• Josh

Please Stop Thinking in Binary about COVID

Updated: Aug 10

I see binary thinking as the central error being committed by nearly everyone when discussing topics surrounding the pandemic and the response. Everything is a spectrum, and we need to acknowledge that in how we talk about difficult issues.


First of all, stop thinking in binary about case counts. COVID cases do not perfectly fall into black and white categories, but rather depend on thresholds of viral load in a person's respiratory tract and our definitions of positive and negative test results. This is very clear: PCR tests have a threshold above which a person is considered "infected", but this threshold is not God-given and one can argue it should be higher or lower. High thresholds would mean that people with plenty of virus particles may come up "negative", whereas low thresholds mean that lots of people with very low levels will be put into quarantine. We do our best but lots of people who are contagious will be set free, and/or lots of healthy people will be quarantined, even if the tests were perfect. And since the tests aren't perfect, we'll have more false positives and true negatives to boot.


And we know that once individual cases have been identified, they vary a lot, so stop thinking in binary about infection. This is related to viral load too, since given a positive test you can have anywhere from medium to lots of virus in you (or little if your test is a false positive), and the more you have the worse your symptoms are likely to be. But this also depends on previous health problems, as well as factors like age and (maybe) race. The same viral load in two people will not necessarily show up as equally bad infections or equally visible symptoms.


By the way, this means you can be infected without knowing it and without showing symptoms, and also you will probably have greater or lesser immunity based on your viral load. So you should stop thinking in binary about immunity. Your body's immune system isn't an "on/off" switch; you can have more or fewer antibodies, they last some amount of time in your bloodstream but eventually disappear. If your mild case of COVID is the result of low viral load, then hooray for you, but also you should still be careful going forward as your immunity is not infinite just because you tested positive.


While we're at it, stop thinking in binary about risk of getting infected. Yes, it is more safe to wear a mask, to social distance, to avoid crowded indoor spaces. But it is possible to a person who has COVID, at close range without a mask, and not get infected. High risk does not equal certainty; when a group skirts the best safety advice and has a big indoor party, it is not guaranteed that COVID will spread, and if it does it will not spread to everyone. We should be aware of the risks we are taking on, for ourselves and our families and others around us, without thinking risk=certain COVID.


Therefore, stop thinking in binary about preventative measures. I've seen on various (right-wing) sites arguments like this: "If social distancing works, then why do we need to wear masks? If masks work, then why do we need to shut down stores?" and so on, but of course these are each partial measures that each reduce risk by some amount. Then people were making fun of the "double maskers", but of course that will be more effective than a single mask; the question is, by how much, and is it worth it? Do we really need randomized control trials and thinkpiece articles to understand that putting things in the way of incoming virus particles riding on respiratory fluids is useful? Now people think the CDC recommendation to wear masks indoors again implies that the vaccine "doesn't work". We should all be smart enough to recognize that any and all preventative measures merely reduce risk by some amount; they do not solve the problem completely. That includes the vaccine: In a world with 100% vaccination rates, we would still see COVID cases and even deaths (though far fewer to be sure). (Nicholas Christakis uses the example of Swiss cheese: each measure (masks, school closures, limits on gatherings, and yes vaccines) is a slice of cheese with holes, but the holes are all in different places. Any one slice won't prevent things from slipping through, but if you have enough slices you end up with effectively a completely hole-less surface.)


While we're on the topic, specifically stop thinking in binary about vaccines. This includes both efficacy and safety. "Vaccines work!" is a silly platitude; instead we should ask, how well do they work? The answer seems to be "very well", but if you don't allow for non-binary thinking here people will be very confused and scared by well-understood and predicable breakthrough cases. Zvi points out that as long as a few dozen breakthrough cases continue to be news, we should be ecstatic at how well things are working, not scared that we or our loved ones will be among those few. And "vaccines are safe!" is equally simplistic. All medical interventions carry some risk; I'm confident some have died or had severe reactions to the COVID vaccines, and this is not surprising. We should acknowledge this, we should carefully catalogue how and why and when it happens, and work to prevent it as much as possible given other constraints (like preventing COVID deaths!). But if you just say "vaccines are safe!", as has been parroted by numerous public health officials and well-meaning doctors and scientists, people will be confused and scared by any preponderance of severe side-effects. Eric Weinstein says this sort of thing a lot (e.g. here), that overselling vaccine safety is bad in the long run, because it requires you overreact to any small risk that appears. A clear example is the AstraZeneca vaccine and the purported association with blood clotting, which led to suspension of the authorized use of the cheapest and most widely-accessible vaccine on the market; as Zvi puts it,

The whole blood clot issue around AZ was never a thing. Of course Pfizer has similar instances of blood clots to AZ, given that not getting vaccinated at all also has similar instances. Also Covid-19 itself actually does cause blood clots, but hey.

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So in conclusion: put on your big-boy and big-girl pants, and think beyond simplistic "does it work or not?" kinds of ideas. The world is big and complicated. Everything you do is a risk of something. Be smart about how you make those choices, protect those around you to the extent you can, and stop arguing like babies.


Rant: over (for now).

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