As we see the number of cases diminishing, we hope the Pandemic is finally winding to a close. I hope you and those close to you have come through it well.
Let’s talk about why there has been so much controversy, rage and rancor over a public health matter. We have been facing a life-and-death clash of ideologies, made more complicated with confusing statistics and misinformation, and then compounded with tribe-bound adherence to tribal creed. Ultimately, the dispute boils down to the conflict between the collectivism of Liberals and the individualism of Conservatives.
This could have all been so much better if we clarified what we were talking about, using terms that are meaningful to each side. Instead, advocates for public health insisted that everyone engage in social distancing and get vaccinated in order to “save lives,” but usually failed to say how many lives could be saved. It then became a matter of public duty, regardless of costs and benefits.
Opponents complained that their liberty was being infringed upon for somebody else’s health. Like proponents, they did not account for how much of someone else’s health that might be. Many of them might have gone along with public health measures if they understood how many lives and how much disability were at stake, particularly if they compared it to public safety measures that they already embraced. (Although the data was available, it was obfuscated by the right-wing misinformation machine. More on that in a future post.)
What we know
As of the time of this writing, there have been 92,919,750 confirmed US cases, and 1,037,017 deaths attributed to COVID-19. That leaves a fatality rate of 1.1% for the pandemic going back to its early days, in deaths per confirmed case. (Johns Hopkins University, 2022) We can reasonably assume that many cases are not reported—home tests in particular—so the true case fatality rate is likely significantly lower. Some people dispute whether all those patients died directly from COVID-19. Nonetheless, over a million people have died in our country because of COVID-19.
Many Conservatives and Libertarians tried to deny or downplay the seriousness of the COVID-19 pandemic (lest it enable increased government intervention). Yet even conservative news outlet Fox News reported that around 8 in 10 people in the US had been infected as of July, 2022. Moreover, they reported that the daily US death count then was around 360 people per day, and a rate of over 2,600 deaths per day at its peak. (Fox News staff, 2022). Most Conservatives would not accuse Fox News of being part of the Liberal Conspiracy.
The current case fatality rate is very hard to ascertain. In a recent study of 4,349 Kaiser hospital patients infected with BA.4 or BA.5, no one required mechanical ventilation and there were no deaths. Nearly half of these patients had had at least 3 vaccinations, and only 17% were completely unimmunized. (Paharia, 2022) We don’t know the immune status of the fraction who were unvaccinated. Many had probably been previously infected. A completely non immune group of people would probably have a higher morbidity and mortality rate.
In addition to the death rate, we must also consider the number of severe cases–5 or 10 times more than deaths–putting people down for days, weeks or months. Earlier in the pandemic, it was thought that as much as half of those cases remained hobbled with persistent, debilitating symptoms for months (Groff, 2021), if not years. A recent study suggest that the risk is down to about 5% with the omicron variant, about half what it was reported for the delta variant in that same study, in a population that was highly vaccinated. Many of them had been infected previously. (Wise, 2022).
The original omicron variant is 5 times more contagious than the delta variant (Head, 2021), and the BA.5 variant more transmissible still. The increased transmissibility is due to their ability to evade detection by the immune system. (IDSA, 2022) Fortunately, the rate of hospitalization for known omicron cases was only 27/1,000, about 1/3 of what it was for the delta variant. Nevertheless, the increased contagiousness caused total hospitalizations to be higher than any other time in the pandemic. (Stone, 2022) Some hospitals were described as “bursting at the seams,” unable to provide timely medical and preventative care, likely resulting in increased morbidity and mortality. (Abbasi, 2022)
Although the severity of omicron is less than previous variants, it can still kill those vulnerable to it. Because of the increased transmissibility, we would have to apply even more effort towards vaccination and social distancing in order to protect them.
Masks work
Good masks (N95 or KN95 masks, and previously, surgical masks), used well, have been very effective at stopping the spread of infection. Studies have demonstrated over 70% reduced contagion (in some settings). Models estimated that 80 to 90% masking would eventually eliminate the disease. (Howard, 2021) Even with the highly contagious omicron variant, wearing an N95 or KN95 has been shown to reduce the odds of testing positive for COVID-19 by 83%. (These were found to be 48% more effective than surgical or cloth masks. Surgical or multilayered cloth masks are better than nothing, but are no longer recommended.) (Berg, 2022) Unfortunately, a voluntary policy was shown to be insufficient to contain the spread.(Howard, 2021)
Do mask mandates work? In Kansas, some counties adopted mask mandates, while masks remained optional in others. The results showed that mandated masks reduced case rates, hospitalizations and deaths by around 60%. An estimated 500 lives were saved in those counties as of June, 2021. (Univ. Kansas, 2021)
Comparing US states with mask mandates and those without, it was found that the daily growth rate was 2.0 percentage points lower in states with mask mandates. It is estimated that the mandates had prevented 230,000 to 450,000 COVID-19 cases by May 22, 2020. (Howard, 2021)
Mask adherence and resistance
In a University of Southern California poll in January of 2021, 83 percent of respondents agreed that wearing a mask is an effective way to protect themselves and others from COVID-19. However, only 51 percent said they actually wore a mask in public (with the exception of grocery shopping, for which it improved to 90 percent). (Fearnow, 2021)
A poll done last summer stated that 58% of adults wore a mask in public indoor settings all or most of the time. (Galvin, 2021)
In a study in which 20% of respondents reported that they were not wearing a mask publicly, the majority of those non-maskers stated that their right to not wear a mask was more important than protecting themselves or others from infection. Another 24% refrain “because it is uncomfortable.”
Just 11% of those who decline to wear a mask do so because they believe that the Corona virus is a conspiracy. (Vargas, 2020)
Political divide
Between April and August, 2020, states that had a Republican governor and were ideologically conservative were associated with a 40 day delay in recommending mask policies. The political influence was a much stronger than the number of deaths or infections in that state. (McAuliff, 2020)
In April 2020, Washington state sheriff Adam Fortney proclaimed, “The impacts of COVID 19 no longer warrant the suspension of our constitutional rights.” (McAuliff 2020) As of April 1st of that year, Washington’s total death count caused by COVID-19 was already at 241. By April 30, the count was 762, or 521 new deaths that month. (I wonder how many deaths would Sheriff Fortney say warranted the suspension of people’s “constitutional rights.”) The death toll is 14,019 deaths as of this writing. (New York Times staff)
In response to Washington Democratic Gov. Jay Inslee’s order for people to wear masks in public, sheriff Rob Snaza countermanded him, telling a cheering unmasked crowd outside a church, “Don’t be a sheep.” (McAuliff 2020) Better to have 14,019 dead Washingtonians than to be a sheep.
A Jan. ’22 poll by The Morning Consult and The NY Times asked the question about whether respondents were going to change their normal activity to prioritize safety and public health, or continue normal activity as much as possible, in dealing with the Omicron variant.
Democrats: Change—65% Continue as usual—30%
Republicans: Change—30% Continue as usual—65%
(Leonhardt, 1/25/2022)
Among evangelicals, support for Christian nationalism and traditional gender roles have been found to be associated with opposition to pandemic-related restrictions and mask mandates (DeMora, 2021)
Essentially, American individualism—the principle that nobody should have to wear a mask if they don’t want to—is the number one reason given by Americans for not wearing one. (Vargas, 2020)
Vaccines work
Even against the nefarious Delta Variant, the Pfizer-BioNTech COVID-19 vaccine was shown to be 88% effective at preventing symptomatic COVID-19 infections, and 96% effective at preventing severe disease. (Mayo Clinic Staff, 2021) Vaccine efficacy appears to drop considerably after 6 months, but even then, it remains what we previously would have considered to be a good, life-saving vaccine. A booster dose decreases one’s susceptibility to infection by over 90%, and resistance to severe infection improves by about 95%. (Van Beusekom, 2021)
So, in terms of lives saved, how well do these vaccines work? Let’s look at the number of deaths observed in the US from the time following the release of the vaccine through May 9, 2021, and compare that to the number deaths that, based on the prior rate, were projected for the same time period. It is estimated that the vaccine saved 140,000 lives in that time period alone. (Gupta, 2021) That figure is almost too great to believe. But even if that number were off by a factor of 10, then it would still be amazing. Even off by a factor of 100, then 1,400 lives saved would still be considered incredible. If that number of American lives were unnecessarily lost because of anything besides COVID-19, it would generate outrage on all sides.
Current vaccines don’t work as well against the Omicron variant. Even after a booster dose, effectiveness is estimated between 55 – 80%. (Head, 2021) However, during the surge in Los Angeles, hospitalizations were 23 times less frequent for those vaccinated compared to the unvaccinated. The death rate for the unvaccinated (0.3%) was about 4 times worse than those who were vaccinated. (Downey, 2022)
Vaccines appear to reduce the risk of long COVID by 50%. (Ledford, 2021)
Vaccine Mandate
We’ve seen how effective vaccines are, especially with a booster. Nevertheless, education, incentive programs, and even mobile vaccination units have failed to control the spread of COVID-19. Consequently, organizations such as the AMA advocated for vaccine mandates. Companies such as Walt Disney, Walmart, McDonald’s, Walgreens, Twitter, Facebook and Google have also mandated that their employees get fully vaccinated. (Berg, 2021)
The US Department of Labor expected that a mandate for workplace vaccination would save thousands of lives and more than 250,000 hospitalizations. (US Dept Labor, 2021) Among those hundreds of thousands of workers who would have severe COVID in the absence of a mandate, up to half will have serious long-term effects. (Groff, 2021) That’s a lot of preventable illness and suffering.
All this became moot when the supreme court ruled that OSHA would be exceeding its authority if it required vaccinations to protect employees from COVID-19, unless they were in a health care setting. (Abbasi, 2022)
Vaccine resistance
Many people fear vaccines, or simply distrust the organizations that advocate them. Having something injected into your body is a little more creepy than just wearing a mask. But more than anything else, most of those who oppose the COVID vaccine do so because they hate being coerced to do something that they don’t want to do. Among Republicans in particular, their concept of freedom has driven them to reject the science. (Wise, 2021)
Individualism vs Collectivism
Who do you think is more important—the individual or the group?
When you refer to the “group,” do you mean your immediate peers, community, region, or political party, or do you mean the whole country, or the entire mass of humanity?
Your answer is fundamental to where you stand politically and your opinion about how we should respond to public health crises.
Our personalities lie on a spectrum from individualist to collectivist (or communitarian). The Individualists among us believe we should weight our own needs and interests over those of the group. They more often pursue their goals individually, and would be more likely to say “What happens to me is my own doing.” (Lu, 2021)
Libertarians inhabit the extreme individualist end of the political spectrum. (Iyer, 2012)
Collectivists, on the other hand, embrace interdependence and shared goals. Their happiness is more dependent on the happiness of those around them. They feel more disposed to sacrifice their self-interest for the benefit of the group. (Lu, 2021)
Collectivists tend to be Liberal. (Iyer, 2012)
Conservatives lie more on the individualist end of the scale, but they value loyalty to their group and conformity to the norms of that group. Their groups may be regional, religious, social, or political, but are decidedly not the great mass of humanity, and include only those they consider to be like themselves. (Mooney, 2012)
“You can’t make me!“
Being individualistic is associated with refusing to wear a mask or get vaccinated. The number one reason people gave for not wearing a mask in public was just that they shouldn’t be made to do it. Individualists show less concern about infecting others and harming the larger community. (Vargas, 2020) The Libertarian Party platform states that people should not be “forced to sacrifice their values for the benefit of others,” and goes so far as to directly oppose vaccine mandates. (Libertarian Party Platform, 2022)
Collectivism was strongly associated with wearing masks, not only because of Collectivists believe in interdependence and civic responsibility, but also as a signal that they are fighting the pandemic together. (Lu, 2021)
Out of character
That so many Conservatives refused masks and vaccines is out of character. Normally, Conservatives strongly protect themselves and their community against threats such as disease, and expect other members of their community to do the same. (Mooney, 2012) But they have joined forces with the Libertarians, united in their opposition to Collectivist government programs. As the aggressively individualistic Libertarians have commandeered the Republican Party, and as Conservatives—generally loyal to party leaders and dogma—obediently followed their new leaders, a large portion of the Republicans refused masks and vaccines. As a result, COVID death rates in strongly Republican regions were over 5 times higher than strongly Democratic regions. (Wood, 2021)
If it were just individuals refusing to mask or vaccinate, then it wouldn’t be so bad. However, hyper-partisanship and the Libertarian hatred of collectivist government motivated a concerted campaign to discredit public health campaigns. This increased the appeal of alternative, non-government-approved treatments with little or no value (but unscrupulous profits), while they downplayed the seriousness of the pandemic.
Confusion and Misinformation
Confusion about COVID-19 arose from multiple sources, some unintentional and some deliberate:
In 2020, this was a new disease, with unknown properties, unknown biological and behavioral responses, and new, evolving therapies.
Information came in faster than it could be verified, and sometimes had to be corrected. When the new information superseded the old information, it made all the information seem unreliable. Science and medicine work best a deliberately painstaking pace, not at the speed of social media.
There was also disagreement or lack of consensus about the implications of the information. For example, when a process or treatment works 10% of the time, is it a success, because it sometimes helps, or is it a failure because it doesn’t work 90% of the time?
Medical science is often non-intuitive. It’s very easy to jump to conclusions about results. We usually don’t know for certain what would happen to individuals if they hadn’t gotten the treatment. Maybe our treatment cured them, or maybe they got better on their own—the lucky beneficiaries of random chance. We have to look at large numbers of people who have gotten the treatment and compare them to a large group who didn’t. The large number of people tends to average out individual differences and unforeseen individual circumstances. The larger the number of subjects, the less likely it is that random chance caused the results.
Even scientific investigators can be biased by their desires or preconceived beliefs, such that they will overlook or interpret things in a way that favor what they want or expect. That’s why the investigators have to be “blinded” to which subjects got the treatment.
The general public is not used to having to deal with things this way. Some people, Conservatives in particular, require a simple yes or no answer, and reject answers that are open-ended, conditional, or otherwise nuanced. (Mooney, 2012)
The CDC goofed with its attempt to produce its own COVID-19 test, and its messaging about mask use, etc., was inconsistent. I’ll present a more detailed discussion about the CDC in a future post.
To make matters worse, government-hating extremists have put forth deliberate falsehoods in order to subvert the government’s and the CDC’s honest attempts to deal with the pandemic. I’ll discuss this further in a future post about the right-wing misinformation machine.
Political In The Middle view
Much of the death and suffering caused by COVID 19 was unnecessary. We could have saved hundreds of thousands of lives and prevented millions of years of debilitating symptoms had we all fought this thing together.
Differences of opinion between Liberals and Conservatives (and especially Libertarians), over “freedom” and the role of government, caused many Conservatives to reject social distancing and vaccination. Tribalism and identity politics made it worse. Anti-government haters and unscrupulous business people spread misinformation. There is blood (or sputum) on their hands.
The Liberals among us expect our government to help people in need, and to protect those most vulnerable. Given what they were up against, the Biden administration and the CDC did about as well as could be expected.
Our Conservatives expect individuals and their smaller community of like-minded folks—not the government—to take care of this protection. Many of them stepped up, protecting themselves and others with social distancing and vaccination. I know. I stuck needles into some of their arms myself. It was the Republican leadership who failed the rest. (If you are interested in the characteristics that make one a Conservative, rather than a Republican, please see my page on ‘“Conservatives” and “Liberals” are not the same as “Republicans” and “Democrats.”’ https://politicalinthemiddle.com/?page_id=60 )
What to do
So, how might we do better next time? For starts, we should be more accurate in our communication. It’s not enough to say that a program will “save lives.” We have to give a reasonable estimate of how many lives. That way, people who are suspicious that government just wants to push people around and take their money, or, at least, will demand a huge effort and sacrifice for a small gain, will have a better idea of what the goals are.
Liberals, who are inclined to venture into the land of diminishing returns in order to make sure that every last needy person has their personal needs met, will be forced to reckon with the cost/benefit calculus.
For the long term, for public health and for everything else, we need to impel unaligned people to be respectful of other people’s values and opinions. We need to fight against the factors that result in hyper-partisanship, tribalism and hatred of the out-group.
Why do I specifically say we need to address unaligned people? Because once people have joined a group and internalized its values and policies, then it’s really hard to get them to consider anything else. This is particularly true for Conservatives, who are predisposed to loyalty to their groups, and generally aren’t much interested in new information or ideas.
We need for skeptical people to be universally skeptical, rather than rejecting mainstream sources of information in favor of things that they like or excite them. That is also hard to do. One needs to have a pretty broad knowledge base to see how easy it is to be deceived. Ignorance fosters gullibility.
We should urge everybody to seek external validation of what they read or hear, and even of their beliefs. Again, people need a pretty broad knowledge base in order to judge what is a good information source.
Internet algorithms are partly to blame for all this mess. Their purpose is to hook people in and generate income, rather than inform. Consequently, they are more inclined to misinform and polarize. (Fournier, 2021)
I don’t think it has to be this way. I think we can change internet algorithms. Although censoring or blocking posts can make things worse, we could just stop search engines from pushing misleading or polemic posts. Maybe we could have search engines that pin articles from accredited scholarly or neutral sources to posts that might be misleading or deliberately polarizing.
I think we should go beyond the internet and social media. I think we should post messages wherever people might see them—billboards, buses, milk cartons. Messages that are subtle yet compelling, constructive, and, most of all, truthful.
References
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