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Hi,
Happy new year. It feels like 2020 is finally behind us.
I'm late in saying that, but hope you're off to a good start. By this point in an average year, 96 percent of New Years resolutions have been abandoned. (An estimate, but it feels right. And this year I'm listening more to my feelings.)
I hope you're in the four percent, but if you're not, don't beat yourself up about it. There will be another opportunity for self improvement in 11.4 months. Until then, I guess, live it up.
Personally, I've been nervous to send another letter since The New York Times' billion(?)-subscriber newsletter unexpectedly linked to The Body(!) and our little group of readers got a lot bigger. Which made me nervous to disappoint the new people, in addition to those of you already accustomed to the disappointment.
If you're just joining us: Welcome! I'm a doctor, but not of the sort inclined to cut or dispense pills. My specialty is public health and preventive medicine, and so I tend to write about the social factors that shape our health. This newsletter is an attempt to contextualize important and/or interesting news, as well as the good work being done by scientists and journalists and artists regardless of its newsiness. I send this out weekly(ish). It's more eclectic and conversational than what I write in books or magazines. But also hopefully more fun and, in some sense, more honest.
From a more urgent perspective: I believe that a lot of the distrust of science/medicine is a result of public officials and experts who—in pursuit of entirely appropriate, dispassionate professionalism—end up seeming like ... not relatable humans. Their facts may be right, and even convincingly articulated. But that's not enough to earn trust. We all care about facts, but they rarely move people to action unless they generate feelings, which are the fundamental driver of our affiliations. (As anyone knows who's been "in love.")
Unfortunately our brains are great at generating feelings and then drawing us to people who reinforce those feelings, even if what they're saying is factually dicey, and we have to bend over backwards to pick a few facts out of the sludge to cobble together an argument that justifies our feelings.
This pandemic has been defined by people wearing out their frontal cortex in attempts to reach people who are being guided by their limbic systems. That almost never works. So, in any case, both are important, and this letter is about balancing them.
If you've joined us in search of COVID information, you're not in the wrong place. We do have that. More than anyone ever wanted.
But this is not a newsletter about the pandemic, and I'm desperately looking forward to writing about almost anything else. Editors keep asking me to write about the virus, and readers write to me with questions, so I keep working on that, and the snake keeps eating its tail. (In this example, the snake is me, and the tail is beans.)
But I do feel the end of the pandemic is upon us. And in this season of starting over: What would you like me to cover this year? I always appreciate hearing. As the pandemic draws to a close, this space is going to develop into its more sustainable, post-emergency form.
One certain thing I'll be doing this year is sharing reader questions (with your permission) directly here, and attempting to answer them. I'd ideally like this place to feel more like a community and less like me careening into your inbox to rant every Friday. If you have questions that you think might be on the minds of other people, please feel free to email. I'm happy to anonymize.
Anyway, what I'm trying to do here is set expectations. Which happens to be the week's theme ...
Our last letter was in December. It was about how you're going to get infected with SARS-CoV-2 at least once.
That has always been, I think, the most accurate and effective way to think about this pandemic. The virus isn't something to avoid forever; it's something you prepare yourself for as best possible, and try to minimize exposures to others as best you can.
But as a population, what we most need is a sustainable approach to reducing risk and living as safely as possible. Systemic reforms and measures to make that happen. Not some ping-pong binary mindset where we "cancel everything" or shelter in place because we expect "normal life will return soon." (Trump, March 23, 2020). For two years we've collectively been the dumped person who keeps texting to ask when things will go back to normal.
So it was heartening to see Tony Fauci finally said, last week, that this virus will infect "just about everybody." This became the consensus very quickly, especially given that it took two years. This week in The Lancet, the University of Washington's chair of Health Metrics Sciences Christopher Murray wrote: "The unprecedented level of infection suggests that more than 50 percent of the world will have been infected with omicron between the end of November, 2021 and the end of March, 2022."
The reason that admission is a big deal is that it's shattering the false binary that's been perpetuated under both the Biden and Trump administrations about "beating COVID-19." Their messages have focused insistently on themes of defeat. We are going to beat this virus.
The war/battle framing is tragically flawed in most areas of health. People who die of a cancer that they vowed to "fight" didn't lose or fail. It wasn't their fault.
That sort of battle framing might work for something like a New Years' resolution—"I'm going to win my personal battle against smoking/drinking/chewing too loudly/dandruff/doglessness"—but pandemics aren't won or lost in that way. The premise was flawed from the start. This was a virus that couldn't be "beaten." It was clearly going to spread everywhere. Insofar as there was a "battle" it was over whether and how we could keep people as safe and healthy as possible.
No one wins in a global catastrophe.
Some countries/cities/communities fared relatively well, by building cohesion and solidarity in the process of minimizing preventable suffering. Other groups lost categorically, actually encouraging infections by way of bizarre political motives, and in the process tearing themselves apart.
America lost. Not simply based on our numbers of cases and deaths. The living are worse off than we needed to be. Our public-health infrastructure is no stronger than it was at the beginning of the pandemic; and public trust has been decimated. If the World Health Organization raised alarms about a new pandemic tomorrow—some hemorrhagic fever virus tearing across continents—I shudder to think how many Americans would tell themselves it was a hoax, and do nothing differently at all.
It's not entirely too late to recover some of the lost cohesion. The political promises to defeat the virus were a serious mistake. They now make it very tough for leaders to communicate basic things like "we have to live with this virus" or "you're likely to get infected" without sounding like you ... lost. You failed. You didn't beat the virus.
The inability to set accurate expectations has been the most enduring, fundamental failure of the pandemic. It underlies so much of the burnout/fatigue/exhaustion that everyone feels. If you viewed this as a two-week problem in March of 2020, then by now you're surely, justifiably, absolutely exhausted, sad, and appalled that it lasted two years! And that's if you even believe in viruses at all anymore.
Whereas if your expectations were set appropriately at the time, then you're merely sad and exhausted. That's not great, but it's importantly better than feeling disgusted or indignant over the idea that you might sometimes be asked to wear a mask, or adopting some bizarre conspiracist ideology about how Fauci, Pfizer, and China worked with Bezos, Gates, Soros, Google, and Hollywood to fake the pandemic. (If you have tips on this, please email me.)
Finally, in the spirit of expectations and new beginnings, what we desperately need is a total re-set. A reframing. Fauci dipped his toe, but Biden would have to take the lead. And he's been oddly reluctant. Just last week, a reporter asked about endemicity, and he didn't make an extreme amount of sense:
It's true that acutely overwhelmed hospitals are not the new normal. But the sooner leaders can accept and communicate that, yes, there will be instances where masks are recommended, or where testing is mandated, indefinitely—but that doesn't mean you need to get all whiny about it, and every effort will be taken to make sure that things are done in ways as minimally disruptive to "normal life" as possible—the more you eliminate the political incentive to spin anything as better or worse than it truly is.
There's no other option. If this doesn't happen, the next director of CDC might be Dr. Harold Bornstein. If there's still a CDC. The stakes are higher than I think people in power now appreciate. There's zero patience left among the general public for a continued rollercoaster of advice and an endless stream of mixed messages shaded by political calculi. We need to start over and finally accept that this is a problem that's here to stay. The best we can do is try to build a world where new variants and new viruses do as little harm—and cause as little disruption—as possible.
If you haven't yet set a resolution for the New Year, there's something to consider in the realm of setting expectations. None of us is perfect at it. Especially in early stages, it involves a lot of guessing. You can't expect to be right all or even most of the time. The real skill—the one worth continually working on—is knowing when to re-set your expectations. So they align with reality as new facts emerge.
Because if you can't do that, or refuse to because you see it as weakness or failure, then you have to waste energy every day trying to reconcile your feelings with reality.
Your limbic system and frontal cortex might not be friends, but they talk. And when they're at odds, you end up living in a haze of disappointment and rage, anger and resentment.
I hope you're not among the many who are.
Take care,
Jim
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