Good morning,
The Covid pandemic has taken a terrible toll. Each of us have had difficulties, but as we each struggle on, we must try to hold in our hearts as much compassion as possible for our 220,000 fellow citizens who have lost their lives; for the millions of their friends and relatives who miss them terribly; for the 80,000 who have died beyond the expected average of deaths this year because this virus has been stalking our land; for as many as 2 million people who have died worldwide, and for all those who are recovering from Covid-19 but are still suffering lingering effects.
And it is also incumbent upon those of us who have not gone hungry, who have not suffered the loss of a job (as perhaps 40 million have in the United States alone — perhaps 15 million permanently), to be mindful of the pain and loss around us, while trying not to succumb to the loneliness, despair, and feelings of grief that so many are fighting to overcome. Each of us must try to push though our own trials and do what we can for those who are suffering during this worldwide tragedy.
While holding this in our hearts and minds, it is also time to look toward what lies ahead — and there is some good news on the horizon.
First, it is reasonable to hope that in 9 months we will be past the worst of this pandemic. By that time there is a good chance a well-vetted vaccine will be widely available. Plus, since somewhere between 30 to 60 million people in the United States have probably been infected by the virus already and, though we do not know how long immunity lasts, almost all of them seem to have some immunity now. (If Covid is like similar diseases, immunity will last for a year or more.) Finally, a wave of new infections is sweeping the world right now, causing terrible suffering. But by next summer the number of people with immunity in the U.S. will have reached a level that, combined with the likely introduction of vaccines, will slow the contagion considerably.
The second piece of positive news is that Covid is not as deadly as was once feared. If there have been 5 total infections for each of those officially found to date through testing, then less than 1% of those infected are dying. Further, as our treatments get better and new medicines are found to help mitigate the disease, the death rate will continue to fall. The elderly and those with underlying conditions — physical conditions that make them especially vulnerable — must be very, very careful, but for everyone else, Covid is not as scary as it once seemed. I know a number of people who have had Covid and seem to have recovered fully with no lasting ill effects.
A third piece of possible good news involves the economy. Although many jobs have been lost for good, our economy is resilient. Many, many of us are creative and industrious. New jobs will come. If, as seems somewhat likely, the Democratic party wins both houses of Congress and the presidency, there will be a large fiscal package by early February that will help those who lost their jobs, support struggling small businesses, provide desperately needed funds to cash-starved cities and states, and give the economy a major boost. The stock market is already anticipating this fiscal stimulus in a positive way.
Lessons to Be Learned
Still, there are things we need to understand much more clearly as we enter the 10th month of this pandemic, and as the second wave of infections gathers steam around the world. One is a reality that should have been obvious from the time the first severe outbreaks occurred in Italy, Spain, and New York — this is, at minimum, a two-year issue. If we in the U.S. had had a better response — developing a national testing and tracing program as Germany did — the severity would have been reduced and there would have been significantly fewer deaths. But once widespread contagion was present on the European and American continents, the pandemic was inevitably going to be a long-term, difficult problem.
Island nations like Australia and New Zealand, by acting quickly, were able to prevent a major outbreak before it could begin. And, because they are islands, each has been able to contain the virus effectively so far. A very different containment example comes from China, a society with a widespread system of authoritarian control. Because surveillance and control systems were already in place, China was able to stop its outbreak by severe limitations on freedom that would not have been tolerated by the people in many countries. Countries with historical patterns of valuing individual freedom, and whose borders are in direct contact with other regions of the world, were never going to be able to stop the virus completely once it had infected a significant number of people around the world.
A third example comes from Japan and South Korea, both well-run democracies with a great deal of individual freedom. Both, however, have unique situations. Each is an island nation (South Korea is an island in the way it functions, because there is no traffic across its only land border with North Korea). And each has a fairly homogenous population, with widely shared values within the populace. Each also has historical and cultural patterns of people valuing the necessity of fitting into agreed upon social norms. This has served them well in instituting practices to limit the spread of Covid-19.
These advantages for dealing with the pandemic, however, are not present in most of Europe, the Americas, India, and most of the Middle East. This means that most regions of the world must now deal with widespread disease and death — and that we will be dealing with it for at least another year. We have built a world that is deeply interconnected, and if India, Brazil, Italy, Spain, and New York have widespread infections, the only path forward is to learn to manage the disease as we find the best ways to go on with our lives.
Further Lessons from Sweden
Because Sweden shares many of the characteristics of the U.S. and Europe, also because it had a fairly significant outbreak of Covid-19 in the early months, and especially because it has managed the pandemic in a different way from most other countries, their example can be instructive for the rest of us. Surprisingly, rather than value what might be learned through studying their alternative model, most observers have attacked Sweden because they have had the audacity to do things differently. For instance, a recent article in Time was vicious toward Sweden’s response to the pandemic. My first reaction to the article was to shake my head in amazement at the animosity being directed toward a country that has tried a different path from the one recommended by the “we know the truth and everyone else is wrong” crowd.
This antagonistic view of Sweden, a progressive country on many fronts, pervades much of the coverage in the U.S, making it hard for anyone reading the mainstream press to have a clear idea what is really going on in Sweden. My take is that they have made mistakes, but that there is much we can learn from their successes.
First, the mistakes: The Swedish authorities have said often they made a mistake in dealing with their nursing homes, and it resulted in far too many deaths of the elderly. Accepting this, why is Sweden criticized so much more harshly than New York? There was a much higher percentage of elderly deaths in New York in the early days of the pandemic than in Sweden. Why, then, aren’t the same writers calling Gov. Cuomo and the leaders of the New York murderers — like this article says about Sweden’s leaders?
The reason this is so important is that the early mistake with nursing homes in Sweden is totally separate from their overall strategy, just as it is totally separate from the overall strategy New York came to adopt. Many people died in New York nursing homes in the early days. That is clearly seen as a mistake, but New York has been praised for its actions since. The same should be true for Sweden — because its death and disease numbers today are better than New York’s.
Another mistake Sweden made (which they were slow to admit) was not starting a major testing program early on. But they have since corrected that mistake also — they are testing a higher percentage of their population every day than Germany, and they fall in the middle of the range for all of Europe.
Moving from the mistakes to the lessons, the article in Time makes it sound like Sweden claimed they had defeated Covid. But this is totally untrue. No one in Sweden ever said they would not have an increase in cases if there was a second wave in Europe. Of course that would be true, and they knew it. Unsurprisingly, the number of infections has risen in Sweden as colder weather has set in, just as they have risen all over Europe and in the United States. But anyone reading the Time article would think that things were going very badly in Sweden, compared to other countries, yet that is completely untrue. Here are the average number of new cases per 100,000 people in the last 7 days in several countries, as well as a few states in the U.S:
Netherlands 320
France 249
U. K. 186
Spain 183
U.S. 125
Germany 53
Denmark 52
Sweden 47
North Dakota 643
Tennessee 205
California 57
New York 51
Does this look like Sweden is now a disaster, as the article implies?
Further, these results are not because Sweden is testing less — they are doing as much or more testing on average as other European countries. And since Sweden is in a much colder climate than some, the seasonal effect is probably greater there.
One further point that needs to be followed carefully is that deaths in Sweden have stayed very low – less than one per day in the whole country (about 10% if what is happening per capita in New York right now). Crucially, while there are headlines in the U.S. about excess mortality being 80,000 lives during the pandemic (300,000 more have died in the U.S. since the pandemic began than the average number that would have been expected without the pandemic, but only 220,000 can be directly attributed to Covid), the excess mortality in Sweden has, over the last 3 months, fallen below the expected average.
In other words, fewer people have died there in the last few months than would have been expected if there had been no pandemic. There are several possible reasons for this, but one is that so many people in their 80’s and 90’s who were seriously ill died in Sweden in the early stages of Covid — people who would have died soon anyway but happened to be counted as Covid deaths — that now there are fewer deaths than would be expected because many of those people would have died soon without the pandemic.
As we register this, we must consider an implication that the plunge in excess deaths in Sweden suggests — that the measures we have taken to limit the pandemic have been the cause of many of our 80,000 excess deaths in the United States. Since Sweden is no longer having excess deaths, we must weigh the possibility that their less restrictive approach is helping to limit excess deaths.
This is, of course, painful to contemplate, and is perhaps the reason for the animosity directed toward Sweden — if their less restrictive approach is succeeding in containing the pandemic and also preventing excess deaths, then all those who have advocated stricter measures have to own up to the downside of their suggested approaches. And, however painful this reckoning might be, it must be undertaken if we are to find the best path forward till July 2020, and — heaven forbid — if there is ever another pandemic.
Here are some things Sweden has gained by their approach, and which might be part of the reason that their excess deaths have fallen below what would have been expected:
1. Normal social life has not been disrupted much all across the spectrum, so the spike in loneliness, despair, suicide, physical abuse, drug abuse, and all the other things we have suffered in the U.S. have not happened in Sweden. Suicides have not spiked. Death by drug overdose has not spiked. Abuse within families and overall murders have not gone up, as they have in the U.S.
2. People are not avoiding going to the doctor or to hospitals, or getting shots they need, so other types of illness have not gone up — while in the U.S. this seems to be one of the major causes of excess deaths.
3. Swedish schools for those 16 and under have stayed open, so there is not much controversy about how to handle schools; parents haven’t had to deal with taking over schooling and care for their young children, and children haven’t lost a year of education.
4. Numerous small businesses are not having to close for good, because they stayed open through the spring and summer. Bankruptcies are thus much fewer than in the United States.
5. Restaurants have stayed open and are therefore not going bankrupt in droves.
6. The Swedish economy has been hurt because of the slowdown of exports, but it is much heathier than almost all other countries in Europe. They will recover faster than most other countries.
7. They have avoided the protests and increasing split between points of view that have exploded in the U.S. and are spreading to many other countries today (Germany, Australia, etc.).
8. They mostly have normal interactions with each other without the extreme psychological effect that trying to communicate through a mask creates. It is becoming increasingly clear we will look back and understand that masks had a negative effect on people’s relationships with other people. Those outside our inner circle are becoming more and more “objects” to us, rather than human beings. I don’t go out much, but I find myself more and more avoiding interactions when wearing a mask because it is so hard to understand others with the muffling of words that masks cause, and with the difficulty of real communication without being able to see facial expressions. What are the long-term consequences of making conversation with most everyone we encounter so frustrating?
This argument is not to say there is no role for masks. There is a role. But, as Sweden clearly demonstrates, masks are not the key to controlling Covid. Most people there do not wear masks, yet they are doing better in controlling the virus than many countries with strict mask mandates. This suggests we should, rather than making masks a political issue (which both sides have done), be looking carefully to find the situations in which masks are truly important and get that message out clearly. At the same time, we need to be researching the situations in which masks are not really necessary — places where reasonable physical distancing is all that is necessary — so we can begin to return to more normal lives. The issue is not masks versus no-masks. The issue is, where are masks an important protection, and where are they not important. Can’t we find a way to get beyond name-calling and yelling insults at each other like kids on a schoolyard on this issue, and begin to work together to find an intelligent path forward?
For instance, if you are going to a doctor, a hairdresser, or a meeting or gathering in a closed space, or are going to be in close proximity to people outside your immediate circle for any length of time, masks can be valuable. But mandating masks for all public areas, outdoors, in fairly open spaces, and in uncrowded areas where people can keep a distance is just creating a backlash. One recent poll found that although a majority of people in the U.S. believe masks are a good idea, only 48% are wearing them when they need to. Wearing a mask must not be a purity test, and mandating them in situations that are not very likely to spread the virus is a serious mistake.
We need to focus on discovering when masks are really necessary and begin a campaign to encourage people, in a positive way, to use them in those situations — rather than battling over mandates. Societal mask mandates are not the answer in the United States — we are too independent and ornery for that. If an individual chooses to wear a mask any time they want, that is great. A store or business or private institution should be free to create mandates within their space any time they want. But broad governmental mandates are a different matter, and fighting about this is distracting us from the things that are truly important. Rather than creating more and more rules, we need positive educational messages, and we need to be focusing on the consequences of “othering” people — and not spreading fear in our society about the dangers of encountering others in the world. What will be the consequences of teaching our children that other people are dangerous objects to be avoided? I am seeing this all the time when encountering children on hikes in the mountains.
The Way Forward Today
The crucial steps forward today are:
1. An intelligent and thorough testing and tracing program paid for by the federal government.
2. Recognizing that Covid is being spread in specific places and ways: bars, family gatherings, colleges, workspaces that force people to be close together, social gatherings that don’t honor a certain amount of physical distancing, churches that haven’t developed effective practices, and sporting events without strict rules. We must work to find ways for people to fulfill their natural social needs while limiting the spread of the virus as much as possible. Rules that are too strict simply create a backlash and eventually a greater spread of Covid-19. We must balance what we are doing between the extremes of protecting ourselves and others while finding the best ways to go about our normal lives as much as possible.
3. We must recognize that rules and mandates have limited effectiveness in a free society — more and more people are finding ways to evade them as they become tired of the dramatic limitations on their lives. We must focus on practices that will be accepted by a great majority of people and with which most people will voluntarily comply. We must find practices that can be maintained with the least possible disruption of lives for another year, while avoiding rules and mandates that will continue to increase the backlash and rebellion already being participated in by a hundred and fifty million people in the U.S. The path forward is not for each side to condemn those with whom they disagree, but to look for things most of us can agree upon. It does not work for those advocating strict rules to shame and blame those who do not agree with them, and it does not work if a lot of people believe the rules should be looser and thus openly flaunt the truly important guidelines.
4. Do everything we can as a society to fund the research and do the necessary verification to find effective and safe vaccines.
Once again, we can learn something from Sweden here. They have not done things perfectly — but it would be good to recognize there are valuable things we can adopt from their contrarian experiment. If things suddenly go wrong there, we can learn from that. Until and unless that happens, one lesson so far seems to be that a moderate position between the extremes is the sanest path forward.
For instance, in Sweden they have consistently taught their citizens the importance of keeping a physical distance when interacting with others not in one’s immediate circle. Most people in Sweden are therefore doing this voluntarily, as opposed to our experience in the U.S, where millions of people followed the rules for a few months, but then became rebellious and went too far in the other direction, increasingly going to parties, bars, family gatherings, vacations without much distancing, and participating in crowded situations of all kinds. Perhaps this would not have happened if the rules had been less strict to be begin with. It seems pretty clear that, besides an effective testing and tracing program, the most effective Covid strategy is for most everyone to voluntarily keep some physical distance most all the time from those with whom they are interacting. My personal experience is that this is not very hard to do, once you make it a consciously chosen habit.
If we in the United States are to come through the next 9 months as well as possible, each of us must make an effort to give greater respect to the views of those who have a different understanding of how to respond to this pandemic, and we as a society must find a middle path that begins to heal our divisions, creates jobs in spite of the spike in infections, and rebuilds our economy as we also try to save as many lives as we possibly can.
May you be well,
May you be safe,
May you be at peace as much as possible in this strange time,
David