Stayin’ Alive: A Guide To Surviving The 2nd Wave

Twitter post from RS_Benedict.

In a world in which our activities have been abruptly curtailed by the novel coronavirus, warm weather, relaxed restrictions and boredom stemming from months in isolation are already enticing many people to engage in behaviors that put their lives, and the lives of others, at greater and unnecessary risk. We can expect that such behaviors will continue and even increase.

We might observe others choosing to take high risk actions that could result in the spreading of COVID-19, like enjoying a meal inside a crowded restaurant. We might infer that if the government allows it, and that if these people think it is okay to engage in these behaviors, then it is also okay to engage in these activities ourselves. We might feel that if we don’t take such actions ourselves, we are “missing out” on what everyone else is doing.

Such behaviors are not presently safe for others, and they are not safe for ourselves either.  Peer pressure should not guide our actions. Those who engage in these activities now are likely to get sick from COVID-19. They may die or spread the virus to kill someone else. The same will be true for the rest of us if we succumb to following their lead.

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There is a popular misconception that migrating lemmings are driven to commit mass suicide, following each other to their death by jumping off cliffs. In this column, this Cliff’s objective is to provide some guidance that will help you avoid acting like a proverbial lemming. I’ll explain: 1) how and why the actions of others are threatening our lives; 2) to what extent the public health objectives of shutting down the economy have and have not been met, and why understanding it is important to your health; and 3) what we have learned about how the virus is transmitted, and what activities we believe are likely to present higher or lower risk.

We can count on neither the government nor our friends and neighbors to protect us so my objective is to help you make intelligent choices to protect yourselves and those whom you love.

How and Why the Actions of Others are Threatening Our Lives

As embarrassing as it is to admit it, America has become a country that is made up of a substantial minority of people who support the glorification of ignorance and stupidity. Emboldened by examples set by our government leaders at the highest levels, selfishness, thoughtlessness, and self-destructive behaviors have become cultishly prevalent.

Those who break social distancing and other safety practices the soonest and the most often typically don’t believe in or understand science, and often treat it with disdain and ridicule. These individuals are at high risk of contracting and spreading the coronavirus, and socializing in the presence of these people is high risk as well. These individuals are already starting to crowd our streets and newly reopened retail outlets, usually without wearing masks, and they are poised to ignite a pandemic wildfire that may result in a second round of contagious infection that in many places may prove far worse than the first wave.

Make no mistake about it… if you allow them to do it, these people will jeopardize your life and the lives of those you love. They are abetted by a federal government and some state governments that seem determined to help them do it. They may not have your name specifically in their viewfinder, but they are making it very clear that their need to be free to infect others in any way they choose is far more important to them than taking simple actions that will protect the lives of others.

Many of our state governments have made it clear that they will allow businesses to reopen before it is prudent in order to reduce the state’s financial obligations caused by having so many people on unemployment. By failing to follow CDC recommendations, they will give many people a rather stark choice to either go back to work in a high risk environment, or stay home and stay safe but lose all unemployment benefits.

And our federal government is taking actions that could kill us as well. They are doing this by refusing to publish guidelines for the safe reopening of the economy recommended by the CDC (See: Docs show top WH officials buried CDC report), by attempting to remove liability risks from businesses that fail to protect their employees from the virus, (See: McConnell’s coronavirus business liability pledge sparks lobbying frenzy), and by failing to step up to the role of supporting and coordinating the actions of the individual states to create an environment in America in which the spread of the virus would be curtailed. The notion that employers who follow guidelines should in some cases be shielded from liability only makes sense if the government publishes and requires businesses to follow sound guidance developed through an appropriate science-based process.

Through both actions and words, this administration tells us over and over again that the needs of the most wealthy to keep making money are far more important than the needs of the rest of us to stay alive. What they fail to tell us is that until proper procedures for dealing with the virus are in place, the efforts to reopen the economy will fail to produce worthwhile results and may in fact cause more economic harm than would have been incurred if we had waited until we were ready.

Steps Necessary For A Safer Reopening

“”We can’t keep our country closed down for years,” Trump said Wednesday. But that was no one’s plan. The plan was to buy time to take the necessary steps to open the country safely. But the Trump administration did not do that, because it did not consider the lives of the people dying worth the effort or money required to save them.”Adam Serwer in The Coronavirus Was An Emergency Until Trump Found Out Who Was Dying

There were several rational motivations and objectives that drove the economic shutdown that began this past March, some of which have been partially accomplished but many of which have not been realized. In many cases, this has been due to gross negligence and inaction on the part of our federal government. We know such actions were feasible, because we have seen many other countries in the world successfully take the necessary precautions. Meanwhile, America has wallowed in a death spiral spurred on by government inaction, confusion and corruption.

Some of the objectives of the economic shutdown included giving us necessary time for:

• allowing our healthcare system to expand capacity and acquire equipment needed to accommodate COVID-19 patients, while also reducing the peak rate at which infections were incurred. Status: somewhat accomplished, we are definitely better prepared now than we were two months ago. While personal protective equipment (PPE) shortages have and continue to provide significant challenges, we have largely managed to expand the capacity of our hospital system to meet the caseload.

• letting some portion of the essential workforce weather the disease and then return to work,  resistant to acquiring it again. Status: A first round of essential workers have indeed contracted the disease and either died or returned to work. Unfortunately, it is presently unconfirmed to what degree, if any, having survived COVID-19 infection provides resistance to getting it again. The U.S. Navy has recently reported that 13 sailors from the USS Theodore Roosevelt who had apparently recovered from the coronavirus and had received negative test results have now tested positive for a second time. See: 13 USS Roosevelt Sailors Test Positive For COVID-19, Again and Why a positive COVID-19 antibody test doesn’t mean much of anything yet.

• permitting the development of sufficient capacity to test and frequently retest those who come into contact with others frequently. Status: our testing capacity has increased but has long lagged, and continues to lag, demand. There is also considerable evidence that some of the tests in common use are not sufficiently reliable.

• putting into place robust contact tracing for those diagnosed with COVID-19. Status: accomplished in all other countries that have substantially reduced infection rates, but in the US there has been no real support at the federal level. Some states, such as New York, are starting to put this in place at the state level.

• better understanding how the virus is transmitted, how contagious it is (very!) and how to better prevent its transmission. Status: while there is much that we still don’t know, we certainly understand much more now than we did two months ago, and this is discussed in further detail below.

• developing treatments for those infected with the virus and ways to prevent infection, including a vaccine. Status: we have not developed any effective treatments. There is one drug that is showing some benefit for those infected and is being tested further. Extensive efforts have begun to develop a vaccine, however the recent proclamations from the White House implying that we should expect a vaccine that is tested and ready for public distribution by the end of 2020 is a blatant lie that has virtually zero probability of happening.

Until a vaccine is available, the three most important things required to minimize the safety risks associated with lifting stay at home restrictions are to: 1) have a massive testing capability in place, and to have businesses prepared and trained in how to use it to keep employees safe; 2) have a contact tracing program in place to quickly identify, test, and quarantine those who have been in contact with someone who has tested positive; and 3) putting in place, and having people follow, procedures that will reduce the transmission of the virus. On the whole, America has failed to accomplish these objectives, while many other countries have performed far more successfully.

Understanding the Risks of Transmission

“Shun wishful thinking, ignore divine revelation, forget what “the stars foretell,” avoid opinion, care not what the neighbors think, never mind the unguessable ‘verdict of history’ — what are the facts, and to how many decimal places? You pilot always into an unknown future; facts are your single clue. Get the facts!”  –Robert A. Heinlein

Transmission of COVID-19 can come either by inhaling the virus (respiratory risk) or through physical contact followed by touching mucous membranes on the face (eyes, nose, and mouth) that act as pathways to the throat and lungs. Other means of transmission are possible but not confirmed or believed to account for a significant number of cases.

In terms of respiratory risk, inhaling a single virus isn’t likely to infect you. Rather, it is the amount of viral exposure over an extended period of time that provides the greatest danger. Extended time in indoor spaces, with limited air exchange or recycled air and lots of people, is very concerning from a transmission standpoint. IN THESE SITUATIONS, THE SIX FOOT RULE IS NOT SUFFICIENT TO MINIMIZE THE RISK. Spending extended time at an indoor concert, an indoor restaurant, a call center, church, or in an office building or airplane can be high risk even if you are social distancing. Being co-located with people who are shouting, singing, coughing, sneezing or face-to-face talking greatly increases the risk, especially indoors.

Using a public restroom can be high risk, even if you are alone when you are using it, because the physical contact risk there is high.

Briefly being near a person outdoors, on a hiking trail, or who is jogging is minimal risk, whether or not they are wearing a mask, although the risk is even lower if masks are worn (I don’t typically wear a mask when I go jogging, but I stay at least 10 feet away from other people). As is noted in the article by Erin Bromage referenced below: “Social distancing rules are really to protect you with brief exposures or outdoor exposures. In these situations there is not enough time to achieve the infectious viral load when you are standing 6 feet apart or where wind and the infinite outdoor space for viral dilution reduces viral load. The effects of sunlight, heat, and humidity on viral survival, all serve to minimize the risk to everyone when outside.”

Visiting indoors with a group of people coming from many different households is high risk. Visiting (or dating) with another person who feels healthy and has been taking social distancing seriously is of moderate risk, but if they have just gotten off an airplane or otherwise have been in a high risk situation, then the danger becomes greater.

People who work in restaurants, grocery stores, and other settings that require them to spend a lot of time indoors with many people are at high risk, much higher risk than those who might patronize their business over shorter periods. After an area undergoes an economic reopening, one would expect that over a period of weeks, many of those who work in jobs that require them to come in contact with many people will become infected. They will then in turn, possibly before they show any symptoms, start infecting many, many others who patronize their business. This is why it is reasonable to expect to see significant jumps in infection numbers about a month after economic reopening. If I go pick up takeout food from a restaurant and I see that the restaurant staff does not even bother to wear masks when coming in contact with each other or with customers, I infer a high likelihood that those working in the venue either are or soon will be infected, and I assume that their lack of prudence and attention to public health applies to all aspects of their operations. I will refuse to take the risk of further patronizing that business.

The following three articles are highly recommended for better understanding the risks of various activities:

Erin Bromage: The Risks – Know Them – Avoid Them.

Julia Marcus in The Atlantic: Quarantine Fatigue Is Real.

Bryan Pietsch in Business InsiderThe risk levels of everyday activities like dining out, going to the gym, and getting a haircut, according to an infectious disease expert.

Recovery Blues

“The major message that I wish to convey to the Senate [Health, Labor and Pensions] committee … is the danger of trying to open the country prematurely. If we skip over the checkpoints in the guidelines to: ‘Open America Again,’ then we risk the danger of multiple outbreaks throughout the country. This will not only result in needless suffering and death, but would actually set us back on our quest to return to normal.” –Dr. Anthony Fauci in an email to The New York Times.

Will America recover from this pandemic? Of course it will. Someday, our cities will emerge from this crisis, perhaps even better than they were to begin with (See: Large areas of London to be made car-free as lockdown eased). The real question is… sooner or later? At the moment the answer appears to be “later.” Things will very likely get worse before they get better.

As I write this column, the death toll from the coronavirus in the United States stands at around 92,000. As the dominoes continue to fall, is difficult to foresee an outcome in which that total will not at least double (See: Study projects US COVID-19 deaths to triple by end of year). It is frustrating that we all have to pay the price and put our lives at risk because people ranging from our neighbors to those in governmental authority refuse to make the effort to follow science-based guidelines.

With all the sacrifices already made by so many, our taking a step backwards will bring feelings of futility and helplessness to many, including those who have engaged in heroic efforts to support the public health emergency. Yet it is important to remember that while many aspects of the situation are largely outside of our personal control, we each have an ability to make a difference by controlling our own actions, and we will each have an opportunity to return to the polls this November to show the world that America is not solely composed of lemmings intent upon self-destruction.

The reality of today’s world is that there are in fact many who, either through deliberate action or general indifference, will cause us harm if we are not cautious and prepared. In the face of these societal forces and pressures, the responsibility falls upon each of us to personally do what is necessary to stay healthy and minimize the risks to ourselves and those we love. Each of us has the power to take meaningful actions. Reliance on the government at either the federal, state, or local level to protect us is utter folly. While the government may, from time to time, do things that will help us, their primary focus is often protecting their incumbency and their budgets, which may or may not align with protecting our health and life. If we are going to minimize our personal risks, it is up to each of us to take personal responsibility and action to do so.

May the odds be ever in your favor.

🎶Feel the city breakin’ and everybody shakin’
And we’re stayin’ alive, stayin’ alive
🎶

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