On Not Tolerating the Intolerable

The pandemic buzzword these days is “endemic,” which is being used to mean Covid’s going to stick around so we might as well just go back to normal lives.

That is not what endemic means, of course. Endemic means an illness that constantly exists at a baseline level of some amount in an area without being brought in from elsewhere. The common cold is endemic in most places. So are a few more dangerous illnesses — the plague, for example.

The other key thing about endemic disease is that the illness doesn’t spread at an epidemic pace. Covid’s clearly not close to endemic. Here’s a piece in Nature that explains that better than I can.

Also, just because an illness becomes endemic doesn’t mean everything is rosy. In the Nature article, Oxford Professor Aris Katzourakis points out:

A disease can be endemic and both widespread and deadly. Malaria killed more than 600,000 people in 2020. Ten million fell ill with tuberculosis that same year and 1.5 million died.

I recall a doctor who was working for a pharmaceutical company telling me years ago that no companies wanted to work on TB drugs because there wasn’t any money in it. That’s why those people are dying.

Coming back to the virus at hand: what endemic does not mean and should never be used to mean is letting people die so we can get back to “normal.”. But in many corners of the U.S., people are using the term to mean precisely that.

Right now 2,600 people a day are dying in the U.S. That’s intolerable. And yet large numbers of people – including officials – are acting like the pandemic’s over.

I’m still angry two years later at the lieutenant governor of Texas who said old people should just die of the virus to protect the economy. By economy he meant Wall Street and investment and such, of course; he didn’t mean the economic well-being of the people living in our society. He has never been interested in their well-being, as is clearly demonstrated by the state government response to the winter weather hitting Texas right now.

These days people who are somewhat nicer than the lieutenant governor say the only vaccinated people dying are the elderly or the immunocompromised or those with “serious” comorbidities, which I gather means anybody who is sure they’re not in any of those categories can just throw caution to the winds and too bad if they pass the virus on to someone who’s not that lucky.

Never mind that throwing caution to the winds means the damn thing just keeps circulating, which keeps those for whom the vaccines don’t work at high risk. And kills a lot of people.

While I’m furious at the anti-vaxxers, I still feel sorry for the unvaccinated who are dying. And even sorrier for the health care workers who have been dealing with the latest surge.

I’m also irritated at The New York Times, which has run three articles and one op-ed criticizing China for continuing to push for a zero-Covid policy at a time when, according to the articles, it’s no longer possible to keep Covid out. This was also an excuse to talk about how authoritarian China’s policies were and how that was hurting people.

I’m certainly not going to argue that the Chinese government is not authoritarian. China is doing a lot of things I find reprehensible. I won’t even argue that their Covid policy is the right one.

But the idea of the flagship newspaper of a country of 340 million people that has officially suffered close to 900,000 deaths from Covid lecturing a country of a 1 billion that officially had 4,600 such deaths offends me.

How dare we, who have failed so badly despite being the wealthiest country in the world, lecture anyone else on how to handle a pandemic?

The Chinese number is probably an undercount, maybe even a major undercount, but the U.S. number is, too.

Since I live in the U.S., I am a lot more concerned with the failures here than I am with the failures in China. I see no excuse for this country failing so badly, and that includes the fact that we had a criminal clown as president when the virus first emerged.

At this point, we must go forward. In the U.S., when we decide to go forward, we frequently try to pretend the past didn’t happen. We can’t do that this time.

I keep reading that we tolerate deaths from the flu and from auto accidents as arguments that we should tolerate deaths from Covid.

No. We should stop tolerating deaths from flu and auto accidents. Those things are not inevitable.

We have learned a lot from this virus. First off, we have amazing vaccines that not only prevent the worst for most (though not all) people, but have been created from a process that will likely be used as a base for vaccines that prevent other diseases.

We have developed antivirals and other treatments, many of which could also be used to develop similar treatments for other viral diseases.

And perhaps most important, we have learned that this virus — and those that cause many similar illnesses — is airborne, which means that if we improve the ventilation systems in our buildings, we can dramatically reduce the number of viral illnesses we are forced to tolerate each year.

Here’s a good starting point on ventilation and related resources from ASHRAE, the organization of engineers who work with air conditioning, heating, and ventilation:

If you add in generous sick leave policies — so that people stay home when they’re sick instead of going out in the world to infect others — and a habit of wearing useful masks in places where airborne viruses can easily spread, such as on public transportation, we would have even fewer such illnesses.

A health care system that can provide antivirals and other treatments quickly when people get sick would also change things. A real health care system, not a patchwork system of overpriced insurance that makes it impossible to figure out what’s covered and what isn’t, not to mention one where it’s possible to get an appointment when you’re sick.

And, of course, we need an actual public health system, one with plans and equipment ready for the next pandemic. Because this is not going to be the last one.

I don’t want to see another pandemic when the simplest of protections — a good mask — is limited because we don’t even have enough of them for health care providers.

I don’t want to see another pandemic in which we don’t do real contact tracing — as near as I can tell virtually none was done in the U.S. — or provide necessary services to the sick. In the U.S., the sick who didn’t end up in the hospital were left on their own, with no place to go to avoid infecting their families and no treatment beyond over-the-counter drugs.

Getting back to normal does not mean allowing the virus to run through society. It means setting up a normal where we can stop rampant transmission of this particular disease without everything else stopping for long.

And then it means setting up a society where we can quickly respond to another pandemic effectively so that we don’t have to spend two years (and counting) trying to guess how to keep ourselves safe and stop transmission.

We need to all be in this together, with good information and appropriate assistance.

I cannot express in words how badly I want to live in that kind of society.

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