How to End the Pandemic Without a Vaccine

If I had been regularly blogging for the last year, there would have been a lot more of these rant blogposts – how we could stop the pandemic sans vaccine and why people are stupid. Since March when the pandemic began, we have been hearing some variant of “There is no end in sight [sic] we might as well go back to normal!” While that slant has taken a hyper-aggressive partisan flavor, it fully overlooks multiple past pandemics that humanity has overcome (even without herd immunity). An end has always been in sight, just not as close as we want it to be, vaccine or not.

This oversight isn’t talked about enough. While I personally never believed quarantine would last for two weeks (admittedly, I have a PhD and background in public health), the fact is, quarantine could have lasted two weeks – if the entire population masked up and quarantined.

I do not write this without acknowledging my own privilege to “stay home.” However, even masked up, the evidence suggests that close encounters for business purposes (“essential” is the 2020 buzzword) would have significantly reduced COVID outbreaks and saved lived. I’ll save you the academic citations.

For a year, people have been quick to recognize and claim they practice “social distancing.” The same people also seem to misunderstand or abuse this concept. Social distancing has two components: 1.) keep six feet away from each other and 2.) maintain a small social circle. The first part we all seemed to internalize. The latter we egregiously overlook or bend to our own individual circumstances. (Note that CDC set the six feet rule; the WHO says one meter. There is no magical distance; it is a number with diminishing returns on viral spread.)

The facts are, COVID is airborne. It spreads from respiratory droplets. When you talk, laugh, cough, or kiss, you send those droplets flying. A certain amount of droplets need to enter another person’s body (usually through the nose or mouth) for the other person to become sick. Masks essentially stop this splatter. (No, you don’t need a HAZMAT suit. Double or triple masking is always better because have you ever played that game where you see how many wet marbles a paper towel can hold? Try it with three wet paper towels. Same principle.)

We also know the spread of COVID is exceedingly rare outdoors. It also doesn’t spread from surfaces that easily (I’d say it’s almost impossible to get from surfaces, but I’m afraid of the comments this post will get). Hand sanitizer is great, but it doesn’t protect from what you’re breathing in.

COVID only hangs in the air for 15 to 20 minutes. It’s not a chemical vapor fog that strikes you down when someone mask-less passes you on the sidewalk. But, yes, being indoors, say, at a restaurant without a mask puts you in a uniquely vulnerable position. If you don’t like indoor smoking, you’ll be aghast to find that COVID spreads similarly. The person three seats away from you could infect you, though you don’t even know their name.

The other big driver of COVID spread is seeing lots of people. This is where I’ve seen even the most public health woke people fail – or at least turn a blind eye to poor behavior. In terms of COVID, your social circle is all the people you see within a two week period – and the people they’ve seen in the last two weeks and the people those people have seen in the last two weeks, etc.

On average, a person will show symptoms five days after COVID exposure, but it can take 14 days for symptoms to show. Also, two days before you show symptoms, you are spreading COVID. So if you saw Jack yesterday, but he starts coughing tomorrow, then you were exposed yesterday – but you don’t know it yet.

But what if you’re only seeing Jack? That’s great – except who is Jack seeing? He surely is seeing somebody else because he has COVID. It turns out Jack saw Jill and Suze a week ago, and he also saw his parents the weekend before. Jill and Suze have seen Rick and Dave, who hang out with Beth who lives alone and sees no one else except she went on a Tinder date last week where she unknowingly got infected by someone who had no symptoms (40 to 60 percent of people infected with COVID will not have symptoms). Consequently, Beth gave COVID to Rick who gave it to Jill who gave it to Jack who gave it to you yesterday.

But you’ve only seen Jack!

This is not social shaming. We all have needs. I am an extrovert. I live alone. I have maintained many relationships during the pandemic. I have even gone on dates with strangers. My barriers have broken down even further as quarantine has dragged on. That said, for months I have asked my friends, dates, and even family who they are seeing before I agree to hang out with them.

This is how the pandemic ends. It’s the same thing as contact tracing, but it’s proactive. We need to ask our friends, relatives, and others who they are seeing and assess if they are worth the risk. We don’t need the intimate details of the interactions, but we should know 1.) how many people have they seen indoors without a mask in the last week and 2.) how many people have they seen outdoors for extended periods. The first number is much more important than the second in terms of risk. An additional question is to consider is how often does one get tested for COVID. (COVID testing is free with or without insurance thanks to the CARES Act – I’ll omit the very few exceptions to this rule. I’ve been tested 14 times since May.)

People incorrectly seem to focus on performative precautions rather than what matters. Getting groceries delivered does not mean you are COVID safe if you have five friends over for dinner. Having your temperature checked does not mean eating indoors at a restaurant is safe (or that you don’t have COVID).

Many of us grew up learning the sex ed concept that we are supposed to use condoms and other birth control and ask who our partner is sleeping with. We should be doing the same thing in the pandemic. Yet, a lot of us practice the former; we neglect the latter.

Masks are condoms. We wear them to protect ourselves, especially with strangers. We tend to take them off around friends. However, many of us are not orgy-goers in our sexual lives. Why do we embrace that flippancy during COVID?

Of course, finding out who someone is seeing still leaves open the question of whether to meet up with that person. We all have different risk calculus and risk thresholds within that calculus. For example, I may be willing to see a friend who has seen three different people, but those three people are allegedly seeing no one else. However, I may be unwilling to see another friend who has seen only one other person, but that person flew cross-country last week and has eaten indoors at several restaurants. I also may be fine getting COVID myself, but I am seeing my parents next week, and they are higher risk. All these factors have to be balanced.

The point is to make informed decisions and to decrease the number of people we are putting at risk. In general, no one wants COVID. Also, no one wants to pass it onto another person, especially someone more vulnerable to a life-altering outcome than one might surmise in themselves. We could entertain an exhausting conversation on the suggested tradeoffs between COVID precautions and the economy and education, but the arguments from every side all trace back to wanting the same thing – health and normalcy.

Even as the vaccines roll out – the federal government estimates they will have enough doses for every American by the end of May (though this doesn’t mean the doses are all administered by the end of May) – and as quarantine fatigue grows stronger, we must remain vigilant. That includes normalizing the conversation about who we are seeing as long as we’re unvaccinated.

I’ve had this conversation many times. It can be awkward, but it shouldn’t be. I’m asking how many people have you seen indoors in the last week, not who you’ve slept with. The conversation is least awkward with those who understand the virus. You give a number, I give a number, we decide if we feel safe hanging out.

If this conversation happens more frequently and transparently (and people make smart risk calculus), the pandemic could be stomped out in weeks. Yes, we’d have a few cases here or there, but the vaccine wouldn’t be so necessary.

I suspect normalcy will not return until the early fall or even early 2022. Vaccine hesitancy is the next hurdle and probably owed a different blogpost. Until then – or at least until we are vaccinated – we should be vigilant. All it takes is a simple question.