Who's Keeping Score?

Last week, I met with a few friends for a birthday dinner. One of the attendees didn't have a mask with him; he tends to keep them in his car, and this time, he didn't drive himself. I keep a few of the blue surgical-style masks in my car, so we walked over to pick some up. It was about two blocks there, and two blocks back. When we made it back to the restaurant, he put the mask on just outside the door. We then entered, walked the maybe thirty feet to the table, and then both proceeded to take off our masks to drink from the water glasses at our seats. Appetizers were ordered, and eaten, then the main course arrived, drinks were served and refilled, and then dessert came. Then, after the bill had been settled, everyone put their masks on, and we walked the thirty feet or so back to the door, and once out in the street, everyone took their masks off again.

I want to say "while I completely understand the reasons for all of this," I'm starting to realize that I don't. And so the feeling that the current iterations of the non-pharmaceutical interventions that governments have put in place to slow (I want to say "manage" here, but it all comes across as too haphazard for that) the progress of the infection through the population comes across as theatrical, in the sense that it's designed to project that something is being done, rather than to be strictly effective.

And it's not that I believe that all of the measures that have been put in place are ineffective. I have no way of knowing how effective they are or are not. So I suspect that they're doing something. I just can't tell you what that something is. And I can't tell you that it's worthwhile. While discussions of the Reproduction Rate for SARS-CoV-2 in a given location have long gone out of fashion, what that number might reasonable be is still useful to know. It's understood that if the Reproduction Rate drops below 1, the disease will peter out at some point; not enough new people are being infected before the people already infected recover, presumably after having purged their bodies of the pathogen. So if measures can push the rate for a disease down to below 1, can keep it there for a sufficient time, they can effectively eradicate the disease in a given population. And for a disease of a given serious, the cost-benefit analysis of those measures will pencil out at some point, and a decision can be made.

On the other hand, there is a Reproduction Rate for a sufficiently serious disease such that the number of people ill enough to require some sort of high-quality care to avoid death or other serious consequences will outstrip the availability of such care, and this place serious strain on the persons tasked with providing such care, especially given that the level of training needed to provide such care makes the supply relatively inelastic. Since that number, whatever it is, doesn't have a set value, we'll just call it x. Again, it's understood that if non-pharmaceutical interventions can bring the local Reproduction Rate down below x, then the overwork of care providers can be avoided. But with this calculation, the idea is that at some point, some other factor, either time or pharmaceutical interventions will come along and push the local Reproduction Rate down even further, or at least stabilize it.

But if broadly applied non-pharmaceutical interventions aren't making the difference between being above a given threshold or below it, are they worth the costs? With the understanding that SARS-CoV-2 and influenza aren't the same thing, I'm going to enlist the flu as my example here. Once the Flu Pandemic of 1918 was a thing of the past, the annual flu season wasn't really seen as a reason to enforce interventions. Even in years where 50,000 or so people died from the disease and its complications, it was understood that the Reproduction Rate wasn't going to rise to x, and it would only be a few months before warming weather pushed it down below 1. Given that understanding, it wasn't seen as worthwhile to pay the costs of mandated interventions, even though it was understood, at least in some circles, that lives would be saved.

I don't know that anyone has ever considered a scenario like the world has at this point, where the lowering of the Reproduction Rate to 1 isn't happening anytime soon, and it's x that's worth looking at. I presume that there are people out there, likely in the public health field, who know what x is. I, for my part, have no idea.

What I also don't know are a) what the current Reproduction Rate in my local area is, b) what the circumstances that create that rate are, and c) how much the current batch of interventions, pharmaceutical or not, are doing to it. Something tells me that I'm not alone in that, because a lot of people I know have come to treat a SARS-CoV-2 infection as some sort of roaming death warrant, just looking for someone to serve itself on. This viewpoint, I think, leads to an understanding that every individual instance of illness is something of an avoidable tragedy and unacceptable outcome; another in a host of frightening trees that completely obscures the forest and give things like mask mandates and a need to show proof of vaccination to eat in a fast-food place an air of being ends in themselves.

With the understanding that a certain amount of consistency and predictability are important, does it really make sense to require people who have to be demonstrably prove they are vaccinated wear a mask for the walk from the door to the table and back again? A sick person in a relatively small area can easily exhale enough virus-laden air to reliably infect a number of people around them over the course of a moderate meal (Something I learned the hard way not long out of college.), so is really worthwhile? Or have things, at least in Blue America, where I happen to live, settled into a need to be seen doing something, and that's what's important?