Hunker down just a little longer

Everyone is tired of living like this. We miss our families and our friends. We miss having fun. We miss kissing our partners goodbye in the morning and packing school lunches. We miss travel and bars and office gossip and movie theaters and sporting events.

We miss normal life.

It has been a long, difficult year, and there are many tough weeks still ahead. The coronavirus is raging, and the United States is facing a grim winter, on track for 450,000 deaths from COVID-19 by February, maybe more. Additional restrictions and closures are inevitable in some parts of the country where cases are rising, hospital beds are full and exhausted health care workers are at their breaking point.

We are entering a dangerous time in the pandemic, not just because of rising case counts but because as a society we seem to have reached peak pandemic fatigue. Many people, sick of being apart from family, flouted public health advice and crowded into airports over the Thanksgiving holiday, setting travel records not seen since shutdowns began in March. Others continue to gather with friends, feeling a sense of resignation or indifference.

But if we can safely soldier through these next few months, then normal life — or at least a new version of normal — will be within reach. New vaccines that are highly protective against coronavirus are being rolled out, first to health care workers and the most vulnerable groups, and then to the general population this spring.

“Help is on the way,” says Dr. Anthony Fauci, the nation’s top infectious disease expert. “A vaccine is literally on the threshold of being implemented. To me that is more of an incentive to not give up, but to double down and say, ‘We’re going to get through this.’”

The vaccine won’t change life overnight. Pandemics don’t end abruptly, as New York Times reporter Donald G. McNeil Jr. wrote this fall. “They decelerate gradually, like supertankers.” It will take months to get enough people vaccinated so that the virus has nowhere to go.

Given the enormity of the crisis, it’s hard to believe that something as simple as declining a dinner party invitation could make a difference. But that’s how you tamp down a respiratory virus. You stop breathing other people’s air.

The more everyone does their part to slow down the virus now, the better and faster the vaccine will work to slow the pandemic once we can all start getting vaccinated this spring.

Wear a mask. Scale back your holiday plans. Avoid groups and indoor gatherings. Restrict your contacts to just the people in your household. Those simple measures could save more than 100,000 lives in the coming months.

“Why would you want to be one of the people who is the last person to get infected?” said Fauci. “It’s almost like being the last person to get killed in a war. You want to hang in there and protect yourself, because the end is in sight.”

Pay attention to this indicator.

You have one job this winter: Keep yourself and those around you safe and healthy. Do that, and you’ll improve the odds that all the people you care about will still be here this spring, when a new vaccine is expected to become widely available and life slowly starts to return to normal.

A crucial number to watch this winter is the test positivity rate for your state and local community. The number, also sometimes called the “percent positive” or “positivity rate,” represents the percentage of coronavirus tests that are positive compared to the overall number of tests being given, and it’s an important indicator of your risk of coming down with COVID-19.

When positive test rates in a community stay at 5% or lower for two weeks, you’re less likely to cross paths with an infected person.

The pandemic is surging, but as bad as things are, the end is in sight. By doubling down on precautions, we can slow the virus and save lives. (Vinnie Neuberg/The New York Times)

But right now, very few states are below that 5% threshold. When test positivity rates start to rise above 5%, it usually means the number of cases and transmission in a community is high, and that only the sickest patients are being tested; many infected people with milder illness or without symptoms may be going undetected. Since the fall, the national test positivity rate has crept above 10%, and it’s been 30% or higher in several states.

Rising case counts and rising test positivity rates mean there is more virus out there — and you need to double down on precautions, especially if you have a high-risk person in your orbit. Cut back on trips to the store or start having groceries delivered. Scale back your holiday plans. Don’t invite friends indoors, even for a few minutes. Always stay 6 feet from people who don’t live in your home. Skip haircuts and manicures until the numbers come down again.

So how will you know when things are getting better? Case counts and test positivity rates will begin to drop as communities impose restrictions and more people stay home. The numbers will continue to decline as more people get vaccinated. You’ll still need to be vigilant until a large portion of the country is vaccinated, but when you start to see the test positivity rate drop below 1% in your community, it will be a clear sign that we’re quashing the virus.

Mask up. You’re going to need it for a while.

A study by the Institute for Health Metrics and Evaluation at the University of Washington estimated that 130,000 lives could be saved by February if mask use became universal in the United States immediately. Masks can also preserve the economy: A study by Goldman Sachs estimated that universal use would save $1 trillion that may be lost to business shutdowns and medical bills.

The Centers for Disease Control and Prevention issued updated guidance in early December, advocating more clearly than before that everyone, infected or healthy, should wear a mask, including indoors when not at home. Many states have issued mask mandates or strengthened their recommendations in recent weeks.

Various studies involving machines puffing fine mists have shown that simple cloth masks can significantly reduce the spread of pathogens between people in conversation.

And the common-sense evidence that masks work has become overwhelming. Dozens of “superspreader events” have taken place in venues where most people were not masked — in bars and restaurants, at summer camps, at funerals, on airplanes, in churches, at choir practice.

In contrast, there have been no documented incidents of widespread transmission in venues where most people wore masks, such as grocery stores. One well-known CDC study showed that, even in a Springfield, Missouri, hair salon where two stylists were infected, not one of the 139 customers whose hair they cut over the course of 10 days caught the disease. A city health order had required that both the stylists and the customers be masked.

Choose a mask with two or three layers that fits well and covers your face from the bridge of your nose to under your chin. “Something is better than nothing,” said Linsey Marr, professor of civil and environmental engineering at Virginia Tech and one of the world’s leading aerosol scientists. “Even the simplest cloth mask of one layer of material blocks half or more of aerosols we think are important to transmission.”

It’s important to find a mask you like and that you will wear, because masks are going to be with us for a while longer. President-elect Joe Biden said he’s going to call for 100 days of universal mask wearing after he’s sworn in on Jan. 20, 2021. And even as more people get vaccinated against the coronavirus, mask wearing will probably continue for some time in medical offices, on public transportation, in airports and when theaters finally reopen.

Close the leaks in your COVID bubble.

Here’s the harsh reality of virus transmission: If someone in your family gets sick, the infection probably came from you, another family member or someone you know.

The main way coronavirus is transmitted is through close contact with an infected person in an enclosed space. Many of us feel safer gathering in our homes, rather than at a restaurant or public space, but experts say we underestimate the risk when it comes to private get-togethers with our friends and family. Homes are now a frequent place where coronavirus transmission happens, accounting for up to 70% of cases in some areas.

“One of the challenges we have is that familiarity is seen as being a virus protector,” said Michael Osterholm, a member of Biden’s coronavirus advisory group and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “You can’t count on knowing someone” to protect you from the virus, he said. “More likely than not, knowing someone is the risk factor for getting infected.”

This winter, with cases surging out of control, it’s essential to limit indoor socializing to just the people who live in your home. Some families, particularly those with young children, have opted to form a “pod” or “bubble” with two or more households, essentially forming a pact that everyone will adhere to strict precautions and limit outside contacts so the group can safely socialize indoors. This summer, 47% of Americans said they had formed a “pod” or social “bubble,” according to an Axios-Ipsos survey.

But sometimes your bubble is leakier than you realize. Farhad Manjoo, an opinion columnist for the Times, had initially assumed his bubble was pretty small, but it turned out to be much larger than he guessed. His children had contact with other children in a learning pod, and by extension their parents and siblings. His daughter went to gymnastics class, where they came into contact with more families. One parent in the group was a doctor who saw 10 patients a week. Others had small children in day care. In reality, Manjoo discovered that his COVID-19 bubble had direct or indirect contact with more than 100 people.

Whether your bubble is just your immediate household — or you’ve formed a bubble with other households — take some time to check in with everyone and seal the leaks. This requires everyone in the group to be honest about the precautions they’re taking (or not taking). And it means disclosing unusual exposures — an outbreak at a child’s day care, a teen sneaking out to be with her friends or an unfortunate taxi ride with a coughing driver.

Osterholm said that convincing people that their friends might infect them has been one of the biggest challenges of the pandemic. He told the story of a man and a woman who both contracted COVID-19 after attending a wedding.

“He told me, ‘We didn’t fly. I knew everybody there,’” said Osterholm. “He somehow had the mistaken belief that by knowing the person, you won’t get infected from them. We’ve got to break through that concept.”

Watch the clock, and take the fun outside.

When making decisions about how you’re spending your time this winter, watch the clock. If you’re spending time indoors with people who don’t live with you, wear a mask and keep the visit as short as possible. (Better yet, don’t do it at all.) Layer up, get hand warmers, some blankets, an outdoor heater — and move social events outdoors.

If you do come into contact with someone from outside your household, don’t worry about brief encounters outdoors. Passing someone on the sidewalk or a runner who quickly huffs and puffs past you is unlikely to result in infection.

Your primary goal should be to avoid “swapping air” with other people, Osterholm said.

That’s why you need to wear a mask if you’re in close conversation with someone outside your household, even if the conversation is outdoors. (One documented case of outdoor transmission in China happened early in the pandemic when two friends chatted for about 15 minutes on the sidewalk. One of them had just returned from Wuhan, and he infected his friend during their chat.)

In an enclosed space, like an office, at a birthday party, in a restaurant or in a church, you can still become infected from a person across the room if you share the same air for an extended period of time. There’s no proven time limit that is safest, but based on contact tracing guidelines and the average rate at which we expel viral particles — through breathing, speaking, singing and coughing — it’s best to wear a mask and keep indoor activities, like shopping or haircuts, to about 30 minutes.

Take care of yourself, save a medical worker.

The country’s doctors, nurses and other health care workers are at a breaking point.

Long gone are the raucous nightly cheers, loud applause and clanging that bounced off buildings and hospital windows in the United States and abroad — the sounds of public appreciation each night at 7 for those on the pandemic’s front line.

“Nobody’s clapping anymore,” said Dr. Jessica Gold, a psychiatrist at Washington University in St. Louis. “They’re over it.”

In interviews, more than two dozen front-line medical workers described the unrelenting stress that has become an endemic part of the health care crisis nationwide. Many related spikes in anxiety and depressive thoughts, as well as a chronic sense of hopelessness and deepening fatigue, spurred in part by the cavalier attitudes of many Americans who seem to have lost patience with the pandemic.

“We’re sacrificing so much as health care providers — our health, our family’s health,” said Dr. Cleavon Gilman, an emergency medicine physician in Yuma, Arizona. “You would think that the country would have learned its lesson” after the spring, he said. “But I feel like the 20,000 people that died in New York died for nothing.”

Many health care workers have reached the bottom of their reservoir, with little left to give, especially without sufficient tools to defend themselves against a disease that has killed more than 1,000 of them.

For Dr. Shannon Tapia, a geriatrician in Colorado, April was bad. So was May. At one long-term care facility she staffed, 22 people died in 10 days. Tapia is beleaguered by the helplessness she feels at every turn. “Systematically, it makes me feel like I’m failing,” she said. “The last eight months almost broke me.”

Shikha Dass, an emergency room nurse at Mount Sinai Queens in New York City, recalled nights in mid-March when her team of eight nurses had to wrangle some 15 patients each — double or triple a typical workload. “We kept getting code after code, and patients were just dying,” Dass said. The patients quickly outnumbered the available breathing support machines, she said, forcing doctors and nurses to apportion care in a rapid-fire fashion.

“We didn’t have enough ventilators,” Dass said. “I remember doing CPR and cracking ribs. These were people from our community — it was so painful.”

Dass wrestled with sleeplessness and irritability, sniping at her husband and children. She couldn’t erase the memory of the neat row of three refrigerated trailers in her hospital parking lot, each packed with bodies that the morgue was too full to take.

Jina Saltzman, a physician assistant in Chicago, said she was growing increasingly disillusioned with the nation’s lax approach to penning in the virus. In mid-November, she was astounded to see crowds of unmasked people in a restaurant as she picked up a pizza. “It’s so disheartening. We’re coming here to work every day to keep the public safe,” she said. “But the public isn’t trying to keep the public safe.”

In state after state, people continue to flood hospital wards, where hallways often provide makeshift beds for the overflow. Jill Naiberk, a nurse at the University of Nebraska Medical Center, spent more of 2020 in full protective gear than out of it. It’s her ninth straight month of COVID duty. “My unit is 16 beds. Rarely do we have an open one,” she said. “And when we do have an open bed, it’s usually because somebody has passed away.”

Many of her intensive care unit patients are young, in their 40s or 50s. “They’re looking at us and saying things like, ‘Don’t let me die’ and ‘I guess I should have worn that mask.’”

What will it take to convince you?

Here’s what Dr. Elisabeth Rosenthal, a former emergency room physician, editor-in-chief of Kaiser Health News and a contributing opinion writer, had to say about convincing a skeptical country about the dangers of COVID-19.

As cases were mounting in September, the Michigan government produced videos with the exhortation, “Spread Hope, Not COVID,” urging Michiganders to put on a mask “for your community and country.”

Forget that. Mister Rogers-type nice isn’t working in many parts of the country. It’s time to make people scared and uncomfortable. It’s time for some sharp, focused, terrifying realism.

“Fear appeals can be very effective,” said Jay Van Bavel, associate professor of psychology at New York University, who co-authored a paper in Nature about how social science could support COVID response efforts. (They may not be needed as much in places like New York, he noted, where people experienced the constant sirens and the makeshift hospitals.)

I’m not talking fearmongering, but showing in a straightforward and graphic way what can happen with the virus.

Maybe we need a PSA featuring someone actually on a ventilator in the hospital. You might see that person “bucking the vent” — bodies naturally rebel against the machine forcing pressurized oxygen into the lungs, which is why patients are typically sedated.

(Because I had witnessed this suffering as a practicing doctor, I was always upfront about the trauma with loved ones of terminally ill patients when they were trying to decide whether to consent to a relative being put on a ventilator. It sounds as easy as hooking someone to an IV. It’s not.)

Another message could feature a patient lying in an ICU bed, immobile, tubes in the groin, with a mask delivering 100% oxygen over the mouth and nose — eyes wide with fear, watching the saturation numbers rise and dip on the monitor over the bed.

Maybe some PSAs should feature a so-called COVID long hauler, the 5% to 10% of people for whom recovery takes months. Perhaps a professional athlete like the National Football League’s Ryquell Armstead, 24, who has been in and out of the hospital with serious lung issues and missed the season.

These PSAs might sound harsh, but they might overcome our natural denial. Only after Chris Christie, an adviser to President Donald Trump, experienced COVID did he start preaching about mask-wearing:

“When you have seven days in isolation in an ICU, though, you have time to do a lot of thinking,” Christie said, suggesting that people “follow CDC guidelines in public no matter where you are and wear a mask to protect yourself and others.”

We hear from many who resist taking precautions. They say, “I know someone who had it and it’s not so bad.” Or, “It’s just like the flu.”

Sure, most longtime smokers don’t end up with lung cancer — or tethered to an oxygen tank — either. (That, in fact, was the justification of smokers like my father, whose two-pack-a-day habit contributed to his death at 47 of a heart attack.)

But studies have shown that emotional ads featuring personal stories about the effects of smoking were the most effective at persuading folks to quit. And quitting smoking is much harder than social-distancing and mask-wearing.

Once a vaccine has proved successful and enough people are vaccinated, the pandemic may well be in the rearview mirror. In the meantime, the creators of public health messaging should stop favoring the cute, warm and dull. And — at least sometimes — scare you.

© 2020 The New York Times Company