Let's write about pandemics: Post COVID on Earth

Dora Anne Mills, MD, MPH
"Not-So-Brief COVID-19 Update"

#vaccinate

Dr. Mills has been publishing the "No-So-Brief" throughout the pandemic, reporting news with her opinions and medical scientific information.

Sunday, July 4, 2021
A Day to Celebrate

Dr. Dora Anne Mills:  Chief Health Improvement Officer for Maine Health

Although this weekend is a time for celebration, there are times when grief and sadness are overwhelming. Recently, running into so many friends and family whom I’ve not seen for months, I realize this yo-yoing of emotions is common. Everyone seems excited to be emerging from the pandemic cave. But everyone is also carrying the burden of loss - loss of loved ones, loss of a job, loss of a former life.
I’m also amazed at how many are making major life changes. People are leaving their office careers. They are choosing instead to farm, to quilt, to fish. Many who are maintaining their jobs are also taking up previously unheard-of hobbies, often related to nature or making things by hand, such as beekeeping, gardening, bird watching, knitting, or cooking. People are deciding not to have children or to have children. Gap years are now routine. It seems as though collectively we’re experiencing an existential crisis, and we are seeking more meaning.

The reasons for such a crisis are obvious. The pandemic uprooted everyone’s lives. Climate change’s worsening is palpable, and now without question directly impacting our daily lives. Political strife is dividing families and friends. Racism’s wounds are gaping.
Despite the yo-yo of emotions and despite the existential crisis, I’m optimistic. History is on our side. As I shared some details in a post on June 8, 2020, accelerated changes for the good emerge from pandemics’ tragedies. The Black Plague that started in the mid-1300s, led to the death of an estimated 60% of Europe’s population. But it also led to the dismantling of the feudal system and ideas, replacing it with the Renaissance. Disproportionately wiping out serfs, who worked in close quarters producing food for the merchants, priests, and kings, the plague exerted unfathomable losses. But the resulting labor shortage meant serfs could negotiate for their wages, and eventually some freedoms. Additionally, as people realized that the practices espoused by doctors and priests did not protect them from the plague, many started questioning prior beliefs. The dismantling of the feudal system and questioning of long-held beliefs contributed to a re-awakening that was a catalyst for the Renaissance.

The 1918 influenza pandemic, intertwined with World War I, also resulted in enormous labor shortages. In unprecedented numbers, women joined the workforce. Although the 19th Amendment (women’s suffrage) had been introduced over 40 years earlier, it finally was approved by Congress in the summer of 1919, sent to states for ratification, and was finalized in the summer of 1920. Clearly the rise of women in the labor market, catalyzed by the pandemic and the war, contributed to its success. Additionally, as people tossed their masks away, loosened their Victorian era corsets, and threw their weapons down, they exchanged them for cigarettes, knee-length dresses worn by flappers, movies, planes, and faster cars associated with the Roaring Twenties. The end of the pandemic and war didn’t return society to “normal”, but rather to a new normal, with novelty and breaks with tradition.

Likewise, the HIV/AIDS pandemic extracted a tragic toll, especially on young gay men. But the heartbreak of this loss, the stigma associated with the infection, and the inaction by government also ignited activism that paved the way for many rights and celebrations, including marriage equality and Pride month.

History shows us that out of the tragic ashes of pandemics, there are periods of extraordinary innovation and creativity. However, with the pandemic still burning in most of the world and with variants emerging that even threaten us in the U.S., why am I so optimistic? Because we have the tools to extinguish the pandemic fire! First, vaccine is the water to extinguish the pandemic fire. But even with the Delta variant causing those who are fully vaccinated to pause, we know from scientific studies from the last 16 months, that masking, ventilation, distancing all work to synergistically - especially with vaccines - to protect us. These form the major slices of the “Swiss cheese strategies” of layering protective measures so the virus cannot escape through any one layer’s holes, as it is blocked by the next layer.

As an aside, yes, we seem to be getting conflicting information on masking, but we’re really not. The World Health Organization (WHO) recommends masking, even for those who are fully vaccinated. However, their audience is global. With only 11% of the world’s population fully vaccinated, and half of the world’s countries with fewer than 5% fully vaccinated, it is important that safety measures such as masking are generally maintained. Yes, the vaccine is protective and an effective fire suit, but as Dr. Fauci has said, that doesn’t mean one should walk into a fire with it. Most of the world is very much on fire with the pandemic, which means in most of the world, even those who are vaccinated should adhere to additional layers of protection, such as masking, distancing, and ventilation.
By contrast, US CDC guidance for the fully vaccinated is that we do not need to mask. With 47% of our country’s population fully vaccinated, the situation is far different from most of the world. Our incidence, hospitalization, and death rates are the lowest they have been since near the beginning of the pandemic in April of 2020. Here, the pandemic fire is simmered down. In most situations, the fire suit of vaccine is sufficient, and additional protective layers such as masking are not needed.

Nevertheless, there are exceptions. For example, in places like Los Angeles and St. Louis, where the disease rates are high or rising, and vaccine rates low, it makes sense to advise for additional layers of protection, even for the fully vaccinated. Again, the vaccine is a fire suit, but if you’re in the fire of a pandemic, you want additional layers. You want more layers of Swiss cheese so there are no holes the virus can escape through.

What does that mean for us in areas of the country with high rates of vaccine and low rates of disease? Officially, yes, the advice is that we don’t need to mask if we’re fully vaccinated. I agree with that. However, especially given the rise in variants such as the Delta strain with increased contagiousness, the rise in disease incidence in areas of rural Maine (where vaccine rates are lowest), and with those <12 not yet eligible for vaccine, there are situations I would consider masking, even if fully vaccinated. I am inclined to mask if I am indoors or in a crowded outdoor setting with a group of people I do not know their vaccine status or if they’re known to be mostly unvaccinated (e.g. a group of young children).

There are also places everyone must mask, as per federal guidance or rules. They include all healthcare and public transportation settings as well as many schools.

Back to other reasons for our collective existential crises and why I’m optimistic. What about climate change? Climate change is clearly one of if not the single biggest threat to our existence. Those of us over 50 remember when the weather was not making headlines every week. And the headlines are increasingly reminiscent of the Biblical descriptions of the battles of Armageddon. However, here again, science has opened up our tool box. We know much more about what is causing climate change and how to address it. Many of the technologies to replace fossil fuels have improved in effectiveness and cost. Political and public appetites for addressing climate change have grown. It is still very unsettling and we are far from overcoming the grave threats that climate change is presenting. 

However, we have many of the necessary tools in place.

What about political polarization and racism? Our country and our world have survived many analogous struggles with related political strife over the centuries, including those in previous peri-pandemic periods - the struggles of the serfs for freedom from slavery and for self-determination, the struggles of women to vote, and the struggles of gay people for equal rights. Although we are far from declaring victory on the struggles against political strife and racism, many of the tools are in place to address these more successfully - a wider recognition of the harms of these issues as well as an increasing collective desire and variety of options to address them. As Martin Luther King, Jr. reminded us, “the arc of the moral universe is long, but it bends toward justice.”

I am convinced that we will return to a new normal and this is also a time for celebration. We need to acknowledge the grief, the losses of this last 16 months - the people we lost, the celebrations we lost, the former life we lived. It has been a very difficult 16 months for all of us. But even if we feel weak, we are also stronger than 16 months ago. We may have wounds that need healing, but we have also slain dragons. We are stepping into a new normal, and importantly, one which we can create.

The founders of this country declared independence on this day 245 years ago. However, July 4, 1776 was not the end of the Revolutionary War. Many battles were fought before and after the Declaration. The Treaty of Paris wasn’t signed by the U.S. and Great Britain until 1783. The U.S. Constitution wasn’t fully adopted until 1788. But July 4, 1776 is the day we celebrate.

Indeed, today is the day we should celebrate and be grateful. That doesn’t mean there are not undertows of grief. That doesn’t mean there won’t be additional battles. We are far from signing a treaty with the pandemic. But do have our weapons - masking, distancing, ventilation. And most importantly, we have our own Declaration of Independence - Vaccination. Indeed, we have a bright future ahead of us and reasons today for celebration.