Getting COVID Wrong

From the very outset of the COVID debacle for a variety of reasons politicians, public servants and public health have been making mistakes. Which is perfectly natural given what was initially thought about the virus.

The imagery out of Wuhan and later Italy were horrific. People falling (apparently dead) in the streets, ICU’s overwhelmed. This was not the flu even if it was not quite Ebola or even SARS. Those images, in the absence of very accurate death rate reporting, meant that the lethality of COVID was vastly over rated. Worse the demographics and condition of the dying were initially hard to discern.

The second misperception was the means of transmission of COVID and just how contagious it was. In the early stages the view seemed to be that COVID was only transmitted by physical contact. The dark joke about licking doorknobs circulated. This was in pre-mask mandate days. Social distance and handwashing were the orders of the day. Then it occurred to researchers that, perhaps, person to person transmission was possible without direct contact. The case rates were climbing and now it became time to “stay home” to flatten the curve to avoid overwhelming the hospitals. (Remember Italy!) We duely stayed at home and the curve flattened out significantly in many jurisdictions. (Cynics suggested that this might have had a lot to do with the coming of Spring in the Northern Hemisphere.)

The good news was that, astonishingly, for Americans and some Europeans, there was a vaccine just around the corner. As I write we are within a few days of the first Americans receiving this treatment. (We Canadians, being led by an imbecile, first backed a Chinese vaccine which did not deliver and then failed to place orders for the vaccines which did. UPDATE: Canada may get some vaccine early in the New Year.)

My friend John from comments will point out that Australia got lockdowns right so they can work. However, Australia seems to the only jurisdiction which has been willing to go hard with lockdowns. (And, well, they were locking down into the warm Spring weather Oz enjoys this time of year.) In England, France, Germany, Italy, Canada and many US states lockdowns have not really flattened the curve much. Nor has the adoption of “mask mandates” done much for the case rate.

The fact seems to be that COVID is very contagious. However, we now know a lot more about its lethality and it turns out to be relatively benign if you are under 80 and don’t have significant co-morbidities, are not significantly overweight and do not live in an extended care facility. Not a nice thing to catch but very unlikely to kill you.

None of this is a secret. But the general reporting on COVID tends to focus on case rates which are then used to power policy. Two things which are not mentioned much are the significant progress which has been made in treating COVID and some of the steps people can take to improve their own immune systems.

Mask mandates and lockdowns notwithstanding, case rates are or have hit alarming levels all over the Northern hemisphere. However, case fatality rates have not been quite so alarming. (Probably because treatment protocols have improved and the dumber Premiers and State Governors have been persuaded not to send COVID patients into extended care facilities.)

Paying exaggerated attention to case rates leads to politicians feeling pressured to up the ante with masking and lockdowns. Their constituents are only aware of the rising case rate and so want “action”, ideally backed by force of law. The costs and marginal efficacy of such actions does not reduce the public clamour.

As COVID has dragged on there have been very real economic, social and psychological costs. A two week “flatten the curve” exercise is very different from a four month “no non-essentials, mandatory stay at home” program. And those costs continue to rise.

There are plenty of optimists who see the whole thing wrapping up over the next few months (slightly longer in Canada) as the vaccines begin to be widely distributed. 90% efficacy and all. Which would be wonderful to see. However, at this stage that is several months off.

The current plan in most Western jurisdictions seems to be to hunker down, lock down, shut down and wait for the silver bullet of the vaccine. The costs of hunkering down for another three or four, or until September according to the imbecile, will be tremendous. Economic, social and psychological costs are cumulative rather than discrete. Once a business closes it has a lower chance of re-opening, once a family is evicted it has a higher chance of being homeless, a closed church or social club or pub is forgotten after a few months. In fact, the patterns of every day life may become irrecoverable after COVID’s long disruption.

The imbecile – along with a lot of other dimwits – want to take this “opportunity” to “build back better”. Another few months of masks and lockdowns and the will to build back at all may very well leave the building.

Societies, economic systems, science and technology are all built on the acceptance of a degree of risk. At the outset of COVID we had a very limited capacity to calibrate the risks the disease posed. We did not know that it was rarely lethal to people under 60 or to people under 80 with no co-morbidities. Now we do. We also had a very limited idea of what the costs of various social measures to marginally reduce risk would be. Now we are beginning to understand those costs.

All over the West we are seeing people taking to the streets to protest the “lockdowns” but, more realistically, the destruction of their lives for relatively marginal benefits. At the moment, the protestors are no more than a small minority. However, as the destruction of those lives continues that minority will grow. And it will be joined by millions of people who are currently described as suffering from “COVID fatigue”.

While governments can certainly back up masks and lockdowns with draconian fines and penalties, ultimately they rely on the co-operation of their citizens. As COVID drags on, that co-operation will almost certainly collapse.

Though it will probably lead to higher case counts it may well be time for governments to look at opening up their economies and their societies. The plexiglass shields are in place, people have learned how to wear masks somewhat effectively, there is some data suggesting that far more people have had COVID than the case numbers suggest. Yes, extended care facilities need to be kept in their bubbles – which will make for a sad Christmas for many families – and, yes, thirty for Christmas dinner remains a bad idea. But opening up retail and restaurants and pubs is almost certainly an acceptable risk. Opening churches to limited congregations is likely fairly safe.

Most fundamentally, governments need to provide the information people need to assess their own, personal risk. If the vast majority of deaths from COVID occur in people 80 and over, explaining that to the public is important. So, frankly, is telling the public to get their vitamin D levels up and to get exercise. People over 70 with underlying conditions should be encouraged to shelter in place and government and social groups should work to ensure that our seniors have what they need without having to spend a lot of time outside their homes.

The next few months, especially in Canada, are not going to be much fun. Unlike our American friends, we will not have a vaccine. And, absent that vaccine, governments with an excess of caution, are going to be pressured to keep the lockdowns and mask mandates in place and enforced. Despite the fact that we now know that COVID is not lethal for the vast majority of people who get it.

(UPDATE: The possibility that Canada may get some vaccine early in the New Year is obviously good news. Now, if it is distributed to i) frontline workers, ii)extended care facility workers, iii) over 85’s, iv) over 75’s and people with co-morbidities the death rate should fall off a cliff. All the more reason to take easing restrictions now seriously.)

Selectively easing restrictions may increase the case count a bit, but it will reduce the economic, social and psychological toll COVID takes. Letting individuals assess their own personal risk and make decisions accordingly is a first step in building back smarter.


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