Disordered Thinking on Covid Mandates

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For a nation of practical people, our thinking about Covid vaccines and vaccine mandates is astonishingly disordered. About a third of us can’t seem to apply simple arithmetic to weigh the odds of getting sick and/or dying with or without vaccines. Our corporate CEOs similarly can’t seem to think straight about their workers or their customers, the majority of whom are vaccinated and would feel safer if their fellow workers and customers were vaccinated, too.

This essay summarizes the Covid risk numbers and analyzes our predicament. The table below uses linked, publicly available sources to compile the annual odds of suffering or dying from various causes unrelated and related to Covid-19. How the odds are “normalized” to one year is explained in the last column of the table and in the notes below it.

Annual Odds (in 100,000) of Dying or Suffering from Causes Unrelated and Related to Covid
Odds of	Odds Per 100,000	How Normalized to a Year
Dying in Car Crash	20	In linked source
Dying in airplane crash	0.01	In linked source
Catching Covid Nationwide (overall*)	8,203	See Note 1
Dying of Covid in Texas (if unvaccinated*)	141	See Note 1
Dying of Covid in Calif. (if unvaccinated*)	108	See Note 1
Dying of Covid in Ohio (if unvaccinated*)	121	See Note 1
Dying of Covid in Vermont (if unvaccinated*)	32	See Note 1
Having serious post-vaccine heart complications	0.1	See note 2
Dying post-vaccine from any cause	1	See note 3

* The CDC apparently does not routinely distinguish between vaccinated and unvaccinated patients in recording cases or deaths, let alone state by state. At least I was unable to find these numbers after a diligent search of the CDC Website for Covid. This is not surprising, since the CDC began collecting data over half a year before any vaccine was approved on an emergency basis (the Pfizer-BioNTech vaccine on December 11, 2020).

So the numbers in the table marked by an asterisk (*) are estimated. We can’t use the numbers from relatively small clinical trials showing vaccine effectiveness, because: (1) no vaccine existed for nearly half the relevant pandemic period, beginning January 2020; and (2) without direct data, there’s no way to know what part of a total population was never exposed to the virus. The best we can do for cases is divide the overall case number by the total population of the United States to get an overall infection-risk factor for both vaccinated and unvaccinated people. (Vaccines’ effectiveness varies with time and ranges from above 80% for hospitalization—apparently increasing slightly with time [scroll down to graphs]—to just above 50% for mere infection among nursing-home residents.) The studies so far just don’t permit accurate calculation of risk of infection among the vaccinated generally.

Death risk is another story. We have a solid number (in the table’s bottom row) for all deaths after vaccination, from all causes whatsoever, presumably including breakthrough infections. Since this death rate is for each dose, rather than for each person, it overestimates the death rate per person and therefore is a conservative estimate. (People who took the Pfizer or Moderna two-dose vaccines had two chances to die afterward, but not all the vaccines were double-dose.) The table’s death rates for the unvaccinated reflect subtraction of this conservatively high rate for vaccinated people (1 out of 100,000) from the state-by-state rates calculated after normalization per Note 1.

Note 1: To normalize to a year, multiply total cases deaths per 100K (for precise tallies of deaths by state, from this interactive map [scroll down]), by 365. Then divide by 590, the number of days from February 29, 2020—the date when CDC reporting began—to October 9, 2021, the date of publication of this post. Then round to the nearest whole number.

Note 2: The most common, non-transient and serious side effect of vaccination is myocarditis or pericarditis. A total of 906 confirmed cases occurred over more than 396,000,000 reported doses given. This fraction is normalized to an annual number as in Note 1. This number includes all cases of myocarditis and pericarditis occurring after vaccination, without proof that the vaccine caused the effect. Therefore it is conservatively high.

Note 3: The CDC data show a total of 8,390 confirmed deaths, from any cause whatsoever, occurring after 396,000,000 reported doses given, normalized to an annual number as in Note 1.

* * *

What rational person, looking at these stats, wouldn’t decide to get vaccinated ASAP? Covid-19 is a nasty disease, even if not fatal. It can last for months or years and ruin your life, not to mention your family’s. The annual risk of catching it or even dying from it is orders of magnitude (powers of ten) higher than dying in a car or plane crash, and orders of magnitude higher than getting serious complications and/or dying from the vaccine itself. For people who assess risks by weighing the odds, getting vaccinated is a mathematical “no brainer.”

CEOs and board members of major corporations are generally well-informed and sensible people accustomed to quantitative reasoning. So it’s unlikely there are many vaccine refuseniks among them. They get themselves and their families vaccinated because they stay informed and don’t take unnecessary risks. (Some reporter or Ph.D. candidate should research these numbers. I’d be surprised if research turns up more unvaccinated, medically eligible people among CEOs, members of corporate boards and their families than single digits in percentage terms.)

If this is so, why would business chiefs let their workers and customers go unvaccinated? That doesn’t make any sense.

It might not matter if workers commute to work by Zoom or if workers and customers can spread out, as in a capacity-limited department store or supermarket. But almost every business that produces a physical product has venues like assembly lines where workers must work in close proximity, increasing their risk of infection. As a result, businesses such as slaughterhouses had to shut down, as early as April 2020, sometimes repeatedly, to stem their internal pandemics and reconfigure their production lines to provide more protection to workers and less access to the virus.

So why didn’t corporate leaders mandate vaccines for their workers long before the highly contagious delta variant arrived in the United States? Its arrival in and likely dominance of the UK were known in April of this year. Now, a mere six months later, it’s estimated to be causing 99% of current US cases nationwide [scroll down to “SARS-CoV-2 Variants”]. Major businesses that have difficulty with social distancing, such as theaters, sports stadia, and restaurants, would have fared much better economically with early vaccines, testing and mask mandates for both workers and customers.

One sector in which corporate resistance to vaccine mandates has been especially devastating is travel. As early as March of this year [scroll down to original post date], the CDC recommended that unvaccinated people avoid cruises. By August, a number of prominent cruise lines had mandated vaccines. Yet, two months later, US airlines are just now beginning a slow process of making sure that their crews are vaccinated, with United and American leading the pack. Vaccine mandates for passengers are still not even on the table.

Think about that. What’s the ratio of passengers to crew on airplanes? Probably about fifty to one, and more on long-haul, wide body planes. The pilots mostly stay in their cockpit. The flight attendants constantly move around. Although often close to each other in their work and sitting areas, they seldom stay close to any particular passenger for more than thirty seconds.

So you don’t need a degree in statistics to understand where the big risk is: passenger-to-passenger contagion. On most airplanes, many passengers sit cheek-by-jowl with complete strangers for as long as the flight lasts—five hours for transcontinental flights and fourteen hours for trans-Pacific flights. The latter point is why Qantas, the Australian national airline, has announced [scroll down to “International travel requirements”] that it will require both vaccines and recent Covid tests for its international passengers, albeit starting in December.

In comparison, cruise-ship passengers sleep and can stay in separate cabins. They can even take meals in their staterooms, with room service. They can avoid close contact with any other passengers simply by using common areas strategically and taking the stairs to avoid elevators. (Long before Covid, my wife and I routinely took the stairs on cruise ships, even when transiting multiple decks, to avoid contagion with colds and flu. Elevators are obvious hot spots for airborne contagion, and using the stairs is good exercise.)

Airline passengers have none of these options. Worse yet, passengers in adjacent rows, and sometimes even right next to you, are usually complete strangers. These strangers stay right next to you for hours, far longer than in any theater, stadium or restaurant. Nevertheless, as of the date of this post, no US-based airline, to my knowledge, has mandated vaccines for passengers. Why not?

For both workers and passengers, the crux of the matter is feeling safe. How can you feel safe when there are no mandatory steps to keep you safe from contagion?

Mask mandates help a bit, but they suffer from two big disadvantages. The most important is that some types of masks are intrinsically unsafe, and many wearers don’t seem to care. Surgical-style masks are easier than N-95s to put on and make it easier to breathe. But they can fall down below the nose, easily and often, where many mask wearers repeatedly let them stay. Imagine yourself sitting next to a passenger coughing and sneezing and letting the mask drop below his nose every five minutes. Feel safe now?

If my own social circle (including Zoom) is any guide, the absence of mandates for vaccination, testing and effective masking can explain the airline industry’s slow economic recovery. We’re mostly comfortably retired or semi-retired people in our seventies. Before the pandemic, most of us made from four to six round-trip flights per year, including transcontinental and even trans-Pacific flights.

Post-delta, a few of us have already started traveling by air, even internationally. But I would estimate that maybe half my social circle has not traveled by air at all since the Covid pandemic began. I personally have not set foot on an airplane since February 26, 2020. I don’t intend to until the industry gets its act together.

So far, it hasn’t. Instead, it’s awaiting President Biden’s regulatory vaccine mandate to give it “cover” for requiring even workers to get vaccinated. It appears to be avoiding doing the obvious to make passengers safer.

As my wife and I travel by car between her home in Berkeley, CA, and mine in Santa Fe, NM, we pass the desert town of Mojave, CA. There airlines have created a huge parking lot for temporarily mothballed airplanes. (The dry desert air there is kind to aluminum.) Since the pandemic-caused economic crash in April of last year, the mothballed fleet has shrunk a bit. But it was still there, and still sizeable, when we passed it last month.

Resurrecting the airline industry is not proverbial rocket science. It’s simply common sense, coupled with a bit of empathy toward workers and passengers. Corporate leaders ought to have both, even if they themselves travel in corporate jets with four to twelve passengers and few if any strangers.

The millions of currently unfilled job openings have a simple cause, now becoming increasingly clear. Paul Solman, PBS Newshour’s economics commentator, calls it “the Great Resignation.” Many workers feel underpaid, abused and marginalized. Many have for years. But for millions, the crux came when they were expected to show up for work and expose themselves to Covid-19 without much thought to protecting them with vaccines, testing, social distance, or masks. It got worse as they saw their co-workers and families decimated. The pandemic, it seems, has made millions of workers see just how little protective “leadership” they were getting from their bosses during the worst pandemic in a century.

So the slow recovery of businesses like airlines, theaters, stadia, and restaurants is a matter of simple cause and effect. Make workers feel safe, and bosses can employ more of them, perhaps even without raising wages. Make customers/passengers feel safe, and there will be more of them.

To do that, bosses have to stop pandering to know-nothings and extremists and get to work on safety. They have to use all the known tools for controlling the pandemic. Most of all, they have to use them in order of known and proven effectiveness—vaccines first, testing second, and distancing third. Masking, while also effective, is very hard to get right and keep right in crowds.

Covid safety is not a marketing ploy, far less a brand popularity contest. It’s not something that proper “messaging” can control. It’s an application of cause and effect to now-well-known principles of science and to the public’s reaction to their application. When people’s health and very lives are at stake, they pay attention, whether they are workers or customers.

Yes, the know-nothings might sue to challenge mandates. That’s a routine legal expense. But millions of would-be passengers, like me and my social circle, will just not fly. Which is worse, a sizeable downturn of unpredictable duration, with mothballed planes in the desert, or a routine legal expense? It seems a question that answers itself. (Anyone who thinks the refuseniks are going to win, let alone for big damages, doesn’t understand the US legal system and its distinction from politics.)

At the end of the day, corporate bosses must see that the vaccine-resistance “movement” has no rational basis. Moron-politicians pander to it and inflame it for perceived political advantage having nothing to do with Covid safety or economic recovery. If not clear from common sense, this point should become increasingly clear from practice, as simple mandates begin to break the back of vaccine resistance.

Corporate failure to understand and apply these truths is not “leadership.” It’s disordered thinking along the public’s last line of defense in an increasingly corporation-dominated world. If disordered thinking retards the economic recovery and cuts bottom lines, corporate leaders have no one but themselves to blame.

Endnote on Future Pandemics. As I outlined in an earlier essay, the continuous and unstoppable evolution of viruses, coupled with increasing population density and air travel, threatens to increase the number and severity of future pandemics. Just since the turn of our new century, we have had two near-pandemics and one averted one: MERS, SARS and Ebola. The death rate from Covid is about 1.6%. That for Ebola ranged from 22% to 88% in various outbreaks; what saved us is that Ebola is not airborne.

But what happens if a new, airborne pandemic evolves, with a death rate somewhere between Covid’s and Ebola’s? Airplanes are by far the principal vectors for global transmission of airborne pandemics. So airlines’ reaction to Covid has been a dress rehearsal for unknown future threats.

Unfortunately, that rehearsal has been an unmitigated disaster. If the death rate were as little as three times as high (about 10%), we would now be in the midst of a global economic depression worse than that before World War II. Supply chains would not just be strained; they would be completely broken. Airlines would be mostly out of business. To avoid such a future catastrophe, airlines must start, right now, making health decisions rapidly, based on science and public safety, not marketing or politics.

ERRATUM: An earlier version of this post put the Covid death rate at 3.4%. That was an early worldwide figure from the WHO, taken from this source. Today I calculate the current US deaths/cases ratios as follows: for the whole US 1.6%, and for some states, from the interactive map in this source: Texas 1.6%, Ohio 1.6%, California 1.5%, and Vermont 0.9% Thanks to Commenter Maxwells22 (on Daily Kos version) for pointing out the error.

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