Covid and the Tree of Knowledge

Has trying to protect society from the pandemic led to an over-emphasis on personal risk? And what's that got to do with the Garden of Eden?

In today’s world where everyone likes to assume bad faith and jump to incomplete conclusions, sometimes it’s worth stating your premises at the top, so to be clear:

• Covid-19 is a highly infectious disease that has killed several million people

• Vaccinations significantly reduce the risk of severe Covid-19, especially in people who have never caught the virus

• I have had three doses of the Pfizer vaccine myself

• I wear a mask indoors in public places, and think masks help prevent the transmission of the virus.

• I think lockdowns and other restrictions may, at times, be the appropriate policy response to a virus pandemic wave, as they were in 2020.

OK, now that’s all out the way, we can begin.

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Ivermectin and the cure for the common cold

A few days ago I highlighted how Reuters misunderstood a press release on Ivermectin.

Arieh Kovler @ariehkovler

Reuters really screwed up just now, wrongly reporting that a Phase III clinical trial showed Ivermectin was effective against Omicron, and then correcting the story after damage was already done.

The details aren’t really important. Basically, a Japanese pharma company announced that Ivermectin retained antiviral properties against the Omicron variant in a test tube.

We’ve known all along that it had such properties against the other variants of the coronavirus — that’s why, a year and a half ago, people thought it might help with Covid. Research so far has NOT found any antiviral effect on the coronavirus in humans, and this press release didn’t say that it had.

But because Kowa, the pharmaceutical company, is also conducting a large human trial of Ivermectin for Covid, Reuters (with the help of a confusing press release and bad translation from Japanese) garbled the two issues and reported, briefly, that Ivermectin helps with Covid in humans. It quickly corrected the story, but the damage is done.

My little thread explaining this was deluged with people conspiracy theorists claiming Reuters tried to bury the story because they’re controlled by Pfizer. On the flipside, some claimed the opposite: actually Reuters, following its merger with Russian wire service TASS, was deliberately spreading antivax propaganda on behalf of Vladimir Putin. But that’s all standard noise.

What stood out to me was a lot of personal testimonies from Ivermectin users, both vaccinated and unvaccinated. The typical reply went something like this:

“Why are you saying Ivermectin doesn’t work? I got Covid and I took Ivermectin and I felt fine after about five days. It’s a miracle cure!

There’s an old saying about the common cold: If you take all the cold medicines and treatments, you'll recover in seven days. If not, you'll get better in a week. People often take some pill or alternative medicine treatment when they have a cold, and then naturally attribute their recovery to the pill and not just natural recovery.

But Covid isn’t a common cold, and people aren’t taking Ivermectin because they think it’ll shave a few hours off of their recovery. They’re taking Ivermectin because they’re scared that they’re going to die or be critically ill. When they have a regular week of mild Covid, they feel like they’ve been saved.

Covid is not a death sentence

Most people who catch the coronavirus don’t die.

Unlike its close relative SARS, the vast majority of Covid infections don’t need to be hospitalised or require any medical treatments at all. This was true before there were vaccines and it remains true of unvaccinated people.

That should be an uncontroversial statement, but the public consistently over-estimates how dangerous Covid-19 is to the average person.

A Gallup poll in August 2021 asked Americans how likely they thought it was that an unvaccinated person who caught Covid-19 would need to be hospitalised.

41% of Democrats and 22% of Republicans said that an unvaccinated person who caught Covid would probably end up in hospital! And there were lots of in-between estimates too.

The truth is that less than 1% of unvaccinated people (and even fewer vaccinated people) who catch Covid are hospitalised.

That “less than 1%” can still be a very large number of people if the virus is spreading fast, enough to overwhelm a health system. And of course, for older age groups, the risk is much much higher than for younger people. Still, the public’s sense of the personal risks of catching Covid is wildly out of step with reality.

Some of this is because people are really bad at estimating personal risk, conflating absolute risk and relative risk. As Dr Ben Goldacre wrote:

Let’s say the risk of having a heart attack in your 50s is 50% higher if you have high cholesterol: that sounds pretty bad.

Let’s say the extra risk of having a heart attack if you have high cholesterol is only 2%. That sounds OK to me.

But they’re both talking about the same (hypothetical) figures. Out of a hundred men in their 50s with normal cholesterol, four will be expected to have a heart attack; whereas out of 100 men with high cholesterol, six will be expected to have a heart attack. That’s two extra heart attacks.

Throughout this pandemic, most people’s individual risk of severe disease or death has remained low. Many risks are collective, not individual: the risk to the very elderly and immunocompromised; the risk to hospitals overwhelmed with Covid patients who, even if they mostly recover, fill beds that other critically ill people need; the risk to a functioning society of having millions of people all sick at the same time. These are huge, real, dangers that risk the lives of millions.

There’s a sense that it’s hard to ‘sell’ collective risk, and that people respond selfishly more to personal risk. Perhaps because of that, there’s been a tendency in discourse to stress — overstress — the personal risk of Covid infection instead.

Don’t Fear the Reaper

Remember the Florida Grim Reaper?

In spring 2020, a local lawyer dressed as the reaper of souls stalked the beaches of Florida, telling the mostly young bathers that death would surely follow them for sunbathing instead of staying home.

This kind of stunt was certainly visually striking, its core message was that the beach was a major Covid risk, and the bathers were taking their lives in their hands. This was never true, of course. Well-spaced, outdoors, fully open beaches without large crowded gatherings were probably one of the safest places a person could be — perhaps safer than a poorly-ventilated apartment where there’s some risk of transmission to neighbours via airflow in the corridors.

Did the Florida Grim Reaper really, literally think the beachgoers were facing imminent death? Probably not, because just a couple of weeks later he himself joined the (also outdoor) protests following the death of George Floyd. This suggests rather strongly that he knew he wasn’t being literal when he donned his costume and made headlines worldwide. He was deploying hyperbole, drama, emotive exaggeration. He was communicating something that he thought was true in some sense, but not literally true.

I think this type of communication has been common over the last two years, well-meaning people overstating the very real risks of Covid-19 in the belief that doing so will keep people safe.

A couple of days ago, I saw a Facebook post about an unvaccinated man in his 30s had just died of Covid-19. One woman commented “well I’m unvaccinated, I just had Covid and I was fine.”

Obviously, this is a horrible response to another person’s death. But several replies to challenged her for a different reason. “You got lucky!” was a common phrase used.

The thing is, it’s not true. A younger person who catches the coronavirus isn’t lucky if they don’t die. They’re unlucky if they do.

Now, most of us don’t want to die or be hospitalized with Covid-19, so getting a free, safe vaccine to reduce the chances of severe disease and death makes good personal sense. But misrepresenting the individual risks of the virus doesn’t lead people to informed decisions; it tries to scare them That can have bad consequences down the line.

Behind the Masks

Something similar happened with masks.

Widespread public masking cuts down on infected people unknowingly spreading the virus to others. Individual masking also protects the mask-wearer from catching the virus. A CDC study, just pre-published, showed that people who report always wearing a mask indoors have a lower chance of testing positive.

Note that this study suggests a surgical mask is 66% protective, and a cloth mask is lower at 56%.

I’m in Israel, where indoor public masking was mandated early and maintained for most of the last 20 months despite lax enforcement. Some people like them, some people don’t but there’s no politics about it.

In the US, masks became a political shibboleth that defined which tribe you were in.

Anti-maskers insisted that masks cause Covid, or hypoxia, or give you parasites. They claimed that governments know that masks do nothing and governments only imposed them to dehumanise people and prepare them for intense social control measures. They refused to obey mask mandates, and in a few cases even murdered shop staff who asked them to follow the rules

Perhaps in response to this insanity (though very much not equal to it at all), a lot of people began overstating the effectiveness of masks. 66% for surgical masks is pretty good; it means if 15 people in 100 would have got Covid without masks, only 5 in 100 got it while wearing them. But the way people talked about masks for much of the pandemic made them sound like magic. Underneath every Twitter report of a vaccinated person testing positive for the virus would be 50 replies asking angrily “Was he wearing a mask?” as if no masked person could possibly get Covid.

A Lesson from the Garden of Eden

Midrash is an ancient Jewish technique for telling stories about the Bible. Midrash comes to fill in gaps, whether major gaps in the narrative or tiny inconsistencies in phrasing in a biblical verse. Sometimes they’re sprawling fanfic-types, like the Midrashic stories of Abraham’s youth . Sometimes they’re minor but striking additions, like the claim that Queen Vashti of Persia sprouted a tail. They aren’t always internally consistent — fanfic is a better comparison here than ‘canon’, pretty much by definition. Midrashim were popular enough that some found their way into the Quran.

A well-known midrash about the Garden of Eden starts with an observation about the forbidden Tree of Knowledge of Good and Evil. When God introduces Adam to Eden, he tells him:

Genesis 2:16-17 “Of every tree of the garden you are free to eat; but as for the tree of knowledge of good and bad, you must not eat of it; for as soon as you eat of it, you shall die.”

Later, though, when the woman (not yet named Eve) talks to the snake, she says:

Genesis 3:2-3 “We may eat of the fruit of the other trees of the garden It is only about fruit of the tree in the middle of the garden that God said: ‘You shall not eat of it or touch it, lest you die.’”

Ancient Jewish readers noticed the inconsistency in the language. How did God’s warning to Adam not to eat from the tree become Eve’s claim to the snake that it would be death to even touch it? The midrash explains:

(Avot d’Rabi Natan 1:5) Adam the first person did not want to tell Eve in same the way that God had told him. Instead, he said this to her (thus making a fence around his words, saying more than what God had said to him): “God said not to eat from the tree that is in the midst of the garden, nor to touch it, lest you die.” He wanted to keep himself and Eve from even touching the tree.

This midrash explains the discrepancy by saying Adam wanted to make extra-sure that Eve wouldn’t eat from the tree, so he invented an additional warning: even touching it would kill you. That’d do it! Another midrash source completes the tale.

(Genesis Rabbah 2:3) When the serpent saw her exaggerating in this manner, he grabbed her and pushed her against the tree. "So, have you died?" he asked her. "Just as you were not stricken when you touched it, so will you not die when you eat from it."

The compilers of these Midrashim, Jewish religious legislators of the Roman and early medieval period, used them to give a warning about exaggerating when it comes to safety rules. If you overstate the risks, people will come to distrust and ignore the real danger you were trying to avert.

Fences around Covid-19

That’s where we are right now when it comes to the Covid-19 pandemic. Partly out of an attempt to build a fence around the coronavirus, we’ve ended up with a mainstream discourse that tends to overstate the real individual risks of Covid on the one hand and over-promise on the effectiveness of mitigation measures like masks on the other.

So, alongside hardcore antivaxxers, we saw young adults refusing to get vaccinated because “my friends had Covid and they were fine, so why should I?”

We see people who were scared of vaccines but more scared of Covid, downing hydroxychloroquine, Ivermectin and even their own urine in a desperate attempt to save their lives. And then we hear those same people praise the pill or the pee as a miracle cure that kept them out of the ICU. “See, they told me I’d die without a vaccine, but all it took was drinking bleach!”

For young healthy people, the main risks from Covid are social, not personal. They’re the risks the virus poses to parents and grandparents, and the vulnerable and immunocompromised. They’re the risks it poses to the healthcare system as hospital beds fill up, delaying cancer screenings and other early detections of deadly diseases.

They’re the risks of school closures not due to government-imposed restrictions but because too many teachers are home sick with Covid, as happened in Missouri in January. Or of global supply chain disruptions leading to goods shortages and inflation.

And yes, the small but real individual risks of severe disease and death are in there too. So’s Long Covid.

Omicron is so infectious that many countries are running out of coronavirus-naïve adults. We’re very close to the point where nearly everyone has either been vaccinated or has had Covid or, in many cases, both.

As the virus moves from pandemic to endemic, we’re all going to have to adapt to a world where we can’t avoid it anymore, whether at the office or on public transport or at in-person school. The real fences we erected around the virus are coming down. Maybe they’ve been down for some time.

So perhaps it’s even more important to take down the fences around our words. Covid poses large dangers to the elderly, the immunocompromised and society as a whole. It poses much smaller personal danger to young, healthy people. Vaccination reduces that danger even lower.

Trying to scare people into responsible behaviour over Covid has its limits, and it’s reached them. Cutting the well-meaning hyperbole is the best path to helping people make informed decisions about their health and their duty.

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Oh, and get vaccinated if you haven’t. Your kids too. Covid isn’t going away ever. That’s what endemic means. Yes, your kids will probably be fine without it. But mostly parents aim for more than ‘probably fine’. Car seats, sleep safety, food safety, toy safety… probably fine without any of them. But why take the risk when you don’t need to?

In November I wrote a spotters’ guide to Covid conspiracy theorists:

Covid Conspiracy theorists: A spotters' guide

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