Four vaccinated adults and two unvaccinated children had mild symptoms. Is this what the end of the pandemic looks like?
A few weeks ago, just after returning from a brief reporting trip to Baton Rouge, I went with my wife, Heather, and our two children on a late-summer vacation to a small house we’d rented in the Catskills. The house had caught our eye: it was a tiny place, a sort of architectural bento box that suggested the delineation of space without actually having walls between rooms. Arriving, we thought, This is going to work. The kids loved it immediately. There were all kinds of drawers and compartments to go through, everything made to fit, and there was a fire pit where we made s’mores, and everywhere we went the mountains opened up in front of us beautifully. We were operating, we knew, in spite of the pandemic; we’d booked late and overpaid. But by the second day we started to experience the happy, seditious feeling of vacation—it felt as if we were getting away with something.
On day three, on a big hike to a waterfall, across mountain streams flooded by rain, I felt two sharp pinches on the right side of my chest. The first was just after we’d forded a stream, when I grabbed my son by the arms and swung him across to the bank. The second was about ten minutes later, at the top of a climb. The rest of the hike was uneventful (though the waterfall was spectacular), but when we got back to the house all I wanted to do was lie down. “Daddy carried a really heavy backpack,” my son explained to his sister. Maybe? I thought. It wasn’t that heavy. The next morning, we took the kids to Storm King Art Center, and I felt fine, but when we got back to the house I just climbed upstairs to the loft and immediately fell asleep. It was mid-afternoon. Heather, who is an oncologist, came up to assess the situation. My lower back and shoulders were aching, and I felt as if my face were burning, but I had no fever, and I didn’t feel in any special distress. It could be covid-19, she pointed out, but we were both fully vaccinated and had been so careful.
“Baton Rouge?” I said. “It’s a hot spot.”
“Oh, no,” Heather said with medical finality, and from that point forward I was pretty sure what was going on.
The next morning, I drove to an urgent-care clinic in Kingston. I found, oddly, that I felt a little better than I had the day before. The muscle ache was gone. My temperature read 98.2. When a nursing assistant asked what my main complaint was, I said, “Fatigue.” But the symptoms and my travel to Louisiana were enough, so the nurse practitioner ordered a rapid test, and about fifteen minutes later it came back positive. covid it was.
I found it a little hard to make sense of my situation. On the one hand, I wasn’t that sick, and I knew the statistics well enough to understand that I probably wasn’t going to get that sick. Detailed data from the public-health department of King County, Washington, (which includes Seattle) suggest that vaccination cuts an individual’s risk of hospitalization and death to less than a fortieth of what it would be otherwise. Researchers at Yale conducted a study of the breakthrough cases in their health system and found that the average age of the patients sick enough to require oxygen was just over eighty. (Those data were collected before the Delta surge, but when I spoke with the lead author, Dr. Hyung Chun, he told me that the average age of recent breakthrough cases had come down by just a few years.) I asked Dr. Céline Gounder, an infectious-disease doctor and covid expert at N.Y.U., if these statistics meant that a breakthrough case was similar, in terms of severity and risk, to having the flu. “I think that’s a good comparison,” she said.
I was relatively protected from harm, but that didn’t mean others were completely protected from me. Those maps which show vaccination rates by state make it seem as if we live in two countries, one vaccinated and the other not, but that seemed pretty misleading—there were unvaccinated people all around me. Massachusetts, where we live, ranks fourth in the nation for vaccination, with sixty-seven per cent of residents fully inoculated, but that still leaves an awful lot of unprotected people. Our kids, who would be starting first and fourth grade in a few days, were not yet eligible for vaccines, and neither were any of their friends. Heather sees breast-cancer patients, many of them immunosuppressed, in clinic every Wednesday. Almost all of them were vaccinated, but they would be especially vulnerable to breakthrough infections, and a few had not received the vaccine. Meanwhile, I had developed a hacking cough and was sneezing, making it plain that I was projecting the virus all over the place. I wasn’t very sick but I was still a threat.
The bento-box house suddenly seemed ridiculous. If we wanted Heather to see patients and the kids to start school on time, they needed to be quarantined from me, and you can’t quarantine in a house that substitutes elegant architectural suggestion for walls. We packed up and drove back home. On the way—between phone calls from public-health nurses, and with their assistance—we made a plan. I’d stay by myself in our home office and sleep on the pullout couch there. If I left the room, or if someone else came in, I would wear a KN95 mask. I would use the smaller bathroom, and everyone else the larger one. I ate dinner in the office while Heather and the kids ate dinner in the dining room, and we yelled banter at one another from two rooms away, which mildly alarmed the kids and highly alarmed our dog. A friend had sent a boxed bonsai (“Something to do!”), but I just looked at the box resentfully. I thought, So this is what it is like to be divorced. One evening, after the kids were in bed, Heather came in to say hello. Both of us were wearing KN95 masks. “What are you—” she began. She meant to say, What are you watching? I had an episode of “The Bureau” playing on the computer, in French with subtitles, probably a bit too loud. At the same time, open on my lap, ostensibly being read, was a book about the rise of Nazism. She said, “What are you doing?”
Whatever I was doing—whatever we were doing collectively—it didn’t work. On Saturday morning, four days after my first symptoms, our daughter, Maude, said she felt a scratch in her throat. Everyone got tested. Maude had covid; Heather and our son, Sam, did not. We made new plans. Maude would stay in the spare bedroom with me, where we would eat and sleep, and we would share the second bathroom. I felt very guilty: my daughter was sick because of me and would now miss the first week of school. But that also meant I could read “Harry Potter” with Maude before we went to bed, and talk about what fourth grade would be like, and have some semblance of a normal parental life.
By this point, we were in regular touch with nurses from at least five different jurisdictions: the public-health nurse from the town where we live, who called every morning (we came to know her well enough that I began my e-mails to the public-health account with “Hey E.J.”); the school nurses; the occupational-health nurses from Heather’s hospital; the nurses from the pediatrician’s office; and the nurses from my primary-care physician’s office, who were conducting some sort of study and wanted daily updates on my condition, which remained basically unchanged. I had a bad cough but otherwise felt fine. Having a breakthrough case of covid, for me, turned out to be thirty-six hours of flu, followed by ten days of being in the Army. The four of us now each had our own timeline for a return to normal, and different isolation conditions we had to follow. Quite quickly, it seemed to us that we would not be able to keep Sam and Maude from playing with each other, so we made a fateful decision. We called Heather’s parents—both about seventy years old and vaccinated—and asked if they would take Sam for a few days, until Maude and I had finished our ten-day quarantines and he could go to school. They live on a lake, and he could swim there—a much better environment before first grade, we thought, than an apartment filled with contagious disease. Eager to help, Heather’s parents thought that it was a good idea, too. Sam had just tested negative, so the risk to my in-laws did not seem so high.
You can guess what happened next. The Delta variant comes for everyone. Heather was being tested every forty-eight hours, and eight days after my first symptoms she had tested positive, too. Sam developed a very slight fever, not high enough to qualify for a rapid test, but his grandparents took him in for a PCR test, and the results confirmed that he also had covid. Meanwhile, his grandparents felt fatigued and achy, and by day twelve of our outbreak they both had tested positive. We were all mostly fine, but we had managed to create a supercluster: six cases, four of them among the vaccinated.
One evening, not long after Heather’s parents tested positive, Heather and I were discussing the situation. She said, “This is going to sound weird, but did it feel to you like your head was a little bit detached from your body?”
I take everything Heather says seriously. I thought about it hard—so hard and so visibly, screwing up my face, that she started laughing. About then I realized the nature of our good fortune. We were not at risk of losing our jobs if we missed a few days of work, we had a spare room to quarantine in, and we had kind and forgiving grandparents on hand. But mostly we were fortunate because we were vaccinated, a fact that turned our experience from something profoundly scary into something that we could see some comedy in, even as it happened. Had I ever felt, in the depths of my covid experience, as if my head were detached from my body? I said, “No, not at all.”
While we were all laid up at home, two questions seemed to dominate the public debate around covid, to which we were now very attentive. The first was how the vaccinated ought to feel about the unvaccinated. In the Times, the sociologist Tressie McMillan Cottom wrote a frank op-ed titled “The Limits of My Empathy for Covid Deniers.” Of the deniers, she writes, “Demonizing them turns my community into a reactionary force.” In The Atlantic, the journalist Elizabeth Bruenig argued that liberals seemed more interested in scolding the unvaccinated than persuading them. She suggested that among the unvaccinated there was “significant willingness to consider vaccination” and that, though she didn’t use these words, a bit of empathy for them might help. When Joe Biden gave a covid address, he seemed, much like McMillan Cottom, to be running out of empathy. “We have been patient,” he told the unvaccinated. “Our patience is wearing thin.” Watching the live stream in quarantine, I wondered whether the emotional pressure on this question might ease if the patterns we see now continue, and it becomes obvious to everyone that breakthrough cases, though not rare, are usually mild, and that the vaccinated have about as much to fear from covid as they do from the flu.
The second big question that circulated during our convalescence was what the next phase of the pandemic will look like. The news was filled with contradictory indicators: cases and deaths were still very high, and economists were warning that the unvaccinated were suppressing what would otherwise be a robust recovery, but schools were opening and the Delta surge seemed to be abating. “Fundamentally, breakthrough cases are the future of covid-19,” Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota, and who was a member of the Biden transition’s covid task force, told me recently. Osterholm pointed out that, in Minnesota, where vaccination rates are high, breakthrough cases already represent a third of all cases. He said that he could foresee a situation in which, in the absence of third doses, breakthroughs represent a larger number of covid cases and the illness they cause in most instances remains relatively mild. Waning immunity or further evolution of the virus could also mean that breakthrough cases grow more severe, making booster shots essential. The question of how breakthroughs evolve, Osterholm said, “is really critical.”
At the moment, according to William Hanage, an epidemiologist at the Harvard T. H. Chan School of Public Health, my own family’s case was “actually fairly typical.” What made it characteristic was not just the mildness of our illnesses but also the speed at which the virus had moved through our family. Hanage said that this experience was reflective of the extreme transmissibility of the Delta variant. “At least part of Delta’s success seems based on the fact that it replicates really quickly so that people can become infectious before their immune system has woken up and jumped on the infection,” he said—in other words, before they feel sick. That phenomenon would be consistent with a rise in cases like mine, in which the virus infects everyone in a family despite efforts at isolation. It also has consequences for workplaces and schools, where you might want more frequent testing to try to keep too many people from being home sick at once, and could be particularly dangerous for nursing homes, where an outbreak of breakthrough cases might still be deadly. “You don’t want even a vaccinated person walking into a nursing home with covid,” Hanage said.
Even if most breakthrough cases were not severe, he said, the goal now is similar to what it was in March, 2020—to “flatten the curve.” The reason that all those nurses kept calling my family with so many different instructions was because keeping people with mild cases like ours from transmitting the virus to more vulnerable groups was key to “preventing a short-term overload of the hospital system on the way to Delta becoming endemic.” Maybe the endemic phase is already beginning. Hanage pointed out that Massachusetts currently has about five times as many covid cases as the state did last September, but only half as many deaths. He said, “Next year, when you and I talk, we’ll probably be talking about whether whatever covid is around plus flu will be serious, and the next year we probably won’t be talking about it all. We should be moving away from the panic stations to the recognition that this is a management issue.”
In our own family, the tension began to ease on the fifteenth day after my first symptoms, when it became clear that Heather’s parents were improving. Their illnesses had lasted slightly longer than our own, but had not been much more severe—the same combination of cough, aches, and general lying-on-the-couch fatigue. In our own house, I came off quarantine first, and then Maude. On her first morning of freedom, we went to the park at 5:45 a.m. to kick around a soccer ball. Then she went to fourth grade, just three days late. Even the public-health nurses stopped calling. Sam’s quarantine lasted longer, but he had never been detectably tired, so the final hours of our quarantine were defined by a first grader’s pinball curiosity. Looking thoughtful, he wandered into my office while I was on a Zoom. I muted the computer. “What’s in air?” he asked. “Heat?”
One of the striking patterns of the pandemic, much noticed by economists, is that behaviors have bunched together, so the same people who are more likely to get vaccinated are also more likely to reduce their economic activity, and to mask, and to stay at home—behaviors that in theory might substitute for one another (a vaccinated person should feel more comfortable going out, for example) but in practice don’t. A front-page Times report last week suggested that the Biden White House was increasingly alarmed by what it perceived as “a psychological spending drag on those in highly vaccinated areas. That is because vaccinated Americans appear more likely to pull back on travel, dining out and other activity out of fear of the virus.” The precautions my family were asked to take were not extreme. If, as Hanage suggested, they are helping to prevent a “short-term overload” of the hospital system while we ride out Delta, then they are more than worthwhile. But if we reach a point where the vaccinated are acting primarily to protect the unvaccinated, who have had many chances to protect themselves and decided not to, then maybe it is time to reconsider.
This week, the Brown University economist Emily Oster argued in her covid newsletter that “When will COVID be over?” is the wrong question. Oster wrote, “Let’s ask instead: When can I stop obsessing about calculating COVID numbers around every choice I make? The answer here is: When you decide to. And it will be a conscious decision.” For us, that point is fast approaching. Last week, on Heather’s third day out of quarantine, she said to me, “That’s it. I’m planning a Christmas vacation.”
(Sources: The New Yorker)
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