Where Our Communities Go From Here

David Trammel's picture

Sharon Astyk has a very timely post which looks at where our communities go from here. Reinfections are starting to be documented and its possible that we will never see a workable vaccine. Instead we are going to have to live with Covid from now on, much like they had to live with Malaria, as a disease that changed society. Her suggestions on how we will have to change the way we live point to the next step downward in the Long Descent.

(slightly edited for politic content)
In a week when Covid deaths globally hit a million, US deaths crossed the 200.000 mark, wildfires took off again in the west and Trump's polls rose despite a series of predictable revelations about (edit) him, it is hard to figure out the single worst piece of news. Still, if I had to vote, it would be for study that was barely picked up by American media, a Lancet pre-print of Covid-19 reinfection in 4 healthcare workers in Mumbai.

In the study, the four workers, who had mild symptoms in their first go-round with the original strain of the virus from Wuhan, showed no antibodies at all in reinfection 19-65 days after full recovery from their first infection. All four were young and had no other illness. On their second go-around with Covid-19, with other mutated strains, all were sicker. All four required hospitalization and one required plasma therapy.

At this point, the number of confirmed cases of Covid-19 reinfection is very small - about 9, to my memory (although I may be wrong about that.) But that does not mean that is how many people have been reinfected. In fact, we've been hearing about reinfection cases since almost the beginning. What has not been possible is to be absolutely 100% certain that these were, in fact, reinfections, rather than long tail symptoms reactivating. The reason for that, discussed in the pre-print, is that most hospital samples do not provide good, full RNA samples. At this point the only way for confirmed (as opposed to presumptive) reinfection cases to be diagnosed is by ensuring that you have a full sample of both first and second case, which is unusual.

What is troubling about this is that all the workers had had Covid well within the one year mark, and they showed no antibody response to the mutated strain. While this certainly does not prove a vaccine will be impossible, it certainly makes it more difficult. And the fact that these workers were sicker on the second round means that at this point, a MAJORITY of the confirmed reinfection cases had worse symptoms the second time around. Now a sample of nine is not big enough to draw substantive comparisons, but it is enough to be concerned.

That is, we are now potentially facing a virus that can reinfect people within months or a year or so, and can make them sick, and then sicker, and already could leave damage in their bodies from the first time. This is extremely concerning, and I think it hasn't made the news because no one really wants to think about the alternative it represents - a future in which we are always masked, always worrying about disease, always apart from some of the people we love, because not only can the disease do lasting harm and kill a portion, but it returns again and again and again.

One of the reasons for vastly reducing the human reservoir of the disease by lockdown has always been controlling the rate of mutation - both in situ mutation in human populations, and also potentially as humans pass it to other animal hosts - for example a Thai researcher is extremely concerned about outbreaks in Asia passing it back into bat species. However, we've pretty much made our choices there. Right now the official line is that covid reinfection is very rare - but that is neither typical of coronaviruses nor has the reality of people getting sick again very quickly ever been quite able to be silenced. Now we know for sure.

Now I'm not a doctor, and I make no claims to be one. I may well be wrong about the danger of reinfection. My hope is always for better outcomes, but we never have achieved those better outcomes simply with passivity. We hoped vaguely that Covid-19 would be controlled without us having to do much, and well, look where that got us. As you know, I have been depressingly correct about how this virus would play out, and while I'd a great deal to be wrong here, I also think the stakes of making the wrong choices AGAIN are extremely high. Globally and Nationally, we have put our faith in two things - a vaccine, and eventual herd immunity. But there is a real chance we can't count on either one, and for the same reason.

Right now our entire infrastructure is operating on the underlying assumption that in four or six or ten or eighteen months at the very most, life is going to be very different - we'll be out of our masks, we'll be back to our pre-covid behavior. And, given a growing economic crisis, the idea of spending money on infrastructure for most businesses, community organizations, and households seems nuts. Oh, we'll put in a pool or a deck to make staying home more fun if the money is there, but for the most part, people want this to go away, rather than to learn to live with it.

But what if we have to? We wanted it to go away by summer. It didn't, and we had the deadliest summer in our history. Now we are sure a vaccine will make it go away by next year. But vaccines work with known strains. A recent study in India found 39 distinct strains circulating. Another in Korea found 16. It isn't clear which of those you might be immune to after one or another, but it is clear that the enormous human resevoir of infection is helping the disease mutate. So far, the only really documented change is a slightly more infectious, maybe slightly milder version. But we don't really know yet. We are likely to find out about a new and more troubling strain when a critical mass of deaths or new symptoms tells us. We aren't doing in the US (or in India or Brazil) the kind of surveillance that would allow us to monitor this and control it in any way.

It is time, to the extent it is possible for us to act like a sane and rational society, for us to begin changing our infrastructure over for a multi-year, long term crisis of endemic disease. That is, we are going to have to learn to LIVE with Covid-19. And while we are in a period of economic contraction already, that is nothing compared to where we're headed if the disease keeps on for years. So it would be very, very smart right now to use our remaining wealth and resources to begin adapting to the reality of our lives.

That means that we have to let some things fail. Right now New York has a bill to bail out restaurants. My local news columnist is a fan, and she's right that the restaurant sector is a huge part of our economy, and that letting 1/2 to 2/3 of all restaurants go out of business due to the coronavirus is a disaster for the food service industry. But the truth is that we won't have the money we pour into the industry twice. If Covid-19 is gone by spring, the restaurants will reopen. And if not...we are already looking at indoor dining being shuttered before it even reopens as New York City sees cases rise. If we bail them out now, what happens in six months, when they need another bail out.

And that goes for commercial real estate, high fashion, lipstick manufacturers, automobile manufacturers. etc... We have to choose - bail out what's already there and keep up the pretense this will be over, or put our remaining wealth into getting ready.

The good news is that energy will be comparatively cheap to do things with. Workers will be grateful for jobs. We have the capacity to make substantive infrastructure changes to industries in collapse in order to ensure some of them survive. For example, a large restaurant facility with a huge dining room might be able to convert some of its dining space to sales of food purchased from restaurant suppliers and repackaged for the public, and another segment that adjoins the current kitchen might be made into two smaller but restaurant functional kitchens with their own glass partitions and ventilation systems. Thus, three restaurants might share the same facilities, one serving breakfast and providing baked goods, another perhaps making different dishes and all making use of an expanded outdoor space in good weather, and providing their own delivery (to avoid paying a majority of fees out to grubhub and like services.)

Downtown commercial real estate centers that are not high rises may need to deconvert back into housing - many old houses in nice towns were once homes, and became restaurants, shops and doctor's offices - they can be converted into housing suitable for larger extended families who will need that space in order to care for older and disabled family members and to educate children at home.

Schools are another thing - if this is a longer term problem, the most sensible way to get American children back to school is to provide education OUTSIDE. The reasons for not doing so are almost entirely infrastructural and habitual. The school year could be flipped in cold climates providing 2 or 3 6-8 week sessions (depending on where you live) where kids enjoy outdoor school with lots of fresh air, hands on skills and also other learning. During fall and winter in the cold climate and summer in the hot ones, distance learning could be the norms, leaving school buildings with the opportunity to create very small classrooms for disabled kids or those who cannot be home all day.

To do this we should engage in a massive build project to create pavillions, outdoor facilities and spaces on school grounds - but also in public parks and other suitable outdoor spaces. Commercial real estate, now reduced in value when so few have to go to work, might find that their outdoor grounds are more valuable than their indoor ones. Revenue for churches and other institutions with extensive grounds could offset some of the losses.

Homes will need to be adapted. If young adult children are going to be home for the longer term, if seniors are going to be cared for by family rather than care facilities, if disabled people are mosty going to be at home, the housing will have to change. Again, this provides a boost for the economy. It won't save us, but it will provide jobs and meaning. We are seeing a lite-version of this already as people buy patio heaters and pools, but we are about to see the truly acute version as people make long term life changes.

The most striking revelation of the pandemic is that women's work (and I do not mean to imply work done only or properly by women, but the domestic labor that has been categorized that way historically, and is now mostly done either by women in a household or by low paid substitutes) cannot be externalized and left out of our economic equation. Those who have followed my work will know that going back to Depletion and Abundance I have demanded we recognize the centrality of the informal economy - unpaid labor done within families, in volunteer organizations that literally makes the world go around. The pandemic has shoved the informal economy front and center.

In a long term pandemic, most kids won't go to school all the time. They may go some years, but not others, or some months but not others, but it will be inconsistent. The same is true of college. Most families who can manage, even badly, will try and keep Mom or Grandma home, rather than play russian roulette with her life. In a world where an unspecified number of million people are contracting, recovering from, dealing with the long tail symptoms of, or the disabling permanent consequences of a revolving disease you can get more than once, CAREGIVING is going to be our lifeblood, and literally the most important work on the planet. As institutions we value lose money rapidly, what is kept alive will be done mostly by unpaid volunteer labor. The informal economy was always the largest part of the human economy, but now we can no longer pretend it is not there, and we will find that we must (unless we also enjoy revolutions and violence) eventually find a way to provide formal economic security to people who are doing the most important work on earth.

The upshot of all of this is simple - there is every reason to believe right now we should begin to reformulate our lives for the very long term. Not a single PENNY should be spent to maintain things as they are. Of course, it will be, because that's the sort of people we are - the weight of previous investment is very heavy, and very, very hard to turn away from. The movie theaters should close. The theater companies should move outdoors and build facilities that arrange for distancing and sound extension. No money for new highways unless it makes our new world richer - and they mostly won't because we aren't going very many places. On the other hand, dollars galore for building places where children can play outdoors even in colder weather, for heated outdoor pavillions to let elders in care home spend winter hours with their loved ones, for new models of school and college, for new public outdoor dining and walking and biking spaces to get us out of our homes. And money for us to take care of one another in all the days to come.

If you have the power (and you do, because people do) to influence things, you should. With your votes. With your membership in community organizations. With your donation dollars, which should be earmarked for substantive change. With your phone calls to elected officials. With your purchases. With your choices for your family and friends. With your imagination, as you think of ways to make this world that is now our own functional, familiar and welcoming in ways it is not now. Because if we don't, we squander our near term wealth and end up with nothing at all in return.

David Trammel's picture

The term for what Sharon is talking about is "antibody-dependent enhancement or ADE", its common in some disease. Malaria is the one I'm aware of. Your body's antibodies from the first infection act in a way that make the virus much worse.

The doctors and scientist I was watching at the beginning of the pandemic were seriously worried about this. Hopefully it is extremely rare.

I made this comment over at Ecosophia and it's worth repeating here.
I have a dear friend who worked in the pharmaceutical industry in vaccines. She's a big advocate for vaccines.

But, the idea (as she said) of rushing a vaccine into production? A TERRIBLE idea. You'll be doing your critical testing in the real world. And, in fact, real-world use ALWAYS reveals issues. Rota-virus vaccines were the example she used. In testing, the risks were minimal. In extensive use, Rota-virus vaccines in children could have the catastrophic side-effect of intestinal blockage.

Rota-virus vaccines were pulled from the market.

I suppose what I'm trying to say is that the more you know about a given topic, the more conservative you are. Media types can rant about a virus within six months because they don't know anything about biology.

We'll all learn to live with Covid-19 just like everyone in the 19th century learned to live with smallpox and tuberculosis. Badly, but they didn't all pretend the world was ending either.

Does any know of a reliable source of information about Sweden's on going experiment with this virus? Nothing ever seems to show up about how Sweden has fared in most media sources.

Here's how the deaths shake out for the G20 countries (giving the EU's seat, since it's not a country, to permanent guest Spain) according to the Johns Hopkins tracker. Sweden's not a G20 country, so I marked it with a gray line. It lands between Italy and France right now.

I'm tracking deaths since test results are distorted by decisions about who to test/how often to test. I'm taking the numbers as-is and not adjusting for differences in age or underlying health between countries. I'm also not adjusting for countries that don't record deaths well in general or that might be flat out lying.

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