The prospect of a prolonged COVID-19 outbreak and constantly evolving roster of restrictions has brought back another feature of pandemic living — anger — among both the vaccinated and those resisting vaccination, writes Stat. And behind that anger lies fear, say mental health experts.
In May, when the Centers for Disease Control and Prevention (CDC) said fully vaccinated people could ditch masks and social distancing, it seemed to signal a return to normalcy, writes Megan Molteni in Stat. But at the time, epidemiologists cautioned that the move wasnʼt likely to be permanent, and shouldnʼt be interpreted as the end of COVID-19 as a daily concern. Colder weather or a right hook in the virusʼs evolution could bring restrictions right back.
Still, Americans seem shocked by the recent turn of events. Last week, the CDC advised everyone — even those whoʼve had COVID-19 shots — to go back to indoor-masking, a decision driven by new data showing the hyper-contagious Delta variant colonises the nose and throat of some vaccinated people just as well as the unvaccinated, meaning they may just as easily spread this new version of the virus, while still being protected against the worst manifestations of the disease.
The prospect of contending with a prolonged outbreak phase, and adjusting again to a constantly evolving roster of restrictions has brought back another feature of pandemic living in America: anger.
This time, itʼs not only the mostly Republican anti-masking refrain rearing its defiant head (though fights over school mask mandates have returned with a vengeance). Coast to coast, and across the political spectrum, contempt for unvaccinated people is rising. “Itʼs the unvaccinated folks who are letting us down,” Alabama Governor Kay Ivey, a Republican, said on July 22, as her state, with one of the lowest vaccination rates in the country, reeled from a 530% rise in COVID-19 hospitalisations in just three weeks.
Among the vaccinated, thereʼs a sense that the freedoms they gained by getting the shots — travel, eating out, concerts, sports, school, seeing friends — are now being jeopardised by those who are still holding out.
Molteni adds that though this new flavour of outrage might look and sound like righteous indignation, mental health professionals say that whatʼs behind it is fear.
“Itʼs scary to admit that somebody else has power over you and youʼre at their mercy and youʼre afraid of them, but showing that is not a very American ideal,” said David Rosmarin, an associate professor of psychiatry at Harvard Medical School and a clinician at McLean Hospital. “Instead of expressing that fear, itʼs a lot more comfortable to blame somebody else.”
Anger is what people in his profession refer to as a “secondary emotion”. Itʼs a feeling that arises in response to a more primal emotion, like fear and anxiety over having some aspect of your life threatened. “The reality is that there are millions of people who are uneducated about something; theyʼre making a big mistake that will have massive consequences that might affect you and your family and that makes you scared,” Rosmarin said. “But nobody is saying that.”
Part of the problem is cultural. “In America, thereʼs an expectation you have to be a god,” he said. Showing vulnerability is akin to blasphemy. Just look at the backlash Olympic gymnast Simone Biles faced last week in response to pulling out of the team event in Tokyo, citing her mental health. He said he would like to see leaders at the state and national level do a better job of modelling that kind of behaviour rather than leaping to blaming and shaming.
For those whoʼve made a living studying pandemics, they see another lesson in the current outpouring of outrage: the danger of setting unrealistic expectations. “One of the big mistakes of the US COVID response, among many, was to not make it clear at the beginning that this was going to be a long war,” said historian John Barry, who wrote the definitive account of the 1918 Spanish Flu pandemic, The Great Influenza.
For much of the first year of the pandemic, many top public health officials touted the idea that our way out of the pandemic was reaching herd immunity, a phenomenon by which a pathogen stops spreading because so many people are protected against it, either by a previous exposure or by vaccination. Between natural infections and vaccines, if we could get to 60% or 70% of the population with some immune memory to SARS-CoV-2, the thinking went, we could erect a wall of protection around the still-vulnerable, enough to stamp out transmission of the virus entirely.
But even before Delta emerged, some scientists were having doubts that this would work. If other endemic coronaviruses were any clue, immunity from natural infections waned within a few years. Vaccines were blocking transmission, but not entirely. New variants could erode the protections conferred by both. Now Delta appears to be doing just that.
A more likely scenario for exiting the pandemic phase of COVID-19, many scientists told STAT earlier this year, was that over time, possibility a period of years, our immune systems would learn enough about SARS-CoV-2 to stave off the deadliest symptoms of infection. In this way the pandemic pathogen would become an endemic one, circulating among us and causing smaller, seasonal surges of milder illness.
Past pandemics all ended this way, writes Molteni. But those, all caused by influenza viruses, followed a familiar pattern. They would hit hard and fast, racking up massive body counts — many of them children — in a matter of weeks. Then abruptly, the wave would pass. Reaching an immunological truce typically took about a year and a half to two years.
SARS-CoV-2 isnʼt pandemic influenza. It isnʼt as uniformly lethal. It spares children the worst of the disease. And surges can last for many weeks, even months, declining only when humans change their behaviour, rather than the virus dying out on its own. “Past pandemics are just not a precedent for this one,” said Barry.
Epidemiological researchers like Emory Universityʼs Jennie Lavine have turned to models to try to project when SARS-CoV-2 might transition from pandemic pathogen to endemic. In a paper published in Science, Lavine and her co-authors predicted that this transition might take anywhere from a few years to a few decades, depending on how quickly the pathogen spreads and how widely vaccines are adopted.
Thatʼs not the timespan most people have been thinking along. As a result, people are now not just angry, but in denial, that after all we have been through, the lockdowns, the staggering death toll, the historic race to build a COVID vaccine, after all that, SARS-CoV-2 is still with us, a threat that still needs to be navigated.
That is why this time around, epidemiologists like Lavine fear it will be even more difficult to get people to don masks, especially those who believed the pandemic was over for them the moment they received their shots.
“There is a way in which the rhetoric around herd immunity has been a disservice, and I think we are probably seeing it make this moment worse as people are starting to face in a tangible way in their communities that this isnʼt going away,” said Lavine.
The good news, she added, is that nothing in the coronavirusʼs recent evolution suggests it wonʼt eventually transition to being a mild endemic virus, joining the family of common cold-causing bugs. That could change if new variants were to deal young children much more severe cases of disease, or completely blindside the immune systems of people who had been vaccinated or previously infected.
“Thankfully, at this point, both of those things are holding,” she said.
“So the light at the end of the tunnel for me is that the long-term picture still doesnʼt look so bad, itʼs just that itʼs not this kind of ‘get to this magical threshold of vaccine coverage and itʼs all overʼ. Itʼs a slower progression with a less clear-cut end. That doesnʼt mean there is not an end. Itʼs just harder to see it definitely, and disappointing when it didnʼt happen the way we were maybe led to believe.”
Stat article – For many, the belated realisation that Covid will be ‘a long war’ sparks anger and denial (Open access)
See more from MedicalBrief archives:
A divided US faces a pandemic entering its deadliest phase
Mask wearing effectiveness, including among asymptomatic COVID-19 carriers
Overview of coronavirus infections, including COVID-19, in children
Delta variant’s dominance in much of the world forces governments to change tack