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So many of us, including me, have been focused on the failure of the federal response to Covid-19, watching President Trump’s catastrophe-by-public-policy roll out day after day since late February. I’ve written a lot about it in these pages. In a misplaced triumphalism, some people in states that have managed to have a relatively quiet summer with low rates of Covid-19 cases have chastised those in states with renewed outbreaks as being foolish or unheeding of scientific advice, as governors still slow-walk the response to the disease and ordinary people shun masks and flock to social gatherings. We all like to think of ourselves as different, doing the right thing, doing our part.
However, it’s not just in red states that wishful thinking has led us astray. In the early days of the epidemic in New York City, Health and Hospitals President and CEO Dr. Mitchell Katz told Mayor Bill de Blasio not to shut down the city, even as officials in NYC’s Department of Health and Mental Hygiene were warning him not to wait any longer, growing exasperated and frantic as the days ticked on. I remember receiving a series of phone calls from activist colleagues—and some politicians from the city—who painted a picture of a mayor who wanted the rose-colored glasses handed to him, rather than seeing the truth of what was about to hit us. By the beginning of August, the health commissioner Oxiris Barbot quit, with Katz and his acolytes from Health and Hospitals taking over the Covid response, sidelining one of the world’s great municipal public health departments.
But political intrigue aside, magical thinking has been elevated even further this summer, perhaps as a coping mechanism. Many of us have grasped at tidbits of scientific information to conjure a bridge to the future through the imminent arrival of a vaccine, or the fantasy that perhaps herd immunity can be achieved more quickly than we thought. Last month I wrote about the difficulties in developing a vaccine, which are about the nature of serendipity in science—hard to overcome despite our best and most determined efforts. This month, I’ve watched some colleagues suggest that herd immunity could be achieved after a small to moderate fraction (10–50 percent) of the population is exposed to the virus.
How tantalizing is it to think that places like New York City might already be over the worst of the pandemic, with community-wide protection already in existence in some pockets of the city—and with similar protection just around the corner for other neighborhoods in cities and towns hard hit by the virus? The New York Times article I linked to above includes caveats, but the headline “What if ‘Herd Immunity’ Is Closer Than Scientists Thought?” traffics in hope. Putting these hypotheses to the test entails giving in to a temptation we all feel right now: Let’s just go back to normal and see what happens. But that’s a dangerous game. Relaxing social distancing even further on a quest to step into the promised land of herd immunity risks the lives of our families, friends, and neighbors. As my colleague Virginia Pitzer, a mathematical epidemiologist here at the Yale School of Public Health, told The New York Times: “We are still nowhere near back to normal in our daily behavior. To think that we can just stop doing all that and go back to normal and not see a rise in cases I think is wrong, is incorrect.”
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Yet we are all testing the waters. This spring I wouldn’t have considered seeing friends in an indoor setting. But I’ve done it twice now, knowing the risks. Maintaining social distancing is so difficult, and I don’t want to pretend to be the poster boy for public health absolutism—I’m trying to minimize risk in my daily life, and it’s getting harder and harder to do. As my colleague Julia Marcus has suggested, borrowing a term from the movement for the rights of people who use drugs, we’re all harm reductionists now.
But managing risk means trying to weigh the evidence, trying to avoid what you know is a potential high-risk exposure, while keeping track of even those activities that might be lower risk so they don’t cumulatively add up over time to trouble. This has to be an active, deliberative process—not just throwing caution to the wind and making post-hoc rationalizations for what you wanted to do all along. This virus is here for a while—we have to find a way to live with it safely. As with HIV, it’s hard to ask people to say no to sex and drugs, but we can help each other learn safer sex and injection practices, just as we did in the 1980s and ’90s during the AIDS epidemic, but now having to build tools for safer living overall.
One of the places in which I am seeing caution thrown to the wind, post-hoc rationalizations aplenty, and lots of magical thinking is on university campuses. Millions of students will return to colleges and graduate and professional schools in the next few days. Doing this safely, minimizing harms, means looking the facts in the face. If a school is in a red zone—where community-wide infection is high—it’s hard to believe one can stop infections on campus. The University of North Carolina rushed headlong into classes last week and now has at least four Covid-19 clusters on campus. They’ve moved to remote learning as of Wednesday.
My colleagues David Paltiel at Yale and Rochelle Walensky at Massachusetts General Hospital have shown that universities need to test two or three times a week to keep an outbreak from getting out of control. In a survey of over 500 colleges and universities, less than 20 percent plan on such regular testing—and only slightly more than half plan to do any testing at all. Even with frequent testing—my own university, Yale, plans to test twice a week—everything else has to go right to prevent the virus from spreading across campus. Last month, Yale psychology professor Laurie Santos—who is also the head of one of Yale’s residential colleges—warned: “We all should be emotionally prepared for widespread infections—and possibly deaths—in our community…You should emotionally prepare for the fact that your residential college life will look more like a hospital unit than a residential college.” This is the most clear-headed exposition of the impact we may see in the weeks ahead. Yet university presidents are saying they can keep students safe despite this, with some saying even if they had access to testing, they wouldn’t use it.
The most egregious case I’ve seen so far is University of Michigan President Dr. Mark Schissel, who suggested that students would use testing as an excuse to behave badly, as in: I got a negative test today, so I can party tonight. Grasping for straws to justify his decision to open up one of the largest campuses in the country without proper safeguards, Schlissel ended up telling a whopper of a lie, too, claiming this is what happened with gay men in the ’80s and ’90s: that on receiving an HIV-negative test, we were going out and having unsafe sex galore. It’s a fabricated tale, stigmatizing gay men all over again as vectors of disease and infection. We’re going to see a whole lot of this panic-blaming, deflection, and outright lies as the fall begins, as colleges and universities, and even primary and secondary schools reopen without the kind of active, deliberative process I described above to manage risk in the context of the evidence (acknowledging that in some cases the risk will be just too high to do what we’d like to do.) Yes, our government has exposed us to this risk, and hasn’t given us what we need to keep safe. But wishful thinking can make things a whole lot worse.
Winter is coming. As the great science reporter Helen Branswell from STAT News wrote last week, we squandered our summer, the last best chance to quash Covid-19 in our country before we all head inside to riskier environments as the cold weather starts and our seasonal influenza epidemic gears up for a collision with a resurgence of Covid-19 all over the nation. Yes, our president, our governors, our mayors have all failed us in myriad ways. But we’ve got to put aside magical thinking and admit that the hardship of vanquishing this epidemic even as it falls on us falls even harder on others with far fewer resources than most of us have. There is no easy out for us—any of us. This is a multiyear event unlike any we’ve ever experienced in our lifetimes in the United States. We’ve got to find a clearheadedness, one that tries to keep focused on what we know from the science, the data, to guide us.
Grasping for straws of hope and casting blame may both be natural reactions—as we have seen over the past few weeks. But they’re supremely unhelpful given what we need to do now. We’re going to have to find a new solidarity to make it through the next few months, to face the prospect together of more lockdowns, and muster support for our leaders to do this with less pain than we’ve seen to date. If 2020 was the year of magical thinking, 2021 could be the year of living dangerously, unless we get ourselves back on track.
Gregg GonsalvesTwitterNation public health correspondent Gregg Gonsalves is the codirector of the Global Health Justice Partnership and an associate professor of epidemiology at the Yale School of Public Health.