Covid, re-evaluated one year later.

 

In early March 2020 I began to write posts about Covid 19. There were few places that people could get good information that addressed the big picture and made it possible to understand what was happening. It seemed like I should write some things that made sense of it all. I wanted to write about what I knew, or thought I knew was true, since there was so much misinformation circulating. So, during the second half of March, I wrote nine blog posts. What did I say and was it true?

In my very first post I talked about how everything would change. How we would burn less carbon, we would learn how not to travel for work, how we would learn not to transmit other viruses, like influenza. That was all true. The demand for gasoline was so low that oil prices dropped to a fraction of the cost of production. Planes didn't fly much. We haven't had a flu season to speak about due to infection control measures. I said we should have massively expanded testing because it would allow people to get back to work, which would have been nice. Also that people would probably be contagious for about 2 weeks after they were infected, which was close to true. I thought that hospitals would get more efficient and people would become kinder to each other. I'm not sure that happened.

The second post said that we should forgive ourselves for not knowing what to do about the pandemic because we had not been through one before. And that we should wear supportive shoes while dancing around the house due to the risk of developing plantar fasciitis from exercising in our houses barefoot. And that the eventual tragedy that would come of this would be hard to predict. Turns out I developed a different overuse injury from exercising around the house, but other than that, the blog wasn't far off.

In my third post I suggested that we would use fewer resources by not traveling or going out and that would mean that we might have more downtime and not have to be as productive which could be good. Indeed people were less productive (and some felt bad about that) and used fewer resources and learned to cook and make music and dance and things. But some also lost their businesses and became homeless. We seem poised to become just as frenetic about spending and achieving and traveling as soon as vaccination/herd immunity makes it safe. We shall see how our consumption resets itself.

The fourth post mentioned that the direct stimulus payments proposed in congress would mean a lot to my patients. They did. Stimulus payments were a kind of experiment with the concept of a guaranteed basic income. They were a way to distribute money from the wealthy to the grindingly poor in a way that would be immediately helpful. In the end it wasn't enough money, and the poor didn't get their stimulus checks quickly enough to keep them from harm, but it was good as far as it went. I couldn't have predicted just how well the wealthy would do, with the stock market recovery. So even with stimulus checks, it seems like the wealth gap between rich and poor has widened.

The fifth post looked at exponential growth. I suggested that we weren't seeing much Covid in many parts of the US because we were on the skinny end of a growth curve which would mean that numbers of sick people would appear to increase slowly until there were suddenly many people affected. This was still a foreign concept for most Americans in March 2020. I also suggested that if we did everything right (at that time it was primarily hand washing and social distancing) we could avoid the huge numbers of cases and deaths that were predicted. Our little Idaho community did avoid big numbers by some pretty serious lockdowns. Brutal exponential growth curves nailed many cities and towns. I predicted, though, that the whole epidemic might last 3 months. I hadn't thought about the second and third waves, which have pushed our troubles out beyond a year now. Despite looking at data from the influenza epidemic of 1918 and 1919 in which there were multiple waves, a pandemic that lasted over a year was beyond my imagining. 

My sixth post talked about PPE, how it's used and what it's good for. It wasn't far off, as far as I can tell. At the end I said that making cloth masks would be of limited usefulness. Not true. We ended up making some pretty good ones, and now adequate cloth masks are pretty easily available. Many cloth masks are ill fitting and uncomfortable and people wear them below their noses, or so loose that they are probably minimally effective. Probably nobody will know what benefit an ill fitting haphazardly worn cloth mask provides but I'm right now going to give it a thumbs up over no mask at all. Surgical masks, N95 and KN95 masks are still better. 

The seventh post had a lot of data which I wasn't at all sure was going to end up being true. Most of it was true. It was stuff about incubation periods, transmission and catching the virus from people who are asymptomatic. Scientists were publishing good data, even a year ago. With one exception: it seems, now, though, that there is very little risk from viruses surviving on surfaces, which is great, because I didn't like wiping down everything with nasty anti-viral chemicals or leaving my groceries out for days while the viruses died.

Post number eight was about sex: whether it is safe during the time of Covid. If sex is defined as in-person messy kissing etc. with one or more casual contacts, the answer was that it was not safe. I linked to a New York public health document that was perfectly explicit. It was all true. Sorry, dating in the time of Covid is super risky.

The final March blog post, number 9, was about death rates. On March 27 the official number of deaths from Covid in the US was a mere 994. I said that this was unlikely to be the actual number of people who had died from the disease because it takes a long time for a Covid death to be correctly counted. I explained why. That turned out to be right too. Imagine that day, in March, when Covid had killed just shy of 1000 people. Now we have lost over 1 in 600 people to the disease. Which is probably still an underestimate.

So overall, it was pretty good information. I've stopped writing about Covid, mostly, because there are now excellent sources of information and much less misinformation going around. Most of us have figured out how to inform ourselves accurately. Many search engines make it more difficult to spread false rumors (though there are still pretty persistent pockets of wrong information surrounding vaccines among other things, easily available on the internet.) In our year of living online, many well informed people have done a beautiful job of writing about the novel coronavirus. This leaves me more time to train my puppy and dance around the kitchen like other people do in the time of Covid. 

Since March 2020 we have experienced a whole year of a pandemic, something that nobody younger than 100 has been through. We have seen a vaccine produced, tested, introduced and delivered in less time than anyone thought would be possible. It became clear to anyone paying attention that having a president who tried to hide the dangers of a deadly and novel infectious disease in order to maintain consumer spending and corporate health had devastating consequences. Who would have guessed the executive branch of government would be so important? Wearing face masks in public has become normal and has prevented a vast amount of viral illness related and unrelated to Covid. I would not have placed money on that particular horse. Most of us have gone a year without going to a gym or dining inside. Seriously? Yes, indeed. That happened. We have made many inconceivable changes in our lives and have almost gotten used to them. Education has been done differently, with many children left behind academically at a time when good mentoring could have changed their lives for the better, but some students have had new opportunities because remote learning can be less expensive and more accessible. Social distancing has also meant social isolation for many people with loneliness, anxiety and depression and we have yet to understand its lasting impact.

The pandemic isn't over yet, which would have been a real shocker had we realized a year ago just how long we would be doing this. When it ends and we tell the story of what really happened, we will be able to answer so many questions. Here are a few that I'm curious about now.

1. How long will immunity from the vaccine last? Which vaccines will provide the best protection? Will the new vaccine technology (especially mRNA vaccines) result in an avalanche of new medical treatments?

2. Was the pandemic in some way the first of many worldwide climate disasters and will climate disasters start to be more common?

3. We know that we reduced carbon pollution and use of fuel during the pandemic in a way that was unprecedented. Will those changes persist?

4. What will be our new normal with regard to illness behavior? Will we actually stop working or traveling when we are sick? Will we wear masks when we are in crowded places with lots of people?

5. Will we eat out as much?

6. Will we all go back to work? Will the Amazon office buildings in Seattle fill up or will they be repurposed? 

7. Will Covid variants mean we have seasonal Covid like we have seasonal influenza? If so, how will we deal with it? Will we tolerate it better as it evolves? Will we find some more effective anti-viral medications?

8. How will the still raging Covid epidemic in poorer countries be controlled and will the need to share vaccines be a model for globalization of resources? Will this help us understand global interdependence better?

It seems like Covid 19 is starting to wind down in the America. I'm fully vaccinated and so are nearly 20% of the US, or 65 million people. Some people who were hesitant are becoming enthusiastic, and in a few days everyone in the age groups in which the vaccine has been tested (not children) will be eligible. There will be adequate supplies of vaccine. May this be a better year.