No, Life Isn’t Going Back to Normal for Many Months

Breaking down the covid risk of various types of human activity.
Source:
https://twitter.com/DKThomp/status/1298422722066882561?s=20

One of the great failings of virtually every public leader in America talking about necessary changes, restrictions, and public health advice for the covid pandemic has been a failure to set expectations for how long life as we previously knew it is going to be upside down.

You can give some grace during the early lockdown phase because all of us were reacting swiftly and tardily to the outbreak of a deadly global pandemic. There are things we would, or should, do somewhat differently then knowing what we know today: outdoor gatherings, especially with precautions, are fine…indoor gatherings without masks are terrible. But what has not changed is a failure by public officials to clearly and consistently say out loud what the public should expect over a longer time horizon.

Because what we should expect is that life isn’t going back to normal for months. As in, deep into 2021 before many current restrictions on life, especially indoor gatherings (remember movie theaters, concerts, and big sporting events?) can even think of returning to pre-pandemic norms.

On a recent trip I took to then not-very-hard-hit Montana to visit one of my best friends I had a conversation with a very nice, intelligent fellow who expressed genuine shock and dismay at my belief that many restrictions would still be in place next spring. That’s a failure of leaders saying out loud (and often) what we’re facing.

Why can’t things return to normal for months? Because what we’ve learned about the coronavirus and how it spreads is much more refined than the early days of March and April. Back then we were collectively worried about spread via touching of shared surfaces, as well as via coughing. The shaking of hands disappeared. Social distancing became a norm. And we cleaned the hell out of everything.

What we know today is covid is often spread by aerosol transmission; finer droplets than those that might be coughed or sneezed and then spread by touching shared surfaces in the absence of good hand washing and the like.

Problem: the growing awareness of aerosol spread has outpaced public health guidelines. Indeed, “[m]ounting evidence suggests coronavirus is airborne — but health advice has not caught up.” All the cleaning steps business brag about are now less relevant than what are they doing to ventilate the hell out of their establishment in order to be open safely.

Only recently did the CDC finally post guidance acknowledging the major role of airborne transmission in the spread of covid (after a bizarre affair a few weeks back where they posted similar guidance then promptly retracted it) . It was a rather obvious case of political interference in public health guidelines during the pandemic.

Why would there be political interference? Because acknowledging aerosol spread means the “re-opening” hoped for by Trump and covid skeptics can’t happen in many respects because anything involving indoor gathering, especially without masks, is a high-risk environment for covid spread.

Instead of talking about cleaning things ad nauseum, as many businesses are doing, we need to talk about ventilating indoor spaces much better as an essential priority if they are going to be used, even in partial capacity:

Strikingly, in one database of more than 1,200 super-spreader events, just one incident is classified as outdoor transmission, where a single person was infected outdoors by their jogging partner, and only 39 are classified as outdoor/indoor events, which doesn’t mean that being outdoors played a role, but it couldn’t be ruled out. The rest were all indoor events, and many involved dozens or hundreds of people at once. Other research points to the same result: Super-spreader events occur overwhelmingly in indoor environments where there are a lot of people.

What does aersol spread look like in poorly ventilated, indoor environments?

Aerosol spread is also why masks have proven incredibly important. Not only does the wearing of masks protect others by limiting the spread of aerosols emitted when talking and breathing (yes…covid spreads when the infected are simply talking and breathing, regardless of symptoms), wearing a mask reduces the amount of virus the wearer is exposed to when that does happen, typically resulting in a lower viral dose and a more mild case.

In sum, we have a lot of proof indoor environments without masks are the real trouble spots. The wave of covid outbreaks in the summer as a number of states re-opened too quickly was closely tied to restaurant spending. In contrast, outdoor dining is flourishing in NYC and has been made permanent, even as NYC has thus far avoided the resurgence seen in some states that have double-dipped with covid outbreaks.

Indeed, the evidence of congregation indoors without masks being a problem is increasingly clear. Take the issue of bars: indoors, no masks, and alcohol to inhibit decision making. What could go wrong?

“If you were to create a petri dish and say, how can we spread this the most? It would be cruise ships, jails and prisons, factories, and it would be bars,” Alozie says. He was a member of the Texas Medical Association committee that created a COVID-19 risk scale for common activities such as shopping at the grocery store.

There is very much a continuum of risk and it’s important people talk about it.

Why all this concern about covid? Because the more we’re learning about covid is that it creates serious problems for even those that “recover.” So, while (the still much higher than the flu) rate of deaths has fallen from the spring as the medical community has learned more and devised more effective treatment protocols, the disease’s impact is more complex and serious in many cases than the “just the flu” nonsense you can still hear sometimes from covid deniers and skeptics.   

How so? “COVID-19 Can Wreck Your Heart, Even if You Haven’t Had Any Symptoms.” That seems bad. And the case for cardiac complications over time is serious:

Speaking of over time, there is also the issue of “long-haulers,” who have covid symptoms for…months:

Of the long-haulers Putrino has surveyed, most are women. Their average age is 44. Most were formerly fit and healthy. They look very different from the typical portrait of a COVID-19 patient—an elderly person with preexisting health problems. “It’s scary because in the states that are surging, we have all these young people going out thinking they’re invincible, and this could easily knock them out for months,” Putrino told me. And for some, months of illness could turn into years of disability.

That challenge is similar to a problem that emerged in the 1918 pandemic: people who survived that very deadly actual flu, yet who found themselves facing chronic disability challenges afterward (I highly recommend The Great Influenza by John Barry to learn more about the foreshadowing event to our current crisis). 

Speaking of 1918, one of the lessons of that pandemic was the importance of fresh air and ventilation to mitigate spread:

College classes outside during the 1918 pandemic.
Source: Billings Gazette
A lot of us could use a pandemic trim right now.
Source: National Archives
Larger outdoor gatherings? Mask up.
Source: AP

We should be doing the same thing and people are waking up to it. While outdoor dining has been embraced as an option where possible, schools have been slow to address ventilation issues as an effective mitigation tool. Our nation’s prioritization of opening bars and indoor dining before we figured out how to have schools open, especially elementary schools, will be one of our great missteps when the history of this pandemic is written. The Zoom status quo of many schools during covid now is a disaster of our own making.

Some schools have taken to more outdoor environments (examples here and here) but that can obviously last only so long in some parts of the country as winter arrives. Getting ventilation right for schools is critical…in part because America’s collective mental health may not be able to take the alternative deep into 2021.

Deep into 2021? Are we really going to be restricted that long?

Well, is COVID-19 going to disappear before there is an effective vaccine in broad use by the population? Likely not (absent a very fortunate mutation by the virus to make the spread less problematic). And when will that vaccine be available?

The vaccine being widely available is the first step of weeks, if not months, for willing Americans to get properly dosed for “herd immunity” to be reached. And if not enough Americans are willing to take the vaccine? Oh boy.

With needed vaccine adoption, we’re probably looking at life being “normal” again starting inn…the 3rd quarter of 2021.

Now, we’re likely entering the next wave of our national covid outbreak as the regular problem of respiratory viruses in our society spiking in the fall and winter as people congregate indoors occurs and too many jurisdictions still aren’t taking it seriously enough (I’m talking about you, Ron DeSantis).

The thing is, covid doesn’t care about our politics. It’s not going to change course because of grievances with various elected officials, media organizations, or our partisan opponents. It’s an airborne virus that spreads easily, and with serious effect, in indoor environments where people aren’t wearing masks. It’s not just in the US, our Western Democratic friends in Europe are also learning the hard way again that covid doesn’t stop caring about spreading just because people get tired of changing their lives because of covid. France just implemented a nighttime lockdown in major areas, more severe than anything in the United States this spring, because they’re learning that lesson the very hard way.

We can either get real about this based deadly, global pandemic on what our experience with covid has taught us thus far…or we can make it harder on ourselves. Either way, life as we knew it pre-covid isn’t coming back anytime soon. Because the virus doesn’t care about our feelings…let alone our politics.

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