Our Pandemic Winter

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S1: When I called up Ed Yong over the Atlantic, I realized I really need a new opening question. How are you doing?

S2: Well, you know, fraught questions still here.

S1: Ed writes about science at this point. He’s a covid expert, but even the experts are struggling with the day to day right now, especially with the weather getting colder.

S2: I live. That’s that’s as much as that’s as far as I will go. I continue.

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S1: Then the official interview began. I brought the kinds of probing questions you have come to expect from this show. OK, so I want to know how you, Ed Yong pandemic experts are preparing for the winter. Like I had one of those moments where I was like I should buy an outdoor heater and then they were all sold out.

S3: I also tried to buy an outdoor heater and they were all out. So we should be prepared.

S4: I know I would love to say that covering this for the entire year gave me some sort of foresight in terms of patio heaters.

S1: But that was that was not to be to be fair, I was hoping Ed was going to psych me up for the months to come. And he did give me a few ideas. It turns out he’s decided to pod up with some friends the quarantine for a bit, then only see each other do the holidays together.

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S5: To be clear, I have not socialized indoors with another person since March who look at at all.

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S6: I have not hugged another person except my wife since March, which doesn’t feel great.

S1: That’s so real. That’s so real feeling. I’m just like you see someone you want to touch them.

S2: Yeah. And, you know, I hope that this is a lesson for everyone here.

S7: I remember writing about the Ebola outbreak in the Democratic Republic of Congo and before that in West Africa and and noting that the true horror of the disease is that it breaks and exploits bonds of community. So it’s things like funeral rituals that allow the virus to spread very easily from one person to the other. And like a lot of Western writers and commentators, view these as silly superstitions that should easily be thrown to the wayside to prevent the spread of a of an epidemic. And yet here we are bemoaning the loss of hanging out in bars or hugging or, you know, the things that we deem to be important and sacred.

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S1: The problem with the winter is that for a lot of people in the U.S., this season is synonymous with sacred, whether you celebrate Thanksgiving or Christmas or Hanukkah or something else. And the virus, it frankly does not care.

S6: It doesn’t become less of a problem because we are tired of it. In fact, it almost becomes more of a problem because we’re tired of it and we start lowering our guard. And and I think there’s a sense that because we trust our loved ones, that they are necessarily safe.

S7: And that’s not true.

S8: Today on the show, we’re going to prepare for the winter with Ed Yong. There’s actually good news about the coronavirus, but unfortunately that good news does not mean you’re safe. I’m Mary Harris. You’re listening to what next? Stick around.

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S1: It was really helpful to me to read something you wrote in the last couple of months where you talked about how in this pandemic, now that we’re, I don’t know, eight months in, we know a lot more about the coronavirus. But knowing so much can actually be misleading because so many people have contracted it so suddenly that you just see everything that can go wrong with this virus. And it makes it seem almost more powerful than it is. I’m wondering if you can talk a little bit about that, about how we’ve learned a lot. But you need to pay attention to the most salient things, right?

S6: I think I think that’s exactly right. So, you know, I don’t think any other disease in history has been subject to this such intense scrutiny by so many researchers in such a short time. So there are other things that we know more about because they’ve been around for much longer. But, you know, the fact that covid-19 didn’t even exist probably this time last year and we now know a lot about it, is testament to the sheer amount of research effort. But two things. Firstly, there are millions of cases. A lot of people have got this. And so rare events like things that only show one in one in a thousand times are actually quite common. And two, we’re paying a lot of attention to it. So we’re seeing things that this virus is doing that we would otherwise not notice for more familiar infections.

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S1: And we should be specific about like the kinds of scary things we’re talking about here, because we’re talking about stuff like people having sudden heart attacks and strokes and thinking, oh, gosh, maybe this is really a vascular disease, not a respiratory disease. You know, we’re talking about long haulers and how how common it might be for this disease to last a long time and have lots of lingering effects.

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S4: Yeah, absolutely. The wide number of organ systems that this virus seems to hit, you know, the fact that some people are very small, number of people have been reinfected even though they had already encountered the disease. These these traits are actually not uncommon to other viruses. We just don’t pay them enough attention to take the heart issue. About 20 known viruses, including quite familiar ones like influenza. I think measles, you know, a lot of ones that you will be you will know about can cause a viral myocarditis, which is inflammation of the heart. Now, most of those cases resolve on their own, some proportionally to long term problems like scarring. And some proportion will progress to a fatal heart problem. But it’s hard to say what numbers of people go into those three buckets because typically doctors only see viral myocarditis in the third group, the people with the most severe problems who then get, you know, some kind of medical scan. But now, because we care a lot about covid-19 unreasonably, so people are scanning the hearts of folks who might have very mild or even no symptoms and they’re seeing signs of myocarditis. Now, is that going to progress? What does that mean? We actually don’t know because we just don’t have the denominator’s and we don’t have a sort of baseline comparison for how normal viruses behave. And I think that there are two ways of looking at this, and they’re both right. One is we shouldn’t totally freak out and believe that covid-19 is utterly unlike everything else we’ve seen before. It is certainly worse than the flu. It is certainly a problem. But it’s not like this completely alien supernatural virus. But also, this should give us pause. It should make us think maybe there are things about other viruses that have gone unnoticed and that we should pay more attention to. And the long haul phenomenon is the classic example of this. There have been lots of cases of chronic illnesses that can be triggered by viral infections that have been neglected and dismissed for a very long time. And if we had paid more attention to those, maybe we’d be in a better position to understand what is happening to covid-19 long haulers and be able to prevent or treat that phenomenon.

S1: So covid-19 it’s not a super infection. It’s not something that’s completely outside of our understanding. And I think that’s good to keep in mind. And there’s this other piece of good news, which is that the death rate from covid seems to be going down. Do we know why that’s happening?

S9: I think that it’s almost certain. Because doctors are just getting better at treating it, and that’s not really because of medicines, I think despite the huge amount of effort that’s gone into testing all kinds of drugs against this virus. I think the only one with really solid evidence is dexamethasone.

S10: That’s a steroid, right? It’s a steroid. That’s right. It reduces mortality rates among the most severe patients by, I think about three percent. So which is not nothing, but it’s not a ton either.

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S4: You know, besides that, I think just the general practice of medical care, like how you treat your patients when they come into the ICU, regardless of, like, the magic drug that you give them, that is just got better. And, you know, there are some other factors, like on average, I think I believe the the demographics of people who are getting infected are skewing younger.

S10: But, you know, yes, you’re right that people who are hospitalized with covid now have a higher chance of survival than they than people who were hospitalized back in March. And that reflects like our better medical understanding. There is a catch, though, which is that if this improvement hinges on the better ability of doctors to treat the virus, doctors are really exhausted. Right now we are into the third surge. Hospitalizations or rising hospitals are once again filling. We are getting the same kinds of stories in March of health care workers without adequate PPE and who are just very, very stretched. And those health care workers have been very stretched for months, like since the spring. And the one thing about this current surge, which really worries me, is that unlike the previous ones, which were concentrated in certain areas, the Northeast initially, the South after that, this third surge is all over the place. It is over a very wide geographical swath of the U.S., which means that unlike previous surges where doctors from less hit areas could travel and help out people in hard hit areas, it’s going to be very difficult to send and mobilize reinforcements this time around. And that should really concern us.

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S1: It sounds like you’re saying don’t go home for the holidays.

S3: What I’m saying is that going home for the holidays where you have different generations of people mixing for long periods of time in close contact indoors, probably without masks, talking a lot to each other is going to be dangerous, not just for you, but for your loved ones. There are ways of trying to reduce that risk, but the risk is there. What I’m what I’m really trying to say above all else, is that people should have be able to make informed decisions. And a lot of folks are still operating on this idea that six feet away magically protected, you know, scrubbing down surfaces, magically protected. That is not the case. If you want to take actions that actually keep yourself safe, staying outdoors, reducing contact time, wearing masks, all of these things are probably going to make more of a difference.

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S1: Some college towns have become hotspots for covid. Do you think about what happens in the next few months as folks go home for Thanksgiving and Christmas?

S3: Yeah, and I am worried about it. And I think a lot of people in public health are worried about it. Like it’s already not looking good, like cases are climbing are higher than they’ve ever been. It is not the case that that is simply just because of more testing. The rise in cases has outpaced the rise in test. Hospitalizations are rising as well. Death rates will almost certainly follow after a little lag and indeed have already started to climb.

S2: And this is even before the events that you talking about. So I think, yes, the mingling caused by college students returning home, caused by people traveling to see their families in Thanksgiving and Christmas stands to make things worse.

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S1: I wonder if it’s possible to look at a couple of specific places to think about what happens next. Like we’re hearing stories of in North Dakota, people are being asked to do their own contact tracing. I don’t even know what that would mean.

S5: Well, I think that I think that it is a it is a shocking indictment of America’s handling of the pandemic at lots of different levels, that these basic elements of public health, which have been so, you know, ready to mobilize in outbreaks elsewhere in the world, have not been adequately put in place here. So things like contact tracing, the fact that doctors still don’t have a. Of personal protective equipment. Now, in October, you know, the fact that the testing, though it has undoubtedly improved, is still behind where we wanted to be. The playbook for dealing with covid-19 is is not rocket science. It doesn’t really take some massive feat that we didn’t know how to pull off. Like it’s been clear America just simply hasn’t managed to mobilize the political will or the coordination necessary to actually pull it off. And which is why, as you say, we’re now in ridiculous situations where people are being asked to do their own contact tracing, contrary to Bob Meadows, the chief of staff.

S11: It’s not impossible to control a contagious virus. This is this conversation that Mark Mattos had with Jake Tapper where he said, yeah, you know, you just can’t you can’t control this thing. We’re just, you know, we’re working on treatments. What we have to do. We’re not going to control the pandemic. We are going to control the fact that we get vaccines, therapeutics and other mitigant. Why are we going to guarantee it? Because it is a contagious virus, just like the flu. But why not make efforts to contain it? Right.

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S5: And to be clear, the world has managed to control highly contagious viruses before waiting for treatments. It does reflect this widespread and especially American mindset of waiting for the biomedical savior to fix everything. Treatments for viral diseases of very, very hard to do and typically produce incremental benefits on top of just general solid medical care. You know, I think the focus on treatments while allow while seemingly deciding to allow the virus to run rampant, not only reflects this magical thinking, but also the split between the biological and social sides of medicine that have happened for much of the 20th century. Like if you look at the things that have really made a difference, this pandemic, it’s things like masks, physical distancing, these things that rely on the behaviors of people. It relies on tolerating a certain amount of inconvenience to protect each other’s health. It’s not a drug, it’s not a vaccine, but it makes a huge difference. And we undervalue that. Like we call these things non pharmaceutical interventions, which again betrays that biological bias. Right.

S1: But we think of them as sort of not scientific enough for something.

S5: Right? Right. What we think of them as like the B list interventions, like the pharmaceutical ones which are going to save the day and then the non pharmaceutical ones, which gets their own sort of miscellaneous category like flip that the in terms of the effect that these things have had on pandemic outcomes this year, it’s completely the opposite.

S1: I’ll be back with Ed Young after a short break. I feel like we have to talk about the election and what’s going to happen. You wrote this article this week that comes as close to endorsing a candidate or I would guess on endorsing a candidate as I think I’ve seen a science writer do. You basically said if you think about this last year of the Trump administration as a kind of experiment to see how Trump would handle a pandemic? This is a failed experiment and you wouldn’t want to run it again.

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S10: Yeah. So the Atlantic has made an endorsement, only the fourth in our very, very long history. I am not doing that specifically. That is above my pay grade. But I do think that it is worth pointing out for things that are pretty inarguable. One, Trump has mishandled the pandemic very badly. His approach has been extraordinarily lax and has contributed to the deaths of hundreds and thousands of Americans. Number two, Donald Trump seems to be completely incapable of learning from his mistakes, and he has made many. But his his rhetoric is still the same, even after he himself has fallen sick with this very virus. Number three, the pandemic is going to continue. So whoever sits in the White House in January, twenty second will still have to deal with it. And finally, number four, perhaps most importantly, there will probably be another major epidemic in the next four years that whoever is president in that term will also have to deal with. And how can I say that for sure? Well, every recent president has had to deal with some major epidemic because these things are upon us. This is an era where new diseases are going to emerge and old diseases will reemerge.

S1: So you’re saying it’s not just our pandemic winter, but prepare for just our pandemic future, right?

S10: It’s yeah. I mean, hopefully most of those things are not going to create a pandemic, but this is an age of epidemics.

S1: Have you seen anything in Joe Biden’s plans or people he potentially want to hire? That makes you think, OK, he’ll handle it better.

S10: Yes. He has talked about a national mask mandate, which I think is a good idea because we have seen that masks can make a difference in stopping people who are infected from spreading this virus. One of the things that I I am encouraged by is that he has also talked about the importance of paid sick leave, which is the kind of social intervention which has often been forgotten during this pandemic. And that, I think, is as important as the biomedical stuff like new drugs. A lot of people simply haven’t been able to take the actions that will keep themselves and their loved ones safe this year because they have had to just go to work. They work on essential jobs, low paid jobs, and they simply can’t afford to stay at home and isolate the way the people with more privilege have been able to. And I think rolling out things like paid sick leave will give people the choice to protect their lives without sacrificing their livelihoods. And I think that actually makes a huge difference to our ability to control the spread of this virus.

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S1: It’s interesting listening to you, because I get the sense there’s so much discussion about a vaccine and the rush to get a vaccine out there. And I get the sense that you hear that talk, you hear about operation warp speed and why you respect it and know that it’s necessary. You also might roll your eyes a little bit.

S10: Well, like, I’m not rolling my eyes, but I am a little wary about what might happen. So it was clear from the spring that a vaccine would be the most likely end game. And that is still true. Like, I think a vaccine will make a huge difference. And thus far, the process of creating a vaccine has been very impressive and been very fast. And these were all good things that we should feel good about. The problem is that there is a big difference between getting an approved vaccine and getting vaccines into people’s. And there are many aspects of that that are going to be tricky. There’s the logistical side to distributing vaccines across the entire country in the middle of a pandemic. There is the issue of having to vaccinate groups of people who typically do not get vaccinated. So like very like elderly people who might mount a much weaker immune response. There’s the issue of trust and the fact that Trump has either lost or corrupted much of it due to his mishandling and due to spreading of constant misinformation. So it’s not as if the FDA is going to announce that a vaccine has been approved and the next week the pandemic is over. A vaccine only heralds the beginning of the end. And there is there are going to be a lot of difficult steps to actually get us to a point where covid-19 is much less of a threat.

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S12: And, you know, I think those those steps are subject to many of the same problems and inefficiencies and failures of leadership that have plagued the pandemic response throughout much of this year.

S1: You do sound like the scientific research makes you optimistic, but you sound a little more wary about whether we’ve learned the right lessons about how to prepare for a pandemic or how to kind of bolster all the things around the science that would make our response stronger next time.

S3: Yeah, I think that’s fair.

S10: Dealing with a pandemic is more than just an issue of science.

S12: As we might traditionally think about it. It’s more than just drugs and treatment. It’s more than virology and immunology and even epidemiology. It’s a lot about our social lives. It is about issues of trust and communication. It is absolutely about politics. And you cannot deal with a crisis like this without dealing with it, thinking about all those things. And I think one could very strongly argue that we have not waited all of those things properly. So if you look at the many indices that were published before the pandemic, ranking different countries according to their preparedness, the correlation between those rankings and how well those countries have actually done against covid-19 this year has been incredibly poor. So either we don’t know what things actually matter in terms of preparedness or we do know, but we don’t know how to wait and assess them properly.

S1: I think America was weighted as like one of the most prepared, right?

S12: Yes. It was, in fact, weighted as the most prepared country in the world for a pandemic. And I don’t think that that has aged very well. That same index, which ranked, as number one, noted, several weak points, access to health care. On that, I think America ranked one hundred and seventy six out of one hundred and ninety plus countries. I think the same index you talked about had I can remember the ranking or even the specific category, but there was something about the political side of things that was that was noted as a possible weakness. But when you actually have a crisis like this unfolding, what you see is that these weaknesses compound each other.

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S10: That’s synergistic side of things.

S12: The fact that problems cascade and compound in ways that we didn’t expect I think is really important.

S1: Well, it’s funny because scientists, I think for a long time have tried to keep themselves apolitical and see their role as just straight ahead science. You know, this is not about my political leanings. Do you think covid will change that for some people?

S9: I think it will, and I think it already has. You know, I think people are very frustrated. I’ve talked to so many experts who have tried to be very neutral. And and I think there is dissent sense in academia. If you just stick to the science, you be objective. You publish your work, you get it out there, and then some magical, faceless policymaker will turn that into some kind of decision that actually works for the betterment of humanity.

S10: And and I think this year it is very clear to many. Researchers that that that model does not work because they have found out a lot about this virus, they have found out that measures like masks and physical distancing and testing and contact tracing and all the rest are important.

S9: But those those findings, all of that research has collided headfirst into two successive walls, like one is political action. And the second is just massive misinformation. And I think people are really shocked by that. I think it’s sort of radicalizing a lot of scientists. Just look at journals like Nature and the New England Journal of Medicine, but some of the most prestigious publications in the academic world and fairly conservative, right? I mean, well, a conservative as like cautious. Cautious, right. Right. Not right leaning, but like but cautious for sure. Like very, very, very academic. Very scholarly. And they’ve written, like blazing editorials talking about the failures of this administration’s pandemic response and essentially saying to people, vote Biden. I think nature has, in fact, endorsed by the New England Journal, has said that the leaders in charge of this response should be voted out of office.

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S1: Hmm. Whoever they may be, right.

S9: Yes. There’s nameless leaders you have never heard about. These are unprecedented moves. I mean, OK, so they are unprecedented moves for modern science as it happens in this century and these decades. It’s not actually that unusual when you go a bit further back in history like I was I was literally just reading accounts of a man named Rudolf Verco, who is a German physician in the mid 19th century, who talked about medicine as this as a social science.

S2: He went to investigate a typhus epidemic and saw so much inequality and suffering that it also radicalized him. Like his report on that outbreak is this incredibly radical manifesto that says, like, if you want to prevent epidemics, what you need are things like democracy, education, the reduction of poverty. Like he’s blaming civil servants, he’s blaming aristocrats. And I think a lot of his contemporaries had similar ideas. But there there has been a move over the 20th century to frame science as this apolitical, quote unquote, objective endeavor.

S9: And I do wonder if covid-19 is going to be part of the process of swinging back into that has already been there have been other things that have helped that momentum, like climate scientists are not unfamiliar with this debate.

S7: And I think the momentum created by those discussions will be enhanced by this pandemic.

S8: Adrian, thank you so much for joining me. Thank you so much for having me. Eddie Long is a staff writer at The Atlantic. He covers science. All right. That’s the show. What Next is produced by Jason de Leon, Daniel Hewitt, Elena Schwartz and Mary Wilson. We get an extra boost every day from Allison Benedikt and Alicia Montgomery tomorrow in this feed. Stay tuned for Lizzie O’Leary with our Friday show, What Next, TBD. And I’m Mary Harris. Thanks for listening. We’ll catch you back here on Monday.