population densities (rural residents), and those who are politically conservative.
Meanwhile, the CDC has said “fully vaccinated people can resume activities without wearing masks or physically distancing.” I’m not one to doubt the CDC when it comes to medical science. My inner social scientist, however, has me worried we’ve gotten ahead of ourselves in this country when it comes to how we’re dealing with the end of this pandemic. Emily Landon, chief infectious-disease epidemiologist at University of Chicago Medicine, told the Washington Post over the weekend that she thinks the CDC’s mask guidance is “insufficient”:
Landon…said the CDC should have included parameters on the mask rules, such as establishing a threshold allowing unvaccinated people to go without masks only if a certain percent of the population is inoculated.
“I think the CDC in May made a mistake,” Landon said. “They made a recommendation based on biological science, but not any social science. Unfortunately, the policy of letting people self-sort into vaccinated and unvaccinated resulted in a sort of behavioral science problem.”
Landon makes a great point: Ending the pandemic in the United States is now as much a behavioral problem as it is a biological problem. The biological problem (How do we keep people from getting sick and dying from the virus?) isn’t going away until either the behavioral problem (How do we get people to do the thing that will keep them from getting sick and dying from the virus?) is solved or the virus simply runs out of people it can infect.
Getting someone to behave in a certain way might be a matter of persuasion, inducement, or enforcement. Unfortunately, when the CDC declared that vaccinated people no longer needed to wear a mask (which was sound advice as a matter of biological science) it lost a significant tool it could have leveraged to address the behavioral problem at the heart of the pandemic. Instead, it fostered something like a free rider problem: Unvaccinated people could now enter public places without masks and leave it up to others to get the shot to stop the virus’s spread. With all these unvaccinated people circulating in public again but without the protection of masks, though, a surge in cases was predictable.
There is support for this theory in June’s Kaiser Family Foundation poll. It turns out if people think the pandemic is over or at least coming to an end—which, I would argue, could be signaled by lifting mask mandates—then people are less likely to get a vaccine:
Public optimism about the end of the pandemic has the potential to hinder further vaccination efforts if low case rates decrease people’s sense of risk and therefore decrease their sense of urgency about getting vaccinated. The latest Monitor finds some evidence that this may be happening to a certain extent among unvaccinated adults. Overall, 73% of the public feels that “more people need to get the vaccine to help stop the spread of COVID-19,” while 22% say the number of cases “is so low that there is no need for more people to get the vaccine.” While the vast majority (91%) of vaccinated adults say that more people need to get vaccinated, half of unvaccinated adults say cases are so low that additional vaccinations are not necessary. This includes 43% in the potentially convertible “wait and see” group as well as two-thirds of those who say they will “definitely not” get the vaccine.
Granted, a lot of those who refuse to get vaccinated probably weren’t masking much anyway, but we’ve made it a whole lot easier for them to go without now that we’ve told a good chunk of the population they no longer need to wear masks. Maybe it would have been better for the CDC to recommend both unvaccinated and vaccinated people continue wearing masks until a certain percentage of people nationally had received the vaccine and case numbers dropped and remained below a certain threshold for a certain period of time. A pandemic, after all, is not something that happens to people on an individual-by-individual basis; it’s something that happens to a group of people. A vaccine does not liberate an individual from the pandemic even if it offers them strong protection against getting sick; the vaccine is instead the tool society uses to stop the pandemic. The pandemic is a social problem that ends once society defeats it. It requires social coordination.
I’m vaccinated, but for the most part, I still wear a mask when I’m out and about. I’ll take it off when I’m in the company of vaccinated people I trust. If I’m dining out, I still prefer to eat outside, but if a space is big and it isn’t crowded, I wouldn’t object to sitting inside. If I’m out shopping, though, I’ll almost always put on a mask. I do so in part because I have a daughter who is still too young to get a vaccine and after more than a year of Zoom school, I really don’t want her catching this virus now that the end is in sight. I understand everything they’ve said about the odds of kids getting sick from the virus, but my mask is just an extra layer of protection for her, who the CDC still advises to mask up in public.
Still, many vaccinated Americans would tell me it is ridiculous to continue wearing a mask since the vaccines work extraordinarily well. And I admit that’s a very legitimate point. As a matter of science, they’re factually correct. They could even argue from a behavioral perspective that when vaccinated people wear masks, they undermine public confidence in the vaccines because their own behavior suggests they aren’t confident in the efficacy of the vaccine. After all, what good are the vaccines if we’re still wearing masks? That’s probably the logic a lot of public figures, including Biden, followed when they began saying and demonstrating that vaccinated people no longer need to wear masks in public. I respect that point of view.
But now it feels like we’re stuck again. As I mentioned earlier, hopefully this is all just one final surge of cases before the pandemic burns itself out, but the rise in cases is unsettling. The pandemic isn’t done with us and we need a new behavioral approach to getting shots in the arms of the nation’s unvaccinated. The key, of course, will be convincing (and, perhaps in some cases, compelling) the unvaccinated to get vaccines. Shut downs would go too far at this point, but we should consider reinstalling mask mandates.
Upon reflection, I guess the main reason I still wear a mask is that deep down I still believe that maybe we’re a country that can work together to solve big collective problems. Asking the vaccinated to continue wearing a mask isn’t a “punishment,” as the L.A. County Sheriff recently suggested when he said he wouldn’t enforce the county’s newly re-imposed mask mandate. It’s a matter of national solidarity: Get a shot and keep wearing your mask for your fellow citizen’s sake, and when we’ve collectively beaten this virus, we’ll declare an end to this pandemic together as one.
Maybe that’s just dumb and naïve. If this last year has taught me anything about politics, it’s to expect to be disappointed and not get my hopes up. It could be that me wearing that mask is some quixotic personal crusade to make the country a better place. Or a quixotic personal crusade to convince myself this country is better than I think it is.
I’ve been told not to worry about the unvaccinated since, at this point in the pandemic, if they had wanted a vaccine, they would have gotten one. In other words (to take this to a dark place) it’s their funeral. But as easy as it would be for me to write people off that way—and it isn’t hard to imagine me getting to that point—right now I just can’t. Those who haven’t gotten their shots need to get them ASAP and still need to wear masks. That remains the most urgent task. But asking the vaccinated to keep wearing masks in public places as a matter of national solidarity in the waning months of this national crisis still strikes me as a decent, patriotic, and prudent course of action.
Photo credit: Engin Akyurt (Pexels.com)
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A Reader Comments on My Ransomware Article
If you didn’t get the chance, check out the article I wrote about ransomware attacks here. A reader wrote to add some extra insight. It’s really useful; I reprint it here in full.
To me, any discussion of conflict in cyberspace needs to consider carefully the strategic doctrine advanced by the US Cyber Command.
It commits US forces to the doctrine of "defend forward,” which is defined as "persistent engagement" and capacity to disrupt all the cyber assets of any potentially adverse party. It announces that US cyber assets are continually perfecting the capacity to disrupt any cyber-related asset and rejects any conception of limits to intervention in the cyber battlespace. Weapons in cyberspace cannot be bench-tested, nor can they be field-tested the way a kinetic weapon can be tested on the range. You do not know if a cyber weapon system is operational until is has indicated functional operation in the adversary’s space.
To me this doctrine is an essential to understanding the current history of conflict in this domain. Stuxnet was not a one-off exhibition of a capability. One has to take the US cyber command at its word. It is operationally mobilized in Russia and elsewhere, or else the claims of persistent engagement by the US Cyber Command are a lie. Is Russia starting a cyber war? Or simply exhibiting its capacity to react through state actors and while taking a permissive attitude toward its private ones. Who started this fight anyway?
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I’ll be on the road for the next few days so there won’t be an article this Friday. Hope to see you back next Tuesday. In the meantime, have a great week!
Exit music: “Waiting on a Friend” by the Rolling Stones (1981, Tattoo You)