COVID Update September 14: For every 10% of people who won't take a vaccine, that leads to about 100,000 more deaths over 4 months. 1/

I spent the day playing with a new toy: a model engineer and pandemic expert Bill Joy built for me. It's rough numbers and filled with a lot of assumptions, but it divides the country into groups: Cs and Ns.

Cs where a mask & take a vaccine when available.
Ns don't do either. 2/

The more people that become Cs, the quicker we move on & the fewer people who will die. This assumes that Ns spread COVID at an R of 1.4 & Cs at 0.4. That is, a vaccine or mask won't work perfectly & people who aren't compliant only spread the virus above average, not wildly. 3/

Those numbers-- some people spreading the virus to 1.4 people & some to 0.4-- work out about right at today's level of cases if 60-70% of people are relatively compliant today. 4/

I should also add that there are two types of non-compliant people

--those who voluntarily non-comply-- anti-vaxxers, fauxers, young people at parties & bars.
--those who don't comply unvoluntarily because of exposure-- essential workers, farm workers, multi-gen households 5/

If 10% more people become compliant, it saves about 100,000 people's lives in 4 months. If 10% of people become less compliant, 100,000 more people (or so) die. (This model uses a death rate of .8, but gives an answer over 100,000 so this is rounding if .6 is more accurate.) 6/

The actions of 1% of the population effect 10,000 lives over the next few months. 6/

Now let me pause here before I go onto the implications.

It was only a few months ago when we watched TV solmenly as the first 1000 people died. And I'm aware that analyses like this only coarsen us to accepting large numbers of deaths-- which I think is a very big problem. 7/

So I'm really hesitant to write about this work because when I stare at the spreadsheet my eyes glaze over. It makes me feel hollow. I don't want to lose the ability to mourn a single death or to somehow feel relieved if the death rates drop to a few hundred per day. 8/

I also add that its really a bad idea to think of people with COVID as living or dying (which I am doing here). More people are surviving, but chronic COVID conditions are relatively serious cardiac, kidney, brain & lung function. Long haulers episode. 9/ http://smarturl.it/inthebubble 

We have people who are not only growing numb but are mocking these losses openly.

People who mocked @larrybrilliant and @mtosterholm for years as fear mongers you would think would be saying-- well, "I guess they were right," are instead doubling down. 10/

If ignorant and selfish had a baby, the baby's first act step would be to threaten a public health commissioner for promoting masks. 11/

What are the implications of this model?
1. The first lesson is for the @US_FDA. Vaccine trust. You roll out a vaccine and if 20% more people don't trust it because you politicized it, 200,000 more people die.

Roll out the vaccine the right way and save lives. 12/

This has nothing to do with the effectiveness of the vaccine BUT the process by which it is rolled out. Consistent transparent data on safety will make a big difference.

If we wait 1-2 months to roll out the vaccine but do it with high trust, you could save more lives. 13/

2. A vaccine matters for different groups for different reasons.

-Compliant groups need it because they won't build immunity
-Non-compliant groups need it to save their lives

All of us need it because reaching a certain level of immunity brings the virus to a negligible level14

3. As we know we take action for others here, not just ourselves.

In a greater good or "all boats" society like Japan, this fact raises compliance & lowers death tolls quickly
In an individualistic society, it likely means prolonged agony & death 15/

The number of people who die every day, while monstrous, is apparently not high enough to make the individualistic (or self-centered) people worry the Russian roulette bullet will end up in their chamber. 16/

4. Most of the people who die are non-compliant people. And it would be tempting to say-- "individualist" + "knowingly tempting fate" = "they made their own bed."

But remember all of the involuntary non-compliant people. 17.

Who are these people. Chances are they work for you.

They're growing our food.
They're packing & distributing it.
They're working in stores.
They have lower incomes & live in more crowded settings.

And... 18/

They are people we label vulnerable--

In nursing homes, vulnerable to spread
With illnesses or disabilities
In congregate care settings

They are the people society always victimizes & we're victimizing them again 19/

5. Our policies towards essential workers in any just society would dictate our behavior.

If we have a lot of people working for us so we can keep the economy (& our basic systems) moving, that obligates us to compliance-- masks, social distancing, vaccinations. 20/

In a nutshell, if you want to be "individualistic," don't actually depend on people.

Go hunt rabbit, live in the woods, pee outside, don't collect social security and sure, be free not to wear a mask. 21/

However, stop with the phony individualism.

This is the final conclusion that the model leaves me with. If you want to go see the Alabama-Auburn game, but a hot dog, have people pick up your litter, you're dependent on about 1000 people. Go to the grocery store & its 100,000.22/

Bottom line: science will get us out of the mess we couldn't manage to get ourselves out of. And with a vaccine we can trust, that can happen in 2021.

But we can choose the cost in lives. That's the power we have. 23/

That's how I spent my Sunday. How did you spend yours? /end