How to beat the coronavirus

Photo courtesy of SJ Objio

By Peter Katona and Seth Freeman

As anyone who follows sports knows, a good coach constantly sees what the other team is doing and makes adjustments. The other team, if well coached, will also adjust accordingly. Blindly following a failed strategy doesn’t win games.  

The players on the team don’t complain, “Hey, you collapsed the outfield and now you’re sending them deep – which is it?” or “You told us to crowd the basket; now you’re telling us to shoot from outside – this is confusing.” or “For the first quarter we ran the ball, now you want us to pass – do you even know what you’re doing?”  

So why are we carping about our public health leaders, especially the Centers for Disease Control and its Director Dr. Rochelle Walensky, when they are trying to make real-time adjustments, often with incomplete data, to counter the relentlessly changing tactics of an ever-evolving deadly disease?  

The CDC undoubtedly made some messaging and even decision mistakes – ending mask requirements too soon – which didn’t help. The agency is also still recovering from the severe loss of credibility it suffered in the last administration. But maybe, just maybe, sports fans, we haven’t really understood the game we are playing.

A virus doesn’t think up new ways of attacking humans. It doesn’t have a brain. Some doubt that it is even a living thing. It’s an opportunistic collection of “parasitic” molecules and genetic material that invade the cells of actual living organisms and co-opt that host’s genetic material to replicate. Inside a person, a virus can generate billions of new copies of itself, exact clones and close matches of the original. With so many replications, inevitably mistakes are made and made often, creating new modified versions of the virus in a short period of time. Many of these will not be effective at infecting new hosts. They are biochemical screw-ups and will simply die out.

The CDC undoubtedly made some messaging and even decision mistakes – But maybe, just maybe, sports fans, we haven’t really understood the game we are playing.

Except. Every once in a while, a new strain improves, in virus terms, its survivability. The Delta variant of Sars-CoV-2 is such a strain. It has learned to survive fluctuations in temperature, humidity and other environmental insults, not unlike a skilled sports team fine-tuning its offense and defense. It is thought to be 50% more contagious than the strain of Covid which was infecting people in the winter of 2020, and it already accounts for the vast majority of new cases in the U.S. It can also be more lethal.  

Some of these characteristics were clear from studies and clinical reporting in other countries at the time that the CDC changed its guidelines on mask-wearing a few months after the roll-out of mass inoculation in the U.S.  Israel, then Germany and Spain had just strengthened mask requirements in the face of Delta.  

It was frequently said at the time that CDC and the administration had to give people something in return for getting vaccinated. If they are still going to have to wear a mask indoors with friends or in the grocery store, many argued, what is their motivation to get vaccinated? Evidently, radically lowering a person’s risk of serious, painful infection or death was not sufficient incentive. Since, at the end of the day, what is going to get us out of the pandemic is widespread (probably over 80%) global vaccination, the CDC may have felt that enticing people to get vaccinated by reducing the mask requirements was worth the risk of more people going around mask-free.  

But the problem is that now having loosened mask requirements it becomes psychologically more difficult for people to re-adopt them again, especially while keeping businesses open. Also, specifically absolving the vaccinated of the need to wear masks left many of the unvaccinated feeling a sense of shame when masked in public, if they were even honorable enough to follow the guidelines. From the beginning the eminently sensible practice of wearing an appropriate mask during a respiratory disease epidemic – and wearing it properly, with a good fit covering both nose and mouth – has caused many people to bristle at being told what to do, and, of course, it has been cynically politicized by those who see an advantage in claiming that wearing masks is somehow launching us on a downward, slippery slope toward the extinction of our basic freedoms.

When a four-year-old girl died of Covid-19 a few days ago in a Los Angeles emergency room, it was not her fault. It was a massive failure of those around her, particularly the larger non-compliant society in which, all too briefly, she lived.   

So do we need mask mandates for the unvaccinated in most circumstances and for the vaccinated in some? Of course. They are the fairest way to protect everybody, most importantly children under twelve and others who simply cannot get vaccinated. When a four-year-old girl died of Covid-19 a few days ago in a Los Angeles emergency room, it was not her fault. It was a massive failure of those around her, particularly the larger non-compliant society in which, all too briefly, she lived.   

It is halftime in America’s Covid-19 pandemic. In the first half we did some things well and some things poorly, but in its most recent move, our opponent changed strategies, with devastating effect, gaining a powerful advantage against us. We need to adjust now, just as we will again in the future. Ultimately our path out of the pandemic is to get many more billions vaccinated, but until then masks are a critical tool.  

Let’s understand the game we are playing and realize that there are different strategies to achieve victory, which isn’t about winning a trophy, but is about saving lives, keeping people healthy, reviving the economy and getting back to concerts, parties, social events and having fun. If Americans get vaccinated and mask up, we will ultimately bring home the gold.  

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Peter Katona, MD, is a Pacific Council member, Clinical Professor of Medicine at the UCLA David Geffen School of Medicine, and Adjunct Professor of Public Health at the UCLA Fielding School of Public Health. He chairs the UCLA COVID-19 Infection Control Working Group.  

Seth Freeman, MPH, is a Pacific Council member, an Emmy-winning writer/producer for television, a playwright, and a journalist who writes about technology, policy, and public health.

The views and opinions expressed here are those of the author and do not necessarily reflect the official policy or position of the Pacific Council.