No One Gets Out Alive

“There must be some kind of way outta here

Said the joker to the thief

There's too much confusion

I can't get no relief.”

”All Along the Watchtower,” by Bob Dylan

At the beginning of the covid-19 crisis, I was on the phone with my 78 yo mother. We were discussing the virus as it pertained to getting my sons home from college. I was worried domestic travel would be closed and they were both away at school. I needed them home, and as soon as possible, before they were left stranded on closed college campuses. During the conversation she said, “I know I’m going to die someday, we all do. But the idea that I might die in the next few weeks is scary. I’m not sure I’m ready.”

To which I replied, “Mom, I don’t think anyone is ever ready.”

Ten weeks later and so much is still unknown. We don’t really know how contagious the virus is, why most people have mild to no symptoms while others die a horrifying death, or how to treat it effectively. We do have some knowledge—our doctors and scientists are working around the clock. But at the moment, the privileged among us have been sheltering-in-place for over two months and there’s still no real plan forward. Those workers considered “essential” have been living under the stress of possible death every day while the rest of us bicker online whether or not we should stay inside until it’s safe, or storm the capitol because our constitutional rights are at risk and dammit, I don’t want to wear a mask in public.

People talk about the middle ground, but last night, as I read about the super cyclone now bearing down on India and Bangladesh and the fact that due to covid-19 social distancing requirements, at least 100,000 evacuees will NOT have a safe place to shelter, it dawned on me that the middle ground requires a challenge that most of us in the first world aren’t prepared for. The middle ground is of course a slow reopening, sticking our toes out the door and testing the waters, ready to run back inside the safety of our homes if too many of are sick, or bodies start piling up in the morgue. I’ve been a supporter of this path, and I still am, but that way is filled with risk and death and I’m not sure we have the strength as a society to do it. Discipline is needed as well as courage, for in order to live in society, we have to be active in society. We have to actually leave our houses and do the work of building, playing, studying, and that means being near one another. And at this time, to be near one another means a certain number of us are going to die.

Thus, to move forward, I have to accept, as my mother pointed out, that I might die in the next few weeks, or next few years even, from this disease. I also have to accept my children and loved ones might suffer the same fate. I’ve known this to be true—no one gets out of life alive—but gosh, now it’s right there in my face and until we look death in the eye as society, we run the risk of either staying inside too long, leading to an unraveling of social order only your worst nightmares can imagine, or returning to “normal” all willy nilly with the ignorance only a toddler can imagine. In one case, we don’t act because of fear of death, in the other case we act out because of a denial of death.

But if death is in the cards for all of us, then perhaps the time has come to face it.

The terrorist is someone who isn’t attached to their physical form. This is also the definition of an enlightened one. Two sides of the same coin. Both types of people operate from a place of freedom—one where death cannot dictate the terms of life. I’m not a doctor, expert, scientist, I’m a blogger who writes her ideas an shares them in hopes of a conversation, and the way I see it, there are only two ways to the end of this: 1) We do the thing humans and viruses always do, dance with one another until herd immunity is established, either naturally or via vaccine or 2) There’s no such thing as herd immunity and we learn to live with at least 2% of us dying naturally of this disease until we find a treatment as it mutates and our immune systems try to keep up. Both of these options have the same solution, moving about and creating a society able to deal with this crisis, and both require the courage to accept death, rather than see it as a failure.

OPTION 1: HERD IMMUNITY

The biology of the immune system is stunning. I assume most of us know how this works, but if you need a primer, here’s a good one. Essentially the body in motion is constantly coming in contact with viruses and bacteria hell bent on killing it but not before using said body to find another body to infect. In most bodies—human, animal, and trees even—the moment we come in contact with these micro-bastards, our immune systems check it out. Have I seen it before? Yes? Shake it off. No? Fight it and get it’s number. Most of the time, the microbe doesn’t even make us sick. A healthy immune system kicks it immediately. Other times we have to take longer to deal with it. Fever, cough, sleep, chicken soup (old wives tales actually have some truth in them), all work to help the body attack the contagion and kill it, while recording the genetic template of the disease within our own immune database, so that when we encounter the bug again, we can shake it off. I realize this is a simplified explanation, but herd immunity is based on this science. When about 70% (note, not a real number and not the same for all disease, just using this as an example) of us have recorded the genetic code of the virus inside our immune systems, the virus no longer has enough bodies to infect and the crisis is over. This same science is what enabled us to create vaccines, one of the two medical miracles of the 20th century (antibiotics being the other). By injecting a bit of the virus codes inside of us, our immune systems record the information and when we meet the virus in real life, we shake it off, and when at least 70% of us do this, the disease is eradicated.

In order to address this crisis head on and bring it to a close, we must build herd immunity, either naturally or with a vaccine, and neither are completely safe. Since a vaccine is anywhere from 18 months to 3 years out, let’s start with the natural approach—slowly open up and dancing with the virus. We know that those who are older and suffer comorbidities are more in danger of dying from covid-19. We also know that determining the mortality rate of this disease is currently variable, meaning it has changed since the beginning of the outbreak, and is vastly different depending on where you live. For example, current case fatality rates (CFRs) vary widely between countries, from 0.2% in Germany to 7.7% in Italy. See this fabulous write-up about on the Mortality Risk of Covid-19 and you will understand just how impossible it is to ever be safe until the virus runs its course. There’s a HUGE difference in outcomes depending on age and health going into the disease, and this matters when it comes to public health policies. For most of us, getting covid-19 will have mild to no symptoms, with very low fatality rates. According to Worldometer, current data collected from NY deaths showed the following share of deaths: 0-17 0.06%, 18-45 3.9%, 46-64 22.4%, 65-74 24.9% and 75+ 48.7%. Moreover, 75% of those who died had pre-existing conditions. For example, there were 9 total deaths in the 0-17 age group, but 6 of the deaths were in young people with a health issue before contracting covid-19.

So, we know that our vulnerable need to be protected. The question is, how many of us are vulnerable? That depends on where you live, your lifestyle, and to a great extent, your age. This is why the CFR varies so greatly between counties, cities, and nations. What then are we supposed to do? How do we determine if the odds are in our favor or not?

Unfortunately, America has a fairly unhealthy population. According to the National Health Council, “Generally incurable and ongoing, chronic diseases affect approximately 133 million Americans, representing more than 40% of the total population of this country. By 2020, that number is projected to grow to an estimated 157 million, with 81 million having multiple conditions.” That’s a lot of vulnerable folks. If 70% of us need to encounter the virus, building natural herd immunity will mean that some portion of us will die, and in order to do my part, I have to accept that I may be one of those people.

This is why many want to wait for a vaccine, but here’s the catch, vaccines aren’t perfectly safe either. Before I go any further, I want to say that I AM PRO-VACCINE. I had pertussis when there was an outbreak in California ten years ago, and let’s say, “go DTap boosters,” okay? However, they are not 100% safe. As a matter of fact, some people, mostly babies and old people, do die from vaccines administration. In a study done May 2015, Death Reports in the Vaccine Adverse Event Reporting System Among Persons Vaccinated 1 July 1997–31 December 2013 showed a total of 2149 deaths, with 68.4% being in children under the age of 17 and 54% of those being under the age of 1. Now, 2149 deaths over 16 years is a low number, but there are 300 million of us, and 70% of us will have to have the vaccine or natural antibodies for the rest of us to be safe. That’s 210,000,000 vaccines administered within a short time period, not spread out over 16 years. Some of us gonna die. And we need to identify who are the most vulnerable to vaccine injury, so that they are protected. My guess is that those who are most vulnerable to covid-19 are probably the same group for whom a rushed vaccine might not be a good idea.

Parents are afraid of sending their kids to school because they might catch covid-19, however according to the CDC, as of 4/2/2020, only 3 people under the age of 17 had died from the disease in America. Latest stats from NY above to suggest at least 9 deaths in this age group by 5/14, and I can’t find a more recent report on children specifically on the CDC, but here’s the link to all their latest reports. More research needs to be done, but we must ask ourselves why we’re willing to risk our child to a vaccine that will most likely be rushed, but not this virus, when it appears the risks might be close to the same. Just a thought.

In the meantime, herd immunity implies an end the crisis, but like the poor evacuees in Bangladesh left out in the storm, some of us will be sacrificed before it’s all said and done. Our leaders will take such risks into consideration as they open things up. For my part, I need to accept the risk of dying is higher for me right now than it ever has been before, and I can’t be a part of the solution if I deny it.

OPTION 2: NO HERD IMMUNITY

There are plenty of reports that perhaps there’s no guarantee we can build herd immunity to covid-19. Fair enough, I’m not going to argue because I’m not a virologist studying this disease. But does that change anything? On one hand, yes, for if we can’t build herd immunity it means we can’t build an immunity to the virus, most likely because it changes too quickly. That happens sometimes. No matter how we frame the dance, the virus demands it’s price. However, if this is the case with covid-19, that means we won’t have a vaccine. You can’t vaccinate against something that changes so quickly humans can’t build an immunity to it. We have boosters for our viruses because many of them do change over decades, but if herd immunity is impossible, then the first vaccine might be useless before we’ve even shot it into all 210,000,000 of us. If this is the reality of covid-19, then the way forward is one in which it’s even more important for the majority of us to get out of the house and build a new world—one in which living with death is the reality. If we don’t, if the wealthiest of us stay inside, we run the risk of either complete societal meltdown, or we entrust our current crop of politicians to build a future of control, forced labor, and vast economic inequality.

If 98% of us will have mild to no symptoms, living with covid-19 isn’t any different than our risk of other diseases, for example, one in two men in the US have the risk of developing cancer (all types) and one in six risk dying from it. We’re pretty sure that our food supply and toxic way of living causes cancer, yet we refuse to do anything about those systems to prevent these needless deaths. Perhaps this can be the blessing of the corona pandemic—we now see how we’ve been killing ourselves and our planet for some time and we’re ready to take action. What sort of action? 20% of us are about to be unemployed, 7.7 million of those young adults, who won’t even have colleges to return to. A FDR style infrastructure project can channel these idle hands into new ways of living, traveling, generating energy, and growing our food. Of course, that requires electing an entirely new type of politician, one who can lead us out of this crisis with a clear head and open heart.

In the meantime, it’s up to us personally to prepare for this future, because there’s no avoiding it. We have to do the personal work of learning to die and we also have to do the physical work of building our immune systems and curing our chronic disease, especially if herd immunity is impossible. Eating healthy, exercise, meditation, and sleep. It works. I lowered my cholesterol from 215 to 175 just by changing my diet. Sorry, but Zoomtails everyday during quarantine and baking all that bread ain’t going to prepare you to live in the age of a pandemic. I hate this fact, I do, but it’s not too late to turn this thing around. I want to be with you, the people of my nation, and I promise to do the work needed to build the courage and the body to face this by your side.

Because the only way out of this involves death. Then again, that’s always been the basic rule of life.