(Jeremy Faust, William Hanage, and Benjy Renton)
Just before Christmas, two Harvard researchers, Bill Hanage and Jeremy Faust, along with recent Middlebury College grad Benjy Renton, developed a model with an accompanying website to track hospital capacity by state and county in the United States. The color coding of the map indicates when a county hits or is at risk of hitting the limit of their local hospitals’ capacity—at which point a circuit breaker (a set of targeted restrictions to tamp down community spread) is necessary to keep hospitals from being overwhelmed.
There are hundreds of counties right now across the US at full capacity, that need to hit a circuit breaker, or are heading towards that threshold. As I listen to friends, colleagues, and trainees on the front lines, the statistics from the dashboard become real flesh-and-blood pleas for help. Health care workers are confronted with a tidal wave of patients pushing to their wits’ end doctors, nurses, and other staff, who are exhausted, burned out, and falling ill themselves. And while it’s true that far fewer people are getting desperately sick and dying from Omicron because of vaccination—and possibly because of the new variant’s own biology—the sheer volume of cases means that even a low rate of complications requiring hospitalization leads to the scenes playing out in emergency rooms and in ICUs across the country right now. Meanwhile, schools are being shuttered and other essential services are disrupted as those sick or infected stay home, leading to staff shortages that may persist for weeks. The seriousness of the situation is not lost on ordinary people outside of health care and public health, as millions have sought to get tested to either manage their own illness or protect those around them over the holidays, even if some of them are the worried well, concerned about exposure during these past few weeks.
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Yet our political class—the vast majority of politicians of both parties, and the pundits who swim slowly behind them like pilot fish with hot takes on social media or on cable TV—have either thrown in the towel in terms of any notion of introducing a time-limited and targeted circuit breaker—or new restrictions of any kind—or have doubled down on nonsense. In Florida, the state’s surgeon general, with Governor Ron DeSantis at his side, took to the mic this week to discourage testing for Covid-19, reiterate opposition to masking and vaccine mandates, and tout the benefits of “natural immunity” against the virus—all while pimping for expensive, scarce treatments for Covid-19 as an alternative to vaccination for managing the disease. In my own state of Connecticut, profile-in-courage Governor Ned Lamont—who has been pushed to reinstate a statewide mask mandate by legislators in his own party and clinicians in hospitals, including here at Yale—recently said, “I don’t want to put a lot of counter-pressures on and rebellion and people fighting back against it.”
No one is going to fight you, Ned. Some people will ignore a mask mandate, but it would send a signal to many, including businesses, that masking up is the right thing to do. Not wanting to be left out of the surrender-to-Covid caucus, influential pundit Matt Yglesias went further, suggesting it was time to lift all non-pharmaceutical interventions. The corporate sector has been no better, with groups like the National Retail Federation, the Food Industry Association, and cthe International Warehouse Logistics Association suing the Biden administration over vaccine mandates—because nothing says good-for-business like spreading SARS-CoV-2 in your workplace or to your customers out front.
And where is the White House? Bumbling and checked-out. Last month, the president made a speech to address the arrival of Omicron in which it was clear the only measure the man had on his mind was vaccines, despite pleas to do more since his presidency began. In the speech he promised 500 million rapid tests (a drop in the bucket, by the way) sometime this winter, though back in October he had been pressed to prepare for the winter surge with a testing campaign and he rejected that advice. On masks, though the president suggested Americans should wear them, there was no mention of the need to put cloth masks aside and upgrade to the more serious protection of N95s (though anyone who encounters the president, vice president or their families is required to use them) nor was there any plan to get N95s to Americans across the country with free and widespread distribution—not even to high-risk workers and vulnerable individuals.
Even on vaccines, Biden’s focus does not extend beyond US shores. While the president and others in the administration said no one saw Omicron coming, experts have been warning for months and months now that the failure to scale-up vaccination worldwide risked spawning variants just like the one racing through the country right now. At the end of the year, the administration announced that it was reducing the duration of isolation for those with Covid-19 from 10 to five days, largely to address the surge of cases from Omicron, while—to the consternation of some experts—at the same time suggesting that no test was needed to exit from isolation. A few days later, administration figures were announcing that a testing requirement was indeed being considered. Yet no justification has been offered for either decision: The data that usually accompanies CDC recommendations—the modeling or empirical research supporting the agency’s conclusions—hasn’t been released. What the administration has done has sown confusion about isolation and testing right in the middle of a surge, both among the general public and even among researchers like myself.
Just this week, a group of leading global public health experts urged a vaccine-plus strategy as the best approach to combating the pandemic. In a statement published in The BMJ, they suggested that in addition to vaccination there needs to be a greater reliance on high-quality masking; improvements in ventilation; data-driven criteria for guiding the imposition and relaxation of non-pharmaceutical interventions; social and economic support for the vulnerable, including those who are isolating because of Covid-19; and an urgent drive to vaccinate the world. All extremely sensible. The authors of the statement warned that vaccine-only approaches allow high levels of community transmission, giving new variants the chance to emerge, but also commenting: “There are other drawbacks to a vaccines-only strategy. Countries which tolerated high transmission have seen rises in both Covid-specific and all-cause mortality, healthcare worker shortages, and repeated lockdowns to control surges in case numbers.”
Meanwhile, back here in the US? While the president is emphasizing vaccination as the only national response to the pandemic, we have an entire political party (aided and abetted by corporate actors) pursuing a strategy of “let ’er rip”: promoting community transmission through opposition to vaccine and mask mandates, colluding with anti-vaxxers suggesting that resistance to vaccination is an embrace of freedom and liberty, discouraging testing—and then demanding expensive drugs to treat Covid-19 when people get sick. I don’t even know what to call this strategy in technical terms—or even in polite language. What is clear is that “the best lack all conviction, while the worst are full of passionate intensity,” as said W.B. Yeats in his poem “The Second Coming,” written in 1919 in the wake of the first world war’s devastation. Those oft-repeated—perhaps too often—lines perfectly describe our pandemic predicament as we enter 2022, the third year of this plague.
What no one wants to admit openly in the United States is that we are a nation gone mad. Instead, we get analyses trying to explain away our misfortune as part of the country’s ongoing culture wars, to justify rejection of basic public health strategies as un-American or unconstitutional, or rationalize irrationality as simply part of who we are as a country: We just don’t like being told what to do. But the numbers don’t lie. Among the G7, the US ranks the worst in per capita deaths in 2021; according to Reuters, “The death rate in the United States was more than three times higher than in neighboring Canada and 11 times more than Japan.” Some of this is about stochasticity—the randomness of how pandemics play out—but a lot of it is about decisions we make. As Celine Gounder, a physician in New York, has written in The Atlantic, “The Death Toll Says it All”: It is true that “many Americans do not care about COVID.… But it’s also callous. What it really means is that many Americans don’t care about the people who have died from COVID, and who will keep dying of COVID.”
We have become a nation of death-eaters. We can consume the tragedy of losing 826,063 men, women and children to this disease and respond with cries to do less, to get us back to normal. And our politicians, pundits, and business leaders are all too willing to oblige. We are all exhausted, frustrated, and angry. We could actually have a better, more humane approach to Covid-19 in the United States—beating back the virus, while lifting up all of us—because other countries have done it. Only there are simply not enough people willing to fight for it; there is no political will to do more.
But the thing about pandemics is you cannot go around them or skirt their march by the force of your desires—or wish them away by how you feel. You have to go through pandemics. Right into the heart of them. And you make choices. You can ask what can I do—what can I do for others?
Or you can say throw another body on the pyre, it doesn’t matter much to me anymore, Covid is over, Matthew Walther, editor of The Lamp, a Catholic literary journal, and a contributing editor at The American Conservative, wrote in The Atlantic in mid-December. Walther lampoons coastal elites with their outdoor mask wearing, but really offers a far broader rejection of public health practice—even with full knowledge of the impact of the virus in his own community: “[O]utside the world inhabited by the professional and managerial classes in a handful of major metropolitan areas, many, if not most, Americans are leading their lives as if COVID is over, and they have been for a long while.… the virus simply does not factor into my calculations or those of my neighbors.”
Many of us may be over Covid, but it is not done with us. Not by a long shot.
