Endgame: Endemic
Tl;dr: The perception of the pandemic has been driven by various interests who benefited from keeping the fear level high for the last year (incentives matter a lot in human affairs.) Now, with trillions in stimulus spent and a new institution friendly administration we can expect that narrative to change and the pressure to ease.
The SARS-COV-19 pandemic is comprised of two elements:
Medical — The actual impact of the virus on the human body and the population as a whole.
Psychological — The human perception of the severity of the virus.
Medically, COVID-19 represents a public health challenge albeit a manageable challenge as goes global pandemics. Social distancing, masks, good hygiene and taking extra steps to protect the elderly are highly effective mitigation measures.
Debate exists over treatments but, in general, doctors have gotten much better at treating COVID patients and over 99% of people who catch the virus survive.
Are there “excess deaths” due to COVID-19?
Yes.
Does COVID-19 sometimes kill otherwise young and healthy people?
Yes.
Medically however, COVID turned out to be almost a best case scenario for a global pandemic.
We got lucky.
So, why don’t we feel lucky?
Why has COVID continued to cripple society long after we learned COVID is survivable for 99% of us and that we have effective measures to protect those who are most vulnerable to the disease?
The answer to that question is an intentional campaign of psychological escalation driven by a set of perverse incentives built into our political and public health systems. Psychological escalation is messaging with an intent of inducing stress in the audience beyond what is merited by the threat in question.
Think of psychological escalation as the music in a movie scene where a character walks down a dark hallway. The musical score playing under the visuals is what creates a perception of threat. Change the musical score and you change the perception of the scene substantially.
Psychological escalation or de escalation is a tool and, until recently, we’ve had a political system invested in escalation.
Let’s look at some of these factors driving escalation and examine if these factors will remain present in the near future.
Trump. The Trump administration thrived on disrupting institutions. In fact, Trump was elected on a promise of “draining the swamp” (a.k.a challenge institutional powers) and he did that for three years.
A pandemic however, required the administration to work constructively with the institutions it had attempted to disrupt like the media, the World Health Organization and the federal bureaucracy. Even if Trump had the skill set to organize a massive coordinated response it’s not clear that any of the institutions would have been interested in helping Trump look effective.
The Presidential Campaign. Compounding the conflicted relationship between Trump and our institutions was the election.
The Trump Administration’s rivals had a good reason to lean toward a “glass half empty” approach when messaging the pandemic response. The two main culprits here were the media and Democratic governors who were never going to give Trump a win on any part of the response.
The politicization of the pandemic came to full effect by last May with Republican states starting to open and play down the virus and Democratic states staying shut down and playing up the virus.
As a result, public confidence in the response fell and public belief in the severity of the crisis rose over the course of the last year.
The Pharmaceutical Industry. When it comes to perverse incentives, the pharmaceutical industry has a few hundred million. On the one hand, our drug companies had the technology and scientific skill to turn money into a viable vaccine.
That is good for us.
On the other hand, the pharmaceutical industry benefits substantially from an ongoing public panic over the pandemic. The more fear that exists the more government funding goes toward drug or vaccine development and the more people sign up to take the vaccine.
That is bad for us because the drug companies are the largest advertisers on national news networks. During the early part of the pandemic, there was a time when they were the only major advertiser still buying ads.
While difficult to prove, it’s not hard to imagine how a billion dollars of ad buys with national media outlets may shape coverage of vaccines, generic therapeutic treatments and government spending on drug research.
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So, here we are.
The campaign is over, a pro-institution administration is in the White House and billions have been deployed on vaccine development and distribution.
How do incentive structures now align?
First, the Biden administration has a political motivation to manage expectations in the near term in order to deliver better then expected results in the medium term. Given the continued distribution of vaccines and a WHO advised reduction in test sensitivity, the caseload is going to fall.
An explanation of PCR “test” methodology is beyond this essay but, in general, we’ve been using extremely high test sensitivity thresholds for the last year. As a result, we count people as “new “ cases who may have had the virus weeks or months before. Reducing the test sensitivity will produce a drop in “new” cases.
The kink in this strategy would be the emergence of a new COVID strain that challenges the current mitigation efforts or vaccine. In general however, the rush to re-open Democratic states is going to relieve substantial psychological pressure on Democratic constituencies and give momentum to a sustained opening even in the face of a more virulent strain.
The government and most of America’s institutions are now aligned in reliving the psychological pressure of the pandemic. There is simply no political or economic benefit to persisting in the “panic” state. As a result, we are weeks away from every state being roughly as open as Florida and Texas.
The only player with the resources and motive to keep the pressure up are the pharmaceutical companies. Vaccine acceptance has been below expectations and effective treatments for COVID continue to emerge that make the current vaccine a marginal benefit for many populations.
Economically, the ideal situation for drug companies would be that the entire population is required or strongly encouraged to take the vaccine each year. Additionally, these companies are aiming to commercialize the mRNA vaccine technology for other use cases. Such a commercialization would be extraordinarily profitable given that governments largely paid the tab for the development and testing of the mRNA technology.
Luckily, the conflict between the drug industry and the Biden administration over psychological deescalating of the panic will be simple to resolve through a final tranche of funding in an upcoming COVID stimulus. A recurring government funding source for mRNA vaccine development and a government commitment to buy a fixed quantity of vaccines each year should placate the industry.
The virus will still spread and remain deadly for some people who don’t get vaccinated but it was never realistic that the virus would be eradicated from a large, open country like the United States. Our reality will be one where we come to terms with a new endemic pathogen that spreads, mutates and kills people albeit at a lower rate than we saw last year.
We’ll be wearing masks and distancing for the foreseeable future. International travel will remain burdensome. Workers will never again return to offices in mass. The economy will become more lopsided.
We won’t emerge into the old world that existed prior to the pandemic. The virus and our response has carved a new economic, political and social landscape. By relieving the psychological pressure of the pandemic however, we may be able to restore some level of stability back to everyday life.
