The Great Pause Week 100: Covid in 20/20 Hindsight
"When you are looking at the spread of an infectious disease it is like looking at a distant star — time-wise, it will always be light years ahead of you."
With soon-to-be one million notches on the handle of his six-shooter, US Health Secretary Xavier Becerra is the deadliest gun in the saloon and has never had to slap leather. The total number of US Covid cases stands at over 79 million — 100 million according to some — and his Hole-in-the-Med gang can lay claim to more than half the 950,000 dead.
We may be at week 100 today, but in the larger scheme of things this week is hardly more remarkable than was week 36 or could be week 290. It is as good a time as any to reflect on what lessons we should have learned by now.
The U.K. plans to scrap self-isolation rules for people in England who test positive for Covid-19, ending the last of the pandemic restrictions that have dominated daily life for the past two years. The dramatic step would move England beyond other major Western countries in relaxing virus curbs.
— England calls time on the pandemic, Bloomberg, Feb 10, 2022
University Hospital in Newark, New Jersey, is besieged with Covid patients packing its intensive-care unit, where rooms have been improvised from plastic sheeting and staff have fallen victim to the disease. The U.S. Army is reinforcing its defenses.
— U.S. troops in a battle of attrition, Bloomberg, Feb 10, 2022
First lesson: As Yogi Berra said in the 1973 National League pennant race, “It ain’t over till it’s over.”
It was obvious to me, watching from the relative safety of a remote nature preserve, that repeated declamations of victory were b.s.. For those suffering loss of loved ones, loss of work, loss of pay, loss of insurance, children out of school, wishing it were true sure made it seem true. But it wasn’t. Pretending it was over just gave the virus strength. It gave it new life. It prolonged the pandemic. So did vaccine jingoism, but that’s separate lesson.
By the winter of 1919–1920, Americans were weary of the limitations on daily life. Nearly all of the public health restrictions — such as mask-wearing, social distancing and the closure of schools and churches — had been lifted. A hasty return to public gatherings led to an increase in case numbers. Politicians either blamed people’s carelessness for the reemergence of the virus or downplayed the seriousness of it.
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But if the fourth wave failed to generate the kinds of headlines and fear of its predecessors, it wasn’t for a lack of lethality. In New York City, more people died in the period from December 1919 to April 1920 than in the first and third waves, according to a research paper on influenza mortality in the city. Detroit, St. Louis and Minneapolis also experienced significant fourth waves, and severe “excess mortality” was reported in many counties in Michigan because of the flu.
— The 1918 flu didn’t end in 1918. Here’s what its third year can teach us
Washington Post, Feb 6, 2022
There are many nations around the world — Denmark, Sweden, U.K. among them — that have now declared the pandemic over and are telling everyone just to go back to their normal lives. Ding Dong, the Wicked Witch is dead. I will watch with interest what comes of that in coming weeks and months. Hopefully I am wrong and it really is over, but when I see reports of the Omicron virus jumping to deer, mutating, and potentially jumping back into humans as a new variant, I doubt this is going to be over soon.
Second lesson: There were many who saw the pandemic coming and foretold with remarkable prescience how it might play out. That our leaders chose to ignore them should concern us.
Some went so far as to give TED Talks, like Bill Gates, or write books, like Laurie Garrett (Betrayal of Trust), David Quammen (Spillover), or John Barry (The Great Influenza). Others described the fiasco in real time, like Michael Lewis (The Premonition) and Nicholas A. Christakis (Apollo’s Arrow).
Michael Lewis (author of The Big Short and Moneyball) describes in The Premonition how a small team of “Wolverines” assembled by the Junior Bush White House created a pandemic plan and then passed that playbook to Obama. The O Administration improved on it, allocated some of the much needed resources, including an office within the White House, and passed the playbook to Cobblepot, forgetting that Grandpa Trump had paid the kid at the next desk to take his son’s tests and the orange-haired boy had never read anything more than a teleprompter his whole life. Cobblepot gave it to John Bolton, who, two years before Covid, fired the whole health team and zero’ed out the part of the federal budget that responds to pandemics.
Robert Redfield became the director of the Centers for Disease Control and Prevention on March 26, 2018. He was appointed to the post by Cobblepot after the president’s first appointee, Ob/Gyn Brenda Fitzgerald, resigned in scandal. Before she was head of CDC, Fitzgerald was best known for the time she and Newt Gingrich threw crates of tea into the Chattahoochee River to launch her failed Tea Party bid for Congress. She was booted for slush-trading tobacco and opiod stocks while CDC Director. Historically, directors had been selected by merit by the Secretary of HHS, not the President of the United States (POTUS).
When it became clear to a previous Director how short his successor was falling in doing the job CDC was created to do (ie.: “control and prevent disease”) Director Foege wrote Director Redfield:
“This will go down as a colossal failure of the public health system of this country…. It is a slaughter….”
In 2018 I toured and photographed a fresh market in Dujiangyan, Sichuan — a place no doubt similar to the Wuhan stalls that sold caged pangolins and kangaroo dogs in the winter of 2019. Zoonosis was in the air. David Quammen had warned us. Many had known, or expected, that the pandemic would come. We opened a gigantic door to zoonotic spillovers when we traded the lives of the Yanomami of the Amazon and the orangutans of Borneo for cooking grease.
Third Lesson: To once again re-quote the mathematics professor Albert Bartlett, “the greatest failing of the human race is its inability to understand the exponential function.”
In any viral outbreak of potentially deadly impact, rapid response is key. In The Premonition, soon to be a major motion picture, Michael Lewis’s protagonist Carter Mescher compared the lag between data collection and the need for action to “a weird car that accelerated or braked 15 seconds after you hit the pedal.” When you are looking at the spread of an infectious disease it is like looking at a distant star — time-wise, it will always be light years ahead of you.
At one time, CDC would have provided this rapid response, as it had done with smallpox and ebola. By 2020 it had been neutered. Its name should be changed to Centers for Disease Observation. Rather than controlling viral spread, after March 2020 it saw its role as gathering data by letting the epidemic play out, then analyzing and publishing the data months to years later. Any public health official who called CDC in the early stages of Covid was dutifully instructed, “Do nothing.”
If access to health care is considered a human right, who is considered human enough to have that right?
— Paul Farmer
Fourth Lesson: No one is safe until everyone is safe.
As former CDC Director Foege wrote to CDC Director Redfield:
Fourth, the need for global cooperation, which you clearly understand from your work in Africa, has been squandered by an ”America First” policy that mocks what we learned in Sunday School and leaves us on the outside of the global public health community.
The White House has rejected both science and good management. To depend on someone like Dr. Atlas, who doesn’t understand herd immunity, is simply one of many examples. It was our ability to refocus India from herd immunity that attacking the virus that allowed smallpox eradication to succeed. When Debbie Birx said she wouldn’t believe anything that came out of the CDC, I realized how dysfunctional the [White House Task Force] had become but I still thought the White House would see how disastrous their approach was and finally turn the job over to professionals. Now I know that won’t happen.
Given the miracle of safe and effective vaccines arriving in record time, the Biden administration did not change the “me first” policy to any significant degree. Many more vaccine doses expired in the United States by their age than were given or allowed to be sold to other countries. Because of jingoism, cronyism and American exceptionalism, “universal” vaccination stayed within sea to shining sea. India was prohibited by patents from purchasing the very vaccines it manufactures. Same for México. India responded by producing the Delta variant. Africa was only 5% vaccinated when the Johannesburg airport discovered Omicron (it was seen in New York sewers 5 days earlier). Those waves broke upon American shores. Thinking their vaccines would spare them, unmasked and incautious USAnians were easy prey for the powerful new variants.
We continue this postmortem next week, when we look at Origins of Covid.
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As the world confronts the pandemic and emerges into recovery, there is growing recognition that the recovery must be a pathway to a new carbon economy, one that goes beyond zero emissions and runs the industrial carbon cycle backwards — taking CO2 from the atmosphere and ocean, turning it into coal and oil, and burying it in the ground. The triple bottom line of this new economy is antifragility, regeneration, and resilience.
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“There are the good tipping points, the tipping points in public consciousness when it comes to addressing this crisis, and I think we are very close to that.”
— Climate Scientist Michael Mann, January 13, 2021.
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