How Do We Get out of This?

A friend of mine sent me this thought-provoking essay, written by pediatrician and child psychiatrist (and mother) Elizabeth Pinsky, from the current issue of the Atlantic, the main point of which is that the author’s town, Somerville, Massachusetts, has done all the right things and controlled the virus to the point where it’s safe to go back to school. While I disagree with some of her secondary points, specifically the contention that anyone who wants to open other parts of the economy is just a pleasure-seeker putting instant gratification ahead of children’s wellbeing, I agree that in the parts of the US (and the UK) where the virus has been sufficiently controlled, the psychological, physical, and academic cost to children of remaining isolated is far greater than the risk of COVID-19. Most of the rest of the world agrees, too, as this article in Science details. And in most of those places, other parts of the economy are opening up, too.

Why, then, are so many Americans who have been guided by the science during the peak of the pandemic suddenly resistant to expert opinion? The first reason is purely emotional and would probably have occurred even if we’d managed COVID fairly well. It takes a leap of faith to go back into the world you’ve now conditioned yourself to believe is too dangerous. Most of us have seen “even one death is too many” repeated on social media and in union flyers. Our children have been safe with us at home, the logic goes. Why would we send them out to potentially catch COVID-19 or infect their grandparents? Because, I would argue (as Pinsky does) that saving a child from an unlikely COVID death might very well cause deaths for a host of other reasons, and would probably disproportionately affect the people on the lower end of the socio-economic ladder. And if we were to follow that logic, we would never let our kids do anything—no matter how much benefit they get from those things. We’d never drive them anyplace, we certainly wouldn’t enroll them in sports programs, we wouldn’t let them out of our sight.

And think about how we received the news and how we acted at the start of the pandemic, before anything locked down. Of course, we had no idea how bad it already was, much less how bad it was about to get. We went on with our lives. I flew out to Los Angeles on an emergency visit to my son, who’d been struck with a mystery illness that landed him in the hospital for 2 days. We now assume that illness was COVID-19, although he has still not been able to get the antibody test for it. By the time I came back to London, I was a little apprehensive when the man next to me on the plane was wearing a mask and sniffling, but I wasn’t paralyzed with fear the way I’d have been a couple of weeks later, when Brits started dying in large numbers. Had it not gotten that bad, had relatively few people died in our part of the world, as with the 2009 H1N1 outbreak, we’d maybe have been slightly more cautious, gone to the doctor more quickly, and gotten on with our lives. We don’t stop the entire functioning of the country or world every time a new illness emerges. It was precisely the scale of this illness that caused us to grind to a halt. Unfortunately, once you’ve halted, it’s exponentially more difficult psychologically to believe it’s OK to go back to some semblance of what you were doing before.

That’s where leadership comes in. The problem the US and the UK have right now is that people do not trust the leadership and so everyone is making up his or her own mind. In the UK, this is because of the contradictions (remember Dominic Cummings?) and U-turns that define the government. Just this week, after traumatizing the nation’s university applicants with an algorithm that cost many students their university places, the government further confused things by announcing that they would not use the algorithm. Because universities have even more limited places than usual with social distancing, this means that many students are still out of luck. How can we expect the average citizen to trust the government with our children’s health if they, once again, didn’t foresee the fallout from this decision? But while the numbers aren’t as good as the countries with the best experience, the UK is down to about 10-12 daily deaths from COVID, compared to over 1000 per day in the US. And the test positivity rate in the UK, the metric that Andrew Cuomo is using to determine whether it is safe for children to go back to school in New York, is hovering at 0.6 to 0.7 percent, or slightly lower than New York’s 0.8%. So it would appear that the perception of ineptitude and self-interest is the UK’s biggest obstacle to getting back to normal—or the pandemic version of normal.

In the US, there is the same distrust of the government, coupled with huge regional differences in both COVID rates and pandemic response. Since the Federal government has not coordinated a response to the pandemic, states are on their own. I wrote in my June 30 post about a city in the UK, Leicester, that had been put back into lockdown because of a surge in COVID cases there. Although the handling of this decision was less than stellar, it worked and now  Leicester is reopening. This is why certain countries seem to have done so much better at containing the virus. Despite President’s Trump’s tweet that it is experiencing a “terrible surge,” New Zealand, for example has orchestrated a response that has made it a world leader in control. That “surge” came mostly from a cluster of people who had travelled elsewhere and are now in quarantine at a “COVID hotel.”  Since the start of the pandemic, New Zealand has experienced 22 deaths from COVID. While these countries have succeeded by locking down when the numbers warranted it, the Trump administration’s response has been to threaten to withhold Federal funding if states continued to be in lockdown, regardless of the numbers. Last month, for example, he threatened to withhold COVID aid to states that did not open schools, regardless of their rates of infection.

Is it any wonder, then, that people are nervous? They are looking at stories from across the country that don’t necessarily reflect the experience in their region. It’s impossible to see the numbers in Florida or California without being nervous. When, last week, New York Governor Andrew Cuomo announced plans for reopening schools, the plans were very detailed and very cautious. They also allowed individual districts with particular concerns to opt out. Yet he was met with an opposition based on feelings. United Federation of Teachers head Mike Mulgrew issued this statement: “As Governor Cuomo noted, parents and teachers must be confident that schools are safe before they can reopen. In New York City that is still an open question.” While Cuomo’s plans are heavy on specifics and thresholds, Mulgrew’s statement, so far, provides no alternative thresholds or conditions that would give parents and teachers that confidence. Representative Alexandria Ocasio-Cortez tweeted the perfect tweet to make parents and teachers anxious without having to provide support: “If it’s not safe enough for indoor dining, what makes it safe enough for indoor schooling? And restaurants actually have soap in the bathrooms,” thereby implying that school districts wouldn’t be making sure children were following safe hygiene practices, even though the districts have to submit detailed plans before they can reopen.

All of this infighting and politicking just makes the average citizen more unsure as to whether they should be following their leaders’ advice. That, coupled with a complete lack of coordination at the Federal level, means that people in the “good” states feel that they are at the mercy of people in the poorly performing states. People in New York or New Jersey see the numbers in Florida and even with air travel bans, etc., they know that there’s an awful lot of travel between those two states and Florida and they worry that when they start opening up, they will get slammed again with people returning to the Northeast from the sunbelt. One of the ironies of the different responses to opening schools is that people who are least appreciative of education and academic achievement, those who believe the least in things like science, are the ones shouting the loudest that we have to reopen the schools. As Andrew Cuomo has said, New York’s current test positivity rate has been hovering around 1% for weeks. Florida’s is over 16%, yet while Cuomo is allowing districts to make their own decisions, Florida’s Governor Ron DeSantis, following his president’s lead, has threatened to cut school funding if schools don’t fully reopen for instruction.

So where are the numbers for the nation as a whole? My friend sent me another article from the Wall Street Journal (so you may hit the pay wall) that reports that case numbers are declining, which is good. Yet, if you read the article, it’s a tale of two nations. Several states are seeing very few cases and very few deaths, yet some states are continuing to see their numbers rise while their citizens fight masks and social distancing and closures. And test positivity, judged by Johns Hopkins, Oxford, and others as the best measure of a state or country’s COVID experience because it looks at both how widespread testing is and at how many cases there are, is above the WHO threshold of 5% for 35 states and below for 17 states. If we take New York’s 3% threshold, we’re down to only 12 states that have the virus enough under control to think about sending students back to school:

Since positivity is a more complicated measure of testing and cases, let’s go back to simpler measures: the number of COVID cases, hospitalizations, and deaths. Of these statistics, the number of cases, of course, has been the most criticized, since having a lot of asymptomatic cases might mean multiple tests, inaccurate tests, or just that some states are being unfairly dinged for testing more people. So, although I’ve included cases in the table you can download below, I’m going to concentrate on current hospitalizations and daily deaths (per 1 million people).

If we sort by hospitalizations, the highest ten states all have over 150 people per million hospitalized, with Mississippi, the top state, coming in at over 350:

By contrast, the lowest 10 states have hospitalization rates ranging from 7 to 45 per million:

Mississippi, the state with the highest rate of hospitalization, has a rate over 50 times the rate in Maine, the lowest state. The players don’t change all that much if you sort by rates of death instead. Louisiana supplants its neighbor Mississippi as the worst-performing state with a daily death rate of 17 per million (Mississippi is second with 12). The good news is that at the other end of the scale, there are fully 22 state with daily rates of COVID death at 1 or 0. At the top end of the scale, there are only three states with daily rates in the double digits now, with South Carolina rounding out the top 3 with 11 per million. Florida, Arizona, and Georgia all come in at 9. And even though all these rates of death show a far better experience than a month or two months ago, there are still over 500 deaths a week in Louisiana. And it’s not merely a left state-right state divide. Right now, it’s scariest to live in one of the dual-personality states. Louisiana has a moderate-left governor who has been sued by bar owners for closing bars in the face of the outbreak (they lost). California, which squeaks in below the 10 on all the measures we’ve been looking at, still has almost 7,000 new cases and over 50 new deaths a day, even though they faced one of the toughest early lockdowns and then, after starting to reopen, went back into a stricter lockdown.

Why did New York and New Jersey, for example, do so much better than California? I’m segueing from fact to hunch now, but I always think of California as the sort of England of the US. And not the stereotypical non-existent England Americans love. In each place, there is a small, militant group of people who oppose masks, think it’s all a hoax, and take to the streets with guns strapped to their chests (well, that last part isn’t England, thank heavens). But they’re a relatively small group. There’s also a larger group, particularly around the cities, who follow the rules, wear their masks, avoid crowds, and understand, as Family Guy creator Seth MacFarlane has tweeted, that we could defeat the virus much more quickly if we all followed the rules:

Or, in the words of TikTok star Karan Raj:

The problem in both California and England is the largest group in each place. These people aren’t militant, they’re somewhat self-centered and seem like they haven’t been paying attention. They want to do what they want to do, and they haven’t gotten the message that they could do it much more quickly if they followed the rules for a relatively short time. The lockdowns have had to drag on the way they did because of these people. And while our governments are arguing or contradicting themselves, this group won’t get the message and everyone will suffer.

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