Jen Gerson: The Case for Optimism

Keep calm, get jabbed, carry on.

An extraordinary thing happened on Thursday morning; while managing two separate phone conversations, I logged on to a website run by Alberta Health Services, waited for 39 minutes in a queue of 34,397 fellow 30-something Albertans, and booked a time for my COVID-19 jab. After a week of disastrous communications on the vaccine file that left me feeling utterly despondent about the state of our national pandemic response, I have to admit, the booking perked me up. 

No doubt, many people are feeling the weight of this long global emergency; 14 months in, case rates spiking, particularly here in Alberta. I've felt it too. A sense of hopelessness; that the vaccines won't be enough, that not enough people will get them, that we're going to be in whack-a-mole lockdowns indefinitely. That we're going to lose another summer. 

On Wednesday, we ran a piece by Kevin Newman spelling out the pessimistic scenario. 

Now, I think it's important to counter it. 

There is every reason to expect that the end of the pandemic is in sight. Our vaccination rates are continuing at a healthy clip. Early returns suggest that the jabs appear to be effective against the most common variants of COVID-19. Our health-care systems are strained, but have not collapsed. Our COVID-19 mortality rates are already dramatically lower than they were during the second wave. And while we are in the thick of a third wave, there's no reason to think that Canada is going to be unique; we should expect our case rates to drop as more people are vaccinated and the weather warms up. 

As always in Canada, spring comes in fits and starts. But always, it comes. There is a case to be made for optimism. 

A Tale of Three Countries

I want you to take a look at three graphs depicting daily COVID-19 case rates in three countries; Israel, the United Kingdom, and the U.S.

This first graph from Israel is interesting. Why? Because on March 7, the government permitted restaurants, event halls, and cafes to open nation-wide. Further, individuals who had received full immunization could eat inside, while those who had not yet received their shots could eat outdoors. Even some students were sent back to class. What do you notice happens on the graph after March 7? That dramatic downward slope is called exponential decay. 

When Israel opened, its per capita case rates were close to where Ontario's had been near the height of that province's third wave. Further, you can't credit the drop in cases post March 7 to severe lockdowns — case rates declined most dramatically after that country began to ease restrictions. 

Just as the immutable march of math pushes COVID-19 case rates upwards exponentially in a virgin population, so too does vaccination or herd immunity work its magic on the other side of the slope. Israel started to lift restrictions and re-open when about 60 per cent of its population received at least one dose and half had been fully vaccinated. The result was miraculous. 

Now let's look at the United Kingdom. 

The Brits took a much more conservative approach, beginning to ease a strict lockdown on March 8 by allowing schools to return, and permitting people to meet outdoors. Further easing occurred at the end of March, and the most serious lockdown restrictions were lifted on April 12. 

The easing began well after the U.K. was over the worst of its second wave — which was much worse than anything we experienced here in Canada. More than 128,000 people died of COVID-19 in the U.K., compared to 24,000 deaths here. Yet there, cases continued to decline right through the Spring, just as our own third wave was beginning to pick up. 

By April, the U.K. had given a first dose of vaccine to 30 million people — just under half the total population — and the minister for vaccine deployment declared that month "second dose month" as the vulnerable began to receive its second jab within 12 weeks of the first. 

The last chart is from the U.S.

Now, admittedly, it's harder to draw conclusions from this graph. The U.S. isn't one country; it's dozens of states, with no real centralized health-care system, and a farrago of restrictions. Some states have seen COVID-19 numbers drop even as they've eased up; others have seen spikes as vaccination campaigns begin in earnest. 

What is increasingly clear, however, is that while COVID-19 will continue to be a background concern in America for the foreseeable future, there won't be any more waves like the one that swamped the country over the winter. In many states, life is returning to normal. As of May 5, according to the CDC, 56 per cent of the population had received at least one shot. Again, their case rates have steadily declined as ours have spiked. 

To say that Israel, the U.K. and the U.S. vaccinated their way out of a third wave is not a controversial observation anywhere but Canada. 

Vaccines Are The Way

If you think that the way out of the pandemic is going to come predominantly through regimes of ever-harsher lockdowns and restrictions, Italy, Poland, France and Germany have some bad news for you. All of those countries are experiencing a third wave, akin to what Canada is recording. When I think of countries that scream "incompetence" and "insufficient internal controls," Germany is not the first to come to mind. Yet all of these jurisdictions have suffered the same kind of reactionary lockdown strategies and reversals that have overwhelmed most of us here, too.

There is no real dispute that lockdowns buy us and our health-care systems time. But they come an extraordinary cost, particularly to children and youths, small businesses, and the marginalized and poor. For a host of political, financial, and psychological reasons, lockdowns do not appear to be sustainable for any length of time. So we’re all trapped in a cycle of half-measures: We open up. Case rates increase, we panic, governments come down, too late, like the hand of God. The case rates go down, we relax, and the cycle begins again. The more often we repeat this cycle, the more distrust in government grows, social cohesion frays, and the less buy-in and compliance we can expect. This has been our unhappy limbo for the last year — and we’re not alone in it.

So is it possible for a liberal democracy to lock down hard enough long enough to actually crush COVID-19 after the disease begins to spread uncontrollably within the community? That’s the question we’ve been struggling to answer all year.

In the abstract, it seems like the answer should be: “yes.” But when weighing that question, we have to plug in ephemeral but practical factors like political competence, enforcement capacity, the state of voluntary compliance, social cohesion, and mass financial and psychological resilience. It's possible that a sprawling, decentralized and sclerotic state like Canada never really had a hope of controlling the disease this way. But if Germany was unable to prevent a third wave using extended lockdown measures, surely that question ought to give us pause. There’s more happening here than mere lack of political will. Perhaps there are factors contributing to spread that we don’t yet fully understand — not least of which, group dynamics and human psychology.

It appears that lockdowns are necessary but not sufficient; by comparison vaccines (in large enough numbers) are both necessary and sufficient.

The European example should put a question mark over the claim that if only the provinces had been harsher earlier, we would have been able to avoid our current predicament. Maybe the provinces could have Done Better. That’s always an easy take. That doesn't mean I'm blaming the federal government, either. It's possible that the Liberals moved as fast as it reasonably could to secure a supply of vaccines. As contracts between our country and vaccine manufacturers are largely private, I lack the data right now to make that assessment. 

But it's worth noting that the only countries that are not deep in the poop right now come in one of three medicinal-candy-covered flavours; either they locked down and banned travel early, preventing COVID-19 from getting a foothold (ie; New Zealand and Australia); they began to vaccinate aggressively in February and March (ie; the countries noted above); or they just got lucky. Canada matches none of these conditions, and our situation is exactly what it ought to be, considering. 

But there's a bright side to that analysis as well. We know that while lockdowns are unsustainable, neither are they futile. The vaccines are working, we just need to buy time to get enough of them into arms to make further spikes of COVID-19 case rates mathematically unlikely. The examples of the countries above should give us some hope that we're much closer to the dizzying downslope than it may seem at the moment. 

Lockdowns as Lifestyle

In case the above is not clear, I'm optimistic about COVID-19. Or, rather, I'm optimistic that we have the tools and capacity at hand to reduce this disease from a global crisis to just one of the many everyday background risks that we all navigate while living an ordinary life. I suspect we will never totally eliminate COVID-19 — just as we have not totally eliminated any of the serious and crippling diseases that have plagued mankind from the inchoate darkness of pre-history, save smallpox.

We carry on. 

If I'm pessimistic about one thing, it's not the state of our science, but of ourselves. More than a year into this pandemic, and we have two factions in society that have turned their relationship with this disease into a lifestyle, and a statement of values and self. 

The anti-lockdown crowd has allowed itself to be so dominated by fear of the government and oppression that it has extended its distrust to the very object that can deliver us from our current state of collective misery — vaccines. These are reviled as either too risky and experimental, or, at the extreme end, a tool of nanobot-fuelled mind control.

On the flip side, we have a #COVIDZero crowd calling for a fantasy; these are the types who wear triple masks for walks in abandoned streets and hector children not to touch on playgrounds. In their fear of this disease, they've elevated COVID-19 and its attendant rituals into purity theatre; the demands for more collective suffering is a show of virtue and civic engagement. Doctors become priest-like. The writ of terrifying models, never falsifiable, must be obeyed no matter how wrong. Condemnation for the #COVIDIOT is a moral duty. Stricter rules will deliver us.

This is the kind of preening that immediately paints over a mural because the art (absurdly) protests putting children in masks. It justifies the decision with the (equally absurd) logic: “Art that is dangerous is beyond the scope of what the not-for-profit people of Springboard believe in and what we do … I couldn’t guarantee that the mural could do no harm so it had to go.”

Paradoxically, this approach also undermines vaccines, as it treats them as secondary measures intended to supplement the all-virtuous lockdown. This has created a narrative that over-emphasizes the risks of vaccines, and casts doubt about their efficacy. It is pessimism and fear hardened into a way of life, and rewarded as a show of political affiliation. (The Atlantic recently wrote about this phenomenon here.)

Don't rush to get AstraZeneca; you can always just wait another month or two or three or four for the "preferred" vaccine, can't you?

What's another summer in your house? 

To a large and, I suspect, growing number of Canadians, the answer to that proposition is a resounding no. They will not comply with another lost year. The good news is that I'm ever-hopeful that it's a demand that need not be posed. 

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