Andrew Sullivan: “We Can’t Go on Like This Much Longer”

24 Apr

Photo: Cindy Ord/Getty Images

I began to lose it this week.

I know, I have it very easy. I’m not required to put myself at risk every day as a hospital or essential worker. I’m still employed. I’ve got some savings, and don’t have to worry about basic survival. I get food delivered. I haven’t lost any family members or friends from COVID-19 (though I did lose my dad in a horrible accident, and couldn’t get to the burial). My apartment gets plenty of sun and I have two dogs who love me. I get a couple of good walks in a day, and have plenty to read. I don’t have kids. I have direct, personal experience of living through a plague once before in my life.

All of that should make me a prime candidate to hang in, take this period as a disciplinary exercise, and generally be a good citizen. And I have been — I haven’t had any physical human contact for two months now, I wear a mask everywhere, I use rubber disposable gloves for groceries, I keep my six-feet distance so far as I can, even though it’s impossible in my neighborhood to walk on a sidewalk or in a park and not be accosted by joggers, who routinely come within inches of my face. I have no intention of breaking any of these rules, although I am tempted by homicide if any of these fit, entitled motherfuckers actually spit on the ground near me.

But I can recognize signs of psychological and physical stress, and I’m beginning to lose it. This week, for some reason, Wednesday was a bad day. Or at least I think it was Wednesday. What day is it again?

My sleep patterns are totally screwed up, and I find myself waking up tense several times a night, or crashing out for 10 or 12 hours at a time. I wake up and want to go back to sleep. My appetite is waning, and my body longs for some weights to push and pull. My teeth grind all night long and my jaw is tense. I have all the time in the world to read and write, and yet I find myself anesthetized with ennui, procrastinating and distracting myself. Yes, I scan the news every day, often hourly, to discern any seeds of progress.

And here’s the thing: I can’t see much on the horizon. Get unlimited access to Intelligencer and everything else New YorkLEARN MORE »

Yes, it’s a big relief that our hospitals are no longer overwhelmed and daily deaths have plateaued or even declined a little. Yes, the epidemiological worst has not happened — largely because of the new behavioral rules — even though we could well be headed past the White House’s estimate of 60,000 casualties in the medium term, and countless more whose bodies will be permanently wracked by the damage this virus does to the lungs and heart and kidneys.

But I’m also aware that even this modest arrest of a previously exponential disease has only delayed the inevitable. “Flattening the curve” has actually been a remarkable success — but its very success will likely draw this epidemic out for months and years. Yes, if you’re being super-realistic: years. Vaccines do not happen overnight — and even an 18-month deadline for vaccine salvation is being optimistic. We still don’t have a vaccine for HIV, and probably never will. HIV is a retrovirus, which is far harder to vaccinate against than a coronavirus, but COVID-19 is exponentially more contagious than HIV, if not as fatal. Remove constraints and it will spread like ink on a napkin.

A study yet to be peer reviewed from China suggests that the virus has so far about 30 mutations, some far more severe than others. It is also unclear that antibodies can even succeed in preventing the disease, and for how long: “Preliminary studies on monkeys suggest COVID-19 antibodies provide partial, short-term protective immunity to reinfection, but, as Harvard epidemiologist Marc Lipsitch recently wrote for the New York Times, these early results are just ‘educated guesses.’” Notice the word: “short-term.” We are going to be dealing with some form of this virus for the indefinite future, and it has a good chance of becoming endemic: “Other coronaviruses, which cause common cold symptoms, lead to a very weak immune response and people can catch the same bug multiple times in their lifetime.” A preliminary study of convalescent patients in China was not encouraging: It found that 30 percent of those who had been infected by COVID-19 had so few antibodies to the disease it was unlikely they’d have any immunity. If this finding turns out to be true, we’re truly, royally fucked.

Treatments? That’s at least worth some limited optimism. It was treatments — not a vaccine — that allowed us to turn the corner on HIV. And that’s why I still do get up in the morning. The trouble is that it took years to develop effective treatments for the vast array of opportunistic infections, and more than a decade for scientists to come up with an effective treatment for the virus itself.  When a virus is brand new, and we don’t know much about it, it simply takes time to figure out its weak spots, and develop treatments to exploit them. We’re talking several months at best, and — as with HIV treatments — we will be disappointed most of the time. Hydroxycholoroquine turns out, in some patients, to make things worse, not better. Gilead’s remdesivir is one reason I have some hope. Seven clinical trials are underway, and anecdotal studies in Chicago have raised hopes. Yesterday, leaked data from one trial suggests it might be a flop, but that particular trial may also be misleading. We don’t know.

This pattern of hopeful rumors that were later dashed is a familiar one for HIV survivors. There were countless possible treatments for various aspects of AIDS opportunistic infections in the late 1980s and ’90s, and trials were constant. Many succeeded in arresting some aspects of the disease — but many very promising trials turned out to be duds. What looked like breakthroughs in phase three trials often became crushed hopes in phase four. Remdesivir is an already existing drug, designed for Ebola (and eventually rejected in favor of better treatments). AZT was also a preexisting medicine that seemed promising at first, and then we discovered, through rigorous trials, that mono AZT therapy was basically useless, and usually toxic. It took years for researchers to come up with drugs that could, sometimes in combination with AZT, bring viral loads to zero. It may take just as long to develop brand-new treatments that could make a decisive difference with COVID-19.

The obvious massive difference between the race to find treatments for HIV and those for COVID-19 is also that HIV in America was relatively contained within the world of anal sex and intravenous drug use (and still is). The broader society could go on as normal, even though the gay world was experiencing medieval levels of death. With COVID-19, in stark contrast, we have shut down almost our entire economy and restricted all human interaction in unprecedented ways. Even in 1918, there was no national shutdown similar to the one we’ve imposed more than a century later. Yes, there were masks and social distancing and business restrictions, but the most draconian measure, in Saint Louis, shut down all economic activity in only one city for just 48 hours.

So we have created a scenario which has mercifully slowed the virus’s spread, but, as we are now discovering, at the cost of a potentially greater depression than in the 1930s, with no assurance of any progress yet visible. If we keep this up for six months, we could well keep the deaths relatively low and stable, but the economy would all but disintegrate. Just because Trump has argued that the cure could be worse than the disease doesn’t mean it isn’t potentially true. The previously unimaginable levels of unemployment and the massive debt-fueled outlays to lessen the blow simply cannot continue indefinitely. We have already, in just two months, wiped out all the job gains since the Great Recession. In six months? The wreckage boggles the mind.

All of this is why, one some days, I can barely get out of bed. It is why protests against our total shutdown, while puny now, will doubtless grow. The psychological damage — not counting the physical toll — caused by this deeply unnatural way of life is going to intensify. We remain human beings, a quintessentially social mammal, and we orient ourselves in time, looking forward to the future. When that future has been suspended, humans come undone. Damon Linker put it beautifully this week: “A life without forward momentum is to a considerable extent a life without purpose — or at least the kind of purpose that lifts our spirits and enlivens our steps as we traverse time. Without the momentum and purpose, we flounder. A present without a future is a life that feels less worth living, because it’s a life haunted by a shadow of futility.” Or, in the words of the brilliant Freddie deBoer: “The human cost of the disease and those it will kill is enormous. The cost of our prevention efforts are high as well. You’re losing something. You’re losing so much. So you should mourn. We’ve lost the world. Mourn for it.”

We have done what we had to do, and I am not criticizing the shutdown strategy so far. I’m simply saying that it cannot last. We keep postponing herd immunity, if such a thing is even possible with this virus. A massive testing, tracing, and quarantining regime seems beyond the capacity of our federal government in the foreseeable future. And we are a country without a functioning president — ours thinks we should inject bleach to kill COVID-19, and is also doing what he can to divide the nation to keep his fast-diminishing candidacy from imploding. And we know this much after three and a half years: The worse this gets, the worse he will get. Already he is lambasting shutdown orders as well as Georgia’s attempt to end the shutdown. He is an incoherent, malevolent mess of a human being. I used to be disgusted by him. I am now incandescent with rage at him and the cult that enables his abuse of all of us.

And so we wait. Absent a pharmaceutical miracle, we are headed, if we keep this up, toward both a collapse in the economy and an inevitable second wave that will further cull the population. Yes, I’m a catastrophist by nature. I hope and pray something intervenes to save us from this uniquely grim future. But I learned something from the AIDS years: Sometimes it is a catastrophe. And sometimes the only way past something is through it.

Nice to have two dogs that love you though.

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