Recent developments in the Covid-19 pandemic have exposed a grim reality: If we keep doing what we’re doing now to prevent infections, we’re screwed. Well, even more screwed.
That’s because the virus appears to be getting even better at infecting us. Since at least December, new, more contagious variants of the SARS-CoV-2 virus that causes Covid-19 have been outcompeting earlier versions of the virus in countries as far and wide as Brazil, the UK, and South Africa.
The advantage the new variants carry seems to be that in any given situation where people are gathered, they’ll infect more people — an estimated 30 to 70 percent more in the case of the B.1.1.7 variant first identified in Britain, which has now been identified in 50 countries.
B.1.1.7 is already believed to be circulating at low levels across the US. On Friday, the Centers for Disease Control and Prevention reported it has been detected in 10 states and is expected to become the most prevalent variant by March. And for a preview of what might come, look at how cases surged in the UK and nearby countries where this variant gained a foothold:
Even after a lockdown in the UK in November, the virus ripped through the population, overwhelming hospitals and forcing the government to implement even stricter stay-at-home orders by January.
While these variants haven’t been shown to be more deadly, a more transmissible virus is actually worse in many ways than a more lethal one. Cases snowball at a faster rate, Harvard epidemiologist Marc Lipsitch said on a recent press call. With a 50 percent rise in infectiousness, for example, “in less than two weeks, you get twice the number of cases,” Lipsitch said. “And in a month or so, you have four, five times as many cases. But that’s very approximate.” The case growth could be even more dramatic, as Vox’s Brian Resnick reported.
More cases mean more really sick people, more strain on hospitals and health workers, more rationing of health care — and more deaths, including the entirely preventable ones now firmly linked to ICU bed shortages. More cases will also give the virus more opportunities to mutate further and potentially escape our vaccines, perpetuating the cycle of doom.
The implication is clear: If we want the pandemic to end as fast as possible, we need to pump the brakes right now. And we don’t have to wait for the vaccines to slow the spread of the virus. We simply need to do what we’ve been doing all along to prevent infections, just much, much better. At an individual level, that means avoiding optional gatherings with other people — even grocery trips — whenever possible, or cutting them very short.
“Shopping for five minutes in the grocery store is a lot better — six times better — than shopping for 30 minutes,” said Tom Frieden, the former director of the Centers for Disease Control and Prevention, since the odds of becoming infected rise the longer you’re exposed. “Picking up groceries at the curbside is even better, and having them delivered is even better still.” (If you’re able to get groceries delivered or pick up curbside, it will also help reduce the number of people in stores, potentially cutting the risk for essential workers or shoppers who can’t order online.)
It’s also time for governments to bring more urgency to what they should have been doing already — steps that could have an even greater impact than our individual actions: protecting at-risk groups by setting workplace standards, running inspections, offering programs like paid sick leave and paid isolation, and ensuring better masks for the population.
It’s time to avoid other people, even at the grocery store (if possible)
We know the virus can’t spread if we keep our distance from other people. But with the new variants, it might be even easier to catch.
The B.1.1.7 variant, for example, may generate a higher viral load in the respiratory tract of people who are infected, causing them to spew particles laden with even more virus into the air. Or the variant’s spike protein — the thorny edges on the surface that fit into the receptor in our cells — may be even “stickier,” meaning it’s even more effective at entering human cells.
We still don’t know the exact reason the virus variants appear to be more contagious, University of Utah evolutionary virologist Stephen Goldstein told Vox, but we don’t have to wait for the answer. “The best protection still remains avoiding contact with other people indoors, especially for a sustained period of time,” he said. In other words, if you must meet others, a few minutes is much better than an hour or a few hours.
The activities we already knew were risky, like going to bars, eating in restaurants, or hanging out with friends at home, are probably even more so now. And even less risky indoor activities — going to a busy grocery store or pharmacy — could carry additional danger in contexts where the virus is spreading.
“Maybe if I’m in New Zealand [where new virus cases have mostly hovered below 20 per day for months], I can go get a haircut,” said Julie Swann, a professor at North Carolina State University who has studied Covid-19 mask effectiveness. “But I would not go in person to get a haircut if there’s a virus that’s 50 percent more transmissible spreading where I live.”
The emphasis here is on indoor activities. That’s because indoors is where most coronavirus transmission still takes place, even in the UK. In a recent report from Public Health England this week outlining where new cases of acute respiratory infections, including with the coronavirus, occurred, most popped up settings like workplaces, schools, long-term care homes, and hospitals.
There is a lot of chat about outdoor cycling and jogging.
But we need to focus on how to prevent transmission *indoors* – in care homes, workplaces, etc. That’s where transmission takes place.
— Dr Duncan Robertson (@Dr_D_Robertson) January 12, 2021
Concerns about going for a walk or run even in this scary new context are misplaced, experts say. “There seems to be a bit of a fuss about needing to be more wary of transmission outdoors, but I don’t know where that has come from,” said Richard Lessells, a University of KwaZulu-Natal infectious disease specialist in Durban, South Africa. “Based on the evidence, we still think risk of transmission outdoors is very substantially less than indoors, and there’s no reason to believe the new variants change that equation substantially.”
But what is the likelihood of catching the virus outdoors? Contact tracing studies suggest that transmission risk is 20 times higher in indoor settings compared with outdoor environments. The risk is not zero but significantly lower. (4/n)
— Muge Cevik (@mugecevik) January 11, 2021
Get a better mask
When you do have to be around other people, use a mask — but not just any mask. The other lesson of the new variants, Frieden told Vox, is that we need to get better at masking.
“The fact that [the variants] are so infectious suggests to me having a better mask is a good idea,” Frieden said. When it comes to avoiding an infection, “a surgical mask is better than a cloth mask, a tight-fitting surgical mask is better than a loose-fitting mask, and an N95 is better than a surgical mask.”
Most Americans, however, still rely on cloth masks. Part of the problem is that the CDC continues to recommend cloth masks — what should have been a stopgap measure while the government procured better, medical-grade masks for citizens, Zeynep Tufekci and Jeremy Howard pointed out in the Atlantic.
This is a failure at a time when other countries around the world have managed to follow the evidence and get high-quality face coverings to people. It’s also an opportunity for the Biden administration to show leadership and learn from other countries.
In Austria, for example, the government is distributing FFP2 masks — the European equivalent of N95s — to citizens over the age of 65. In Taiwan, every citizen has access to new high-quality masks every week following the government’s manufacturing scale-up, Tufekci and Howard report. In Bavaria, Germany, the government has also boosted its mask supply and is mandating FFP2 masks on public transit and in stores.
If you can’t afford or access a higher-quality mask, Swann said, tight, well-fitting (cover that nose and mouth!) homemade masks with multiple layers are better than single-layer cloth masks. Similarly, double masking is better than single masking. And, of course, any mask is still better than no mask.
“But the best protection still remains avoiding contact with other people indoors, especially for a sustained period of time,” Goldstein added. “Masks are not 100 percent effective. Staying away from people is 100 percent effective.”
Employers and governments need to step it up fast
Of course, not everyone has the privilege of social distancing. From the United Kingdom to Sweden to Canada, we have evidence that the virus preys on people employed in “essential service” jobs (bus drivers, nurses, factory workers), which don’t allow for telecommuting or paid sick leave; people in low-income neighborhoods; and people in “congregate housing” like shelters, prisons, and retirement homes.
People of color tend to be overrepresented in these groups — but there’s no biological reason they’re more likely to get sick and die from the virus. Simply put: They tend to work jobs that take them outside the home and into close contact with other people, live in crowded environments ideal for coronavirus contagion, or both.
This means that, even when social distancing orders are in place, because of an individual’s work or living circumstances, they may be less able to physically distance. If they test positive, they may not be able to isolate themselves from family members or co-workers.
So policies like free testing, paid isolation, hazard pay, and paid sick leave are more important than ever — and the federal government also has a role to play in setting standards and carrying out inspections to ensure safety for workers. This is especially true in congregate living settings, such as long-term care facilities and prisons, where the virus is known to spread easily.
But business owners don’t need to wait on the government to intervene, Swann said. They should step up anti-virus measures now. For example, managers can ask employees who have just returned from holidays or other high-risk gatherings to self-quarantine for five days and then take a PCR test before coming to the office. “This gives time for an infection to have enough viral load to show up in test,” she said. Managers could also make sure workers avoid eating and socializing without masks, pay for testing, and consider supplying better masks for their employees.
[Updated] Total vaccine doses administered:
Saudi Arabia 178K
Total doses per 100 people pic.twitter.com/YG74mxxNMW
— Edouard Mathieu (@redouad) January 13, 2021
Then there’s the vaccine. Early data from Israel, which now leads the world in Covid-19 vaccines per population, give us a preview of what might happen as more people are immunized. There, transmission is already slowing among people who got the shot. (Right now, the vaccines are still believed to work against the new variants or be adaptable to them, but more testing needs to be done.)
Most countries aren’t moving as quickly as Israel, and governments need to catch up in the race against the virus. Because if we continue doing everything the same way we’ve been doing at earlier stages of the pandemic, we’re going to help the virus get even better, and “the trajectory can get worse with a more transmissible variant,” Goldstein said. At a time when nearly 5,000 Americans are dying of the virus each day, anything worse is hard to fathom. But the point is: the situation doesn’t have to deteriorate. Even before governments announce new Covid-19 plans and programs and vaccines are injected into every possible arm, we can change the trajectory of the pandemic.