There Is Something Wrong With the Herd

The problem with the current pandemic is that we don't know if we're coming or going. It's as if we're swimming far from shore, overwhelmed by one wave after another, and we're unsure if we're heading toward land or away from it.

China was the early face of COVID-19, but it hasn't faced many infections since last spring. Europe, like the United States, has experienced successive outbreaks. Brazil continues to be hit hard while Turkey is only now seeing a reduction of cases from a mid-April surge. Thailand and Cambodia are only now dealing with their first major upticks in the disease.

But the real surprise has been India. Early on in the pandemic, journalists and scientists were trying to figure out why the virus had made so little mark on the subcontinent and left so few deaths in its wake. Now, after a collective sigh of relief following a modest surge in late summer and fall, India is now overwhelmed by over 400,000 cases and more than 4,000 deaths a day, which are both likely to be undercounts.

When it comes to COVID-19, this country is only as strong as its weakest links.

There are several reasons for India's current catastrophe. A more infectious variant started to appear in the population, which the World Health Organization this week labelled a global health risk. The Indian government was not only unprepared for the crisis, it was dangerously cavalier in its approach to the disease. After last year's surge, it grew lax on testing and contact tracing. Nor did it put resources into the country's inadequate medical system or in stockpiling key supplies like oxygen.

Then there are the errors of commission. The government did nothing, for instance, to prevent Kumbh Mela, a Hindu religious event last month that draws millions of pilgrims to a holy location on the Ganges, from turning into the largest super-spreader event on the planet. Prime Minister Narendra Modi even continued to hold mass political rallies as the COVID numbers began to rise.

When it comes to vaccines, the government has been slow to order doses, distribute them to the population, and secure the raw materials to scale up manufacturing. Although India is the world's largest producer of COVID vaccines, less than 3 percent of Indians are fully inoculated against the disease.

Well, that's India, you might be saying to yourself. They have a Trump-like fanatic for a leader. Their medical system has long been inadequate. It's an obvious place for COVID to have a final encore.

Here in the United States, meanwhile, the number of cases has fallen dramatically since January. Hospitals no longer face overcrowding. More than a third of the population is fully vaccinated. The Biden administration is expecting that the country will return to some semblance of normality this July.

But wasn't it a similar complacency that proved India's undoing? So, is India the ghost of America's past or a taste of things to come.

Our Herd Problem

In early 2020, the scientific community went into hyperdrive to develop not one but several vaccines against COVID-19. In the United States, the government and the medical community worked overtime to set up the infrastructure to get doses into arms around the country. Clinics and volunteers have jumped into action at a community level to make sure, as of this week, that 58 percent of adults have gotten at least one shot and over 70 percent of those older than 65 are fully vaccinated.

But all this effort is now hitting up against resistance. Or hesitancy. Or barriers to access.

States are cutting back on their vaccine orders from the federal authorities. Daily vaccination rates have dropped nearly 20 percent from last week. Employers are basically bribing people to get their shots. Millions of people aren't even bothering to show up for their second doses.

Barriers to access is perhaps the easiest problem to address. According to one recent survey, 72 percent of African-Americans and Latinos want to get vaccinated, but 63 percent reported that they didn't have enough information about where to get a shot.

While lack of information may well be the reason why some Americans have yet to sign up for their vaccinations, a hard-core resistance has developed to vaccines in this country--and COVID vaccines in particular. According to polling this April, around 45 percent of Republicans report that they'll never get the vaccine. In all, as much as 37 percent of Americans are now saying that they're going to opt out.

That means that tens of millions of doses are now chasing the remaining 5 percent of Americans who want to be vaccinated and haven't yet gotten their first shot.

This resistance has nothing to do with lack of information about how to sign up for a shot. It's all about misinformation: that the vaccine is unnecessary, that it's dangerous, that it comes with a microchip that will track you forever.

Recently, Republican pollster Frank Luntz set up a focus group of vaccination-hesitant Trump voters to see what it would take to convince them to get shots. It was not an easy crowd. The husband of one of the participants had gotten seriously ill from COVID--and she still didn't want to get vaccinated.

In over two hours of discussion, Luntz brought in such vaccine-boosters as a former head of the CDC, Senator Bill Cassidy (R-LA), and House Minority Leader Kevin McCarthy (R-CA)--and still, the participants barely budged. Only after several emotional stories from former New Jersey Governor Chris Christie and a final round of facts from the CDC official did they start to change their minds.

"I would say I was probably 80 percent against when this started today," one man said. "Now I'm probably 50-50-ish."

Luntz considered that a success. But in this age of Twitter, it's not a workable model to expect skeptics to sit still for more than two hours while Republican Party grandees and noted doctors barrage one small group after another with stories and facts.

A more representative reaction to such attempts by Republican Party influencers is what happened when Ivanka Trump posted selfies of her own vaccination. Twitter responses included:

"Love your family but this is a huge NO for me & my family. Will be praying you do not get any of the horrible side affects."

Others replied, "Please stop promoting this nonsense," "HARD PASS," and "Sorry, don't trust it."

Even more concerning, some anti-vaxxers are already planning to use fake vaccination cards to get into public events. Hundreds of sellers have appeared on eBay, Facebook, and Twitter to hawk such cards. In this way, "live free or die" is quickly becoming "live free and kill."

In a nutshell, the United States won't achieve herd immunity because a significant portion of the herd is suffering from mad cow disease. Whatever the reasons for this obstinacy--anti-government, anti-science, anti-liberal--it will ensure that large pockets of this country will continue to play host to a very infectious disease.

This resistance potentially puts the United States in the same category as the Seychelles. An island nation in the Indian Ocean, the Seychelles has the highest rate of vaccination in the world. More than 60 percent of the population is fully vaccinated. But that still hasn't been enough to ward off COVID. The Seychelles is now experiencing its largest outbreak, which, on a per capita basis, is even larger than what has overtaken India.

The same thing might happen again in America, for instance in states with very low vaccination rates, like Mississippi and Idaho. When it comes to COVID-19, this country is only as strong as its weakest links.

Perennial Pandemic

When I lived in New York City, I used to wonder why my apartment was so overheated in the winter. It turns out that the heating systems in old buildings had been designed (or redesigned) to accommodate open windows in winter. During the flu pandemic in 1918-19, open windows and greater circulation of air were supposed to guard against the disease.

Modern societies were once structured to handle periodic outbreaks of infectious diseases, from the steam heating in buildings to the TB sanatoriums that dotted the landscape. Americans braced for outbreaks with greater frequency than the cyclical reappearance of the cicadas.

Three major waves of cholera struck the United States between 1832 and 1866. Typhoid killed 25,000 people in New York in 1906-7. The flu in 1918, diphtheria in the 1920s, polio in the first half of the twentieth century: Americans became accustomed to infectious diseases as a way of life.

COVID-19 isn't going to disappear completely. It will return, again and again, just like variants of the flu or that other coronavirus, the common cold. If we're lucky, it will come back in a less virulent form or the antibodies in our systems--those of us who received vaccinations--will render it so. If we're not lucky, COVID-19 will generate ever more infectious strains that overwhelm us on a periodic basis.

In the best-case scenario, what's happening in India today is COVID-19's last gasp. With the worst-case scenario, India is our future.

So, don't delete your Zoom app or give up your home office. Don't throw away those masks. When it comes to infectious disease, we are all dependent on the herd. That's great if you're living in South Korea or New Zealand where compliance is second nature.

But in America, the home of the free, the brave, and the stupid, the herd may prove to be our collective undoing.