Villainous Acts, Part 2: Unnatural Courses and the Second Wave
In Villainous Acts, Part 1, I clarified some very specific ways that words and numbers are being misused publicly — by the media, by politicians, and even by scientists. Now that we have put some of this “information” into perspective, let’s add some further context and see if we can defend ourselves against the misconceptions and logical traps that are approaching in the near future.
The Natural Course of Epidemics
Epidemics have been recorded throughout human history. One thing they all have in common is that they end — whether or not governments have intervened, vaccines were available, or new drugs were discovered. In fact, almost all epidemics have not been influenced by those factors. So we know that if we do nothing, epidemics will end.
But what happens when we do something? What happens when we shutdown the global society?
Well, frankly, no one knows. No global “quarantine” like our current lockdown has ever happened in all of recorded history. We are all now part of a huge social and biologic experiment. We will all have to find out together how this turns out. When we look back, will there be benefits to our collective isolation and germophobia? And, if so, were they worth the risks to our economy, our social structure, and our general way of life?
To put things in perspective, let’s examine some past epidemics, starting with the most common one that occurs almost every year (influenza) and then turning to the one most similar to COVID-19, the 2003 SARS-CoV epidemic.
Outbreak
Influenza is an example of a well-studied viral pandemic that occurs almost annually, to varying degrees. In the United States, there are generally 3.9–49 million cases every year of flu and “Influenza-Like Illness” (ILI) and approximately 30,000–50,000 deaths. Globally, there are about 250,000–500,000 deaths attributed to the flu.
As we’ve discussed, any viral strain that kills its host quickly tends to also die out quickly. Any strain that can’t evade the host immune system or which cannot cause its host to cough, sneeze, or otherwise transmit it to someone else will also die out quickly. The “Goldilocks strain” that can cause just the right amount of non-lethal disease and transmissibility will replicate and spread throughout the community.
Of those who are infected, some will actually get sick.
Of those who get sick, a small amount of vulnerable people will die.
Those who have antibodies to that viral strain (either from a prior infection or from vaccination) are at lower risk of infection and illness.
When enough people in the community develop protective antibodies, the virus has a hard time infecting new hosts, and its numbers will start to dwindle. If the vulnerable people know a virus is passing through, they can stay home to reduce their exposure to it. Once the numbers start going down, they can then resume their usual activities, and their risk of infection and illness returns to its prior baseline. They aren’t absolutely “safe;” no one is. But their risk is about as low as it’s going to get.
In real life, the “community” is constantly changing as individuals move to and fro, so the virus can get carried to other communities and repeat it’s process there. Eventually, however, once the virus runs out of individual communities, its numbers will really start to plummet. It can linger in low numbers for many years, but it won’t cause widespread pandemic-level disease anymore.
It can, however, also mutate enough to avoid detection by those antibodies to the original virus. In that case, the new, mutated strain can now re-infect all the previous targets and can circulate around the globe again. Which is what happens every year with flu.
(Incidentally, this is one reason the flu vaccine is not always that effective. Because they have to formulate, test, and produce the vaccine months in advance, scientists have to basically guess ahead of time what new virus mutations will appear next. Sometimes they come pretty close; sometimes, not so much.)
Herd Immunity
When enough of the population has some protection against the virus, the virus can no longer thrive. That is called “herd immunity.” Herd Immunity usually requires at least 80% of the population to have had some exposure (depending on various factors like transmissibility). Just the way an elephant family protects its young by encircling them with strong, healthy adults when predators are nearby, if enough of the strong, healthy people are around, the vulnerable people can temporarily take steps to protect themselves.
The healthy people may get hurt but probably won’t die, and as long as the little ones stay put, they probably won’t die either. After the predators have given up, then everyone can go back to their baseline level of risk until there’s another predator at the door.
Example: SARS-CoV1
Now let’s turn to the 2003 pandemic due to SARS-CoV1, a virus with strong similarity to SARS-CoV2 (no one is calling SARS-CoV “SARS-CoV1" yet, but they likely will, so let’s just get to it). The 2003 virus originated in China, caused about 8,100 cases worldwide with a total of 722 deaths (remember, “cases” were defined differently in 2003 than they are today). The entire pandemic lasted 4–7 months (depending on how we count), and no cases have been reported since July 2003.
Various Asian governments imposed activity restrictions of various sorts, mostly quarantining people with significant contact with a person suffering from known illness, eg, international air travel while sitting within 3 aisles of each other. The bottom line is that with no vaccine or mass public shutdowns, the SARS-CoV1 pandemic lasted one season and caused approximately 0.1–0.3% of the deaths that occur in an average flu season. Frankly, with such successful management, it really makes one wonder why we did not follow the exact same protocol this time around…
The Unnatural Course of Our Response
So far, we have examined the usual course of an “average” respiratory viral pandemic (influenza) and that of SARS-CoV1. All of these pandemics have had tragic but limited mortality, mostly among those whose life expectancy was already curtailed by age or comorbid illness. So without widespread social distancing, we already know what costs to expect (the unfortunate deaths of some vulnerable people) and the benefits (herd immunity and a quick end to the virus) from common and similar pandemics.
The unprecedented global restrictions associated with COVID-19, however, carry unknown risks and benefits. Any potential benefits remain to be seen. Already at this stage, however, we can clearly identify some of the huge costs we’ve paid.
Distanced, Now More Than Ever
We do not yet and may never know if the “social distancing” measures we’ve taken have had any benefit in reducing illness or fatalities due to SARS-CoV2. Although many of us consider ourselves “safe” under social distancing, we should all remember that very few — if any — of us have really adhered to a strict quarantine in the actual biological, medical sense.
The truth is we have clearly all been engaging in activities known to spread viruses, eg,
sharing public spaces (e.g., grocery stores),
transferring mail and packages,
buying goods produced and transported overseas,
taking clothes to the dry cleaners’,
eating non-local produce and meat,
touching doorknobs and elevator buttons,
constantly washing and scrubbing our hands and our homes (thus eliminating needed bacteria),
and much, much more. Frankly, the above list encourages me as I’m (obviously) a big believer in a healthy microbiome.
We should remember that an actual “quarantine” requires that an individual — a sick individual — as well as all his stuff stay 100% secluded in one space, away from everyone, all the time. It is the sick people (who are in the minority and are not able to work anyway) who are quarantined, because it's impossible and counterproductive to meet that kind of standard for a healthy, able-bodied population whose labor is essential to the economic and literal health of everyone, sick or well.
If quarantining someone is analogous to keeping a cap on a soda bottle, then what we’ve done is leave the lid dangling on top, not attached or screwed in. Is that really enough to keep our soda from going flat?
Of course, politicians and public health officials have considerable incentive to convince us that these measures have been effective; they are, after all, responsible for imposing those measures. It's certainly in their best interests to label the COVID-19 response as a success. It reminds me of Marge Simpson’s blithe and empty reassurance to her kids: while watching Homer on a live broadcast of a disaster in the making, she tells them that their father was going to be ok. To which Lisa calmly responds, “What are you basing that on, Mom?” “Who wants ginger snaps?” was Marge’s answer.
Our Selling Price
So before we accept the baseless claims of politicians and media personalities, maybe we should ask for some evidence. That will, unfortunately, require time that will only delay the decisions that demand our immediate attention. So while we are waiting, let’s consider some of the huge costs and sacrifices we have already made in exchange for the uncertain benefit yet to materialize.
Biological
Biologically speaking, we have forfeited the opportunity to develop herd immunity, which is the quickest way we know to eradicate a virus from existence. There are some cases — eg, SARS-CoV1 discussed earlier — in which public health efforts quickly curtailed an epidemic in the absence of herd immunity, but we haven’t employed those methods either. And as we continue to hear reports of “new cases” (more on that below) and preliminary test results around the world showing only 10–40% of the population with past infections, we are a long way from herd immunity.
Financial
Economically, I hardly need to mention the rising unemployment and the near-bankruptcy of hundreds of businesses. Even for those who have kept their jobs and are still able to make ends meet now, none of us can escape the rising food costs or the inflationary effects of injecting trillions more dollars into the currency supply — not to mention the long term consequences of eliminating the reserve requirement for every bank in the Federal Reserve system and the astronomical tax burden awaiting all of us whether we “recover” financially or not.
Social
Socially, our networks of support have certainly shifted. In my practice, I have seen some families bond more tightly, and I have also seen others slip into (or further into) depression. Although the effects have clearly been different for everyone, one effect we have all felt is a decline in face-to-face interactions and an increased reliance on electronic forms of sharing information. Much of this has been filtered through others — the usual news agencies but also private organizations like social media platforms.
In Who Owns Information I mentioned two ER physicians in California, Drs. Dan Erickson and Artin Massihi, who recently expressed a logical, coherent, expert medical opinion that dared to question the need for continued social distancing. After their press conference sparked a viral surge of its own on YouTube, however, their video was swiftly taken down. Subsequent efforts of others to republish the video on YouTube and on Facebook led to equally rapid shut down. This level of censorship should be deeply troubling to anyone concerned with science, a free market economy, or even the idea democracy itself. All of these cherished institutions can only exist in a climate of free and open distribution of information.
I hope the COVID-19 situation has alerted us all to the inherent danger in monopolization of the public discourse. This widespread suppression of dissenting views — already accepted by many as a necessary concession to “safety” — is possibly the most devastating social consequence of COVID-19.
Psychological
Psychologically, we have been encouraged to live in a state of fear and uncertainty. This has led many of us to accept and even welcome behaviors we would otherwise condemn.
The sense of immediate danger causes certain predictable changes in the human brain — such as preferential attention to negative emotions like fear and rage, a tendency to hyperfocus on one single issue (and therefore lose broad perspective), and a polarization into black-and-white thinking — all of which threaten to widen the social distance already separating us.
In teens, traumatic experiences (even ones experienced remotely, through mass media alone) can shape their overall world view — an effect which may persist for decades. The constant death counts, stories of grieving relatives, and now the images of children hospitalized with multi systemic inflammatory syndrome (MIS-C) — these all promote a state of anticipatory fear, ie “What next?”
Murky Undertow of the Second Wave
Assuming we ever get over the first wave, we all seem to accept a Second Wave as a foregone conclusion (even though no such thing occurred with the previous coronavirus pandemics, SARS-CoV1 MERS).
Reopening ≠ More “Cases”
Numerous public officials have already informed us that testing is “essential”, and, of course, as more testing becomes available there will obviously be new “cases.” Many of the tests used will likely be for antibodies, the shortcomings of which we discussed last time. Aside from the unknown (and unknowable, really) numbers of false negatives and false positives, these tests don’t necessarily mean that a person is currently ill — or ever was, for that matter.
But since a positive antibody test qualifies you for a diagnosis of COVID-19 (per the CDC guidelines), these people will be reported as “new cases.” They will be reported by the labs and may also be reported by individual physicians; it isn’t clear what measures — if any — are in place to prevent double counting.
It seems almost inevitable that the “new cases” will be attributed to “re-opening” (which is already being done in some states). Since we’ve already been taught to anticipate the Second Wave, any rise in numbers will add to our confirmation bias — that is, our tendency to more readily accept information that confirms our pre-established beliefs and to disregard information that refutes it.
Rhetorical Politicking
Onto this stage of rising numbers and our indoctrinated fear of the Second Wave, enter the drama of presidential election politics. As if the average election coverage were not already dripping in mud-slinging epithets and fear-mongering sound bites, how much more will we be forced to swallow this election year?
Incumbents will no doubt try to convince us that their efforts at containing the virus literally saved our lives, while challengers will predict imminent death and disaster if we don’t elect them. The divisiveness that attends every election season is likely to only further raise the nation’s level of hostility, fear, and polarization.
Fatigue & Helplessness
Furthermore, with near constant reporting about COVID-19 coupled with COVID-19-saturated political rhetoric, we are all likely to develop alarm fatigue (or “Quarantine Fatigue”, if you will). The American Association of Critical-Care Nurses defines alarm fatigue as:
…sensory overload is when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms.
Although nurses are responding to literal alarms, the rest of us can be just as affected by and respond similarly to words and messages. We hear terms like these all the time: death, disease, fatality, mortality, hospital, quarantine, conflict, surveillance, police, crisis, recession, threat, disaster, infection, contagion, bankruptcy.
These are words which tend to trigger our internal, instinctive, limbic-driven alarms, even if we are not conscious of it. When these noxious stimuli are coupled with passivity and a sense of powerlessness, a condition called learned helplessness results.
Learned helplessness means that we are simply spent — beaten down, given up, defeated. It means that even when there are paths to relief, we don’t take them because we can’t even see them anymore.
When we are constantly bombarded with fear-triggering words and are then forced to stay home and sit on our hands, many of us are bound to end up in this helpless state. In that position, many of us will be powerless in the face of authority and will simply succumb to whatever unreasonable and ineffective restrictions may be imposed on us.
Since our constitutional right to assemble has already been “temporarily” revoked, and since our public voice through mainstream and social media is being purged of all dissent, there will be no convincing these people that any alternative course of action would be warranted — or even possible.
At that point, those of us with differing opinions or alternative solutions will have been all but silenced. Not by authoritarian control as much as by the lassitude of the masses who themselves have already been silenced without even realizing it.
If there is a silver lining to the COVID-19 crisis, I hope it will be a growing awareness of the ways we are being funneled, corralled, and manipulated into certain courses of action. I hope that as we wake up to the many ways our opinions are being shaped, we will reclaim our rights to be autonomous, thinking, feeling, spirited human beings. I hope that the more dissenting voices are marginalized, the more we will actively seek them out. And more than anything, I hope we will be encouraged to think and decide for ourselves.
Until next time,
Stay thinking, my friends.
