COVID-19

Free Beer or Campus Mandate: Addressing the Reluctant

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Others’ vaccination status affects all of us.
Me after my first dose.

As of April 27, 2021, 141 million Americans have received at least one dose of a COVID vaccine and 95.9 million are fully vaccinated, according to The Washington Post. These rates differ greatly by state and demographic.

We are witnessing a growing number of people who fit in a gray space of immunization, in which they aren’t against getting vaccinated for COVID-19 and yet, they haven’t received their first shots. Clumped into this group are also those who did get the first dose, but have lagged for the second.

The largest two clusters of unvaccinated people: conservative, rural white people that believe that any COVID precautions (including the vaccine) infringe on their freedom and people of color, whose hesitancy stems from a history of medical betrayal. While these groups (especially the latter) certainly warrant attention, I’d like to focus on a different population: those who are not opposed, but aren’t very motivated to get vaccinated. College students, twentysomethings, and additional folks that fit this description feel that they don’t have enough of a reason to make a vaccine appointment and then take time from work/school/life to go to an immunization site and get the shot. I say “shot” and not “shots” because these people need the one-dose. If it’s hard to prompt someone to get a first dose, the second dose is unlikely (helping to explain the drop-off of 2nd-dose recipients).

With the current widespread availability of vaccines in the U.S. for ages 16 and over, most people who were eager and willing have already been immunized. The vaccine-reluctant, then, need to be targeted, with their carrots identified. History is repeating itself on this one. In the late 1950s, this same age group held out on getting the polio vaccine, believing they weren’t susceptible enough to the virus to make it worth the shots. As I wrote about in my article for The Washington Post, the Ad Council initiated a mass public health campaign addressing this hole in the herd immunity.

How do we motivate the vaccine-reluctant during our current pandemic? We need a combination of targeted campaigns with messages that appeal to this age group, combined with incentives. Creative motivators have already sprung up: free donuts from Krispy Kreme, beer from Sam Adams and a number of breweries in New Jersey, on-campus vaccine site raffles, and employer-specific bonuses of vacation time or cash, to name a few. West Virginia Governor Jim Justice has promised savings bonds of $100 for those 18-35 who get the vaccine. In D.C., the organization Marijuana Justice gave out free joints at vaccination centers on April 20th, much like the Michigan-based “Pots for Shots” campaign. Such incentives have and will help close the gap of the vaccine-reluctant.

However, it’s not enough. What we need are vaccine requirements for various activities and places. To be pandemic-responsible, concerts, music festivals, and other large-gathering attendees should have to provide proof of vaccination — a notion that is being considered for Burning Man and other events scheduled for later this year. Additionally, college campuses need to mandate COVID vaccines for students, faculty, and staff. According to The Chronicle of Higher Education, 209 colleges will mandate vaccines. Most of these institutions are private and located in blue states. Mandatory COVID vaccination fits with existing immunization requirements (MMR, varicella, meningitis) and still allows for religious exemptions. Widespread college and university COVID vaccine mandates will (obviously) incentivize the difficult-to-reach population, normalizing this immunization for young adults. This approach also reinforces the necessity of mass vaccination as vital to public health — not as a person choice.

We need drastic action to even begin to dream of herd immunity, if that is a possibility. Motivating the super-spreader group to get vaccinated should be a top priority. Since emotional appeals may not reach the vaccine-reluctant, it’s time to create incentives and requirements that push them to get vaccinated. A free beer and the return to campus life?

Where are we in the pandemic timeline? (It’s not good).

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The interactive COVID-19 map, updated and published by The New York Times.

COVID cases continue to escalate and the death toll for the U.S. has exceeded a quarter of a million. Yet, as this FiveThirtyEight poll shows, over 30% of Americans are “not very” or “not at all” concerned about infection. Obviously, as we head into the holiday season, this is incredibly problematic.

The division between those who believe in science and the anti-maskers can be attributed in particular to one’s political affiliation and primary source of information. These factors are mitigated by geography, as local and state authorities set the tone for the regional public response early in the pandemic, often paralleled in local news coverage. Moreover, experience with COVID’s effects, either personally or through friends and family, also shapes the extent to which people view the disease as a threat.

We also can’t dismiss the toll of “pandemic fatigue” on public behavior, as individuals stop caring about precautions that they would have taken months ago because it feels like we’ve been doing this forever. Why are we in this spot? Unlike past outbreaks, our global access to information enabled countries around the world to learn about COVID early on and (to different extents) take action. In short, we feel like we should be past this pandemic because we’ve been in it so long. Except we haven’t.

Last spring, we pretended that the first wave had a conclusion, a denouement. It did — if you live in New York City or other places that experienced the surge and the dwindling of cases. The rest of the U.S. was really in a waiting period. In this calm before the storm, many people took the precautions needed to carry us through the pandemic. However, collectively, we acted like that was it, that we had made it through the wave. In reality, most of the U.S. has only just begun its red zone.

Let’s compare where we are to this moment in past outbreaks/epidemics/pandemics. From my study of 200 years of epidemic history, I can tell you that both small and large-scale outbreaks follow specific patterns in their construction in media messages and in public perception. For this comparison, ignore the amount of time we’ve known about COVID., focusing instead on the severity of the crisis itself.

Placed in the midst of other epidemics, we are approximately at the same timeline point as . . .

  • August 1721, Boston smallpox epidemic
  • October 1793, Philadelphia yellow fever epidemic
  • October 1918, “Spanish Flu” across U.S., “Spanish Flu”
  • Late January 1925, diphtheria in Nome, Alaska
  • September/October 1952, polio in the Midwest
  • December 1968, “Hong Kong” flu in New York and many other places

These critical points not only mark escalating cases within different outbreaks/epidemics/pandemics, they also share collective public emotions: sadness, scarcity, panic, and loss. While there are certainly variations in responses, shared characteristics define the severity of the situation. Listed above are the peaks of despair, when hospital ran short of staff, beds, and equipment. Gravediggers and coffins became in demand. Images of this moment captured rows of the ill in makeshift hospitals, stacks of wrapped bodies, and quarantine signs. Towns and local media became solely focused on the sick, dying, and deceased, seeking supplies and care providers, while banning public gatherings and funeral bell tolling. Ministers ceased holding services for fear that they were spreading disease among parishioners.

This is where we are in our COVID-19 pandemic. If you are not feeling this moment yet, it is not due to the case numbers. Rather, it is the cultural climate that is imaging a reality that is not this one. Many local news outlets have opted not to publish cause of death as COVID-19 or showcase the experiences of survivors, blocking communities from the devastation from this disease. We have convinced ourselves that we did the work last summer so we must be fine now. NOPE. Even if you are not personally seeing it, the U.S. (and most of the world) is in crisis mode.

We are at a crossroads for what will happen next. Changing the course of the pandemic needs to occur at all levels, including our individual choices. It might feel like we’ve been in this pandemic state forever. Unfortunately, though, we are deeply in the midst of the crisis — a reason to stay home, not to give up.

What Polio Can Teach Us About This Pandemic

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Most historical comparisons to our current crisis have been to the “Spanish Flu.” And while several of my essays challenge some of the parallels put forth, I understand why people have been so quick to return to 1918 for answers. Its global reach and profound impact on the U.S. and most of the world feel somewhat similar.

Yet in focusing on this comparison, we miss the series of epidemics that might in fact paint a closer image to our current reality. Throughout the 1940s and 1950s, poliomyelitis emerged periodically in epidemic form, reaching its peak in the summer of 1952. Less than a year later, Jonas Salk’s vaccine was approved for a mass trial, which would prove effective.

What can these polio epidemics teach us about COVID-19? The diseases themselves are not similar. Polio is caused by a three types of a human enterovirus that spreads through contact or contaminated food and water. COVID-19 is a a novel coronavirus, transmitted by respiratory droplets.

What we can relate to is the mystery surrounding the disease. As with COVID-19, with polio, you never knew who would become ill or how bad it would be. Approximately 72% of polio cases were asymptomatic. Those who felt sick usually had mild symptoms. Only a small percentage developed the paralytic form, experiencing either temporary or permanent paralysis of a limb, limbs, the diaphragm, or multiple affected sites–its course unknown. And although it was characterized as a disease of children, adults also contracted polio, particularly in the later epidemics. [Note: I’m speaking in past tense here to refer to the mid-century outbreaks. Polio cases are still emerging in Afghanistan, Nigeria, and Pakistan).

What we can take from the periodic polio epidemics in the first half of the century are ways of living that are accustomed to interruption, the importance of a unified public response, and a healthy respect for disease itself. No one knew when polio would come to town. But when it did, local spots quickly closed down to reduce the spread of disease. People were quarantined and isolated as needed, sometimes even at camps. Movie theaters, public pools, and other gathering places shut down, as parents were advised to avoid having children mingle in new groups. Polio also led to local school closings for short periods, which were opened back up when it was believed that the threat had passed.

No one proposed that polio was a hoax or questioned the severity of the threat. The National Foundation for Infantile Paralysis (NFIP), founded by President Franklin D. Roosevelt and his business partner, Basil O’Connor, united the nation in the fight against poliomyelitis. NFIP campaigns provided education and raised money for rehabilitation and research toward a vaccine. During outbreaks, the NFIP provided additional health professionals and resources, including rocking beds, iron lungs, and other equipment, through coordinated efforts between the local and national levels.

We know the work of the NFIP was successful, demonstrated in the number of people helped and the production of two effective vaccines. At the same time, the NFIP also modeled what can be accomplished in terms of care and research when a nonprofit organization receives long-term public and governmental support.

Polio reminds us of the enigma that is disease. Privilege has shielded developed countries from experience with contagion, causing people to forget its power. In the early to mid-20th century, most people wouldn’t openly resist public health efforts to curb outbreaks. Rather, they were grateful for scientific progress against disease and celebrated the diphtheria antitoxin, each new vaccine, and the introduction to antibiotics.

It is problematic to only look to the 1918 influenza pandemic for lessons. Its first wave was largely unknown, meaning that the experiences of the Spanish Flu were limited to just a few months. As I outlined in earlier essays, we can’t even compare today’s mask mandates to restrictions of that pandemic (and yes, I’ve heard of the Anti-Mask League of San Francisco). Since World War I very much dominated public agenda and therefore, the pandemic seemed to both appear and conclude quickly. Instead, we should learn from the polio experiences. We can remember that we have done this before and can do it again. But, as in the past, we need to support health professionals, public health experts, and those working to develop a vaccine.

Appeared in Vogue and other media outlets

Why We Can’t Compare the “Spanish Flu” Waves to This Pandemic

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The 3 Waves of the “Spanish Flu”
Most people had no idea that the first wave was happening, thus a faulty comparison to now.
Centers for Disease Control and Prevention / Public domain

We’ve heard the predictions of multiple COVID-19 waves for months. Our current stage is being disputed, with some people calling this the 2nd wave, while others argue that we’ve haven’t left the first. Regardless, the comparison between this pandemic and the “Spanish Flu” has been ongoing throughout this crisis. This focus on the waves of the 1918-19 influenza pandemic has particularly been used as a PSA of what not to do now. However, as I wrote in my post “Your Wise Friend Was Wrong” about a “Spanish Flu” meme that was circulating, this ahistorical comparison assumes too many similarities between then and now. Yes, we can and should learn from historical outbreaks, but we have to first understand what was known about disease at the time and what was communicated to the public.

Influenza (also called “la grippe”) was a familiar disease in 1918, predictably seasonal and usually mild. Doctors were not required to report deaths from influenza to the U.S. Public Health Service, even though it became epidemic in several years, including 1915-16. Influenza was not usually fatal, at least not for those outside of vulnerable populations.

The First Wave (from a contemporary understanding)

The H1N1 virus that attacked in 1918-19 was unique in its frequent complication of a deadly pneumonia and its high mortality among young adults. Outbreaks of this influenza/pneumonia likely first occurred in Kansas, at Camp Funston and the nearby Haskell Institute. Throughout the next two months, other military camps experienced high numbers of cases. These clusters of disease and death received almost no media coverage, other than a few stories that presented the outbreaks as isolated incidents, downplaying the severity of this new threat.

This article appeared at the bottom of page 2 of the Topeka State Journal on April 4, 1918. Coverage of (what we now identify as) the first wave was limited.

By the end of May, the outbreaks dwindled in the U.S.

Looking back, we now recognize these Spring outbreaks as the “first wave” of the influenza pandemic. However, in the moment, the lack of media coverage meant that most Americans had no knowledge of the rising cases. Most attention was directed to supporting the soldiers in World War I.

For the people of 1918, the influenza pandemic appeared to begin in June. Stories in The New York Times, Washington Post, and other U.S. papers reported on June outbreaks in China, Madrid, Morocco, India and Berlin and then throughout Europe in July. While cases appeared back in the U.S. at the end of the month, American media outlets only covered the epidemics elsewhere.

The Second Wave (but it seemed like the first)

It wasn’t until an eruption of U.S. cases in mid-September that the government and press publicly acknowledged that the epidemic had arrived. From September through November, the “Spanish Flu” raged throughout the United States. Quarantine was imposed at various degrees, as stores, public venues, and schools closed for 1-2 months. The people felt and lived this wave, as it affected the everyday lives of even the healthy.

The Third Wave

A third wave followed in the Spring, much of which was attributed to the mass transport of troops following the end of the war. Life didn’t shut down for this reemergence, however, at least not on a mass scale.

Why we can’t compare the pandemics

Outside of their available newspapers and magazines, the people of 1918 had very little media access. Information beyond what was in print simply wasn’t conveyed to the public, including the prevalence of influenza in Spring of 1918. To them, as presented in media, the first wave didn’t exist, the “Spanish Flu” began overseas, and even at the height of the epidemic, the war dominated all news.

With our abundant media outlets and individual-created content, we are in a different world than 102 years ago. We have known about COVID-19 since 2019, tracking its spread and watching its devastation. In other words, we cannot compare the notion of waves in 1918 as applying to this pandemic, at least not in the response of the public back then to now. What we can take away, however, is that the “Spanish Flu” eventually did subside, as will COVID-19.

Why We Need Journalism More Than Ever

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Until the number of U.S. cases and deaths recently skyrocketed, many people have been dismissive of encroaching pandemic. A Pew Research survey from the week of March 10-16 showed that 37% of the 8,914 adult participants believed that media greatly exaggerated the risks of coronavirus. Perceptions of media coverage have varied by the amount of news and the specific source primarily consumed. As the tides are tragically turning, with cases skyrocketing in the U.S., this is not a time to criticize or dismiss messages, nor clump all outlets and content into a faceless “Big Brother” media entity.

I’m not advocating that we heed all advice, especially the (mis)information spread by social media. What I mean is that we need to stop demonizing journalists and recognize that we have never needed them more. If we’re lucky enough to be stuck at home, professional and citizen journalists are our link to local, national, and international information. Without our own eyes and ears in the world, we must rely on others to tell us what is going on, especially when the stakes are so high.

To keep reporting and producing media content during an outbreak is an act of bravery. In 1793, Andrew Brown was the only printer to keep producing his daily newspaper throughout the yellow fever epidemic. In an era centuries before computers, the Federal Gazette became the only means of informing and connecting the people of Philadelphia.

While we certainly have an abundance of choices now, it doesn’t make the work less dangerous. Journalism is an essential service. As Chris Kieffer wrote in this letter of appreciation to the staff of the Daily Journal of Tupelo, Mississippi, “Great reporting and photography can’t be done from a safe ‘social distance.’” Reporters have already become sick on the job. And yet, our focus has largely been on criticizing this risky work.

Instead, we should be supporting journalists and producers of media content at this critical time. We need to recognize the value of all people who continue to work to make our society function. Without credible media sources to turn to, we won’t know how the pandemic is impacting lives outside of our own bubbles (which are quite small these days). We won’t know who needs help or ways to help from afar. We won’t know what to do if we have symptoms or where to go. And, without news, we won’t know when the crisis finally subsides and life can return to our new normal.

Social media is great for connecting with friends and family, but it is not a substitute for local, national, and international news content. Recognize the value of those producing content so that most of us can have the luxury of staying home and the benefit of learning through media channels when it is once again safe to experience life first-hand once more.

What the Archives Didn’t Teach Me About Life in a Pandemic

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In researching my book, I spent months studying primary sources: newspaper articles, pamphlets, public health records, personal correspondence, diary entries and other materials. I never expected that I would see first-hand what a global contagious threat would look like in my life time. I had an idea of the progression of quarantine and the pattern of media coverage. At the same time, no book or microfilm prepared me for a number of aspects in this experience.

  • The Waiting Game: Nothing that I’ve read addressed what it is like to feel fine, have your family feel fine, but know that the danger is coming. . .for months and is not a matter of if, but when. I’m sure the people in the army camps of 1918 that got hit with the March/April wave of influenza felt similarly–just no one wrote about it.
  • Balancing Crisis Mode with Everyday Life: In the yellow fever epidemic of 1793, townsperson Elizabeth Drinker made daily notes in her diary that combined mundane activities like taking a walk with notes about the latest death toll and friends who had passed. I never imagined how strange it would be to do the basic things we have to do, like buy dog food, within the context of the COVID-19 cloud. Everything is the same, yet it’s not the same.
  • Some people are fools. Newspapers of the past occasionally mentioned individuals that broke quarantine and were then arrested. Since they didn’t have social media in 1925, for example, there weren’t Instagram photos capturing crowds flaunting their poor choices and lack of consideration for others.
  • Parenting in a pandemic: This is a big one that NO ONE talked about in the past. Children were part of past epidemics, of course, and were mentioned when they became ill and died, but the stories of active parenting during such a time were not documented and a preserved. As parents, it’s a tricky time. Not only are we juggling childcare and work, but we are also trying to balance crisis and despair with making sure our kids are fed, engaged, and have pretty good days. We have the added challenge of explaining and demonstrating this new reality without terrifying them and inciting panic. At the end of the day, our kids deserve to think that the world is good, they are safe, and this will pass.
  • How much I would miss the world during social distancing. I am certain that the groups of students quarantined at the University of Kansas and other schools felt lonely, bored, and isolated. However, we don’t have their personal testimonies about the experience. We are privileged to be safe here as a family. Yet, I will fully admit that I mourn our normal reality.
    Being extra-extroverted, I knew that I would have these feelings. But it’s not just my friends that I miss. I love being part of a community–like a normal one, in which you see the same faces at stores, parks, karate, and on campus. I miss teaching to human students sitting in front of me, even if they fall asleep sometimes. I want maskless faces to slightly breech the six-foot distancing just to chat for fun, comment on the weather, or to just return a “hello.” Someday we’ll get back to a new version of that world.

What does this all mean, aside from my own lamenting? We need to be writing our stories and recording the diverse experiences of others so that future generations can better understand what living at this time was like.

Nothing is normal. We’re in a pandemic. Shifting Expectations in the Midst of Crisis

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In 1751, George Washington’s diary entries stopped for 24 days because he was ill with smallpox. Forty-two years later, the yellow fever epidemic in Philadelphia forced President Washington to relocate to Mount Vernon. Disruption due to disease was frequent and expected.

This pattern continued with other epidemic moments as well. When influenza hit in 1918, Kansas, like many states, canceled all group meetings and conferences, closed businesses and schools, and prohibited public loitering. The University of Kansas canceled all classes and mandated quarantine. Even though students were stuck on campus, they were not expected to continue their studies. Healthy male students practiced drills and smuggled cigarettes into the makeshift hospital for their ailing friends. Female students cared for the sick, but were also encouraged to go on hikes and roast hot dogs.

In the midst of an epidemic, historical precedent suggests that life dramatically shifts to revolve around the outbreak itself. We are in that moment. For months, we’ve seen it coming. Videos and images from other countries have been showing us what will happen, how bad it will become.

I’m not advocating that we completely shut down working from home, online learning, or virtual activities. However, we do need assume that everything we do, task we assign, and decision we make is shaped by the current and future reality of this global pandemic. Our expectations in our normal, pre-social distancing world do not directly carry over.

Even if we are fortunate to not be sick, the current situation dramatically influences all of our routines. A month ago, this was my typical Friday morning: Wake up, care for dogs, make breakfast, wake up kids, get kids and husband off to school, exercise dogs, do some writing or other work, drive to campus, hold office hours, teach, stop at the grocery store, eat lunch. Now my Friday morning consists of juggling parenting, attempted home-schooling, attempted online teaching, and attempted writing. Added to the mix are my worries and concerns unique to this time: Will the kids get to see their teachers or friends? Am I doing enough to help them through this? And then, the questions plaguing all of us: Will the stores have milk? What about people who are less fortunate than we are? How will local businesses survive? What will happen to the economy? Does it make sense to plan anything in the next 6-8 months?

At the same time, our face-to-face outlets for dealing with stress and working through situations have been cut-off. Without lunches with friends, gym workouts, or (gasp) in-person meetings, it’s hard to emotionally process it all. I’m glad that we can have online classes, connect over social media, and take virtual karate. But let’s not pretend it is the equivalent of the real experiences that we all crave right now.

My point is that we need to adopt a communal understanding about this time. Our standards and goals, even for daily productivity, should not be the same because our lives are not the same. What we do now will inevitably affect the future, but it doesn’t mean we are setting the bar (or lowering the bar) for next year and beyond. In other words, we need to asterisk * the things we think, decide, do, and communicate with the pandemic grain of salt.

This * is already happening for many people. If you are sick or care for someone who is, or if you work in healthcare, you are already there, where the details of a pandemic are all that concern you. A month into the yellow fever epidemic, every article in the Federal Gazette mentioned disease–even those that talked about a local fire. Every poem and parable printed focused on the epidemic. Ads only addressed “remedies” and other related goods and services. Even if we are lucky enough not to be in this place and can play with the kids, teach our online classes, and do “regular things,” we need to remember that not everyone shares our fortune.

This is a strange time full of uncertainties. Enjoy the moments that feel a bit normal, especially if they bring hope and optimism. But let’s also give ourselves permission to take a breath and just try for average, not exceptional, since every accomplishment is extraordinary right now. If Washington could ease up multiple times because of disease, then so can we.

Stop Telling People to Wash Their Hands: The Myth of Responsibility in the Pandemic

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Image may contain: one or more people, possible text that says 'Exhibit A...Coronavirus swab. Yes that is where the swab goes. So unless you'd like this done to you... u...stay home and wash your hands!!! Please. Facebook/MedicalMemes'
Meme going viral right now

This meme is going around social media. Along with these:

Plus parody songs that time washing hands, instructional videos on how to get that lather, and a shortage of anti-bacterial soap that demonstrates people are listening.

So I don’t seriously think you should stop washing your hands. It should have been standard practice. And yes, we could all use a little reminder to linger at the sink and up our thoroughness.

That said, I have several issues with this message as the dominant one we’re still reciting, meming, and sharing. Back in January, this “wash your hands” campaign was a good introduction to the escalation about to come. And yet we’ve spent more time repeating this phrase than sharing vital information from the CDC, World Health Organization, public health departments, and other sources.

We are past the initial stage of the crisis and should be focusing on identifying symptoms, where to go for testing, how to protect yourself from infecting others, and what to do for yourself if you don’t need hospitalization. This is the information we should be spreading online.

Using risk language (like in the meme above) simplifies disease transmission into a Magic Bullet Model. Under this falsely-conveyed causation, if you test positive for COVID-19, then you must have failed at washing your hands or not touching your face. This is not how disease works. Transmission, susceptibility, and immunity are complicated. We don’t know exactly how each person got infected so we need to stop assigning blame for those yet to be infected. And with that, stop blaming people from other countries too. It won’t protect you. Instead, treat everyone like they are Tom Hanks, Rita Wilson, or Idris Elba.

Here’s the deal: We need regular people to feel comfortable coming forward and sharing their personal experiences so stop stigmatizing individuals who have tested positive (and the many who likely have the disease but aren’t being tested). It is helpful to hear about the varied unfolding of this disease and how it affects different people. We should be thinking about how we can best be prepared and help out, not accusing others of improper hand washing. The when is here. It’s time to shift our own messages accordingly.

(And, yes, we wash our hands).