Looking Forward, Looking Back

It’s been welcome and strange to give myself permission to take a step back from nearly four months of constant engagement with the pandemic and its ensuing crises; however, the privilege of stepping back itself is simply a function of where I sit, in New York City, as, globally, the COVID-19 situation has never been worse. Cases and deaths are spiking sharply in Brazil, India, and Mexico, and across the United States, we are witnessing a precipitous collapse of even our modest mitigation achievements.

Briefly, the New York Times shows 27 states now registering increasing daily confirmed case rates; Rt Covid-19 depicts, differently, more or less the same; this graph from 91-DIVOC shows new national confirmed cases per day climbing sharply in the past two weeks; the percentage of positive test results in NYC has quietly ticked up since the weekend (though whether or not the uptick is statistically significant, I can’t say) and we are still registering more than 300 new confirmed cases daily in the City, even as we move into further reopening; the Times further reports that, predictably – after the de Blasio Administration’s disastrous mishandling of the effort – contact tracing in New York is “Off to a Slow Start”; the jury remains out on the impact of the protests on the spread of COVID-19 (with Business Insider urging last week, “Don’t blame Black Lives Matter protests for the spike in coronavirus cases across the US,” while, more recently, officials in Arizona – perhaps in an attempt to divert blame for their disastrous failures to contain the virus – are suggesting that the protests may be responsible for some of the explosive spread of the disease in that state); but it is certain that our society is still studded with institutions – including prisons, jails, immigration jail and prisons, long-term care facilities and nursing homes, meatpacking facilities, Amazon warehouses, etc. – where congregate settings couple with corporate and governmental sadism to create near-perfect conditions for transmission. Such institutions in turn fuel the spread beyond their walls. (Good audio interview here on that front.)

David Dayen explains why death rates may not be spiking as sharply as new case counts (basically, new infectees are skewing younger – as governmental abandonment of pandemic control forces elders and those otherwise at risk to take matters into their own hands or otherwise risk their lives, while low-risk youths pretend like the pandemic is no longer a thing – and treatment and understanding of the disease have improved), while a recent study in Nature Medicine suggests that infection with SARS-CoV-2 may not confer lasting immunity (that is, that reinfection risk may be very real).

In short, we should all still be taking this disease very seriously, and here in New York City, I encourage everyone to make a daily habit of looking at the regional monitoring dashboard and the early warning monitoring dashboard lest we lose sight of what we suffered through and what it is we hope to avert going forward.

Now, looking back, I promised to spend some time thinking about what I got wrong in recent months. First, I’ll give myself credit, I think I got the big picture right, and I’ve never really varied from my core position: That drastic measures were necessary, given our disastrous mishandling of the crisis, but that we never should’ve been in that position in the first place, because we’ve known for more than a hundred years (in New York City, most of all) how to confront epidemic disease, and we should have been preparing from January onward and ready with an aggressive program of testing, tracing, isolation, and quarantine to complement clear public health guidance and widespread public buy-in to practices of social distancing, mask-wearing, etc. All of this, I’d say, is pretty obvious now, but it was obvious even in March to anyone who’d spent much time engaged with New York City history.

Okay, that being said, a few things I clearly got wrong, working backwards:

I fear my concern about the protests as sites of major contagion may have been overstated. Only in June has it become increasingly clear that outdoor transmission of the virus is extremely limited; that mask-wearing is highly effective (and perhaps the most meaningfully mitigatory intervention individuals can commit to personally); and that surface transmission is extremely limited. Some transmission must certainly have occurred and be occurring at demonstrations, but the greater risk remains the hapless reopenings and utter abdication of responsibility by all levels of government in this country, and, had the scientific consensus been clearer in late May regarding transmission pathways, I suspect my concern about the protests as potential superspreading events would have been somewhat less pronounced.

Ditto on the concern about people’s careless behavior outside. I never advocated park closures (at least, I certainly don’t recall doing so), but I was very alarmed by people’s behavior on the streets and in the parks and public spaces of my own neighborhood, and it would seem – in view of what we now know, which varies markedly in some respects from the earlier public health guidance – that transmission risk in these settings is quite limited. That being said, the drunken street parties that have been materializing across NYC in recent weeks are probably still ill-advised.

On masks, I embraced them as soon as the CDC guidance came out, but I was not among the earliest adopters, and actually expressed a degree of skepticism, not so much as to their efficacy, but to the commensurateness of mask-wearing as an intervention as NYC’s crisis was peaking. In some ways, I stand by that position; we’d dug ourselves so deeply into a hole, that truly draconian mass quarantine measures became necessary, but, nonetheless, I was off-base in understating the relative importance of mask-wearing. Again, now it seems obvious, and had there been strong guidance to wear masks in public starting from early March, I think we would have seen a different and less awful outcome in NYC, even if all the other bungling had gone forward unabated.

This is a more subtle point, but I challenged, in March, the “ideology” of flattening the curve as one of which the “relevance for us was short-lived.” My overall treatment of the issue was balanced, as the original post from March 22nd bears out, but, as a matter of fact, I’d say NYC did manage to flatten the curve in a more or less textbook fashion (from a very high baseline) in a way that likely averted much deeper catastrophe here. I’ll let readers go back and make their own assessment of the post if they care to, but I believe that its core assertions – that a lack of coherent public health guidance was leading to a “blindfolded leading the blindfolded” scenario of policy-making via Internet influencer, and that strategies of mitigation (rather than suppression or elimination – which was not even in my pandemic vocabulary at that point) were likely to lead to mass, if reduced, death – hold up pretty well.

Finally, coming back to the present, the discourse around the nationwide movement for racial justice is, at the moment, cacophonous. I stand by reservations I’ve voiced previously, while also continuing to feel conscience-bound to support and participate in this movement. I worry about the unkind aspersions, the “bizarre purity tests/ stupid infighting on the left” as my friend Dan put it, and the ahistorical analyses bubbling to the surface in a heady moment, but let’s see what the future holds. In the meantime, I hope and work for the best.

And to end with some good news, here’s to victories by AOC, Jamaal Bowman, and (hopefully, as the vote counts come in) others! Volunteering on AOC’s 2018 primary campaign, and her subsequent victory, were transformative in my life, and I hope we see a future where such victories are increasingly not the exception but the norm.