It’s Back: The Virus That Never Went Away

It’s Back

Over the past few days, Washington State, King County and our neighbors Oregon, Idaho and California have all posted record new numbers of confirmed coronavirus cases—as have the US overall, many other states, and the whole world. In Washington and King Country, these spikes come on top of rising case counts stretching back more than a month.

Unlike our March surge in cases, this surge has not yet been followed by a large increase in deaths, for several reasons: medical care has improved (a lot has been learned the hard way), it’s too soon yet for most cases to have progressed that far, and the average age of new patients is MUCH younger this time. The young got restless, and then got sick. The young don’t die as often from this virus, though they are vulnerable to a horror show of other effects. This suggests that we may see a two-step cycle, where the current rapid increase in youthful infections will cause a secondary surge in infections of older people a few weeks down the road, and then the deaths will come. Deaths are up, nationally, and are now increasing faster than new confirmed cases, so we may be seeing the beginning of the next wave.

In response to the surge, Washington Governor Inslee has put the brakes on the reopening process, as have many other governors. Weary people and businesses, who have been leaning forward in anticipation of the restored freedoms of the next phase, are sagging in their saddles, realizing that we’ve been set back. How far back is anybody’s guess right now, but it’s clear that the virus is active across the county and state, and in many places infections have slipped back into an exponential growth rate.

Why?

1. We’ve relaxed. A little less vigilance with the masks, a few more get-togethers with family and friends, more time out of the house, more time in grocery stores, and so forth. It still feels like we’re “being good,” but we’re not quite good enough, and that’s helped to nudge our virus’ reproduction rate back up above 1.0. The little events seem to be a particular issue: a family birthday with just a few extra people; a baby shower for just closest friends; a wedding much smaller than had been planned; dinner with the neighbors. These much-missed moments of human joy have become viral amplifiers, vest-pocket super-spreader events.
2. State and local governments have no control over borders and travel. Even though air travel is reduced, people still arrive at SeaTac from hot spots in Texas, Florida, Arizona and Southern California every day, and fan out across the state. People drive back and forth between the population centers of Western Washington and the hot spots in Yakima County and Spokane County every day. Contact tracing is very difficult in such an open environment.
3. We never did fully shut down. Compared to the countries that have few deaths, we half-assed this, big time. We brought our peak numbers down from April, but not nearly low enough before relaxing restrictions. A large part of this is political: thanks largely to President Trump, a substantial minority of Americans believe that not wearing masks is a statement of personal freedom and political solidarity. In Yakima County, currently burning with virus, about 2/3 of the populace objects to wearing masks. Home Depot has quit trying to persuade customers to comply with state-mandated mask-wearing, because their employees feel more threatened by aggressive non-masking customers than by the invisible risk of infection. Even in liberal King County, there are plenty of people who are proudly unmasked. It has been a major leisure-time activity in some quarters of this state to hate Governor Jay Inslee, and defying him now is part of that same game. Anti-masking is the new anti-vaxxing.
4. We never established a full system of testing, contact tracing, and quarantining. We never got the case rate numbers low enough to make it work. With a small number of new cases/day and a well-organized team it’s possible to jump on every case and chase down the contacts. With over a thousand new cases/day, some of them in parts of the state where many people and businesses are hostile to the whole idea of testing, tracing, and quarantine, the system falls apart.
5. The economic pain is huge and real, which made it too tempting to open up too soon.

Now What?

People talk about “the vaccine” a lot. It’s certainly impressive how fast development has been pressed, but we’re still not even close to having a magic bullet. We’ve seen that vaccines can, in small group tests, stimulate the production of antibodies to this virus. That’s good, but it’s not clear yet how long these antibodies last, and there’s reason to be concerned about that: a vaccine that’s only good for 3 months is still an improvement, but it’s not good enough to end the problem.

Candidate vaccines still have to run the gantlet of large-scale in-the-wild testing (Phase III) and demonstrate safety and efficacy. If they do, they still face the gantlets of manufacturing, distribution, and administration. This virus is already so global and so infectious that we can’t just solve the problem for one state or one country—we need to suppress it globally.  

Odds that a partial vaccine will be available in the US by mid-spring 2021 aren’t bad, but a complete vaccine may be years away. To survive those years, we’re going to have to do a better job on our “NPIs” – Non-Pharmaceutical Interventions—for the foreseeable future. We can think of mask-wearing, hand-washing, and work-from-home as NPI 1.0. We need to upgrade to NPI 2.0, with better masks, reconfigured spaces and protocols for work and other gatherings, improved understanding of what works and what doesn’t, and effective testing, tracing, and quarantining. We’re likely to get help along the way. Examples: a phone app that can tell from changes in your voice if you’re infected, even if you’re asymptomatic; a scratch & sniff tester for lost sense of smell; better information about exactly where the danger spots are, in real time; better ways to keep sick people alive and not permanently harmed.

Above all, we need to learn how to open up and close down in synchronized ways as the virus ebbs and flows around us. There will be waxing and waning viral loads every few months for the foreseeable future. We need to function as a giant public drill team, snapping off quick changes in behavior on short notice. Western Washington has demonstrated better-than-average initial aptitude, but it’s a heavy emotional and economic lift to the next level—cycling in and out of behavioral protocols and restrictions for several years into the future. As we get better at it, and as pharmaceutical assistance arrives in the form of antivirals and partial vaccines, life will improve. Take a deep breath—just be sure you’re wearing a mask when you do.