Some simple advice for anyone contemplating a holiday gathering: Wait until March.
Hunkering down to wait out the coronavirus isn’t easy. The costs of isolation are steep. Quarantine fatigue is real. The chance to gather with extended family and friends this holiday season is particularly alluring to those of us battling loneliness. Ritual is the bedrock of human society, and forsaking it feels even more destabilizing in a year that has already thrown us all off-kilter.
Even so, I have a simple suggestion for anyone contemplating a large gathering this month: Wait until March.
I recognize that’s not a small sacrifice. For most Americans, the COVID-19 restrictions began last March, when schools shut down and toilet paper was nowhere to be found, and the toll has only mounted over time. It’s been a long year. Human connection is no luxury, not something we can easily forego. Socializing is one of the most important contributors to our health and well-being. Social isolation predicts mortality at similar levels to smoking. It’s a greater risk than obesity, elevated blood pressure, and high cholesterol.
But this Christmas will be a particularly terrible time to catch the coronavirus. Hospitals nationwide are already overwhelmed, ICUs stretched to their limit. A surge of cases tied to the holidays could further challenge hospitals’ capacity to provide lifesaving care. Meanwhile, treatments are improving, testing is expanding, and vaccines are arriving. If your loved ones can stay healthy a few months longer, they might be much likelier to survive the disease—or to avoid contracting it entirely.
If you want to convince your relatives—especially your elderly relatives, who are at greatest risk—that gathering this holiday season is a bad idea, warning them of the potential consequences will get you only so far. Instead, offer them something that’s recently been in scarce supply: genuine hope.
There are good reasons to believe that the United States is about to experience a dramatic turnaround in its fight against the coronavirus, even as much remains uncertain. Keep your fingers crossed, knock on wood, sprinkle evil eyes in every nook and cranny, and offer a thought and a prayer and more coffee to the millions who will be working hard to pull this off. The future—even the near future—looks hopeful, even as the current moment looks particularly grim.
While apples-to-apples comparisons are hard—we were testing so much less in the spring—we almost certainly face a much bigger nationwide epidemic today than we did in the early, awful days of the pandemic, but the death rate is now much lower. Better clinical practices, more drugs, and a deeper understanding of how to treat COVID-19 have improved outcomes. However, those gains are fragile. The current surge of cases has placed hospitals around the nation under great strain. Some face shortages of beds and space, or even more dire, of trained personnel. An ICU bed without ICU nurses, after all, is just a bed.
Since the surge is occurring nationwide, health-care workers cannot go to the trouble spots to relieve their exhausted colleagues, as they did during the initial spring crisis in the New York area. Moreover, many are simply exhausted after a very difficult year. Inexcusable shortages of personal protective equipment at the outset of the pandemic forced nurses to improvise, with some donning garbage bags to treat patients. The months of hard work that followed forced many health-care workers to stay away from family members, to spare them from the risk. Some have watched colleagues succumb to the disease, or faced staffing shortages so dire that they had to keep working after testing positive for COVID-19.
We’ve recently been breaking horrifying records almost daily: the most cases detected. The most hospitalized. The most deaths per day. All the gains in saving lives may be lost if hospital capacity is so strained that standards of care drop—and they may well drop, because people can only do so much for so long—or if overcrowding forces hospitals to raise the bar for admission. When caregivers are spent and sleep-deprived, medical errors increase, and motor and perceptual skills decline. Exhaustion strains our attention, memory, flexibility, and ability to adapt, and our general mood. We can push our health-care workers and hospital capacity only so far before feeling the consequences—indeed, those consequences are already being felt.
The fight against the coronavirus has been called a “national marshmallow test” that we’re failing. In a famous study, children were left alone with a marshmallow for 15 minutes, and promised a second if they didn’t eat the first. Kids who were better at delaying gratification were found to be more successful later in life. At first, this correlation was explained as demonstrating the importance of willpower and executive function.
Later, a team of researchers set out to replicate this study and uncovered something profound. Once they adjusted for factors such as household income, mother’s education, and home environment at age 3, the effect disappeared. Further variations of the study showed that whether the children judged the promise to be reliable made a great difference in whether, and how long, they were willing to hold off for the reward. Indeed, access to a consistently well-stocked pantry makes it easier to believe those who say that a bigger reward awaits those who can resist eating the marshmallow right away. The precarity and instability of poverty encourage people to live in the moment, simply because the future is so uncertain. Willpower and grit are not merely personal characteristics, existing in a vacuum devoid of social reality. And, yes, hope works, but only when it is realistic and not an empty promise.
If we failed our national marshmallow test this summer and fall, perhaps that says something about how little reason the public was given for optimism. Hope can’t just be a slogan or a pep talk; it must be justified by facts, experiences, and trustworthy promises. And in fairness, until last month, it was less clear when and how this would all end.
But hope is justified today. Multiple vaccines are now in development. Pfizer’s, just approved for use in the United States, and Moderna’s, expected to be approved shortly, both use messenger RNA—a piece of genetic code that carries instructions to create a protein—to deliver the spike protein of SARS-CoV-2 to our cells. The spike protein is the bit the pathogen uses as a key to gain entry to our cells. The idea is that by allowing the body to do target practice with just the spike protein, we can train it to handle the actual virus. Using messenger RNA in this fashion has until now been just a promising idea—but research during the pandemic has shown that at least for this virus, it works very, very well.
As late as April, Anthony Fauci and other experts cautioned us that even a year to 18 months would be an optimistic timeline for having a vaccine. Just five months ago, the FDA announced that it would approve vaccines that were at least 50 percent efficacious at preventing disease. Despite that long timeline and those modest expectations—both amply justified by previous experience—we already have two vaccines that have proven to be about 95 percent efficacious in large-scale trials. Even better, they have been shown to cut severe disease to near zero.
The United States is hoping to vaccinate 50 million people by the end of January, and the actual number vaccinated this winter could be even higher. The logistical challenges are substantial and many things can still go wrong. But speedy, effective vaccines have been the most stellar part of the global response, and more—many more—are on the way.
The first 50 million people to be vaccinated will give us more bang for our buck than the next 50 million, because the vaccination rollout will start with the elderly and other high-risk groups, health-care professionals, essential workers. While the exact order of vaccination has not yet been decided, the elderly and those at high risk must get some of the first vaccines, because those groups suffer the most from COVID-19. The risk profile of this disease is strikingly exponential: The risk of death for those ages 65 to 69 is a staggering two and a half times that of those just a decade younger. Those just a few years older, ages 75 to 79, face six times the risk of death compared with that same age group (ages 55 to 59). The steepness of this age curve really matters, because it means that protecting the most vulnerable groups with a highly efficacious vaccine will both quickly change our experience of the pandemic and relieve the strain on our hospitals. After that, vaccinating health-care workers ensures that they can continue to fight the pandemic without being sidelined. Essential workers don’t have the luxury of staying at home; their jobs may expose them to the virus, and they can expose others in turn. But it now seems plausible that many millions will be vaccinated rapidly. Indeed, the first batch of almost 3 million doses is being distributed as I type.
What about all the skepticism and the cautions? All the warnings that we don’t know if the vaccine prevents infection rather than just disease, that we won’t be able to stop wearing masks and social distancing anytime soon? Here, it’s important to distinguish between things we don’t know yet and things that just won’t happen. Sometimes, as in this case, We don’t know just means “We haven’t yet measured it.” While we need to wait for actual confirmation to relax, there is no need to assume the worst, which would be that the vaccines suppress the disease but provide no protection against infectiousness.
We already know that symptomatic COVID-19 patients are a lot more contagious than those who remain completely asymptomatic; it is reasonable to expect that reducing or eliminating symptomatic infection will help reduce transmission. Early results, moreover, already suggest that the vaccines may lower the rate of asymptomatic infection by two-thirds just weeks after the first dose is administered. Deepta Bhattacharya, an immunologist at the University of Arizona, told me that decades of research on viral immunology suggest we should feel confident that the vaccines will reduce transmission and contagiousness as well. Studies on those questions are in progress now, but all the indications we have give reason to be upbeat. And those who have been vaccinated already are known to benefit greatly in terms of avoiding the disease themselves.
There are also open questions about the durability of the immunity provided by the vaccines. The existing trials have tracked participants for at least three months and have provided tremendously encouraging data for at least that long. As millions more are vaccinated and as trials and measurements continue, we will get a lot more data. Yes, it’s wise for those who have been vaccinated to maintain their precautions for now, especially since vaccines take a while to have an effect. But we can also remind ourselves that, so far, all the data we have seen have been greatly reassuring, far exceeding our initial hopes.
All these reasons for optimism are also reasons to delay your Christmas gathering until March. Even if our hopes are not fully realized, at a minimum, waiting until March helps avoid the risk of infection during this grim period. Plus, March offers potentially better weather, which seems to slow down transmission of the virus while also allowing us to engage in safer practices such as gathering outdoors and opening windows. While young people can occasionally suffer greatly or even die from the coronavirus, and while questions remain about the long-term effects of the virus, an overwhelming majority of those who are hospitalized or die are older, with higher risk factors. As the elderly are vaccinated, hospitals may finally be able to gain some breathing room—lavishing better care on a smaller number of patients, and further driving down the death rate. Plus, scarce lifesaving therapeutics such as monoclonal antibodies—in short supply for everyone except the politically connected—will become available to a greater proportion of those who fall ill. As the essential workers on whom we rely are vaccinated, the rate of transmission is bound to slow down for all groups. And as hospital workers are vaccinated, they may become less stressed.
Vaccinating the first 50 million people won’t just protect them—it will make all of us safer and the nation better-off. We don’t yet know how much better things will get this spring, but we can already tell that the situation seems set to rapidly improve. We can see the brightening light at the end of the tunnel, if we can make it through this last, darkest stretch. Postpone that Christmas party, if you can. Protect the members of your family who are elderly, or who are at heightened risk; keep them safe now, as we stand on the precipice of relief. We cannot guarantee the future, but just as the dangers of this grim winter are real, so are the reasons for hope.