How the COVID Delta Variant Changes the Stakes

 As I tend to do when I'm worried about something, I've been reading up about the Delta variant of COVID-19. What does the emergence of this variant, which is outperforming all others today in terms of spread, mean for us? I have drawn two chief lessons. I share them here in case they are helpful.

LESSON 1: Not If but When.

The high transmissibility of the Delta variant means it is largely no longer a question of if you will get infected with COVID, but when. The remaining question is this: When you are infected, will your immune system be primed to fight off the disease quickly and efficiently—likely so quickly and efficiently that the virus is licked without you ever realizing you were sick? 

 It you are vaccinated, then the answer will be yes. If not, then the first time the virus enters your body, your immune system will be scrambling to figure out how to fight it. It may succeed--or, as has happened to too many people, it may flounder and go haywire in ways that jeopardize your life.

You will meet the Delta variant sooner or later. Its spectacular transmissibility pretty much guarantees that.

This means we are now in the situation of comparing head-to-head the health risks associated with getting the vaccine with the health risks of getting COVID. That didn’t used to be the case, at least not quite. Before the Delta variant came along, someone could reasonably say, “If I get the vaccine, I’m sure to face the risks associated with that. But if I don’t, I might never get COVID and so never face the risks associated with either one.” 

That is no longer true, unless you are capable of total isolation.

Of course, no vaccine is totally risk-free, but in a head-to-head comparison of vaccine vs. COVID risk, there really is no comparison. Both have been intensely studied by medical experts. For ordinary citizens, the chances of serious health complications from the vaccine is one in millions. The chance of serious health complications from COVID, if you're unvaccinated, is one in hundreds.

Put simply, from a health-risk standpoint getting COVID is many thousands of times worse.

There are few medical decisions these days where the difference between the options is so stark—similar in clarity to the choice between whether to have ice cream or someone else’s vomit for dessert. The only difference is that in the case of the ice cream vs. vomit, we don’t currently see loads of people playing up the risks of lactose intolerance while trying to make the vomit more appetizing by sprinkling hydrochloroquinine over it.

LESSON 2. We Mitigate Through Mandates or Face a Health Care System in Crisis

You might ask, if the Delta variant is so transmissible that everyone will be exposed eventually, why slow down the inevitable with mitigation measures like social distancing and mask-use? 

There are two answers. First, slowing down the rate at which people are exposed gives us more time to get more people vaccinated. It gives us more time to convince the vaccine-hesitant to get the shot before exposure—something that may save their lives. And it gives us more time to finish researching the impact of the vaccine on children under 12—potentially enabling us to protect our children with safe and effective vaccines before they catch COVID.

Second, given just how transmissible Delta is, if we do not collectively and consistently pursue mitigation measures in settings where transmission is likely--something that will likely only happen if we implement mandates on mask-use and social-distancing wherever transmission rates are significant--the virus will sweep through the vulnerable (that is, unvaccinated) population so quickly that we risk completely overwhelming our healthcare system. 

Delta spreads a LOT faster than earlier variants. A substantial vaccinated population--even as low as 50%--might have slowed the spread of other variants down enough to keep hospitals from being overwhelmed. But Delta is a different animal. Unless we take active steps to mitigate spread, it will find the unvaccinated quickly. It will spread among the unvaccinated quickly--especially if we bring bunches of them together in one place (such as grade schools where all the kids are under 12 and so cannot be vaccinated). The most vulnerable among them will need to be hospitalized. Some will need ICU care. Some will die. 

In states that actively preclude mitigation mandates, like Texas and Florida and Oklahoma, ICU beds (including pediatric ICU beds) are already at or near capacity. And that’s before the impact of the school year starting up (here in Stillwater, public schools started up two days ago and the university starts on Monday). Once schools are back in session, if we don’t implement mitigation measures like mask mandates things will get a lot worse a lot more quickly. 

And if you think mask-use will be extensive  and consistent if it is done on a wholly voluntary basis, without mandates, you might want to look around here in Stillwater, Oklahoma, today--and compare what you see with how things looked back before the mask mandates expired in May. Despite efforts to get the word out about the Delta variant and the new CDC guidance, mask use is...spotty.

Spotty masking won't do much good--especially if there is significant overlap between the unvaccinated and the unmasked. Remember, Delta is sweeping through the unvaccinated population, sickening the unvaccinated population, hospitalizing the unvaccinated population, killing the unvaccinated population. Those who are vaccinated can carry Delta to others...but are far less likely to. They can get seriously ill...but are far less likely to. 

Here's the problem. We've got two classes of people: those who take the pandemic seriously and trust the medical experts; and those who either don't take the pandemic seriously, don't trust the medical experts, or both. The former are very likely to have already been vaccinated--and they are very likely to take seriously a strong CDC recommendation to begin masking up in indoor public spaces. But it's the latter who, being unvaccinated, are vulnerable to the current wave of the pandemic--and hence the ones we really need to mask up to avoid a health care crisis. Unfortunately, it is also the latter group that is least likely to mask up voluntarily based on guidance from medical experts--because, for whatever reason, they don't trust those experts.

Of course, some of that latter group will resist mask use even if it is mandated. But mandates still have an effect. Last academic year, all my students wore masks in class, even those who didn't believe it was necessary. They wore the masks because that was the rule. Mandates increase mask-use, and widespread and consistent mask-use--especially among those who are unvaccinated--is a crucial tool in slowing the spread of Delta through unvaccinated populations and thus keeping hospitals from becoming overwhelmed.

An overwhelmed health care system means everyone has less access to lifesaving treatment—whether they’re sick with COVID or something else. An overwhelmed health care system means that doctors and nurses who are already overworked and emotionally exhausted find themselves pushed past the break point.

We’re talking about a health care system in which the human beings who are called to fight this war suffer such serious burnout they can’t continue. And like a kind of feedback loop, an already overburdened system becomes even more overburdened as people burn out and the weight falls heavier on those who remain.

This was a risk before the Delta variant came along, and was a major basis for the decision to shut the country down. Now the Delta variant is in play, with viral loads a thousand times higher than earlier strains and transmissibility rates many times higher. Unless we mandate mitigation measures like indoor mask-use, we will quickly reach a healthcare crisis once Delta starts to spread in schools. 

If the crisis gets bad enough, we won't be talking about mandating masks in schools. We'll be talking another shutdown. And we'll be burying too many beloved dead.

Love your unvaccinated neighbors--by getting vaccinated and wearing a mask.

Love your local health care workers--by getting vaccinated and wearing a mask.

Love yourself--by getting vaccinated and wearing a mask.

The Campaign to Get People Vaccinated: Manipulation vs. Reasoned Persuasion

I've seen the following meme recently on social media, and given the timing of its spread it presumably relates to current efforts to convince Americans to become fully vaccinated against COVID. Here's the meme:

(In the event of any difficulty reading the image, it says the following:

How Manipulation Works

1. FEAR--Do this or something bad will happen.

2. FLATTERY--Do this and you're a good person.

3. BRIBERY--Do this and I will do something for you.

4. VIOLENCE--Do this or else...

By the way...We're at step 3.)

Looking at the meme as a philosopher, there are numerous problems with it. One problem relates to "steps" 1 & 2, and involves the failure to distinguish between what Plato called "mere persuasion" and persuasion that proceeds via "instruction"--or what I'm inclined to call the distinction between manipulative persuasion and reasoned persuasion.

The point is that we can persuade people through a kind of trickery in which we bypass people's rationality and responsiveness to evidence and arguments, instead appealing directly to irrelevant feelings and emotions to shift a person's view in the desired direction.

Or we can persuade people by give reasons and evidence that support the truth of the view we are asking them to accept. 

The former is a kind of manipulation. The latter is not.

So, consider the so-called "step 1" of manipulation in the meme above, labeled "Fear": 

Do this or something bad will happen. 

Consider this step in relation to what the meme was surely intended to be a commentary about: the ongoing COVID vaccination campaign. Suppose that I point out that while COVID infection often has only mild health repercussions, in a significant number of people (much higher than for viruses like, say, the flu), it can lead to serious long-term health problems and even death. We've been able to isolate some of the risk factors for serious illness, but not all--and many apparently healthy people have died from the disease. 

Suppose, furthermore, that I point out that the vaccines for COVID have been shown to be very safe and effective--and especially effective at prevent serious illness.

And suppose, furthermore, that I note that with widespread vaccination, we will be able to return to our normal lives without either seeing a surge of COVID-related deaths or whole classes of vulnerable people being forced to isolate themselves to avoid infection. But without widespread vaccination, we'll continue to face the tough choices we faced before vaccines were available: either we radically altar our collective way of life to protect the vulnerable (with the economic, social, and personal costs that this brings), or we don't, in which case vulnerable people will either be dying in frightening numbers or forced into seclusion.

And suppose I conclude on the basis of all of this that if we don't collectively make a commitment to vaccinate as widely as we can--which at a minimum means vaccinating ourselves and may also mean urging friends and family to do likewise--then the circumstances in our country will be far worse for many people than would be the case were we to make that collective commitment to vaccinate.

Suppose I lay out that argument. What I've effectively done here is given reason to think that it is true that "bad things will happen" if we don't collectively commit to vaccinating--bad things that won't happen if we do. But the argument above is based on sound evidence, and it logically supports the conclusion. In other words, it is a good argument for reaching the conclusion that if we don't do this, bad things will happen (or keep happening); and if we do this, those bad things will be avoided.

An argument like that is not manipulation. If you are about to drive without a seatbelt and I point out the differential accident survival rates of those who do and don't wear seatbelts, I'm engaged in reasoned persuasion, not the manipulative kind. Likewise with the vaccine argument above.

Of course, reasoned persuasion is open to criticism and response. It evolves through dialogue, through considering objections  and responding. Reasoned persuasion, because it is oriented towards uncovering the truth, is open to being tested in the light of critical questions and the like. The point here, however, is that reasoned persuasion, which is not manipulative, can have the form of saying "Do this or something bad will happen." What distinguishes it from manipulation is that it is backed up by reasons and has an orientation towards speaking the truth.

The same can be said about "step 2." What are the characteristics of a good person? There is no universal consensus, of course, but there are still things we can and do agree about: virtues, or good character traits, that are typical of the people we call "good." 

They care about others. They care about the public welfare. They are willing to mildly inconvenience themselves for the sake of helping others avoid major sacrifices, and they are willing to take small personal risks to help others avoid dire ones. 

Given all the facts laid out in my argument above, you can see that it is easy to construct an argument for the conclusion that, on this broad portrait of a good person, someone who gets vaccinated against COVID is acting as a good person would. (Of course, there are cases of individuals who face a greater-than-typical risk from vaccination, and so might be very good people but choose nevertheless not to vaccinate; but generally, for the vast majority of us, the risk of vaccination is very low.)

In short, everything I said about step 1 applies to step 2: there are non-manipulative arguments for the conclusion that getting a vaccine is the sort of thing a good person as described above would do. Or, put another way, there are moral arguments for getting vaccinated that are good arguments for most ordinary, healthy people. Of course, these arguments are again open to critical examination, questions and objections. People with good motives may be misinformed about salient facts, and so they are unconvinced that they should get vaccinated absent a deeper investigation of those facts. But it is also the case that good people are open to being persuaded by an honest investigation of the evidence.

The point is that there can be good reasons to think that getting vaccinated is the sort of thing a good person, fully and properly informed, would do.

Of course there is manipulative persuasion that appeals to fear, and manipulative persuasion that appeals to flattery. What distinguishes these manipulative forms of persuasion is that they do not invoke evidence and reasons to support their conclusion. Instead, they paint a scary picture without offering clear, sound evidence for the view that the desired behavior contributes to preventing the scary picture from becoming reality. Or they pander to the egos of their audience, making the audience feel good about themselves, and then just trust that those good feelings will spill over onto the desired behavior without offering any solid moral arguments in support of the behavior.

Manipulation is about creating associations between feelings and views through building subconscious connections. You hold up an idea you want someone to believe, and you stoke certain emotions (fear or pride, etc.)--and you hope that those emotions will latch onto the idea in the right way. Fear will be associated with not doing X because of the vivid association created, even though you have done nothing to support the conclusion that failure to do X will have the fearful results. Or that gushy feeling of being a great person is associated with doing X, even though no reasoned moral argument is offered in support of the view that doing X is the kind of thing someone motivated by virtuous character traits would do.

When it comes to steps 3 & 4 in the meme, things are a bit different. 3 & 4 are not forms of persuasion in the sense of convincing you that something is true--either manipulatively or instructively. 3 & 4 are about behavior modification through rewards and penalties. But in labeling 4 "VIOLENCE," the meme ignores the fact that there are a wide array of penalties that are imposed to modify behavior that don't typically fall under the heading of violence--at least not violence in the typical overt form that we usually have in mind when we use the term (there are some less conventional understandings of violence that see all coercive pressures as violent, but I'm not going to dig into those understandings here).

Behavior modification through rewards and penalties is a widespread human practice. Parents do it when they reward and punish their kids. Teachers do it with gold stars and time in the thinking spot, or with A's and F's. Governments do it when they offer tax breaks and tax penalties. Laws are built on negative consequences for disobedience.

It is hard to imagine a functioning society that does not use rewards and penalties when the behavior at issue is important for the sake of social health and success. Of course, there are always pressing questions that we need to wrestle with when we are considering the imposition of rewards and penalties: is the matter important enough to try to shift people's default behavior by adding incentives and disincentives? And if so, what is the best approach: incentive-based, or penalty-based? 

3 is often employed when reasoned persuasion of types 1 & 2 are insufficient. Milder (not-overtly-violent) forms of 4 are sometimes employed when 3 fails, without an overtly violent form of 4 ever being deployed. Many times we stop at 3 because we conclude that the most effective way to proceed is to push on with a combination 1-3. Sometimes the matter is so serious (murder), that we implement a violent (forcible arrest and incarceration) form of 4 immediately without waiting to see whether 1-3 alone, or a milder form of 4, will work. In terms of social tools for getting people to behave civilly and beneficially with one another, we use a mix of 1-4 in ways that don't follow some clear, inevitable pattern.

What is troubling about this meme is that it does not present 3 & (milder forms of) 4 as inevitable features of civil society, where 3 & 4 are employed variously in various situations, in various combinations with 1 & 2, based on assessments of social needs, individual rights, and pragmatic questions about what works. And it does not recognize that the "penalty" side of behavior modification comes in a range of forms, most of it not overtly violent. Instead, the meme represents 4 as violence, and 1-4 as this inevitable progression of increasing severity, with violence the final frightening stage in government population control. And then it ends with saying that we are just about to enter that final stage.

The meme offers no evidence, no reasoned argument, for the view that this is how our nation's campaign to get people vaccinated is evolving. It simply lays out this ominous set of stages, with VIOLENCE (in all caps) about to come hammering down.

So, based on the distinction made above between manipulative and reasoned persuasion, this meme appears to be a case of manipulative persuasion. In that respect, it is distinct from prevailing arguments about the troubling outcomes of large-scale failure to vaccinate, and moral arguments in favor of vaccination, since these arguments (at least the ones I've seen) most often take the form of reasoned persuasion.