With a Whimper…

Vaccine, Redux I do not usually do follow-ups so quickly, but all of my emails after the last newsletter focused on just two questions, so I thought a quick follow-up was in order. Breastfeeding (and a little more Pregnancy) Breastfeeding is not a contraindication for the vaccine. There is no reason to think vaccination would prove a problem for lactating women. In addition, I wanted to share this excellent summary from the Society for Maternal-Fetal Medicine, which makes a strong case that both lactating and pregnant women should be included in vaccination pushes. The whole thing is worth reading, but their bottom line is that there is no reason to think this vaccine would be a problem for women in these groups, and that excluding them is therefore not appropriate (and, indeed, maybe unethical). Long Term Impacts The second question I got a lot: how can we be sure there are no long term impacts of the vaccine? What if there are issues in 5 or 10 years? One answer is, of course, we can never be sure. This is part of the uncertainty we are going to have to live with in the pandemic. One could ask the same (indeed, many have!) about long term impacts of the disease. Or long term impacts of isolation. Or of lost schooling, or of depression. There are many long term impacts we will only learn about in the long term. But a second answer is that there is absolutely no reason to think there would be long term impacts of these vaccines. mRNA is a new technology, in some ways, but it uses a well known biological process. And the basic idea behind the vaccine — to encourage the immune system to develop protection — is the same one we use for all vaccination. There is just no reason to think there would be some secret long term impact here. “Not with a bang, but a whimper” - TS Elliot With vaccine approval, we are starting to talk about “the end”. How will this end? What will the end of the pandemic look like? The first winter I lived in Providence, it snowed a huge amount. There were multiple snow events with more than a foot of snow. For my birthday, in February, Jesse and I went to Boston and walked around the North End, through passageways made in snow drifts which towered above our heads. After every snowstorm, it would first be eerily silent, and then plows would clear a bit of a path. But they were not very effective. For most of the winter, every road we drove on was down to a single lane. And then, slowly, slowly, it melted. Roads became two lanes again, we rediscovered toys lost in the snow. Boston had stored some of their excess snow in giant piles in parking lots, where the last of it melted only in July. This is how the pandemic will end, too. It will end slowly. In drips. We will not awake one morning to find large indoor singing events are back on everywhere. We will not find ourselves all burning our masks in a bonfire on the first day of vaccination. Part of this is because vaccination will not be immediate. Yes, approval this week will probably mean the first vaccines before Christmas. But widespread vaccination will take time. Kids will be later. The NY Times Vaccine Line told me I was behind 267 million other people. If we think we need 60 or 70% of people vaccinated to achieve some kind of herd immunity, then it won’t be achieved in January, that’s for sure. Nor will it happen all at once on some date. But the availability of vaccine will bring on the slow melt. We can expect less spread as more people are vaccinated (even if their vaccination does not protect others, which is an open question, they will at least be less likely to have it). Less spread will bring with it more opening. In most places, a lot of reopening metrics are linked to community spread levels. If there is less COVID with 30% of the population vaccinated than 0% vaccinated, then more restaurants, bars and, perhaps, schools will be open. If you had to ask me to look into my crystal ball, I think the summer will look more normal. Maybe some travel again. More camps for kids (even though they are unlikely to have been vaccinated, a lot of camps operated successfully last summer so I’m guessing this will spur them on). More of us will be back in our offices for more time, if we want. But I don’t think we’ll see large scale music festivals or huge parades (I might be wrong!) quite yet. The slow melt goes beyond the vaccine issues, though. It’s going to take us time to return to where we were before, emotionally. I cannot be the only one who sees people hugging on TV and is like What are you doing?!!?!?! STOP THAT!!! One of my kids told me the other day that when they are around people who are not their family without their mask they “feel naked.” I suspect those of us who wear masks religiously will be wearing them in grocery stores for a long while, even as the mandates to do so fade. It has been a scary, weird, isolating time. It still is. The steps out will be baby ones. And, of course, on the other side not everything will go back to the way it was. I am very confident we’ll have more Zoom meetings in lieu of travel. Although I hope to do some of my August book tour in person, I suspect I’ll get a chance to Zoom some of it, too. And I predict that we’ll see way more masking in general, especially during flu season. Why mention all this now? It’s been on my mind because I think some of at least my stress is the continued feelings of uncertainty. The end is “in sight” but, like, where? And I think this is part of what makes it hard to continue vigilance, and also to just exist. At least for me, recognizing that it will not appear all at once like some kind of jack in the box is helpful. But also recognizing that two months from now things probably will look somewhat better is also helpful. Hang in there, people.

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