• Josh

Two Years of Covid

(Note: This is a personal history, which I am writing as a record of my own thoughts and experiences over the last two years; it may be of interest to you, but I want to get it down while the details are still (relatively) fresh. I will supply links / supporting evidence about specific claims if (and only if) they're readily available, but if I hold myself to my usual standard of epistemic justification then this post will never get written. If you feel that something is factually wrong or misremembered, please let me know in the comments.)


Barring the emergence of a novel variant with much more dangerous properties than Omicron, I think it's fair to say we are seeing the pandemic wind down around the world, as we enter the endemic phase. Countries are re-opening as they climb down from their highest case peaks ever. There is reason to have (tentative, but no less real) hope for the coming year and those to come.


It has been more than two years since the emergence of the novel coronavirus, though almost exactly two years since the virus entered my own life. In this time, I've lived in three countries (Israel, USA, Japan) and experienced a wide range of national pandemic responses. I got married, taught a university course, and organized an international conference, all over Zoom. And I've done my best to follow the most up-to-date sources and written a few times on the state of the covid-world.


There are details of my experience that I don't want to forget; you may feel the same about yours. So I'm going to write them, as I recall them. As I recall what happened, I will add a few comments about things we got things wrong at early times with respect to preventative measures, and what my understanding is today; I'll try to mark these in bold.


So here goes: a history of covid told from my perspective. (It'll be a long one.)


The Pandemic Begins


The COVID-19 [1] pandemic entered my life in roughly February 2020, first as just a rumor of a new virus emerging in China and leading to massive government containment measures. I remember hearing that it had spread to Korea and Japan around this time, when I was in Munich in late Feb for a physics workshop. Very shortly, cases were being reported in Italy as well, and we knew that meant it would be spreading around Europe. People at the workshop started half jokingly / half dead-seriously commenting on whether their flight would be cancelled and they'd be stranded in Germany. Mine was not, and I returned to Israel on February 29.


Things were largely normal in the subsequent week, though troubling news was coming out of Italy as cases skyrocketed (in a way we now know all too well). I was going to work as usual, though I was grateful to have come back when I did, as flights out of Europe did start getting cancelled / Israel stopped accepting them from certain countries. (A colleague of mine went to the same conference in Germany the week after I left, and he was unable to return to Israel until the Fall; I got lucky on that one.) Sometime in the first week of March, Israel announced a policy requiring anyone who had been to specific European countries in the last 14 days to quarantine for the remainder of that 14 days; this list included Germany, and at a seminar dinner one night, my boss informed me that I was to go home and serve my first quarantine.


I had recently begun dating my now-wife, and we had planned a trip to Europe for mid-March; of course, as COVID-19 spread, we decided it would be prudent to cancel. We instead planned a road trip to the north of Israel for the following week, not knowing that I would be required to quarantine. I didn't know much about covid or how seriously we should take this whole "quarantine" thing, and with some apprehension (but not wanting to cancel a second trip), I decided to leave home a few days earlier than required in order to go on the trip as planned. I remember being very nervous about this, being on a visa to work in Israel and not wanting to be deported, but we went anyway.


At one point, I did receive a call from some government phone number (possibly quarantine check) while we were at the Yodfat Monkey Sanctuary and felt very panicky; I didn't answer the call, and they didn't follow-up, and it ended up being fine. I wondered for a long time after whether I had endangered people by my decision to leave quarantine, and felt very bad about it, regardless of the fact that I apparently wasn't sick.


First Real Lockdown


When we got back (2-3rd week of March 2020 now), things were changing rapidly. Israel was preparing to lock down hard, with lots of talk about "the hammer and the dance" and the first calls of "two weeks to flatten the curve." The rules at this time were very strict: you were allowed to leave the house only for food or medicine (all "non-essential" businesses were closed), and otherwise had to stay within 150ish meters of your home. (I don't remember the precise number here; it may have been 100 or 200 meters but not more, because I remember that the radius was too small for me to reach the small public park on the corner of my street. We weren't allowed in the park anyway; I tried to go once and the police showed up and scattered the people there, like we were protestors or stray cats or something.) I started taking long walks in small circles around my apartment building, to get some (ANY!) fresh air.


Police were on the streets and would stop / ticket you if you were out for "unapproved" purposes. Going to a friend's house was straight out. Israel was experimenting with contact tracing and tracked everyone's phone without consent (a system in place for anti-terrorism purposes, as I recall). Some people received a sudden notification on their phone of a "close contact", with the legal implication that they were to start their quarantine immediately; they would sometimes send police to the house to check that they were really there. This never happened to me, but I did hear stories from friends about the system misfiring and leading to unnecessary quarantines.


The government promised that grocery stores and pharmacies would always remain open. Even so, there were runs on stores: shelves were emptied, and nobody could find toilet paper. I bought my first few masks, and enforced a strict regimen of use for only one day, then let it air out for a week before using it again. I was very careful to put on / take off the mask by the straps, and really really tried to not touch the front or sides (or wash my hands thoroughly if I did).


More generally, there was a serious focus on washing: hands, of course, but also wiping down groceries and not touching something someone else had touched. (In retrospect, we now know that this is largely useless for this particular virus, which we now know does not survive long on surfaces and surface-to-host transmission is extremely rare.) I limited my grocery runs to once/week, and avoided people along the way. Ironically, the line at the grocery store created by the entrance check (intended to keep the store from getting too crowded) led to lots of people in close contact in the lobby near the door.


Tensions were high. Israelis do like to yell, but I had never seen so much anger or frustration around a simple grocery visit.


Like many others, I did my best to adapt to working / doing everything else from home. I was, and continue to be, one of the very lucky ones ("the laptop class") who happens to have a job that can be more-or-less ported away from the office. I bought a nice monitor and stand for my desk at home and tried to settle in. I was grateful to have one roommate in a similar situation to me, and we spend many afternoons working "together" at the kitchen table. I'm quite introverted, but still, having company was important for keeping sane in those early days.


Also like many others, I tried to use this time staying "trapped" inside to enact positive changes. I did yoga semi-daily, I read more, I stayed on a strict wake-up / bedtime schedule and tried to maintain a positive routine. It was around this time that I wrote The Long Haul; looking back, I think it holds up well today.

But you don’t know how long your sentence will be. Some say weeks; some say months; could it be nearly two years? You might get parole early, but there are no guarantees.
...
I have the luxury to be able to work from home, and aside from that my calendar is now empty. This is a rare opportunity to change my routine, to change my life, in myriad ways that I “didn’t have time for” before. There sits that pile of books I’ve put off reading, that piano that I’ve put off playing, that family member that I’ve put off reconnecting with, because I “didn’t have time”. It’s clear, now, that I have time. All that’s missing is the motivation, and it’d be a shame not to dig deep and find the will do something positive with this opportunity.
...
So assume you’re in this for the long haul. And as such, you’re going to come out changed, for better or worse; what you do right now matters. Take this time to make yourself better, because I shudder at the thought of having another opportunity like this one.

At the time I thought the "two years" estimate was an upper limit, but now it seems pretty prescient (and possibly an underestimate).


I talked a big game about positive life-changes and habit-building, but also also like many other others, I used this time to drink a lot and feel sorry for myself. These are not quite mutually incompatible, though they do work at cross-purposes.


"The New Normal"


After the first month or so, I think we mostly realized this was going to be indefinite (a "long haul") and the lockdowns eased slightly. Buses continued to run, though there were fewer checkpoints and the police still checked periodically to make sure they weren't overcrowded / the people had good reasons to be out. Restaurants re-opened, for delivery only. We started to learn when and where we could walk around without being harassed by cops.


And we all became accustomed to Zoom. I had agreed to give a course in Statistics at the university I was working at, and it was moved to fully-online; the hardest thing to do was give exams, but we resolved this and overall the course went well. Our weekly university seminars became weekly Zoom seminars. I thought a lot at the time about how weird and unexpected it was, that Zoom emerged as the leader in video conferencing, when it was largely unknown until March 2020 and Skype had been around for years; indeed, even in my own field, where we used to "Skype" each other, we would instead schedule a Zoom call. Around this time, I wrote Zoom: The Other Exponential Growth Story about this topic.


My now-wife was going to school for her master's degree in another city, and between her extremely busy schedule and the lockdown, we rarely got to see each other during this time. She occasionally was allowed to take the bus to Tel Aviv (where I lived) for e.g. a doctor's appointment, and she would stay a day or a weekend with me before going back. Sometimes we would make up an excuse even when there wasn't an appointment. Still, it was difficult to be apart for weeks at a time (though of course, many had it much harder than this).


At some point in Summer 2020, people got fatigued of the strict lockdowns, and started meeting each other. I don't remember if/when the rules changed, but I remember a bunch of articles about how dangerous it was that people were congregating on beaches and in public parks. (Again, we now know that this was quite overblown; outdoor transmission is also significantly diminished relative to inside an enclosed space.) I was allowed to go back to campus but only ~1 day a week, to keep congestion down. When I did, my now-wife would meet me on the street and we would go for a long walk, pretending it was to the grocery store since it still wasn't really allowed.


The public messaging around the pandemic was... mixed, to be kind about it. In an oft-cited example, in Spring 2020, the word from the CDC was that masks mostly don't work, and are maybe counter-productive, as they give the wearer a false sense of security and touching your mask leads to spread by contact. All the smart people around me (including Scott Alexander) took one look at their justification and realized this was junk, and we know now that they were right; later Dr. Fauci and others admitted that part of the reason for the misdirection was the concern that people would use up limited supply of masks, leaving too few for health care workers. For my part, in the absence of Peer-Reviewed RCTs that the CDC kept saying we needed to wait for, I felt the good money was on "masks are at least somewhat helpful" (if you cover your mouth when you sneeze, then you probably agree), and went to great pains to obtain some N95 masks for my parents during this time of shortage. It took me nearly three hours of searching online for a non-scam service that could deliver to my family in Indiana; a box of 20 N95 masks cost me >$100.


The other big question people were asking at this time was: how do we end this? Like we get it, we need lockdowns or other measures to keep hospitals from being overwhelmed like they did in Italy in that first Spring wave, but for how long, and to what end? I tried to outline a few possibilities in COVID: Some Ways Out, including vaccination, widespread + consistent testing, and hard lockdown (the China strategy). At this time, everyone was saying that getting a vaccine would take at least 12-18 months + distribution time, so my favorite strategy was ramp up testing and test everyone all the time, which by the way is still an option in future pandemics.


After the big summer wave in ~July 2020, things settled in Israel quite a bit, just in time for my last month or so living there. My now-wife and I ate at restaurants, went to coffee shops, visited her family, and it was great. I got to see friends that I hadn't seen in many months, and at least say "goodbye" before we left the country on September 12. Just as we were leaving, Israel started into their third big wave, when they locked down hard again over the Jewish High Holidays, but by then we were out of there and back in the US.


A Few Months in the US


We were in the US for about 2 months (for my wife, 4), after leaving Israel and before moving to Japan. Given the limited time, I bounced around a bit to try to visit as many family members and friends as I could, in Chicago, Indiana, DC, Cincinnati and St. Louis. (I took several covid tests as a precaution before visiting elderly or at-risk people.) My wife and I got to meet each other's parents for the first time as a couple.


I would describe the situation in the US, compared to Israel, as very lax. We didn't even need to have a negative covid test to board our flight from Israel! After we arrived, we noticed that people pretty consistently wore masks when they went into buildings, and some of our friends asked to only meet up outdoors as a precaution, but other than that everything was allowable it seemed. (I mean, except an in-person wedding ceremony!) The most "dangerous" thing we did was, I think, an escape room, but we mostly stuck to outdoor activities, or staying in and hanging out with only family and friends.


On October 7, my wife and I were married in her parents' backyard, in a Zoom ceremony with a justice of the peace; there were about 20 other couples "in attendance", who all patiently waited their turn, and we all happily applauded each other. It was a sweet and very memorable experience. Shortly after, we flew out West to Phoenix (we were somewhat nervous about the very crowded flight) to see my sister and extended family. We rented a car and did a ~3-week road trip to national parks and famous sites in Arizona and Utah, with one day at Joshua Tree in California.


We came back to St. Louis in early November 2020. I got my first PCR test on roughly the ~9th, and I departed the US to move to Japan on November 12. My wife would join me in early January, just before Japan issued a State of Emergency order which closed the border to new visa-holders for nearly a year.


The Japanese Strategy


The border control I encountered upon entering Japan was extremely thorough; the process of covid testing, paperwork-handling, visa-checking, and residence card-issuing in the airport took nearly 4 hours. I had to provide proof of a personal residence in which to undertake 14 days of at-home quarantine. I also had to book a private car service, which costed about $500; an ordinary taxi would have been less than half the price but was not allowed, and of course neither was public transportation, and I didn't know anyone in the country who could pick me up. Thankfully the university reimbursed the expense; I don't know what less fortunate arrivals do about this.


Quarantine itself was as you would expect. The university took care of necessary paperwork and answered questions for me as needed. I ordered food by delivery a few times. By the official rules, I was not to leave the apartment "unless it [was] necessary", and generally grocery shopping is considered necessary; still, I limited my visits to once/week just in case. There was a contact-tracing app on my phone, which they made sure I had downloaded / installed in the airport. I was very careful not to leave for any other reason, though I guess it would have been fine to go for walks around the nearby park without my phone.


More recently, Japan has added a "quarantine check" application, which pings your phone periodically asking for location information or initiating an automated video call, to make sure you are where you say you are. At the time of this writing, the quarantine length is still 14 days for most arrivals. (I think this is too long, given what is known about the virus today; almost no-one is contagious more than ~week after the onset of symptoms. Japan is slow to change this rule, but there is some hope it will change in the near future.)


So the airport and quarantine experiences were pretty serious and restrictive. However, once I was in the country, I found that the Japanese response to covid has been quite weak, at least from the government level. My understanding of the situation is that the Japanese constitution prevents the federal government from enacting many of the severest "lockdown" procedures we observed in other countries. The Japanese government cannot force restaurants to close; they can only recommend closure, and maybe provide some subsidy to those that comply. It's a guiding hand, rather than a fist.


This strategy works remarkably well in Japan. The government says "please close by 8PM" or "please do not serve alcohol from now until Date X" (these are two common measures that Japan has adopted) and most businesses comply. At the individual level, the government says "it is important that you wear a mask", and the people comply. I mean, they really comply; we see basically 100% mask compliance everywhere we go in Japan, regardless of case counts. Last month, before the current Omicron wave, Japan was at nearly 0 cases for several weeks, and the masks didn't come off, even in our small neighborhood and even outdoors. The people are cautious, and possibly waiting for it to be socially acceptable to do so, I think.


The other obsession in Japan is with clean hands. Japan has always (from what I've read) valued cleanliness; the word for "clean", 綺麗, also translates as "beautiful". So maybe we shouldn't be surprised that every business has hand sanitizer at the door, and they check that you use it. (Again, cleanliness is important and clean hands help prevent transmission of other pathogens, but for covid this seems misguided, as covid is airborne, and surface transmission is very rare.)


For my part, I've mostly complied with the masks until recently; now I wear them indoors but mostly go maskless outdoors unless I happen to be in a crowd of people. I suppose that people around me find this disrespectful, but I think it makes the best sense given what we know. I still use the hand sanitizer because, why not, though I sometimes start to worry about resistance and superbugs.


The only other experience of note since coming to Japan occurred on returning from a rare out-of-country trip in October 2021, when my wife and I had to go to a state-run quarantine hotel for three days. They put us with a bunch of other arrivals on a bus with blocked-out windows and plastic all over the seats, presumably so that they could sanitize the plastic when we got out. (Again, clear overkill given what we know.) The stay in the hotel was fine, though; we couldn't go outside and the food wasn't great, but it was free and we got out on-time on day three.


As of today (Feb 2022), we are in the middle of the highest wave of cases yet in Japan, but there are signs that the restrictions may start to be lifted soon, as we have seen throughout Europe and in the US. Time will tell.


Vaccination/Infection in Japan vs Israel vs US


The first covid vaccines were approved under an Emergency Use Authorization for use in the US in late December 2020, far earlier than the 12-18 month timeline people had anticipated. I recall some apprehension about the vaccine already back then, but it was coming from Democrats in November / December, as (then) President Trump kept promising a vaccine was "right around the corner." I guess that people were worried it was being rushed to make a big political splash that might win Trump the election, but that's just speculation. In any case, Trump lost, Biden won, the vaccines have been rolled out to hundreds of millions of people, and the poles of the debate have since largely flipped.


When the vaccine started to be used across the Western world (~January 2021), Japan held back and decided to do its own safety testing. Japan has a complicated history with vaccination, as several common childhood inoculations we receive in the US are not recommended in Japan, and none of the recommended ones are mandatory (as far as I know, childhood vaccination is totally opt-in in Japan). After a few months, though, Japan concluded from its own safety tests that the Pfizer vaccine (and later Moderna) were acceptable for administration (link, sorry it's behind a paywall).


I remember myself being somewhat apprehensive about the vaccine at this time, though Japan's policy and postponement made it easy for me to wait and see what happened in the rest of the world. Israel, for example, became the early world leader in vaccinations/capita by striking a deal with Pfizer/BioNTech, and quickly reaching >50% of their population in a matter of months; the US, on the other hand, was plagued by various bureaucratic and political issues that slowed rollout in the Spring. By the summer the US had almost matched Israel's numbers, whereas Japan had only just begun. Once Japan got rolling, they quickly exceeded both of the others.



In the meantime, I'm on the lookout for population-level effects that correlate (at least somewhat) with the vaccination status of a given population, which is the best evidence related to the safety of the vaccine. The most important emerging risk I'm aware of [2] is for increased risk of myocarditis following vaccination, especially in young males, though covid itself also raises the risk of myocarditis, so the whole thing is complicated.


In any event, covid deaths have largely followed reported covid cases, and are inversely correlated with vaccines; the correlation (by eye) is very high.



Same with excess deaths from all causes (except for Japan, which has never been much above the axis!):



Japan's case counts and death toll have been decidedly low, from the beginning of the pandemic until today. My impression is that nobody really knows what's going on here; the weak lockdown orders of Japan don't seem like they should be enough to slow the spread. Maybe what we learn from Japan is that a consistent application of low-level restrictions can work as well or better than strict protocols that vary by state (US) or aren't obeyed by the population (Israel). The consistent use of masks in Japan might be helping keep total cases so low as well. Overall, I don't have a great model of this except that the Japanese population is ultra-conscientious and that goes a long way.


Conclusion?


I don't really have any. If you're looking for a thorough cross-cultural analysis, I'm not that guys and this isn't that post.


Still, from my point of view and lived experience, these three countries have taken very different paths in the pandemic to where they are today. Israel has been the most strict within the country, Japan most strict about border measures, and the US has been a mix but mostly lax, relatively speaking. If the rest of the world could copy Japan's results, I'm sure they would love to do so, but I'm confident that the same approach would fail badly elsewhere.


So... yeah, that's my story. I hope not to have to write another one like this again.


And I hope that the next time I move countries, it's not in the middle of another global pandemic. And if it is, I really hope we learned something from this one.





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Footnotes


1. I get that COVID-19 ≠ coronavirus ≠ SARS-COV-2, but unless otherwise specified I'll basically ignore the epidemiological distinctions and call everything "covid" or "COVID".


2. I'm very much not the right kind of doctor, just a person trying to understand things, so don't take what I'm saying as medical advice.

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