Stand upon a beach and stop an approaching tsunami
So It Turns Out, #39 (and get boosted!)
I don’t know what to say anymore.
So it turns out that you can’t stand upon a beach and stop an approaching tsunami
We’re at a point where, frankly, everyone is just angry and tired of COVID, and no one thinks anyone else’s choices about how much risk to take on are the right ones. We’re playing a civilizational game of iterated Prisoner’s Dilemma, and everyone’s judging everyone.
But, for better or worse, it’s time for you to make decisions. You’re standing upon a beach, and watching an approaching tsunami. But all you have is a bucket to scoop out the water.
So let me write down where I’m at, and try to figure out where I stand. (You might choose differently, and that’s totally all right.)
Delta is still around, and walloping our cold-weather states. Omicron is inside the US, it’s going to be the dominant strain in the US within weeks at the most, but it’s coming so fast that we won’t actually have a great estimate of how hard it will hit.
You see, COVID tends to spread faster than it kills. It takes time in many cases to destroy your lungs and body, and even more so now that we have almost two years’ knowledge of how to fight it, two years’ experience developing treatments for it. And with a new strain, it’s hard to know how dangerous it is, and the early evidence here is unusually confusing and confounded. So by the time we know how bad a wave actually is at scale, it’s too late. Our game plan’s already set.
Delta is still here, and Omicron is coming fast.
Delta, we know. Get a booster, you’re fine. But far too many folks (including in the most vulnerable populations, like nursing homes, as Zeynep Tufecki points out) are unboosted, others are unvaccinated, and it’s already crushing our hospital systems.
But that crisis is already here, has been here for weeks, will be here for weeks to months to come, even if no Omicron. Omicron is not yet that big a share of cases in Boston, we don’t think, and our surveillance metrics there are already skyrocketing:
But you’re extremely unlikely, if vaccinated-and-boosted, to be adding to that hospital burden yourself.
Omicron, we don’t know as much about.
We know it spreads way faster than Delta; we’re hopeful it’s less severe. But even if it is less severe, cases are going way up, way fast, so who knows if that matters. For example:
And even if it is meaningfully less severe — well, if a disease is half as severe, but spreads twice as fast, it’s exponentially worse in the long run. That half severity only buys you one doubling cycle of time, which for Omicron is only 2-4 days, before you have just as many people in the ICU as you would under the old variant.
You need a way less — a qualitatively less — severe disease to meaningfully change the anticipated strain on our healthcare system. And Omicron might be that, but by the time we’ll know, it’s already too late.
Or, to put it another way:
Now, here’s the hard part: the question of risk to our healthcare system, or the unvaccinated, is largely distinct from the question of what the risk is to you, Friends of the Stack, since I know from personal conversations that essentially all of you are vaccinated.
You’re hopefully boosted, and the evidence each day is getting stronger that boosters greatly reduce your risk of severe illness from Omicron; if boosted, you stand a pretty decent chance with a disease this infectious of getting sick, but unless immunocompromised, your risk is quite low.1 If not boosted, your risk is high and getting higher each day, both from Delta and Omicron.
(If you aren’t boosted, STOP READING NOW AND GO GET BOOSTED TODAY, this link has DC’s walk-in sites, this link has NYC’s walk-in sites, and the rest of you in the US should check vaccines.gov. If you’re in the UK, the NHS is now letting you book boosters online. GO GO GO. You have 9 days to Christmas, you’ll be mostly powered up by then if you boost as soon as possible. Drop this newsletter and run!)
And frankly, when at a population level there’s a disease that’s spreading this quickly, with this high of an exponential growth curve, it’s a lot harder to justify claiming that highly-caring, cautious, boosted-and-vaccinated folks should be even more cautious; your behavior just won’t do anything to prevent healthcare systems to collapse.
On a persuasion level, it’s probably even harder to make that argument when you know that so many people who are getting sick are the folks who proudly and angrily fight vaccination, boosters, masking, or really any sort of efforts to fight the tide. The Atlantic2 even ran an op-ed entitled, “Where I Live, No One Cares About COVID,” from a guy in one of the highest case rate areas of Michigan, an area where the hospitals are literally running ads in the newspaper begging people to get vaccinated before their healthcare systems collapse!
We’re essentially in the midst of a distributed denial-of-service incident against our entire healthcare system, where the majority of folks in the hospital right now for COVID is unvaccinated3, and most of those unvaccinated folks thinks it’s their business that they’re unvaccinated — butt out!
The consequences are predictable:
And yet, that’s not the whole story.
I am not unaware that many folks just haven’t gotten around to getting boosters, or are having trouble finding them,4 but right now, that’s just not the majority of who’s going to hospitals in areas with surges.
That all changes as Omicron comes. We’re already seeing significant outbreaks on college campuses where by rule effectively all the students are provably vaccinated (though often not boosted — and given timing, many might have held off on boosting, planning to get it after finals), though we’re not seeing meaningful hospitalizations yet there. That makes sense; I’d still expect vaccinated-but-not-boosted, or boosted folks to be significantly less likely to need hospitalization or ICU admission, but plenty of folks who did everything right will suffer too.
But remember: we’re seeing outbreaks of Delta and Omicron even in communities with perfect vaccination (but imperfect boosting), rules limiting some gatherings, and intense community surveillance from regular testing. This thing is way more transmissible than the original baseline strain.
Your most strenuous individual efforts will only delay the tsunami by a miniscule time at a population level, with a disease this fast- and wide-spreading, and the folks who will most benefit don’t want your help. You can definitely reduce your own risk somewhat, but with an airborne disease this infectious and likely to be so widespread in the population all at once, it’s definitely possible to get a breakthrough case even with significant risk-reduction efforts that make a March 2020 USA lockdown look like a Miami Beach vacation.
And, though I hesitate to point it out, many of those measures just suck to experience, and it seems like an unsustainably bad (and untrue) public health strategy to say, “There is no possible personal benefit to being conscientious about risk, you should avoid everything and everyone; meanwhile, those who don’t care about others get to party and spend time with family as much as they want. Good luck, and see you never!”
If we want to meaningfully bend the curve as a society, we need incredibly strict population-level measures, and it’s clear that there just isn’t political will to invoke those measures right before Christmas, unless perhaps when our hospital systems are on the brink of total Code Black5 collapse. We’re, frankly, gambling on boosters and mildness of Omicron being enough to save our healthcare system.
I know that in general we like to write like good Kantians, assuming that any advice we have is universalized, but in this case, that’s unfortunately not true. And at least half of why I wrote this essay was to figure out something I could do that would matter other than at the person-to-person level, and, well, I’m coming up short.
For me, that means that (as of now), I’m avoiding unnecessary risks to myself and others, but I’m not locking down. Maybe I’m a moral monster and will look back on my risk-reward calculations in horror; I’m sure some of you will think that I am being too cavalier. Others will think I’m still being a scaredy-cat.6
And for some of you, my perspective is all charmingly irrelevant; there are multiple pregnant folks who get this newsletter, and who are likely going into labor during the peak of the hospital overload, and multiple immunocompromised folks, too.
But: this issue of So It Turns Out is not about virtue signaling, this is about harm reduction7.
I’m NOT fully turtling up, not out of a desire to ignore the virus, but out of a belief that totally avoiding exposure risk to Omicron is nearly impossible, and the broader public health challenges are already happening, would happen absent Omicron, and are unavoidable absent significant government action.
But I AM telling you that it’s worth reducing your own risk while doing what you’d do anyways, both for self-protection and to do what little you can to help out hospitals.
I got boosted, I wear high-quality KN95 masks from Bona Fide Masks, I am still seeing people, I am going to happy hours (though the DC global-warming-assisted weather means those are almost always outdoors), I am gathering with friends indoors on occasion. I’m avoiding dumb-ass behaviors that are likely to put me at need of medical care. I’m also rapid testing immediately before travel or seeing large groups, and taking a testing kit with me when I do travel, as well. I’m trying to be responsible, but all I have is a bucket, and I’m not sure that’s going to be enough to bail out my little corner of the world.
Be safe. (Get boosted!)
Prior to travel, also please carefully review The Bard’s In-Flight Safety Video
May Jeans and Jorts bless your timeline
…but do not butter Jorts, vaccination advocate
Pause
Do not forget to feed your otters
Disclosures:
Views are my own and do not represent those of current or former clients, employers, friends, or my cat.
I understand that for those who are immunocompromised, this whole argument is essentially an, “Other than that, Mrs. Lincoln, how was the play?” statement. But I owe you candor.
Contrary to popular opinion, I think it was actually a good thing to run that — most terminally-online-public-health-commentariat-Americans aren’t aware of what many Americans are actually doing on a day-to-day basis. You might say that this demonstrates a fundamental flaw in how we do public health data collection in an era of fucking ubiquitous smartphone cameras, but I couldn’t possibly comment.
Even in top-of-the-US-vaccination-rate-chart Vermont, where you have to expect that meaningful percentages of folks in the hospital are breakthrough cases, the overwhelming majority of folks in the hospital are still unvaccinated:
Seriously, go inspect any of the vaccine hunter facebook groups. They’re suddenly quite active again with high-competency folks who are genuinely having trouble finding booster appointments in some areas. If you are a Friend of the Stack and have trouble finding a booster, email, text, or call me immediately and I will help you find one today.
Yes, I’m aware that “Code Black” doesn’t actually mean “No capacity left, we are on diversion” in many US hospitals where it rather often a reference to guns or explosive threat, but it does mean that in parts of the UK and the US, and frankly, it’s a phrase that invokes a certain image.
The fact that these two are comparable reveals something about the current online infowar metagame, but that’s a discussion for a different day.
Or, to the extent that I’m virtue signaling, it’s actually about signaling that I’m someone who writes down my best guesses publicly and ahead of time, and who cares about your health and your opinion of me.