Protocols, revisited

This page has been pretty grim. I understand why a few people who check it every day were surprised by yesterday’s post. One very good friend of mine even accused me of optimism. I told him that he knew me better than that. Nothing fundamental has changed: I still believe that American authorities have been unwise and inattentive. Sending people back to work feels greedy and premature to me. There are many scary miles to travel.

Yet the optimism is real, and it’s been growing ever since the calendar turned to May. My brightened outlook doesn’t have much to do with what’s happening in America: it’s based on the qualified success of other countries that have managed to slow the advance of the coronavirus. The equilibrium they’ve reached in Brisbane and Taipei might fall apart, but the mere fact that they’ve been able to hold the monster at bay suggests to me that the fight can be won. We don’t need to put our entire population at risk in a chase for herd immunity that might be a fantasy anyway. We can figure out how the pathogen spreads, and proceed accordingly; we can discover what not to do, and we can try not to do those things.

To achieve that sort of operational clarity, we need to work with a real transmission model. For eight frustrating weeks of shutdown, we haven’t had one. This has forced every individual to cobble together a private model based on anecdotes, prejudices, common sense, and superstition. Should I go to a show? Can I sit in the park? Do I need to disinfect my mail? Could I get it from my neighbor’s children? When they cough upstairs, will the virus work its way down through the vents? Is it so pervasive that there’s no way to stop it; should we resign ourselves to the inevitability of infection? In the absence of guidance, we fended for ourselves. Public decisionmakers did too. Their initial containment strategies were motivated by panic, precedent, and guesswork. Lockdowns were a crude means of coping with our mass ignorance: we don’t know how this is getting around, but it certainly is, so we’d better prohibit as much as possible.

Part of the reason why we haven’t been able to get a reliable transmission model together was our uncertainly about the size and concentration of the infectious dose. This remains true: we still don’t know how much coronavirus we’d need to be exposed to in order to become carriers. Scare articles about virus particles found tucked away in corners, or persisting on cardboard boxes, or hanging in the air after a jogger runs by are stupendously unhelpful. What we really need to know is whether those stray particles are present in sufficient quantities to infect us; if they aren’t, they’re just part of the microbial background noise that our systems encounter daily. There’s been reason to suspect that higher concentrations of virus — like those that healthcare workers have been coping with — prompt a more severe version of the sickness. Some people have guessed that chance encounters with low levels of virus lead to asymptomatic cases. Without contact tracing, there’s no way to know.

Our uncertainty has led directly to the circulation of shaky models. Among the most popular — and I know you’ve seen them — are the great animated, colored billows of cloud-particles from the lungs of passersby in stores, on bicycles, at parties, in offices. Because these images conflate the dynamics of respiration with the trajectory of infection, they’re misleading. We can’t be afraid of sharing air with other beings, because it’s all one planet, and no private supply is possible. We need to know how to exist in the biosphere, and how to interact with our fellow creatures, without worrying about getting them sick.

After too long in the dark, a preliminary transmission model is beginning to coalesce. We’re starting to get a picture of how this pathogen gets around, and how we might reorganize our activities to lessen a lethal threat that we’re going to be living with for a long time. The twenty-two threaded tweets by Dr. Cevik contain links to studies that all point in the same direction: in order to thrive, this virus requires close and prolonged contact between humans. This research reinforces the hypothetical models put together by some amateurs, including Quillette editor Jonathan Kay. We’re getting a profile of a serious and highly infectious respiratory illness, that, despite its ferocity, can be slowed down if we wear masks in public to block large droplets, maintain social distance, ventilate indoor spaces, reimagine workplaces before reopening them, get out in the sunshine when we can, and behave responsibly while we’re there.

No contact tracing strategy can ever be complete, and no model of transmission can account for every vector. The best we can do is get a sense of probabilities, and behave accordingly. My protocol isn’t changing: I’m less worried about runners than I was a week ago, and that’s a relief, but I’m still going to cross the street when I see one coming. I won’t be going anywhere without a mask and a plan to dodge crowds and close contact. Basically, I’ll pretend that I’m Taiwanese, and I encourage all Americans, and particularly American leaders, to do likewise. In Taiwan, they’ve taken the pathogen for what it is, rather than fear it for what it isn’t, and their application of prudent science to a biological problem has led to dramatically better outcomes than what we’ve been getting in the States. What prudent science tells us is that we aren’t helpless. We don’t have to build our policy around the lethal misconception that the virus will get us and there’s nothing to be done, so we may as well send everybody back to the meat-packing plant. There are ameliorative options for us, and those remain on the table, no matter how many Americans have been infected. The more tracing we do, the clearer those options become. And that is, I fear, why certain foolish Americans don’t want us to do the tracing.