Getting Used to Covid

Inurement is human nature, for better and worse.

A recent headline in The Atlantic asked one of the most important, and little-discussed, questions of the year: “How did this many deaths become normal?”

“The United States reported more deaths from COVID-19 last Friday than deaths from Hurricane Katrina,” begins the article, “more on any two recent weekdays than deaths during the 9/11 terrorist attacks, more last month than deaths from flu in a bad season, and more in two years than deaths from HIV during the four decades of the AIDS epidemics.”

And yet, it increasingly feels as if the American public thinks, “I’m done with Covid,” to use the memorable phrase of journalist Bari Weiss. No more mandates, masks, and restrictions. It’s over. Time for a ticker-tape parade.

The author of The Atlantic article is Ed Yong. So the article is thoroughly interesting, as any article by Ed Yong is. And it has many elements, as any article by Ed Yong does. But he gives only the briefest of mentions to something I think is fundamental., something so basic it too often gets much too little attention given its importance in human affairs.

To explain what it is, imagine you are a wild chimpanzee.

One day, a strange creature steps out of the jungle. It looks similar to you but it is taller, thinner, and much less hairy. You’ve never seen such a freakish creature before. Quite sensibly, you are alarmed, and you do what chimpanzees do when they are alarmed. You hoot and holler. You circle the creature warily. You stick with the pack and you are all alarmed together.

Finally, after an hour or two, the creature leaves.

The next day, same thing. The creature is still pretty strange but it’s a little less alarming.

The next day, same thing. Now, this creature is more annoying than alarming.

Of course, the creature is, unbeknownst to you, the famous-among-humans Jane Goodall. She wants to study you and the other chimps in your native habitat, but she can’t tell you to never mind her and go about your business, so she comes back, day after day, sits down and waits. And slowly, gradually, you and the other chimps get used to her. Eventually, you ignore her altogether and go about your business, just as she wanted.  

This is “habituation.” Repeated exposure to a stimulus gradually reduces its salience. In a phrase, you get used to it. Carried on long enough, habituation can make stimulus disappear entirely. Even the worst smell will eventually vanish if you are exposed to it long enough.

Of course, Jane Goodall wasn’t a threat to the chimpanzees she alarmed when she first encountered them. Ignoring things that have repeatedly been shown to cause no harm makes perfect sense.

But Covid is still killing people. And in numbers that were considered terrifying not so long ago. You may think it doesn’t make sense to tune that out.

But at a psychological level, it does. The world is full of threats. If we are alarmed and focused on one, we reduce our capacity to spot and deal with new threats, so it would be dangerous to maintain a perpetual sense of alarm. (And that’s without factoring in the damaging effects of constant stress.) Instead, the alarm should be reserved for when the Bad Thing is new and uncertain and it should diminish as the Bad Thing becomes familiar and understood. Even if the Bad Thing doesn’t go away.

This is “inurement.” We get used to the Bad Thing. It becomes part of the background noise of life, always there, seldom noticed.

When the H1N1 influenza virus appeared in 1918, it was an unknown new disease that quickly grew into a Biblical horror. One-third of the globe’s population was infected. An estimated 50 million people died. Life expectancy in the United States fell by 12 years. For reasons that aren’t entirely clear – it may be because the virus stimulated excessive immune responses that were themselves deadly – its victims were disproportionately healthy people between the ages of 20 and 40. Nothing like it had ever been seen before. The uncertainty was massive. The fact that it was a virus wasn’t even determined until 1930.

In the United States, the pandemic came in three waves in 1918 and 1919, then it was over. At least that’s the conventional telling of the story. As Ed Yong noted, quoting the historian John M. Barry, there was a fourth wave of flu in 1920, but officials didn’t respond and Americans essentially shrugged it off.

And even that understates the reality. The virus mutated into less virulent but still deadly forms, and it came back, year after year, all through the 1920s and 1930s, as what became known as the “seasonal flu.” And every year, it killed people at a rate that was far below the peak of the pandemic but still very high – so high it would have been seen as a horror before the pandemic. Yet it wasn’t seen as a horror. It was just there. Like background noise, seldom noticed.

In Only Yesterday – a popular history of the 1920s that was a massive bestseller when it was published in 1931 – the American journalist Frederick Lewis Allen started by reminding his readers of what life was like in 1919. In his profile of that year, there is only a single, minor reference to the plague of 1918-19. There isn’t even one reference to the flu in all the years that followed. In 1952, Allen published The Big Change, a similar book encompassing 1900 to 1950. It contains not one word about the flu. Not the pandemic. Not the seasonal flu. By 1952, the disease was routine. And routines go unmentioned.

The flu is an extreme case of inurement, but there are many other illustrations.

“Of all the menaces of today,” Woodrow Wilson declared, “the worst is the reckless driving of automobiles.” That was in 1906. At the time, American roads were still full of horses, wagons, bicycles, pedestrians, and children at play. Cars were expensive and rare. And dangerous, particularly to pedestrians and children. “Horrible and gruesome incidents are of almost daily occurrence,” a Congressman said in 1910, decrying “bespattered boulevards of blood.” The Congressman wasn’t exaggerating. In the early years of the automobile, cars ran down children at a staggering rate. As the years passed, the number of cars soared, and the fatality rate soared along with them, reaching its peak in 1937-40. Concern for traffic safety, however, peaked and started to fall long before the carnage did the same. People were inured to the losses. What had been horrific became background noise.  

People can become inured to almost anything. If almost any modern person were to witness the routine treatment of dogs and cats in centuries past, he or she would need therapy. But people did not need therapy when it was routine. Indeed, a lot of people actually enjoyed spectacles like the burning of live cats, to mention just one of the many dubious pastimes of our ancestors.

Or consider work conditions. I once toured “Zollverein,” a 19th- and early 20th-century German coal mine now preserved as a museum and design space, and was deeply impressed by the sheer weight and power of its massive industrial machinery. But the most oppressive element was missing. In operation, the machinery generated a cacophony of steel so relentless it temporarily deafened those exposed to it and permanently deafened the workers who came back day after day. An hour or two of it would have been agony to my unaccustomed ears. But the workers who spend decades in it were not in agony. They got used to it. And their wives made jokes about their deaf husbands. And that wasn’t the worst of the daily routine in Zollverein. In another part of the facility, children employed to sort the coal on swift-moving conveyors often had their fingers, hands, and lives snatched away. Sad. But normal. Carry on.

Inurement is both blessing and curse. The ability to push even the worst afflictions into the background and get on with life helps make people astonishingly resilient. War. Slavery. Displacement. There is no hell people can’t survive, thanks in part to inurement.

But inurement can also lead to things being pushed into the background and accepted as “just the way it is” when, in fact, they don’t have to be that way.

For many decades, Americans, in particular, accepted carnage on the roads as the cost of living in the modern world. Thanks to the determined efforts of the likes of Ralph Nader, that started to change in the 1960s. Changes were made to designs of cars and roads alike. The result, starting after 1970, was a decades-long decline in traffic deaths – from 26.8 deaths per 100,000 population to 11.9. Hundreds of thousands of lives were saved. How many lives could have been saved if earlier generations had not shrugged is impossible to know.

What about now? In 2019, 39,000 Americans died on the roads. We could reduce that by doing more – lowering speed limits, enhancing safety features, improving the designs of roads, expanding public transit – but for the vast majority road safety isn’t isn’t even an issue. The status quo feels somehow … acceptable.

The annual toll of seasonal flu varies widely, but the Centers for Disease Control estimates that the flu kills between 12,000 and 52,000 Americans each year. We treat that as background noise. “It’s no worse than the flu” was even used early in the Covid pandemic as a reason to relax and do nothing. But that death roll is between four times and 17 times the death toll of 9/11, which Americans responded to by turning the world upside down. So why are flu deaths treated so cavalierly? There’s more we could do to reduce those numbers, but we don’t do it because the status quo feels somehow … acceptable.

Of course doing more to reduce lives lost – to traffic, the flu, or anything else – carries costs. At some point, those costs really aren’t worth it. You may think that’s cold. “Even one life lost is too many.” That’s noble. But it’s also not true. We don’t actually live that way. We can’t live that way. Consider that we could eliminate virtually all traffic deaths tomorrow simply by imposing a universal maximum speed limit of, say, 10 mph (16 KPH) and strictly enforcing it. But we never will. And rightly so. Because, in addition to many other costs, it would severely damage the economy and make us all a lot poorer.

So what, then, is the “acceptable” level of lives lost on roads? We can’t answer that simply by looking at data. We have to examine the trade-offs – how much cost for how much safety? – and we have to ask whether particular trade-offs are worthwhile. What qualifies as “worthwhile” is a matter of values, not data. We also have to ask who pays? How? Is that fair? These also speak to values, not data.

“Trust the science” has become a popular motto in the last couple of years. I admire the sentiment but its applicability is far more limited than, I suspect, many people realize. Science can settle empirical questions. It is silent about values. So questions about safety and trade-offs are not scientific and scientists cannot settle them.

They are political. We must decide.

When Covid arrived, the countdown to inurement started, and here we are, with vast numbers of people saying, in effect, “I’m done with Covid” at a time when Covid is not remotely done with them. So what now?

It is a mistake, I think, to point to the numbers and insist people maintain a state of alarm and continue to embrace emergency measures. That’s a fight against human nature. Human nature always wins.

But we also need to recognize that inurement urges us to accept the status quo not because we have carefully examined solutions and weighed the trade-offs and found that the status quo strikes the optimal balance. Inurement urges us to accept the status quo only because it is the status quo.  

That’s lazy and indefensible. We can do better.