Delta Has Changed the Pandemic Risk Calculus

By Amanda Mull, The Atlantic

19 August 21

If you’re confused about what you can do right now, you should be.

or the past year and a half, humans around the world have been asked to do something we’re pretty bad at, even in the best of circumstances: figure out what constitutes safety, and act accordingly. A well-understood risk doesn’t necessarily improve our thought processes, thanks to a host of cognitive biases and external pressures that pull some people away from the lowest-level danger and push others toward clear peril. In the United States, at least, the circumstances for making these decisions during the pandemic have been far from ideal, as millions of people have been yanked in either direction by misinformation or political stratification or financial necessity.

Vaccination was a reprieve from this calculus of personal danger, at least for a while—get vaccinated, get your family and friends vaccinated, get back to a far more normal version of life. To a certain extent, that logic holds: The vaccines are still doing a fantastic job preventing hospitalization and death from the coronavirus’s far-more-transmissible Delta variant. But as COVID-19 cases and hospitalizations have roared back, concerns about breakthrough cases among the vaccinated and increased transmissibility among kids have muddied a lot of people’s ability to gauge their own day-to-day risk, just as they’d begun to venture back out into the world and hug, eat, and laugh in the same airspace together again. In some ways, pandemic life is more confusing than ever.

What makes our current moment tricky is that pandemic risk has never been more highly variable, which means the list of things to consider about any given situation is longer and has fewer hard-and-fast rules. Vaccinated people are still far safer than they’ve been for most of the past year and a half, and the unvaccinated are in even more danger than they were in March 2020. The Delta variant is, in some respects, a whole new ball game. What rules are we playing by now?

Delta behaves differently from those that came before it in key ways: It spreads between people far more effectively, it seems more likely to cause a contagious “breakthrough infection” in vaccinated people, and it appears to spread more readily and lead to symptomatic disease more often among kids too young to be vaccinated. Whether Delta causes more virulent disease is, for now, an open question. We’ll get to more open questions shortly.

Because of these differences, there are two categories of things you should consider when you contemplate booking a vacation or responding to a wedding invite. The first is what you might reasonably know about your situation and the event at hand. “It’s your vaccination, and then the vaccination levels of people around you, and then the disease rates happening around you,” Tara Kirk Sell, a researcher who studies risk communication at the Johns Hopkins Center for Health Security, told me. “Do you have kids or not? Are they going to school?” All of these types of questions, she said, help paint a picture of the potential danger you might represent to unprotected people around you, should you get sick. The less likely you are to be exposed and the fewer unvaccinated or immunocompromised people you could conceivably infect, the more confident you should feel.

Assessing risk pre-vaccination was often bleak, but at least the variables at play were somewhat limited: ventilation, masks, crowds, local spread. Now the number of additional, usually hyper-specific questions that people must ask themselves is itself a barrier to good decision making, says Jennifer Taber, a psychologist at Kent State University who studies health risk assessment. “When people feel like things are uncertain, they engage in avoidance,” Taber told me. That can manifest in disparate ways. An unwillingness to acknowledge that many new things are safe for the average vaccinated person is avoidance. So is a refusal to continue taking even minor precautions for the benefit of others.

All of this is made worse given that accurate answers to risk-related questions can be frustrating to gather and difficult to parse, especially in places where local governments limit data collection, and where admitting to being vaccinated can be social apostasy. “There are so many things that make it harder, and not a lot of things that make it easier right now,” Taber said. “Even within the context of good information, there’s so much uncertainty that it makes it really hard for people to make really well-informed decisions.”

That brings us to the second, murkier category of information to consider when gauging the safety of a situation: What do we actually know about the Delta variant and the risks it presents? The situation is, unfortunately, evolving. Because the United States is testing at only a fraction of the rate of countries such as Israel and the U.K.—stop me if this is giving you flashbacks to the spring of 2020—the frustrating reality is that we just do not have a reliable picture of how much infection is currently happening here. When you don’t have an accurate denominator on which to base things such as rate of breakthrough, hospitalization, or death, you have a pretty useless fraction. (Unfortunately, for similar reasons, we are also short on accurate numerators—the CDC is not tracking things like breakthrough infections, and state-level data are sparse.)

Unvaccinated people tend to be clustered both geographically and socially in the United States, and so national or even state-level rates of vaccination are not terribly useful in understanding personal risk. The catastrophic spikes in infection currently devastating places with low vaccination rates, such as southern Louisiana and southeastern Missouri, change how even vaccinated people in those places should think about socializing or traveling, relative to their counterparts in places with high community buy-in on vaccines. Because they are far more likely to be exposed to the virus than someone living in, say, Vermont or Maine, the knock-on effect is a far greater likelihood of spreading the infection to others. And as Florida’s current outbreak makes clear, even middle-of-the-road statewide vaccination rates will not be enough to dampen Delta’s spread on their own.

These gaps in information and state-by-state discrepancies make any sort of risk generalizations difficult, if not counterproductive. What we do know is that vaccination remains the best way to stay healthy, by far: According to a survey of hospitals from ABC News, 94 percent of COVID-19 patients in ICUs at the end of July were unvaccinated, and most of the rest had health problems that likely contributed to decreased vaccine effectiveness. Young, healthy vaccinated people who are working in person or socializing in crowds should take precautions around elderly or immunocompromised friends and family, even if they are also vaccinated, but overall, vaccinated people still can feel quite confident in their personal safety.

How the vaccines are doing against any level of infection is less clear. The most recent and comprehensive data available—from the U.K.—suggest that current vaccine regimens are somewhat less effective against Delta than against previous strains of the virus, but the difference isn’t enormous. If that information feels at odds with reports you’ve heard about breakthrough infections in the U.S., it isn’t necessarily—uncontrolled spread of a highly infectious disease means that even relatively uncommon events are going to happen in pretty large numbers.

Speaking of breakthroughs: One thing that needs to be accounted for is the potential of infecting others if you become sick, even after getting vaccinated. A few weeks ago, the CDC raised eyebrows by estimating that vaccinated people who manage to get infected by Delta may produce the same amount of virus in their nose as unvaccinated, Delta-infected people do—an unexpected sign that vaccinated people could be equally contagious when infected. But the agency’s analysis was based on specific and fairly extreme circumstances: an outbreak in Provincetown, Massachusetts, among a mostly vaccinated group during a week of festivities in which people crowded into old, poorly ventilated buildings. A large analysis of Delta transmission in the U.K. found that vaccinated people carry, on average, lower levels of virus in their nose, which suggests less ability to transmit the virus; a recent study from Singapore found that vaccinated patients were able to clear the virus much faster, shortening the number of days during which they might be contagious. (Although no data are available quite yet, the efficiency with which vaccinated people clear the virus is also thought to make the sometimes severe post-viral COVID-19 symptoms commonly known as long COVID considerably less likely, by preventing the illness from settling in the lungs.)

What must be acknowledged now, a year and a half into the pandemic, is that COVID-19 is not the only risk that people need to balance. Forgoing regular socializing, routine medical checkups, and in-person schooling might be worthwhile in the short term, but abstaining from all of those things in perpetuity comes with its own dangers. “What we’ve given up is not nothing,” Kirk Sell told me. “Something that has been lost in the past year and a half are the trade-offs, and the introduction of readily available and highly effective vaccines and some people’s refusal to get them just makes all of this internal math so much trickier.” As someone who studies risk communication, she said, she hates the phrase an abundance of caution. If you find yourself determining that things you want to do are pretty low risk and still shy away from them, you’re likely cutting yourself off from opportunities that may provide significant health benefits: getting out to exercise, resuming regular social relationships with vaccinated friends and family.

Kirk Sell uses her own decision calculus as an example of what those kinds of evaluations might look like: She thinks it’s very important for her kids to have school in person, even though they are too young to be vaccinated, but she is also actively lobbying the school to implement ways to make that safer, such as enhanced ventilation and filtration. For parents whose kids did relatively well in Zoom school or whose community is in the middle of a serious outbreak, she says, the best conclusion might be a different one, and it might change for any parent as the school year progresses and local case rates go up and down.

Try thinking about precautions in non-pandemic terms, Kirk Sell advises. Every day, people follow safety rules that might not be personally necessary for them, but that also aren’t onerous enough to be harmful—doing so is simply part of living in a society in which you share norms and risk with those around you. “I can swim, but when I go out kayaking, I still wear a life jacket, because it’s required as a general safety approach,” she explained. “Just because you are safe doesn’t mean you don’t have any rules to follow anymore.” This is, perhaps, somewhat understating it: Before Kirk Sell was a scholar, she was an Olympic-medalist swimmer who held the world record in the 100-meter breaststroke. There are few people on Earth at less personal risk from tipping out of a kayak. So, yes, you can probably find it within yourself to continue to wear a mask at the grocery store if the infection rate is growing in your area. You probably do other stuff on that same logic all the time.

If you have read all this hoping to get some solid answers on what you should be doing and now feel like it would have been easier for me to publish, say, a shruggy emoji, I sympathize. It can be difficult to feel like you’re doing the right thing when what that means is so different from person to person, depending on their particular circumstances. People frequently use the behavior of those around them to guide their own understanding of risk, Taber told me, and the fact that everyone around you now has a whole host of personal circumstances to consider when making their own decisions can short-circuit our ability to do that as confidently as we might have a year ago.

Americans will likely be riding this roller coaster of risk assessment for some time. Periods of confusion are natural as we learn what waves of the Delta variant under the country’s modest-at-best safety protocols look like, and we’ve yet to see how swiftly the next wave can be expected after one ends. People are tired of good behavior, and they’re tired of self-abnegating to protect others whom they perceive as refusing to protect themselves, even if that’s not an accurate understanding of why many people have yet to be vaccinated. Right now, the best that most people can do is continue to control whichever straightforward variables they can—get vaccinated, sit outside when possible, choose places that require proof of vaccination over those that don’t, avoid visiting Grandma or your cousin’s new baby the week after attending an indoor concert with a thousand screaming people, get a test if your throat is sore. The situation we’re all in is extremely complicated, but the best ways to keep yourself and others safe still aren’t.

Afghanistan's Footprint

By Stephen Eric Bronner, Reader Supported News

19 August 21

In Memory of Stanley Aronowitz

ormer secretary of state Colin Powell’s “pottery barn rule” applies: “You break it, you own it!” But of course then you can always throw “it” away. That’s what occurred in Afghanistan, known as “the graveyard of empires” because it has historically been difficult to govern and more difficult to conquer. The United States sent in a raiding party to capture Osama bin Laden following 9/11/2001 and then, like “the man who came to dinner,” remained for 20 years – just long enough to keep rekindling an endless civil war, install its proxies, and then leave the nation to rot. Not that this hasn’t happened before in Vietnam and in Syria. There, too, we came, we wrecked, we lost, and we left – though we still engaged in a few post-departure drone strikes and some useless bombing for good measure. Following President George W. Bush’s proclamation of ”mission accomplished” in Iraq, roughly 1/4 of its population wound up either dead, wounded, homeless, or in exile. The Iraqi infrastructure was in shambles, the ecological damage remains brutal, and its a miracle that Bush and his neoconservative henchman escaped indictment by the International Criminal Court for crimes against humanity.

Now the shoe is on the other foot; it’s Afghanistan’s turn to leave its footprint in the sand. Having thrown out the former Soviet invaders in 1989, a loose coalition of ethnic minorities began fighting among themselves. Formed in 1994, the Taliban billed the power vacuum, and finally did the same to the United States. Now there is chaos at the airports, everyday people are scared, and the government is preparing for a shakeup. But the chaos will pass. Civilians will adapt. Draconian punishments could lessen. The new regime might even keep its promise of blanket amnesty and create an Islamic yet “inclusive” society. Yet such a program would contradict the extremist identity that inspired the Taliban over the years. It is difficult to assume that religious absolutists will extend the hand of friendship to the “other.” deep skepticism is necessary concerning the Taliban’s avowals of pluralism and recognition of women’s rights. Nevertheless, the United States and the world community should remain agnostic for now about how this will all turn out.

The United States will have little to say about this: that is what it means to lose. Today, indeed, caution and uncertainty are virtues. Acting precipitously from the desire for revenge for 9/11 first led the United States into the quagmire, and the war was lost as failure spurred the emotional need to engage in a full-scale invasion. The United States took charge of a fractured anti-Taliban coalition of warlords and tribes that lacked a unifying sovereign. Its military proudly occupied Kabul and the ancient city of Kandahar. But there was a problem from the start. American forces lacked support in the countryside, and military command made conditions more unfavorable by backing up Afghani ground troops with bombings that produced havoc among civilians. Worse: there was nothing to be done about the ingrained corruption of the Afghani state with its drug economy.

The United States never coherently articulated the strategic goal of its Afghani policy, outside of killing Osama bin Laden, and it suffered a severe bout of “mission creep.” This malady refers to the unconscious and gradual transformation of aims and the ever-changing justifications required to support them. The seemingly simple plan to eliminate a terrorist quickly got out of hand. Soon, the United States was providing military support for the enemies of those who were hiding him, namely, the Taliban. In for a penny, in for a pound: conflict between warlord leaders made it necessary for the United States to prop up a pathetic regime and ultimately identify with its proxy sovereigns. WHAT was previously seen as a civil war thus became America’s war, which made the fear of losing greater, and lessened the urgency of preparing an exit plan.

Neither in nor out, the United States vacillated. As with the Bay of Pigs, Vietnam, Iraq, and Syria, America’s elected government was constantly misled by a mendacious, self-interested, and supposedly apolitical military establishment. Seeking increased funding with each new budget, it celebrated supposed victories in public, while cynical rumors about inevitable defeat made the rounds in private. With each new budget came the spurious rationalizations for increased funding. Greed was also complemented by ignorance, and ignorance by arrogance. American policymakers consistently underestimated the diplomatic and military skill of the enemy – perhaps because there was so little expertise concerning the actors involved and the region’s political complexities.

The United States went into Afghanistan nominally allied with sixty nations and under cover from the United Nations, which legitimated its attempt to capture Osama bin Laden as an ACT of self-defense. Of course, matters didn’t end there. Over the last twenty years, at its peak, 100,000 troops were in Afghanistan. By 2017, there were 15,000 left and then, after cordially announcing its date of departure as 9/11/2021, there were none. Or no, there were 2,500 troops left. Fold? Or up the ante? On August 14, 2021, another 1000 were sent. No wait, 4,000 more were ready to go. Who cares? What counts is that we are getting out – or not.

Public opinion might just swing back the other way given the polarized state of American politics and its momentary enthusiasms. “Shock” that the Taliban took military advantage of peace talks or the American withdrawal, rather than halt its advance to please its enemy, is either disingenuous or criminally naïve. What’s more, the Taliban would have triumphed whether troops were pulled on May 1, 2021 – as President Donald Trump promised – or today or tomorrow. Blaming Biden for pulling out too soon is absurd. That the withdrawal of American troops could have been undertaken with more finesse is another matter, though even then the victor’s footprints would have been left behind.

The United States Embassy will soon be empty – or in ruins. American arms are being confiscated by the Taliban. German, French, and Italian diplomats are trying to leave. UN peace-keepers and human rights activists are stuck. Communication has broken down. Emigrants are massing on Afghanistan’s borders. Its citizens hover between the ambitions of warlord politicians representing the old proxy state, outright anarchy, and theocratic genocidaires ready (perhaps) to make more heads roll.

How could it come to this? What were our policy-makers thinking? Best to begin with a very American trait – we don’t like to lose! Remember: Donald Trump began his presidential campaign in 2015 not with a white supremacist diatribe, but by rhetorically asking – “when was the last time we won anything?” Four presidents extended America’s stay in Afghanistan, or vacillated concerning its departure, in part because none of them wished to take responsibility for being the first commander-in-chief to lose a war.

Leaders like to think about their legacies; it’s undoubtedly part of being a leader. Following 9/11, it is easy to forget, Islamophobia was galloping through the United States like the plague. Enraged citizens were calling upon the government to “do something” while eating their “freedom fries.” Decisions were made. But times changed – albeit somewhat slowly. According to a March 19, 2021 report by Brookings, more than 60% of Americans supported withdrawal (without a timeline) while 20% opposed it. Getting out must have seemed a prudent political decision for Biden to make – at least at first. The media stepped in and its now fifty-fifty. Whether or not Biden was actually surprised by events, they shook the American public out of its lethargy. Some on the right felt angry and betrayed, while many on the left felt manipulated and guilty.

President Biden inherited a mess that he clearly made messier. Once Chairman of the Senate Committee on Foreign Relations and a supposed expert on foreign affairs given his vast “experience,” which Oscar Wilde noted “is the name we give to our mistakes,” Biden had originally supported the attacks on Afghanistan and Iraq. He tamed down a bit while vice president during the Obama years. Yet his decision to withdraw from Afghanistan was a bold reversal. He promised that all would go smoothly. But then came the “bad optics,” and the scenes reminiscent of Saigon in 1975.

The Republicans were quick to pounce, and they followed Trump, their leader, by calling for Biden’s resignation. As usual, of course, the former president offered no meaningful policy alternative. The real defeat was apparently not the result of Bush’s war, but of the mismanaged withdrawal and the betrayal of our collaborators. One thousand exiles a day have entered the United States since August 13, 2021, however, and it’s not as if the Republicans have exactly been friendly to immigrants. If those numbers continue, indeed, their supposedly principled concern for them will most likely become transformed into a new bout of xenophobia. In any event, Trump’s own improvised peace treaty was thoroughly bungled: there was nothing substantive about human rights, evacuees, or the condition of women. That the former president should now call on Biden to resign for leaving these victims in the lurch – and for incompetence – exhibits a hypocritical chutzpah that is extreme even for our most prominent pathological egoist.

Claims that Biden should have included the Afghani government in the decision-making process presuppose that it was sovereign – it hadn’t been in years. Admittedly, he could have provided visas earlier and escape plans for our collaborators. The president might also have begun negotiating an international response to the plight of immigrants and executed the military withdrawal in well-defined stages. Easier said than done. Bureaucratic competence in moments of crisis is usually a vain hope. Which states would prove reliable in helping with immigrants is also unclear. Unless Biden had publicly declared his decision to stay the course, moreover, whether to withdraw gradually or not would have had little impact on the final result. It is difficult to invent an exit from a twenty-year war that neoconservatives undertook without a clear sense of purpose.

But there is something else. The American intelligence establishment radically underestimated the Taliban’s base of support. Unlike Boko Haram, al-Shabab, al-Qaeda, and other extremist organizations, the Taliban was not comprised of a few hundred fanatics thoroughly divorced from Afghani civil society. To the contrary: the Taliban represented those elements of the nation who identified with the agrarian economy, tribal lifestyles, and atavistic religious traditions, which appear increasingly threatened by Western infidels and a globalizing modernity. It is worth noting that three-quarters of Afghanistan is decidedly rural, and that repression following the Taliban victory is occurring primarily in the cities.

Who benefited from this mess? Who paid the price? Both Republicans and Democrats originally supported the invasion of Afghanistan, and they will undoubtedly point to the 6,200 American soldiers and contractors killed, the 20,000 wounded, and the $2 trillion in loans taken by the United States to pursue the war that, according to Forbes (August 16, 2021) could reach $6.5 trillion in debt by 2050. Of course, it was far worse for the Afghanis: 69,000 police and military dead, 48,000 civilians, and roughly 200,000 wounded. These numbers were surely helped along by Trump’s massive air raids of 2019.

Afghanistan is right back where it was when the United States first intervened. The rationale for American intervention is still lacking. There was no geopolitical gain; the national interest was not served; human rights remain imperiled; and material costs dwarf any possible benefit. Will the American public grasp the reality? Or, better, the deeper reality beyond the heart-wrenching photos and videos of Afghanis by the thousands trying to leap on departing planes, desperately awaiting rescue on rooftops, densely crowding the roads, trembling in fear of the looming purges, dreading the repression of women, and bewailing the introduction of rigid Sharia law.

That deeper reality is: the Taliban won. The country has been wrecked, purges will take place, and the United States will lose credibility and probably suffer a new version of the “Vietnam Syndrome.”

As he threatened, President Biden can begin bombing should the Taliban interfere with the “evacuation,” or any other stated concern, and even reinsert troops. But it’s too late. Using military force to salvage order from chaos does not exactly offer a plausible connection between means and ends. Such a strategy would also further harm American standing in the region. It would be better to aid those friends and allies trying to get out, either by taking them in ourselves or helping other nations to do the same. It would be better to develop some version of the Berlin airlift of 1948-1949, which successfully dropped food and supplies to an imperiled populace, and offer to build hospitals and clinics for the Afghani people. With an eye on Russia and China, and the help of renowned moderate imams and the Arab League, President Biden and an international team might also try integrating the Taliban into the world community.

The United States should not pretend that its original goals in Afghanistan have been met, or can be met in the future; that an alternative to the Taliban exists; that America bears no responsibility for what transpired; or that some “stab in the back” by liberal doves made victory impossible. There is already revanchist talk by Republican about Afghanistan becoming the launching pad for fresh international jihads in some tired imitation of the old domino theory – and how it is necessary to “do something!” Again? Really? Let’s first see what the Taliban does. It’s still early. Purges, pitiless repression, enforced ignorance might all come later – or not. Movements can change – and the United States must remain open to that possibility. In any case, it’s time to turn the page and, for better or worse, begin a new chapter under the title: Taliban Redux.

Stephen Eric Bronner is Board of Governors Distinguished Professor Emeritus of Political Science at Rutgers University and Co-Director of the International Council for Diplomacy and Dialogue. His most recent book is The Sovereign (Routledge).

Reader Supported News is the Publication of Origin for this work. Permission to republish is freely granted with credit and a link back to Reader Supported News.