In my last post, I mentioned how partisan echo chambers have impeded progress on one of the most important issues of our time: climate change. But an even starker example was our response to the COVID-19 pandemic.
This was evident early on. Already in the summer of 2020, conservatives in my life claimed that partisan bureaucrats and medical staff were over-attributing deaths to COVID in order to exaggerate the severity of the pandemic for political reasons. Fortunately, there’s a simple way to validate the accuracy of COVID death statistics, which is to compare them to excess mortality. This is a measure of the number of deaths from all causes in excess of that which a regression model based on prior years would have predicted. The red line on the chart below shows the cumulative number of excess deaths in the U.S. since the start of the pandemic. It indicates that something caused over 1 million more Americans to die than would have been expected based on previous trends. In fact, the number is higher than the death toll attributed to COVID (blue line), perhaps due to under-attribution, or the knock-on effect of other illnesses going undertreated due to fear of COVID or lack of medical resources.
Another controversial topic has been vaccine safety. Now, I want to acknowledge that vaccine hesitancy comes in many forms, some more defensible than others. I know someone who chose not to be vaccinated because of a pre-existing autoimmune disease that is easily aggravated, and they compensated by taking other precautions such as distancing and masking for longer than most did. You can disagree with their risk assessment, but that’s a different rationale than believing the vaccines contain microchips or that mRNA vaccines alter one’s DNA, which is based on a lack of understanding of how protein synthesis works. (In brief layman’s terms: mRNA are the recipes that tell the body’s protein factories what to make. Normally, DNA is the source of these recipes, but in the case of the vaccines, it is skipped entirely as the vaccine inserts custom mRNA instructions to create benign proteins that look like parts of the COVID-19 virus, which the body produces antibodies to destroy. This primes the immune system to more quickly mount a defense against the real virus, lessening the severity of infection.)
Although their effectiveness has waned as COVID has mutated, and it’s difficult to assess all the various subtle side effects that some have experienced, the data for vaccines ultimately paints a pretty clear macro picture of their safety and efficacy on at least the most important criteria: death.
To see if vaccines were causing significant numbers of deaths, as some have claimed, it is instructive to compare the trends of excess deaths, vaccinations, and spikes in COVID infection. The chart above shows all three since the start of the pandemic (deaths are shown with a different scale for visibility, so the absolute height of the line relative to cases/vaccines is not important - what is important is the correlation of peaks and troughs). We can see significant numbers of excess deaths correlated with Alpha variant cases which continued throughout 2020 and spiked during the winter of 2020-2021. Vaccines only started to become available at the very end of this period, so obviously vaccines were not the cause of these deaths. We then see the huge spike in vaccinations during the first half of 2021, during which excess deaths went down significantly. This was in part due to a lull in infection, but they were even lower than a previous period with a similar case rate - suggesting that rather than causing deaths, vaccinations were reducing them. The next rise in deaths corresponds to the more severe Delta variant that spread from mid-to-late 2021, at the same time that vaccinations were down significantly. Delta bled into the winter 2021-2022 Omicron spike, which still caused many deaths but at a much lower rate. During this we do see an increase in (mostly booster) vaccinations, but the correlation with Delta and Omicron makes it impossible to conclude that it contributed to those deaths, especially given the clear evidence from largely-unvaccinated India of the deadliness of Delta in the Spring of 2021.
From this aggregate data we can see no evidence that deaths rose after vaccinations, and some evidence of the opposite. But there are better ways to get an idea of how effective vaccines were at saving lives. The first, is to look at the share of deaths by vaccination status:
This shows that in late 2021, when vaccines had been recently widely administered and the prominent variant was Delta, far more unvaccinated people were dying than vaccinated. But as the primary series wore off and COVID mutated into the more resistant Omicron variant, we see the proportion start to even out. Of course, an important factor that isn’t shown here is the vaccination rate of the population - this too grew throughout the period, and it stands to reason that the more people are vaccinated, the more people that die will have been vaccinated (if everyone is vaccinated, a single death would represent a 100% proportion by this metric). So, while this does illustrate the importance of vaccines against Delta, it’s a bit hard to tell from this how important vaccines are now.
But another metric is death rate by vaccination status, which paints a rather clearer picture:
Although we again see a drop in efficacy as Delta gives way to Omicron (and as vaccines administered in 2021 wear off), it’s still quite obvious that you’re much better off being vaccinated even now. And if you recently got the bivalent booster, you’re roughly half as likely to die as if you were vaccinated but didn’t get that booster (though the risk in both cases is very low). In short, while vaccines do trigger an immune response that may have some noteworthy non-lethal consequences in some individuals, the data shows that – especially earlier in the pandemic when the virus was more deadly and the vaccine more effective – the risk calculus clearly favors vaccination.
That’s not to say the medical community has been right about everything. Those who criticize the CDC have a point when they say that its guidelines were too slow to adapt to new information about the virus. The 6ft distance rule was not based on any hard scientific evidence, and the messaging on masks early in the pandemic was intentionally dishonest in order to prevent a run on personal protective equipment for front-line workers (an understandable reason). It was also a bit irrational that during Omicron, when the vaccine was mostly effective in protecting against serious illness rather than preventing infection or contagion, there were still places that mandated vaccines but not masks. Masks are a less invasive and effective control against community spread (contrary to misinterpretations of a recent study), which should be the primary purpose of mandates.
Nevertheless, while it’s fine and useful to critique in good faith, it’s entirely another matter to personally demonize the career professionals like Dr. Fauci who were just doing their jobs under immense pressure and trying to save lives. COVID-19 came on the scene mere months before it became a public health emergency and as such was not well-understood at the time that many of these recommendations were being made. Its rapid mutation meant that we were always playing catch-up, and we should extend some grace to those who were doing their best to make sense of and translate the latest data into advice for us to keep our families safe.
And that brings me to my closing thought on this subject: the lack of empathy and grace we Americans have shown for those who responded differently to the virus than we did. I’ve been guilty of this - looking down on those not wearing masks at the grocery store in the summer of 2021 and assuming they were unvaccinated Trump voters who thought it was all a hoax. But maybe they were actually vaccinated or immune from a recent infection, and were just trying to finally enjoy a sense of normalcy? For that matter, during the post-Delta lull, when I was still somewhat recently vaccinated and transmission was low, did I really need to wear a mask, or did I do it to signal that I was a responsible and well-informed citizen who “trusted the science”? By the time I finally did start taking off my mask in semi-crowded indoor spaces, it was hard to get past the feeling that a mask had become part of my identity, and by taking it off I was assuming the identity of the people I judged.
The pro-lockdown left has, in retrospect, been wrong about a number of things. School lockdowns, justified at the beginning when we didn’t understand yet how dangerous it might be in a school setting, ultimately went on for too long in many places, and students and families - especially poor ones – suffered. Meanwhile, affluent kids like my daughter found in-person private schools or tutors and hardly missed a beat, extending their advantage over those with less resources or opportunities. And there was a lot of over-confidence among those, including myself, who saw the early reopening and anti-mask-mandate positioning of Governors like Greg Abbott and Ron DeSantis as destined to lead to many more deaths. In reality, while Texas and other conservative states do rank among the highest in age-adjusted COVID deaths per 100,000, Ron DeSantis’ Florida is below Gretchen Whitmer’s Michigan, and not far above California. That statistic alone doesn’t prove those policies didn’t harm people (they probably did), but at least the situation was more complicated than the “trust the science” crowd was predicting. Nor does that statistic account for the economic, educational and psychological benefits of relaxing restrictions.
Having said all of that, though, there is a big difference between raising legitimate critiques and disagreeing about the best way to balance risks, and acting as though a requirement to wear a piece of cloth on one’s face is a violation of one’s fundamental rights. Especially when that piece of cloth helps to reduce the risk you pose to others through the spread of a deadly disease. It seems more than a little hypocritical that so many of the loudest opponents to mask mandates were those on the staunchly “pro-life” end of the political spectrum. We accept (or should, at least) other reasonable restrictions of our freedoms in the name of protecting others, whether that’s outlawing drunk driving, scanning airline luggage, limiting industrial water use, regulating waste disposal, restricting the sale of firearms, requiring childhood vaccinations and enforcing speed limits. But a requirement to wear a mask that filters dangerous virus particles from the air we exhale, during a global pandemic that is killing millions worldwide? Hell, no! Mask mandates were not primarily about protecting the individual, but the community. Those who defiantly refused to wear masks in indoor public places before vaccines were widely available and the virus was still very deadly, were neither pro-life nor loving their neighbor.
In many ways, COVID was kryptonite for the United States. It was an invisible, changing enemy which took time to understand. Even the best experts made mistakes and miscalculations as they tried to keep up with this foe, which was exploited by purveyors of misinformation and conspiracy. Cynical politicians, most of whom quietly got vaccinated themselves, bowed to the wishes of their supporters who had come to believe that COVID was an overblown plot to undermine their president, and that the vaccines were untested and dangerous. What should have been an opportunity for Americans to move past their divisions and come together against a common threat, led instead to Americans seeing each other as the real threat. The hermetically sealed information siloes I described in my introductory post were now killing us.
Next time, I’ll address another thing that’s killing us: guns.