How many deaths can you live with?
After almost two years of living with Covid-19, many of us are ready to go back to our pre-pandemic normal. Of course, SARS-COV-2 doesn’t care about how it has thrown our lives into turmoil, sown the most terrible grief among hundreds of thousands of families in the United States, disrupted and destroyed lives forever. Nonetheless, over the next few weeks from Thanksgiving to the New Year, we will rush to greet friends and family after months of relative solitude have fed a deep longing for human contact. Those with resources may stop off at the local pharmacy to pick up a rapid test to provide them some comfort that they are not bearing SARS-COV-2 as well as holiday gifts as they descend on the homes of their loved ones, but most will go mask-less into these celebrations. In settings with everyone gathered vaccinated, perhaps boosted, the risk of infection and serious complications of Covid19 will be slight, but approximately a third of all Americans are still unvaccinated after all these months, making these joyous occasions far from safe for many.
Many are suggesting we will, at some point, enter an endemic phase of our Covid-19 era: where the infection rate stabilizes, even if we have occasional flare-ups now and then. But endemicity isn’t just an epidemiological phenomenon; it’s a set of private and public choices about how many deaths we can tolerate as our steady state and consider the public health emergency over and done with. Those choices—the number of deaths we can live with—matters in several ways.
First, our capacity for human suffering tells us a lot about who we are as a people. In some US states in which vaccination rates are low, deaths per 100,000 still remain higher than in the rest of the country. In these places politicians raised the “Mission Accomplished” banner months ago, while sending what at best are mixed signals about the need to get jabbed, if not promoting outright skepticism about vaccination. These are the states that already have some of the worst health outcomes and whose political tolerance for mass suffering and death long preceded the pandemic.
In other regions of the country, with higher vaccination rates, cases have still resumed steeply rising in some places, with vaccines offering a partial firewall preventing the deaths per 100,000 we are seeing elsewhere. However, the case rises suggest that the precautions many were taking a year ago are falling by the wayside. Across the United States this week, we’re nearing 100,000 new cases a day, slightly over 50,000 hospitalized and 1,000 deaths daily. This is the new normal. Whether this is our endemic future remains to be seen. But clearly, SARS-COV-2 has more susceptible individuals to infect and the epidemic in this country has not stabilized by any measure yet.
Second, regional and intraregional variations in vaccination and other disease mitigation measures matter. While here in the Northeast we may be able to live with relatively lower levels of hospitalizations and deaths achievable through high vaccination rates, we will have towns and neighborhoods—mostly poor, some just politically conservative in a sea of blue—that will remain at higher risk than others. But as travel ramps up through the holidays and into a what many will consider a post-pandemic 2022, people will crisscross the country by the millions, offering chances for new clusters of SARS-COV-2 infection to emerge. Moreover, once we start to raise our heads and look over the parapets of fortress USA, the stark inequity in global vaccination rates means that, thanks to our failure to address the global pandemic, we still have millions of new infections happening daily. As our leaders try to get the world economy back to normal and to stabilize supply chains disrupted by the pandemic, and especially as commercial travel and transport opens up, the virus will hitch a ride to anywhere it wants to go on the planet.
As Aris Katzourakis, professor of evolution and genomics at Oxford, tweeted earlier this year, this all makes global endemicity nearly impossible, setting us up for a future of epidemic waves, with variants of the virus emerging bearing new and potentially deadly features in their ability to be transmitted, cause serious disease, and evade neutralization by vaccine-induced immunity. This also makes the hostage-taking by Moderna and Pfizer—who refuse to share the technology for their potent vaccine mRNA platforms to allow faster and more extensive global manufacture and production—more than a question of their not “doing the right thing”; they are endangering us all by their greed. The fecklessness of our political leaders who have surrendered our fates to the whims of CEOs is both a political failure and a public health failure of monumental proportions.
Our endemic future is not around the corner. As more and more people get vaccinated in the United States, we will see fewer and fewer hospitalizations and deaths—provided we get lucky and no variant emerges at home or abroad which escapes the control of our current immunogens. But SARS-COV-2 will still cut a swath of death and destruction through the American landscape into 2022, even if many of us stop noticing it happening as we resume our old lives. W.H. Auden wrote a poem in 1938, in the lead-up to another historical calamity, on Bruegel’s painting Landscape With the Fall of Icarus. The poem, “Musée des Beaux Arts,” is a meditation on human suffering centering on the death of Icarus, who in Bruegel’s painting is hard to find in the frame, appearing as just a half-submerged pair of legs in a corner of the canvas. The painting is a rural scene by the seaside, with a farmer plowing his fields, a shepherd tending his flock, a ship sailing out into the ocean. No one notices the drowning boy.
About suffering they were never wrong,
The old Masters: how well they understood
Its human position: how it takes place
While someone else is eating or opening a window or just walking dully along;
How, when the aged are reverently, passionately waiting
For the miraculous birth, there always must be
Children who did not specially want it to happen, skating
On a pond at the edge of the wood: They never forgot
That even the dreadful martyrdom must run its course
Anyhow in a corner, some untidy spot
Where the dogs go on with their doggy life and the torturer’s horse
Scratches its innocent behind on a tree.
In Breughel’s Icarus, for instance: how everything turns away
Quite leisurely from the disaster; the ploughman may
Have heard the splash, the forsaken cry,
But for him it was not an important failure; the sun shone
As it had to on the white legs disappearing into the green
Water, and the expensive delicate ship that must have seen
Something amazing, a boy falling out of the sky,
Had somewhere to get to and sailed calmly on.