LA County broke another record on Wednesday, reporting more than 22,000 new coronavirus cases. Meanwhile, Moderna’s vaccine may be available as early as next week. Frontline health care workers are already getting the Pfizer vaccine. “ The beginning of the end ” is how Governor Gavin Newsom described this moment earlier this week.
However, Dr. Nicholas Christakis argues that the end is much further away than people might think. He’s a sociologist and physician at Yale University. His new book is “Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live.” It’s one of the first comprehensive books on the pandemic.
“In 2024 we’ll finally be able to put this awful experience behind us and enter the post-pandemic period,” says Christakis.
But why will it take three years? Look to history for answers, he says.
“It's very important to understand that plagues are not new to our species. They're just new to us. We think this is so unusual, and we're ready for it to end. And we think oh, it'll soon be over. But just that's not a realistic expectation.”
That’s because a COVID-19 vaccine must not only be distributed to at least 50% of the population, but people also need time to recover from the psychological, social, and economic shock of a plague. Even after 2024, Christakis argues that society will feel ripples of the virus’ effects. That includes the educational and medical impact of COVID on humanity.
Christakis refers to one example: use of a public spittoon before the 1918 Spanish influenza pandemic. At the time, it was common to spit into this container in front of strangers. But as the pandemic raged on and eventually ended, a new movement began to prevent spitting into brass buckets. He says advertisements warned against the practice, stating “spit is death,” and spittoons were removed from restaurants.
Today, Christakis says similar situations might unfold. Virtual gatherings, working from home, and abstaining from flying internationally for meetings could become normalized. Providing health care or comprehensive employee benefits to all might also become common practice.
“People are realizing that the cockamamie system we have for health care in this society doesn't make much sense. It doesn't make much sense to tie people's access to health care to their employment, when in a time of an epidemic, people lose their jobs because the businesses go out of business.”
Distributing vaccines according to how social someone is
Christakis has one theory on how to successfully distribute vaccines. It starts with what he refers to as network science, which would allocate treatment to those who have multiple numbers of connections to people. That’s in comparison to those who might be homebound or are more isolated.
“If you vaccinate that [connected] person, you might prevent that person from spreading the disease to five elderly people. Or you could give that same dose of vaccine to one elderly person. You might actually save more lives if you did the mathematics, by allocating vaccines to working age people.”
He says you can track who’s more popular by studying their social media data, or by exploring the friendship paradox.
“You can go into a group of a population, pick people at random and say, ‘Who's your friend?’ And they say, ‘Oh, so and so's my friend.’ And then you go give the vaccine to those people,” Christakis says. “We've actually done experiments with this and shown that you can use this idea to turbocharge the spread of public health interventions in many settings around the world.”
Public health messaging and rallying together
Christakis says since the onset of the pandemic, public leaders have done a poor job in educating Americans about the threat of COVID-19, lacking coherent, honest, and credible public health messaging.
“We should have been manufacturing PPE. We should have been manufacturing ventilators. We should have been way ahead of the curve on testing. The public should have been prepared. We should have spoken to the American people and said, ‘Look, this is awful what is happening. It happens once every century, it happens to be happening to us. And we as a people need to band together.’ There should have been a call to common purpose, a call to sacrifice, a call to maturity, to confront this threat.”
Christakis says he understands why Americans tried to ignore the COVID-19 problem, but wishing something wasn’t happening isn’t an adequate solution.
“I still hope for us to kind of rally to get our acts together, to work together to confront this pathogen to minimize its damage to our livelihoods and our lives,” he says. “We will see the other side of it. Plagues end. They always end and I look forward very much to that ending.”
Photo courtesy of Little, Brown & Company.
Read an excerpt from Nicholas Christakis’ new book “Apollo’s Arrow"
Things Change
In Monza, he happened to pass a shop which was open, and had bread set out for sale. He asked for two loaves, so that he would not have to go hungry later on, whatever might happen. The baker signed to him not to come in, and held out a small dish filled with water and vinegar on the blade of a shovel, telling him to drop the money in there. Then he passed the two loaves over to Renzo one after the other, with a pair of tongs.
—Alessandro Manzoni, The Betrothed (1827)
In March 2020, as the lockdowns were coming into force in Europe, seismologist Thomas Lecocq of the Royal Observatory of Belgium noticed that the Earth was suddenly still. Every day, as we humans operate our factories, drive our cars, even simply walk on our side- walks, we rattle the planet. Incredibly, these rattles can be detected as if they were infinitesimal earthquakes. And they had stopped.
After Lecocq’s initial observation, seismologists around the world began to share data. With the anthropogenic shaking of our planet subdued, they could even detect the rushing of rivers far away. The unexpected calm allowed them to use naturally occurring back- ground vibrations, such as the crashing of distant ocean waves, to better understand the deformation of the Earth’s stony crust. The coronavirus had changed the way the Earth moved.
Other signs pointed to a changing world as well. In the spring of 2020, many videos went viral of wild animals moving into cities. Herds of wild goats, crocodiles, leopards, even elephants wandered streets now devoid of traffic. Satellites high above our planet looked down and detected the disappearance of pollution as manufacturing ceased. In India, where over 1.2 million people die each year as a consequence of air pollution, residents of the city of Jalandhar looked up to see the Dhauladhar peaks of the Himalayas over one hundred twenty miles away. The mountains appeared in startling relief against incredibly clear blue skies for the first time the older residents could remember since they were little children
While the rest of the natural world began to heal, humans continued to suffer. We reshaped our way of life to slow the spread of the virus. Of course, our nonpharmaceutical interventions were able to postpone and mitigate the pandemic, not stop it. Once the virus had been established in our species, the outcome of the pandemic was inevitable almost no matter what we did. There would be many deaths. The epidemiology alone—an R0 of about 3.0 and a CFR of 0.5 to 1.2 percent—dictated that.
In the summer of 2020, I kept trying to push these thoughts from my mind. But I could not think of a sound reason to justify optimism. As I reviewed the graphs showing sudden spikes in caseloads in states like Arizona, Texas, Florida, and California at the end of June, and as I listened to President Trump and Vice President Pence insisting that this escalation was merely a function of “too much” COVID testing, I felt despair. In talking to my epidemiology colleagues, I detected a similar gloom. In his public pronouncements, Dr. Fauci, though he expressed “cautious optimism” for the rapid development of a vaccine, was clearly somber.
Other concerning signs appeared over the summer as well. We learned that in India, for unclear reasons, younger people died of SARS-2 in higher proportions than in other countries. That country was being hit so hard that it resorted to using railway cars to create eight thousand more beds for COVID-19 patients in the capital. At the same time, the virus reemerged in China and in other populous countries, such as South Korea, that had previously successfully controlled it. In Brazil, whose president, Jair Bolsonaro, was so dismissive of what he called a “little flu” that a federal judge had to order him to wear a mask, the virus ran loose. In fact, like Boris Johnson in England before him, Bolsonaro became infected himself. Very preliminary hints also emerged from genetics laboratories around the world that the virus might possibly have certain variants that were worse for humans—more deadly or more infectious or both. And, with the passage of time, information began to accumulate about the long-term morbidity associated with the virus; some patients would be debilitated for months after recovery
In other words, for all we have learned about the virus through the early stages of the pandemic, there is still colossal uncertainty about exactly how it will continue to change the shape of our society in the coming years. Nevertheless, it’s quite clear that the virus has already changed our world and that it will continue to do so for some time.
Let’s first establish a time frame. If we are able to make a safe and effective vaccine, distribute it rapidly and widely, and get large numbers of people to take it, we might shorten the duration of the pandemic. But even if we are able to clear all of the hurdles for such a rollout, the vaccine still might not arrive before we achieve herd immunity. That is, since we are likely to reach an attack rate of roughly 40 to 50 percent by 2022 no matter what we do, unless the vaccine becomes widely available in early 2021 (which would be the fastest a vaccine had ever been developed by far), it will not make much of a difference in the overall course of the pandemic (though even then, the vaccine would still be enormously valuable to protect uninfected people).
Either way, until 2022, Americans will live in an acutely changed world—they will be wearing masks, for example, and avoiding crowded places. I’ll call this the immediate pandemic period. For a few years after we either reach herd immunity or have a widely distributed vaccine, people will still be recovering from the overall clinical, psychological, social, and economic shock of the pandemic and the adjustments it required, perhaps through 2024. I’ll call this the intermediate pandemic period. Then, gradually, things will return to “normal”—albeit in a world with some persistent changes. Around 2024, the post-pandemic period will likely begin.
We cannot anticipate all the ways our lives will change, and in fifty years, we may not even remember which changes the pandemic catalyzed. For example, spittoons and public spitting were wide- spread in the United States up to the beginning of the twentieth century. But they were both abandoned in part because of the 1918 influenza pandemic, when they were rightly seen as unsanitary. For a more recent example, I was well into adulthood before it became obvious to the world that flying in an enclosed space or waiting in a hospital for a medical procedure were not opportune moments to light up a cigarette. In hindsight, these unneighborly practices seem ridiculous. We do not go into restaurants and wonder why there are no spittoons, and the no smoking signs on airplanes feel like an abstract formality. We have forgotten how the world used to be.
Many personal attitudes and practices, at home and at work, have had to change due to the pandemic. The deadly virus on the loose, the isolation, and the slowed economy all worked together to foster.
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Copyright © 2020 by Nicholas Christakis