Thread by @dwallacewells

"In the U.S., the story of the pandemic has been dominated by the president who presided over it so ineptly. But for all his sociopathic indifference, if the story were all about Trump, American failure would look exceptional, too. It doesn't." (1/x) nymag.com/intelligencer/…

"In fact, before the arrival of vaccines, the American experience of the coronavirus was not exceptional but typical — at least among those European nations it typically considers its peers. "

"The metric of deaths per capita is crude, but by this basic standard the U.S. has suffered less than the U.K., Portugal, and the Czech Republic. It sits clustered with a number of other European nations — Italy, Spain, France — near the E.U. average."

"The South American average is just below. None of these countries, save Brazil, had presidents or prime ministers who so callously downplayed the threat of the disease as Trump, or who tried to suppress testing, or who held indoor political rallies during a local surge."

Few even had local officials, like Florida governor Ron DeSantis or South Dakota governor Kristi Noem, who so nakedly flouted public health guidance, then were celebrated as future presidential candidates for their efforts.

Not that pandemic resistance was peculiarly American, either: there were large anti-lockdown protests in Holland, in Germany, even South Korea.

Of course, American politics inhibited the American response, with few of the resources available at the federal level deployed in a good-faith campaign to actually combat the disease.

“But that’s not to say that in some counterfactual scenario where someone else was president, we would not be having difficulty,” @nataliexdean told me. “There are only so many tools at our disposal.”

@BallouxFrancois goes further. “It’s not obvious that different measures taken in different places have clearly led to different outcomes,” he says.

"There’s a lot of idiosyncrasy, and I think it’s simplistic to say that the countries that have controlled or eliminated the virus did things extremely differently."

"If you just list, for instance, the interventions that places like New Zealand or Australia have implemented, they’re not drastically different — in stringency nor duration — than in some other places."

"The country that had the strictest lockdown for longest in the world is Peru, and they were absolutely devastated. I think the slightly depressing message is that there is not just a set of policies that will bring success and can just be applied to any place in the world.”

"This is not how the disease has been regarded by most American liberals, who’ve tended to see COVID as a straightforward management challenge, in which the pandemic can be 'solved' through science-first policy and dutiful compliance."

"This perspective has given the pandemic features of a morality play, in which matters of social distancing and masking become tests of executive and personal virtue that determine the course of the disease."

"But the coronavirus hasn’t precisely cooperated with the spirit of determinism. The highest per capita death rate, for instance, is not found in Texas but in New Jersey."

"Through the devastating fall surge, a poll found that 90% of American adults were wearing a mask 'sometimes, often, or always.'" A CDC study found mask mandates reduced the growth rate of the disease by between 0.5 and 2 percentage points.

"Close contacts in states with heavy restrictions were not dramatically higher than in laissez-faire places, and even draconian lockdowns produced, typically, plateaus or slow caseload declines, not rapid descent to zero."

"There are, within the U.S., a few relative success stories—Hawaii, notably, has registered almost no excess mortality. But death rates in Florida, proudly one of the loosest states, are hardly any higher than they are in California, self-flagellatingly one of the strictest."

"This is not to say that policy and behavior don’t matter — only that containing a novel disease we understand incompletely is not as simple as hitting the 'Science' button."

"The mitigation measures on which the country has focused the most — masking, social distancing, school closures, restaurant restrictions — are curve-benders, not firewalls."

"And many of the factors playing a much larger role in shaping the spread of the pandemic fit much less comfortably in a technocrat’s shoulder bag or a liberal’s scolding moralism."

"There is chance and bad luck, often called the 'stochasticity' of the disease, driven in part by 'superspreader' dynamics according to which the vast majority of new cases are produced by a thin slice of existing infections and most disease chains simply burn out."

"There is demography, with age skew so dramatic (the lethality risk of someone in their 80s hundreds of times that of someone in their 50s, and thousands of times that of children)..."

"...that the structure of a country’s population shapes its experience of the disease profoundly enough that in many of the world’s younger countries there has been an almost invisible death toll."

"There’s geography, with islands protected by their ocean borders in ways other nations are not, and with communities at higher latitudes apparently more vulnerable, perhaps due to the salubrious effects of sunlight on health."

"There is climate, with temperature and especially humidity appearing to shape national outcomes much as they’ve shaped some seasonal rhythms of the disease within countries."

"There is the possibility of a Vitamin D effect, with fall waves even more closely correlated with latitude than with recent temperature and humidity—though Adrian Martineau, a global authority on Vitamin D, calls the evidence merely 'suggestive.'"

"There is air conditioning—whether you have it, and what kind. There is time spent indoors. There is infrastructure and housing patterns, and comfort with closed borders and restricted movement."

"There is what the La Jolla virologist Crotty described to me as a version of the 'hygiene hypothesis'—the possibility that regular exposure to pathogens generally might train your immune system like it does your gut biome."

"There has also been speculation that previous exposure to other coronaviruses may play a role in disease spread, and that Asian populations proximity to local bat populations may have endowed them with some additional protection..."

"...though, as Balloux points out, that effect would likely show up not in case numbers but in disease severity, and while some small-scale studies have shown reduced lethality among those with previous exposure to the common-cold coronavirus..."

"... in comparing national outcomes the fatality rate, corrected for age, has been remarkably consistent all around the world. (Indeed, “absurdly so,” Balloux says, given regional variations in genetics and comorbidities.)"

"There are cultural forces, a catch-all covering everything from mask willingness to how many people live in multigenerational homes to deference to public health guidance to, perhaps, cheek-kissing and handshake frequency. I could go on."

"Any time you try to put a finger on a single, dominant factor, the disease slips away, defying reductive models and suggesting counterpoints and counterfactuals: Japan is old, Brazil is largely tropical, England is an island, and there’s hardly any air conditioning in France."

"And even beyond these factors, there is what the controversial Stanford epidemiologist John Ioannides calls the 'chaos' of the disease — the seemingly random, and still mysterious, dynamics of spread, even beyond stochasticity, which can be at least mathematically modeled."

"The recent collapse in American case numbers, for instance, came right after the New Year, in the middle of what the country had just been warned—by epidemiologists and the new president, in his inauguration speech—would likely be the pandemic’s darkest season."

"The CDC aggregates and showcases 26 pedigreed models predicting the near-term course of the disease. On January 18, only two of the 26 showed the dramatic case decline the country experienced by February 1 as being within what’s called the 95 percent confidence interval."

"In other words, 24 of the 26 models said what ended up happening over just the next two weeks was, more or less, statistically impossible. The other two gave it, at best, a sliver of a chance."

If our best models are still that bad at predicting the course of the disease just two weeks out, it says an awful lot about how poorly, more than a year on, we understand the basic spread dynamics of this disease.

We have vaccines, and rapidly improving treatments. And yet we are still living in remarkable pandemic mystery and viral uncertainty. (x/x)