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It is striking how much Covid confusion still reigns. Some of the informational miasma is deliberate – there is profit for some in confusing others – but much of it comes from the fact that epidemics challenge our intuition. So here are five counterintuitive Covid truths that easily escape our understanding:
1. If a significant part of hospitalized people are vaccinated, it is a sign of success. It’s common to see headlines noting that a substantial minority of people who have been hospitalized or even killed by Covid have been fully vaccinated. These figures suggest that vaccine failure is alarming.
The error only becomes clear at logical extremes: before vaccines existed, not everyone in the hospital was vaccinated; if the vaccines were universal, then everyone in the hospital would be vaccinated. Neither scenario tells us if the vaccines work.
So try this. Imagine that 1% of the unvaccinated population will end up in hospital with Covid over a period of time. In a city of one million people, that would represent 10,000 hospital stays. Now let’s say that 950,000 people are fully vaccinated, the vaccine is 95% effective against hospitalization, and the vaccine does not reduce transmission (although it does).
Here’s the math: 500 of the 50,000 unvaccinated people end up in hospital. In total, 9,500 of those vaccinated would be at risk of going to the hospital, but the vaccine saves them all but 5%. These unlucky 475s are still going to the hospital.
The hospital holds 500 unvaccinated and 475 vaccinated people – almost half and half – making it look like the vaccine is barely working. Yet when 95% of people take a vaccine that is 95% effective, hospital visits drop from 10,000 to less than 1,000.
2. Collective immunity is not the end pandemic. In the simplest epidemiological models, herd immunity is when so many people are immune – either from vaccines or from a previous infection – that the epidemic begins to go away on its own.
The keyword here is “begins”. An epidemic has momentum, like a train. Collective immunity is the beginning of an upward slope, initially very gentle. If the train is moving at full speed when it starts to climb the hill, it will continue to travel for a long distance before stopping.
The difference between hitting herd immunity during a raging epidemic – yes, I think in the UK – and hitting it with vaccination during a lull could be millions of unnecessary cases.
3. Masks matter, but not for the reason you think. Microbiologist Ravi Gupta has called the end of the mask mandates in England “criminal”, while a radio presenter Julia Hartley-Brewer said she would boycott the Waterstones bookstore if they politely suggested wearing masks. What is there in the masks that ignite such rhetoric?
It’s all about social issues. While you can’t see who has been vaccinated or who has ignored a ping from contact tracers, you can see who is wearing a mask.
I think it’s considerate to wear a mask, an act the evidence suggests may protect me, probably protect others, and certainly reassure them. For most people, wearing a mask is only a minor annoyance, so why not do it?
Only our innate tribalism can transform the wearing of the mask from a simple promising precaution into a dividing line between the saint and the damned. Cabinet ministers bragged about removing their masks as soon as possible, which is like boasting of farting in an elevator: it may be a relief but it’s a strange thing to advertise. Once you realize it’s all about signaling tribal loyalty, it makes more sense.
4. Blockages are also less important than you might think. It’s understandable that we have focused so much on containments. The sweeping social distancing ministers have imposed has been an unprecedented change in the way we live, but it has saved millions of lives.
What we forget is that much of this social distancing would have happened anyway. Many people “locked themselves in” before the lockdowns themselves, out of fear or consideration for others, or both. The most famous study on this subject by economists Austan Goolsbee and Chad Syverson estimated that about 90% of the reduction in consumer traffic was voluntary.
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You don’t have to believe the exact number to accept that people have often acted out of choice, fear, or altruism. The flip side is also true: a lockdown that is not widely supported is neither effective nor sustainable.
All of this matters because it’s easy to think it’s all about the rules. Most importantly, social solidarity, clear information and prominent personalities setting a good example. Unfortunately, we had to be content with social solidarity.
5. Covid was a near miss. After the disruption of life, love, education and commerce, and after more than four million confirmed deaths worldwide – with many more unconfirmed and many to come – it may seem strange to to say it. But it could have been much worse. It could have been as contagious (or more) than the Delta variant from day one. It could have been as deadly as Mers, which killed a third of those confirmed to have contracted it. He could have attacked children rather than very old people. And it might – like HIV – have overcome efforts to create a vaccine.
So, while we are counting the cost, we should also be counting our blessings – and dramatically strengthening our preparedness for the next pandemic.
Tim Harford’s new book is titled “How to Make the World Add Up”
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