Living with the virus

It's a mess and is going to take some leadership

Welcome to Plugging the Gap (my email newsletter about Covid-19 and its economics). In case you don’t know me, I’m an economist and professor at the University of Toronto. I have written lots of books including, most recently, on Covid-19. You can follow me on Twitter (@joshgans) or subscribe to this email newsletter here. (I am also part of the CDL Rapid Screening Consortium. The views expressed here are my own and should not be taken as representing organisations I work for.)

Today I want to talk about living with the virus. As regular readers know, the virus is likely to be endemic. But we haven’t quite worked out what that means. Emily Oster has noted the uncertainty regarding that. And it is something I am feeling too. So allow me to first recount a couple of incidents that impacted me personally before turning to the problem at hand and potential solutions.

Incident 1: The Gym

Now, now don’t fall off your chair. I haven’t and am not intending to go to the gym. I’m squarely a Peloton person and that will do. But the rest of my household are big gym-goers and it serves them well. Of course, during the 8 months long Ontario lock-down, this was all virtual which was imperfect but continued on.

They attend a small gym in our neighbourhood. It is kind of a boutique operation where you spend a ton of money to get personal training. But it works which is the point. When they couldn’t go there, the training happened virtually.

Now the gym is re-opening but a clear issue has emerged that we knew was coming. The instructors are not vaccinated. A dirty little secret in the fitness and athletic community is that these supposedly health-conscious groups are shunning the vaccine, for the usual excuse of not knowing the long-term health effects. Is this a view we share? No. Do we agree with their assessment of the risk calculus? No. But what is a real problem is that fundamentally, they are making that choice with regard to their own health risk. That’s all well and good but what about their customers?

This gym is just a single small room. At any time, there can be upwards of 6-7 people there. All of them are working out. There is only so much ventilation can do but it is on a main road so even that is non-existent. So you have instructors who are not vaccinated, customers who probably are and no one is wearing masks.

This wouldn’t be a problem if instructors were being regularly screened. If they were taking rapid antigen tests daily or even every other day, then we could be assured that there was a low chance that you would be visiting a superspreader event. But again, since they don’t think the risks to them are high, they are not doing that.

We are all vaccinated. Should we care. On the one hand, the vaccines mean our risk of severe Covid is low and almost zero. On the other hand, those are averages. If you are in a room for an hour with a high viral load person, you may shift those odds. Basically, the higher the viral load, the riskier that everything becomes.

But I think what really got us was the lack of judgment. We are supposed to be trusting these people with our health and fitness, yet they are showing judgment that demonstrates that they are not really concerned about that. So we are saying goodbye to this gym as customers. Our custom there will not survive the pandemic.

Incident 2: The University

I have been looking forward to returning to the office. I had intended to do so in September. So I was interested in how the University of Toronto’s guidelines would evolve now that 80 percent of the people who entered our buildings were vaccinated and the caseload in Toronto was in the low hundreds with dirt low positivity.

Yesterday, we received an announcement of our brand new, evolved building access rules. Here they are:

1) Faculty are now allowed to use the building and their offices without pre-approval. Staff and students still require pre-approval.

2) You must complete UCheck daily.

3) Only one person is allowed in each office. Anyone who has a shared office should coordinate with their office mate. If you both need to be in the office, you will have to arrange for an alternative space.

4) Masks must be worn in the building.

5) No guests are allowed in the building.

6) Use of a meeting room requires booking.

Now you might be excused if you looked at these and wondered if these were any different from the guidelines that were present when no one was vaccinated and we were in one of the world’s worst Covid-19 waves back in March. 2 through 5 are exactly the same. 1 has apparently changed in that faculty can now come to the building without applying for pre-approval. I have to admit, I didn’t register we needed pre-approval before but apparently, we are free to work but we have to wear a mask and try to avoid everyone. You know, like at home but with the added fun of wearing a mask all day.

When I queried these requirements, I was told, of course, that the University is exercising an abundance of caution for our safety. But can that really be the case. Are they encouraging or registering vaccination rates? Are they conducting rapid antigen tests regularly? My US colleagues have those things in spades. But at the University of Toronto, the end of Summer 2021 looks exactly like the end of Summer 2020 despite now having two terrific risk management tools at our disposal.

What cheeses me off

This cheeses me off. (Want to know what that Australianism means, read here). The exact same outcome is arising in each case: you have to stay away. The underlying cause is also precisely the same. You could come in if we just opted for the two clear pandemic management tools (encouraging vaccination and regular screening) but we won’t so there!

Neither attitude — no reason to do anything because we think the risks are low AND no reason to do anything because we think the risks are high — are compatible with the notion of living with the virus. Thinking the risks are too low is a quick recipe for disaster and, in a sense, the market will help take care of that. Thinking the risks are too high is a lack of thinking about what living with the virus will look like.

So let’s look at that. Here’s the thing: one can imagine some viruses where there is no vaccine and it is pretty lethal where we have to change society in order to live with it. We might have to always wear masks and never have large gatherings again.

But that’s not Covid-19 or its variant children. Instead, we have a virus where, if you are vaccinated, you will most likely get a case of mild Covid. What’s that? It is as painful as a bad flu or gastro. This Slate article articulates this point.

The bad news is that reporting this article has changed how I’ve thought about the risk of breakthrough cases (I now suspect it’s higher than I had thought) and what it would be like to get one (worse than I had thought). The good news is that I don’t think that means we’re heading back toward lockdown, even though I think we are, once again, going to be tasked with having to think a little bit more about our personal risk calculus—especially if you want to avoid COVID entirely. But the most interesting thing I’ve learned is that if you are fully vaccinated, avoiding a “mild” case of COVID, even if it sucks, might not actually be as important as you think. Given that we have just spent a year and a half dramatically altering our lives to avoid COVID, reorienting in this way is understandably going to take a little bit of time. But it’s worth the effort.

We have learned to live with the flu. We don’t take precautions, we take vaccines but not religiously, we suffer some bad years but in the process give our immunity system the regular workouts it needs.

An endemic Covid means we have to do the same thing. We need to get to a situation where the reproduction rate is less than one in a world where we are not doing abnormal stuff like distancing and mask-wearing. That means herd immunity one way or another. We may not get there with vaccines alone and so the temptation is to continue doing the abnormal stuff while we are not beyond herd immunity.

At the same time, however, we need a mindset change and that’s not easy. My goal up until now has been to avoid getting Covid at all. Rationally, I now realise that is an unrealistic goal. I don’t want to create undue risk by having family members attend gyms that are a high-risk environment of their own making. But I also don’t want to bunker down at home and want to do stuff without anxiety and with a measure of the right mental attitude. My irrational self isn’t quite there.

This is why the University’s attitude is most disappointing here. They are in a position to show leadership. They could have started to encourage people to come back to work slowly and ramping up. They could have provided a means by which people could get comfortable with the realities of a post-pandemic but continual risk life. But instead, they have chosen to squander the summer. Keep away is their message. We are not here to help you return to work in a mentally appropriate state. Instead, we will reinforce the irrational side. And this is just for faculty. What do you think they are saying to staff and students by all of this?

The role of leaders is to lead us to where we need to be. This isn’t being done all over the place. The vacuum is going to be strongly felt in the months to come.