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The Coming of “The Tyranny of Tiny Risks”?

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Washington University economist Ian Fillmore sent to me the following e-mail, which I share here in full with his kind permission.

Hi Don,

Our youngest child, Jack, was born in early December of 2017. It was a particularly bad year for RSV. As you may know, RSV can be quite serious for newborn infants, but for older children and adults it usually feels like a cold. The reason is that RSV causes you to produce a lot of mucous, and a newborn’s airways are so small that they get clogged. Anyway, Jack came down with a serious case of RSV in January. We were pretty confident that our daughter brought it home from preschool. The rest of us recovered quickly, but Jack ended up in the PICU on a ventilator for a few weeks. The PICU was full of patients just like him–newborns with serious cases of RSV. They had to convert an additional floor into PICU beds to accommodate all the patients (sound familiar?). Thankfully, he recovered and is healthy now (he does wheeze a bit when he gets sick, so we keep an inhaler on hand).

Would masking and social distancing at our daughter’s preschool have prevented Jack’s infection and PICU visit? It’s certainly possible, even likely. And that’s exactly my worry. Based on the logic we’ve established with Covid, I don’t see how we ever stop with masks and social distancing. While there’s mixed evidence that these things actually slow the spread of Covid, the evidence looks pretty strong that they’re really effective at slowing the spread of influenza and RSV and the common cold.

When it comes to mask mandates, social distancing, or any other pandemic restriction, what is the limiting principle? Or, putting it differently, under what conditions can we get back to normal? Based on the public health logic currently in vogue, I fear that the answer is never and that we are entering a new regime–the tyranny of tiny risks.

As you have pointed out, the vaccines have turned Covid into a disease that is no more worrisome than influenza, and less worrisome for healthy, young people. Now influenza can be serious, which is why I get my flu shot each year. But we have been dealing with influenza-like risks forever. So, at this point, I think it is reasonable to take the same level of precautions around Covid that we take around influenza. Encourage everyone to wash their hands, and strongly encourage vulnerable people (ie the elderly and the obese) to get a vaccine. In my mind, the pandemic is already over in that, through the miracle of modern medicine, it has been transformed into a manageable endemic disease, much like the other endemic diseases we are already accustomed to. That may not be the outcome people were hoping for, but I think it’s the best we’re going to do.

Ian Fillmore