This Bug Is Beatable

Social distancing is a privilege. We forget because it feels like a hassle.

Photo by De an Sun on Unsplash

This bug is beatable. I talked to three lab directors, the Food and Drug Administration, two former FDA commissioners, three epidemiologists, two virologists, and a senior White House scientist so I could give you a consensus on what we know.

Much of the spread is highly clustered. Everyone who gets the flu is more or less evenly infectious. Here, a small number of people are highly infectious. And there are a small number of places where the virus is highly spreadable.

Compared to other viruses, we would much, much, much rather not have asymptomatic spreaders and presymptomatic spread, but fortunately, not everyone coming in contact is getting it. It’s not the measles.

Knowing who and where are the important mysteries to solve. We have figured out the “where”: cramped places, indoors, with poor circulation, and loud talking and laughing. The “who” is trickier. (No World Health Organization jokes, no Abbott and Costello jokes — surprised at my discipline?)

We know kids shed the virus. We know adults shed the virus. We know some people shed a lot more. There’s a mixed view as to who that is. The view toward kids is we know they shed but have little idea why they don’t shed to adults very often.

One person said don’t be surprised if it is kids’ height relative to adults and that their particles drop. We could, of course, be facing a virus that is much more devastating to kids than this is. We are all grateful, and a few of the people I talked with worry that with the next virus, we might not be so lucky.

One pretty hardened scientist made that comment with a quiver in their voice. In fact, I heard “I don’t know” a lot.

Another piece of good news I describe this way, although none of the scientists used this language: For this virus, God gave us the gifts to fight it. “Respiratory” means avoiding places and wearing masks and social distancing.

Social distancing is a privilege. We forget because it feels like a hassle. But the reason that the more time goes on, the more this is afflicting immigrant, Latino, and essential workers is essentially that. Some places and jobs stack the deck — public housing, factories, farms.

Sociologists tell me that as people feel less personally at risk, the pressure on them to stay safe subsides. White communities, suburban communities, and college kids don’t keep the difficult habits up.

A lot of this explains why hard-hit communities see a sustained drop in cases that’s often commensurate with how bad it was. New Yorkers are scared straight (old TV show reference); Phoenix too. Places with mild cases, like Charlotte or Minneapolis, can’t get cases all the way down. In those places, you’re more likely to see a hundred-person gathering, a bar open, people going maskless. As time passes, we will see how long the effect lasts.

The better the informed they are, the less the scientists pretend to understand immunity. All the certainty we have is Twitter certainty. Can people get reinfected after a period of months? We now know they can. How likely? How bad? We don’t know.

Will all New Yorkers have lost their immunity in a year? No one really knows. They don’t think so, but obviously it can’t be known. When does herd immunity slow down the virus? Is there a cross-immunity benefit? It’s unknown, but the consensus is likely small if at all.

Asymptomatic testing? Everyone believes it is vital until we have the virus well under control. The next big innovations in testing? Saliva test prevalence is growing. And at-home testing is a month or two away.

Therapies: not much enthusiasm for convalescent plasma. Much excitement about monoclonal antibodies. Steroid treatment (Dexa) > Remdesivir. Cookies and milk > hydroxychloroquine.

We will need to stop discussing Covid-19 as alive or healed and start measuring chronic cases as well. People in somewhere between 10% and 50% of cases report not being back to normal within two months.

Many long-haulers are having trouble being believed. Just like with the bug, people in our country have a tough time believing things they can’t see with their own eyes. We may be the most literal people in the history of the planet.

I asked every scientist this question: From March, are we as far along as you would have thought or further behind? Everyone was disappointed in one way or another; some were very disappointed.

I asked a few if they were fear-mongers. Every one of them to one degree or another was personally somewhat scared of Covid-19. But all agreed: This isn’t the killer bug.

In fact, Covid-19 is more of a test-run bug. San Francisco, Hong Kong, and Singapore are experiencing Covid-19 with much more capability because they have had other viruses, and they have real public health systems.

This was pulled and lightly edited from my September 5 Twitter thread.

Former Medicare, Medicaid & ACA head for Pres. Barack Obama. https://twitter.com/ASlavitt

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