Drawing by Derek Evernden at New Year’s, a year ago. Oops!
The outcome of this match was hard to predict at the outset. Humans have fared pretty well over the last century at dealing with viruses. But the problem is, if you don’t keep practicing, you lose your edge. And compared to humans, the viruses have been getting in a lot of practice in the 21st century. Here’s how the moves have gone so far:
- Viruses: The game began, it seems, in a bat cave in China, in 2019. Bats, which have a natural immunity to most viruses, can have up to 15,000 different pathogenic viruses , each with lots of strains, and the viruses are constantly mutating. Some of the bats in one cave in Yunnan in particular*, seemed to have hosted a range of randomly mutated coronaviruses that had not previously been seen. The cave was near a station on the new Chinese high-speed train that had Wuhan as a major stop. So the virus’ first move was a novel one — a move never before tried in the game. But then many, many viruses are novel. Your body contains about 400 trillion of them at any one time.
- Humans: The humans, flummoxed by this bold and unorthodox first move, hesitated before deciding on their response. In this game, time is of the essence, and hesitation can be disastrous. The humans nodded and smiled to their fans, telling them this was nothing to worry about, it was all in hand. But meanwhile they were huddling furiously to decide how to respond. Under cover of their public display of confidence, the humans decided on two equally bold and unusual responses. First, the Chinese mapped the genome of the new virus and immediately sent it to scientists all over the world, so that a first vaccine candidate would be identified a mere week later (January 2020). And secondly, they decided to lock down much of a country of 1.4 billion people.
- Viruses: The virus had anticipated this, and was way ahead of the humans. This was an extremely transmissible virus, and it had the element of surprise on its side. The humans knew, from SARS-CoV-1 early in the century, that global mobility of humans had reached such a high level that attempting to limit the spread of highly transmissible viruses by closing airports and restricting travel was utterly futile. Back in 2008, the US DHS had even recommended that such measures not be even tried, as it would be a waste of time and energy. Instead, the public health scientists knew, it was important to test everywhere and everyone quickly and repeatedly to isolate all cases, and to use universal masking if the virus was transmitted by aerosol particles. This virus put everything into transmissibility, trading off for lower morbidity (it had lost previous matches with SARS and MERS, using a higher-morbidity, lower-transmissibility strategy).
- Humans: A combination of cockiness and ignorance meant that the humans’ next move was totally bungled. The public health scientists knew that there had been none of the preparation for a high-transmissibility virus that had been recommended a decade earlier, so there were pitifully few medical masks available for the public, and no infrastructure in place to test even a tiny proportion of the population for infection and isolation, so their early advantage in sequencing the new virus was useless. So instead, the humans responded with a feeble attempt to encourage, rather tepidly, use of hand-and surface-washing and inadequate cloth masks, an idea they ‘sold’ poorly to the population, and supplement that with ‘social distancing’ — which might work if the virus only spread via droplets and was not transmitted through aerosol means. They tried to convince themselves, and the public, that this was likely a droplet-transmitted virus — A fatal mistake. Worse than that, the political humans, embarrassed at how quickly this virus had seized its advantage and how unprepared they were, and wanting to believe the whole thing wasn’t happening, suggested that (a) it was probably ‘no worse than the seasonal flu’, and (b) it was the result of human error in China, so it was up to the Chinese to ‘fix’ it. Meanwhile, absolutely nothing was done to resolve the problem of grossly inadequate masks and tests. It was as if the humans were in denial that anything was happening at all. To “protect patient privacy”, most citizens saw nothing of the horror occurring in thousands of hospitals and institutions. Most human energy was now diverted to the blame game, and finding dubious scientists who would explain the virus’ astonishing early success away.
- Viruses: Thanks to the almost total lack of preparedness by the humans, there were not even enough high-quality aerosol-preventing masks for front-line professionals, so the virus’ strategy of high aerosol transmissibility had clearly been the right one to try. Further stealth was achieved in two ways: (a) a 21-day lag between onset of symptoms, which at first seemed usually rather innocent and flu-like, and death, and almost as long a lag between first symptoms and hospitalization; and (b) the majority of transmission was asymptomatic, so millions of people were unknowingly spreading the disease, and the virus was busy damaging 19 different human internal organs, including the heart and brain, in unique and subtle ways that would mostly only be discovered months later, or when autopsies were performed.
- Humans: Belatedly and inadequately, the humans acknowledged that this virus had more than ten times the morbidity of seasonal flu, and was far more prevalent worldwide than anyone had thought, and they introduced mask mandates, encouraged use of at least medical-quality masks (but not N95-quality), and introduced lockdowns where and while cases were high. It was the summer of 2020, and the tide seemed to be turning — cases dropped, and then so did death rates, dramatically in many cases. But then, as if they were determined to undercut their own success, the humans made the stupidest move yet — they relaxed the mandates and lockdowns. Almost immediately, the virus recovered.
- Viruses: Stealth had proved to be the best strategy for the virus, so it stuck with that strategy. Laying low for the summer, it continued its largely invisible damage to the bodies of the billion or so humans infected so far, setting the stage for up to 20% of the survivors to develop Long CoVid chronic ailments in, and destruction to, their bodies’ organs. And with its vast experience and spread, it now began to develop mutations. In September of 2020, when the humans were beginning to publicly declare victory, the alpha variant debuted and quickly became the prevalent strain. Two other, very different strains followed soon after.
- Humans: Psychologically rocked by being seemingly so close to defeating the virus and then undone by overconfident relaxations and lack of diligence, the humans again turned to the blame game, blaming poor health care advice (true in part, since most public health care research and most pandemic preparedness programs in many countries had been gutted over the previous four decades), blaming other humans (especially the young, the uneducated, the already-sick, and the old), blaming governments and pharmaceutical companies, and blaming others’ ideologies and the media that fanned them. Still there were inadequate and insufficient masks. Still there were absurdly insufficient test resources. So now, demoralized, the humans went ‘all in’ on a giant gamble — a vaccine would be found, soon, and everyone would take it.
- Viruses: The winter of 2020-21 belonged, like the winter before it, to the viruses, as cases again soared. After the daily death toll had dropped 90% in the previous summer, to the point a “Go For Zero” strategy was actually viable in some places, the humans instead again relaxed mandates and restrictions in the late summer and fall, and deaths subsequently reached record levels in most countries. Only the vaccine now stood between the viruses, which had now claimed close to 30% of the human population, and victory.
- Humans: The vaccine arrived in January 2021, a monument to human ingenuity, global scientific collaboration, and collective capacity in times of crisis. Although it had taken a year to test, this was a fraction of the time that previous vaccines had taken to develop, and these vaccines were novel too, relying on a different mechanism, rather than infecting the patient with a small amount of the actual virus to prompt an immune response. So these vaccines were also safer. And there were several on offer, so that if one underperformed humans could switch to another. This seemed like it would be the deciding blow in this match — the virus would soon be on the ropes. But again, the humans undermined their own success. Because of decades of neglect and privatization, the infrastructure needed to order, distribute and administer the vaccines was almost entirely absent, and it would have to be built from scratch. And worse, the political humans interfered and tried to discredit other ‘unfriendly’ countries’ vaccines and hoard their own for their own citizens. Still, the race was now on.
- Viruses: It was coming down to whether the virus could mutate fast enough to beat the new vaccine into the bodies of the remaining 70% of humans. Thanks to the slow production and distribution of vaccines, the virus quickly unleashed the delta variant, and cases again soared. This was especially advantageous for the viruses, because when cases were rising even as a massive vaccination program was underway, it played into the doubts of the vaccine hesitant and the fevered imaginations of the conspiracy theorists. Now, not only did the humans have to deal with inadequate systems for delivering the vaccine, they had to deal with a large proportion of the population who refused to take it. It looked as if the match might end in a tie, with half the humans getting the disease (and a significant proportion of them getting Long CoVid), and the other half getting inoculated.
- Humans: Trying to tip the game to their advantage, humans began to offer third “booster” vaccines, especially to the most vulnerable. There was disturbing evidence that, while it was rare and their symptoms usually mild, some fully vaccinated people were getting infected with the delta variant. The “booster” seemed to restore the vaccine immunity, but the real challenge was still the enormous reservoir of disease that those who refused to get vaccinated offered to the virus as it continued to mutate. A “tie” match was looking to be the best that humans could now hope for, especially if the game went into overtime, and with another winter on the horizon, overtime looked like a distinct possibility.
- Viruses: Human hesitation, lack of preparedness, and foolishly giving up on mandates and restrictions, provided the viruses with all the time they needed to mutate into yet another variant, called omicron. This was exactly what the virus needed to win — it was even more transmissible, including to those who had been vaccinated (though it was much less transmissible and had a much lower viral load in vaccinated bodies). Again, it sacrificed morbidity for more transmissibility, since this was now a sprint, not a marathon. Even with much lower morbidity it could still infect more people (and that is its existential purpose) because essentially everyone who had not been vaccinated, and some who had, would get the disease. By any judge’s criteria, that would be a ‘win’.
- Humans: So here we are now, in January of 2022, and it’s our move again. One of the moves we tried in earlier rounds is now, suddenly, not available to us: With positivity rates in the 15-50% range in most areas, sending people home to isolate after infection would so deplete essential services that they would largely cease to function. We still have a woefully inadequate testing capacity and infrastructure and a woefully inadequate vaccine supply and infrastructure in much of the world. Most people do not own an N95 mask (which are still out of stock in most places) and many do not even use a hospital-grade mask; many others use their masks improperly or only intermittently.
So, given continuing high rates of vaccine hesitancy, there would now seem to be only two moves left: (a) the massive deployment of N95 masks and their ubiquitous use everywhere indoors until the virus is starved of new victims and test-and-isolate once again becomes a viable strategy, or (b) resign the game, and cede victory to the virus, allowing it to spread freely to all except the most vulnerable (essentially isolating the most vulnerable instead of the infected) until it runs out of potential victims.
As ghastly and depressing as the latter strategy seems to me, I can’t see the former strategy working at all. It depends on a patient, enforced, consistent, effective and ubiquitous mask mandate that all of our experience to date indicates simply will not be forthcoming, either from us as citizens, or by those who are charged with enforcing it. A half-way move of asking people nicely to mask up all the time is a worse-than-nothing compromise. As the Chinese and other countries who have been successful at stemming the virus (so far anyway) have learned, you don’t compromise with a deadly pandemic that has already killed about 14 million people in two years (including about 1 out of every 80 people over age 65), and could well double that toll before the game is finally over.
To put this in perspective, globally, about 20 million people die each year from cardiovascular disease, and about another 10 million die of cancer. Most of those deaths are probably preventable, if we had the will to require and enable people to eat a healthy diet, and to exercise properly, and if we had the capacity to rid our world of the toxic substances that our civilization has produced, and the massive chronic stress of precarity it induces. We have, of course, no such will or capacity. Adding another 7-14 million lost lives for a year or so before the pandemic runs out of steam, will, I suspect, soon become a devil’s bargain we are prepared to accept to get over the tumult, disruption, shame, and psychological, social and economic turmoil we have lived with for the last two years. Though the burden on hospitals will be pretty horrific, even as we continue to look the other way.
When that happens, and I think it will come this spring (and seriously hope the additional deaths will be much lower than another 14 million), we will not want to hear the daily numbers any more, much as we tired of hearing the death toll from HIV after 1995, when it finally ceased to be the #1 cause of death for young Americans, though it still killed two million globally in 2004.
My sense is that we’re quickly running out of options, since we failed to take the actions necessary to bring this pandemic to a close at least five different times over the past two years. No one is to blame for that. This played out the only way it could have.
We have played our best game, and lost. Hope we do better next time.
* For those new to this virologists’ discussion thread on the origins of CoVid-19, I’d recommend you read the last (bottom, September 2021) entry first, and then go back to the top and read through the entire thread. It’s technical, but not hard to follow.