Editor’s Note: Kent Sepkowitz is a CNN medical analyst and a physician and infection control expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion at CNN.
Right now, a year into the pandemic, the scariest Covid-19 story is not in Texas, where the gloomy governor is still pretending he can ignore the pandemic into oblivion. Nor is it the news from Brazil where its frustrated president, Jair Bolsonaro, has told citizens to quit whining about the unchecked death and illness that surrounds them.
Rather the most alarming situation is in Europe. There, for unclear reasons, the pandemic appears to be in the earliest stages of resurgence. The World Health Organization in Europe announced on March 4 that after six weeks of decline, cases in the continent rose by a staggering 9% compared to the previous week — putting the continent again over 1 million cases weekly.
For the record, “Europe” for public health reporting purposes is not the European Union or another configuration but rather the 53 countries in WHO-Europe, including Russia, with a population of more than 700 million people. According to the WHO-Europe, cases of Covid-19 are increasing not only in eastern and central European regions among countries such as the Czech Republic (which has a current and a former leader who tried to ignore the virus into non-existence), Hungary (ditto) and Poland (more dittos) but also in western Europe. The wrong-way curve is reemerging in Italy, France and other countries that already experienced calamitous months last spring.
Understanding the reason for the rise is essential for the US and the world as we prepare for what may lie ahead. Thus far, the potential explanations for the European increase have fallen into two basic schools of thought: Those who ascribe this to (bad) human behavior and those who focus on twists and turns of viral variants.
Social psychologist types, particularly fans of the Scottish author Charles Mackay’s classic, “Extraordinary Delusions and the Madness of Crowds,” surely foresaw the bizarre Covid-19 refusenik (and its mitigation refusenik) movement coming from the start of the pandemic. Though it may have reached an apogee in the US, the no-mask, no-distancing, no-way crowd has been active in Europe throughout the pandemic.
Surely, those who gleefully are burning their masks are contributing to a continuation of the pandemic, but it is not certain that their numbers are increasing. Furthermore, the timing of the resurgence in Europe — amidst the vaccine rollout — raises the issue as to whether some mask moderates are starting to lose their enthusiasm as injections reach more and more arms and the end of restrictions seems within sight. A wave of people who ease up too soon, a familiar public health misstep, could certainly drive a surge in cases.
Perhaps anticipating the mask fatigue, the US Centers for Disease Control and Prevention last week reported that US counties that required masks saw fewer cases of Covid-19 than counties that did not between March and December of last year. Clear and compelling evidence of mask effectiveness may do little to sway the hardcore refuseniks, a group that seems uninterested in facts and figures, but hopefully will inspire those straining under the current guidance to bear down a bit longer till the threat is finally under control.
Next to behavioral scientists are the eagerly pessimistic virologists who have hit the freak-out jackpot with the identification of so many viral variants that they account for more than half of current cases in New York City. To add to their futuristic mystique, the variants are assigned not names but numbers: B117, B1351, P1, CAL20C and all the rest as if created by a comic book lineup of evil alien masters. Right on cue, each viral variant report is more frightening than the one before it, as a worsening in transmissibility, lethality or as a threat to vaccine effectiveness all appear possible.
Surely the most transmissible variants, like B117, are driving a proportion of the increase in Europe as well as the US. Our understanding of the exact proportion of US cases contributed by certain variants, though, is hobbled by the improvident decision last year to initially not determine the genetic makeup of recovered isolates as was done in many other countries. The CDC began systematic genetic testing of Covid-19 isolates only in November, once the threat of variants already had been described in other countries.
Though tempting to place most of the blame for resurgence on the ever-evolving virus, such a focus completely misses the point. Yes, we are at the mercy of an unpredictable pathogen — but remember, the virus has no direction, no five-year plan, no career strategy, neither malice nor altruism in its genetic code, no favorite habits — in fact, it has no idea of anything at all.
In contrast, the other part of the host-pathogen equation — the human — has the ability to make choices. What the news from Europe last week and — possibly — that creaking sound from a few areas in the US (looking at you, Nebraska and South Dakota) is telling us is simple: The virus will always find a way around things — become more transmissible, less vaccine-controllable, whatever.
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Like everything else in the real world, pandemic control will require that people make good decisions. We have come to rely too much on hard science to pull us out of our man-made messes. Though vaccines are essential to move us swiftly towards something resembling normal life, the only way to establish durable protection from this virus or the next or the next is for people to make informed, intelligent decisions and leave the delusion of crowds for another century.
All in all, not a very promising blueprint.
