The inadequacy of the stories we told about the pandemic - 0 views
messaging-custom-newsletters.nytimes.com/...oakv2
shared by Javier E on 13 Oct 22
- No Cached
race partisan covid infection fatalities research results pandemic culture
-
Increasingly, it feels possible to take stock not just of what happened but also of the inadequacy of some of the stories we told ourselves to make sense of the mess.
-
This week, I want to consider two prominent frameworks about the pandemic that are nevertheless rarely considered alongside each other: disparities in Covid mortality by race and by partisanship.
-
Partisanship was a huge driver of that more significant second-year failure, since Republican resistance to vaccination explains a large share of cumulative American Covid mortality
- ...25 more annotations...
-
at least in Ohio and Florida, despite what seemed at the time to be almost unbridgeable divides over things like mask wearing and school closures, social distancing and lockdowns, the excess mortality gap between Republicans and Democrats in the pre-vaccine phase of the pandemic was relatively small, with Republican excess mortality only 22 percent higher than the death rate among Democrats.
-
The country clearly stumbled in 2020. And yet before vaccines were widely available, and when we tried to slow the spread of the disease through behavioral measures, the scale of the failure was relatively small compared with what followed in the years after.
-
In 2020, American death rates and excess mortality fell merely at the worse end of its peer countries — above Germany and barely France but below Britain, Italy and Spain, for instance
-
In the vaccine era of the pandemic, American performance has been much worse, with our death rates becoming much more conspicuous and dramatic outliers — enough to make the country by far the worst performing of its peers.
-
Overall — from the beginning of the pandemic until the arrival of Omicron — Republican excess mortality in Ohio and Florida was 76 percent higher than Democratic excess mortality.
-
only 62 percent of Republicans have completed their primary vaccinations, compared with 87 percent of Democrats.
-
income and education tell a similar story: Only 67 percent of Americans with household incomes below $40,000 have completed their primary vaccinations, compared with 85 percent with household incomes above $90,000
-
What does this all mean for the next pandemic fall and winter? Well, thankfully, the racial and ethnic gaps around vaccination have almost entirely closed, which is one major reason the mortality gap has, too: According to Kaiser, 74 percent of Black and Hispanic Americans have been vaccinated, compared with 77 percent of whites
-
The demographic gaps for boosters are slightly larger: 50 percent of white adults have been boosted, according to Kaiser, compared with 43 percent of Black adults and 40 percent of Hispanic adults. (Only 31 percent of Republicans have been boosted.)
-
while the news from Europe isn’t especially reassuring, it would probably take an Omicron-like curveball to deliver a new American peak like those we experienced each of the previous two winters, and there does not seem to be anything like that on the horizon.
-
But according to The Times’s global vaccination tracker, Americans are doing almost exactly as poorly with boosters as we did with the first round of vaccines, not worse. The country ranks 66th globally in the share of population that has completed a primary vaccination course. For a first booster, it ranks 71s
-
One set of answers is implied by the story of vaccination and mortality by race, and the way improvements on one measure changed the trajectory of the other: more first shots and more boosting. This is the central strategy offered by the Biden administration. But the vaccinated share of the country has barely grown in months, and the uptake of next generation bivalent boosters looks, in the early stages, quite abysmal.
-
yet Americans are still dying at an annualized rate above 100,000 — a rate that may well grow as we head deeper into the fall. What are we doing about that?
-
another possible set of responses suggests itself too, one that wouldn’t require a reversal of vaccination trends or a transformation of the pandemic culture war either: an approach to public health infrastructure, both literal and legal, that would reduce spread through background interventions without meaningfully burdening individual Americans at all.
-
in a perverse way the arrival of vaccines seemed to almost retire them from public discussion. They include better ventilation in public buildings, particularly schools
-
Testing could help, too, of course, though culturally it seems to have been dumped into a bucket with masks, as an individual tool and individual burden, rather than one with investments in ventilation improvements, as part of an invisible Covid-mitigating infrastructure
-
Over the last six months, an individual risk approach to Covid has predominated — both at the level of public health guidance and for most individuals navigating the new, quasi-endemic landscape
-
This argument is unhelpful, not just because it is needlessly toxic but also because the terms themselves are inadequate. One of the lessons of that early phase of the pandemic, and especially its racial disparities, is that mitigation is not strictly a matter of individual risk management. Spread matters, too, as do structural factors. We have tools to help both, without returning the country psychologically to the depths of Covid panic.
-
And although the partisan gap grew with the arrival of vaccines, it never grew as large as the racial gap had been in early 2020. In 2021, Republican excess mortality in those two states was at its highest, compared to Democratic levels: 153 percent. At the peak of racial disparity in the pandemic’s first wave, Black Americans were dying more than three times as much as white Americans.
-
structural factors — not only race but class and education, too — appear to loom just as large, complicating any intuitive model of what went wrong here that emphasizes the pandemic culture war above all else.
-
Especially in the initial phases of spread, it can be hard to disentangle the effects of policy and behavioral response from somewhat random drivers like where the virus arrived first, what sorts of places those were and what kinds of people populated them, and even what the weather was like
-
This dynamic changed almost on a dime with the introduction of vaccines, with an enormous gap opening up between Democrats and Republicans in 2021
-
the excess mortality data collected here suggests that however self-destructive red states and Republican individuals seemed to be, in 2020, the ultimate cost of that recklessness was less dramatic.
-
For Americans without college degrees, the number is also 67 percent, compared with 85 percent of college graduates. For uninsured adults under 65, it is just 60 percent