Whether or not it is too late just yet to wish people “Happy New Year” I cannot say–as a rule of thumb, etiquette experts at The Emily Post Institute suggest retiring the greeting about now, after the first week of January–but it is certainly not too early, I think, to propose a candidate for the 2022 Word of the Year. My suggestion would be “endemic.”
The ancient Greek word “demos,” familiar to us as the root of “democracy,” is also the essence of “endemic.” “Demos” means “people,” and “endemic” means, by extension, “among the people.” SARS-CoV-2 is (or at least it was upon its discovery in late 2019) a novel virus with no history of infection in human beings, and COVID-19 is consequently a new disease. Whether or not it is too late in 2022 still to be using words like “novel” and “new” in connection with this pathogen I cannot say, but it is certainly not too early to be using “endemic.” There is no going back.
I should emphasize that “endemic” is not synonymous with “harmless,” as the histories of hepatitis, influenza, HIV, and malaria all make clear. Yes, the Omicron variant is less of a threat than previously dominant SARS-CoV-2 variants, with lower associated rates of hospitalization and death, and vaccination continues to be a demonstrated defense against serious infection. Moreover, the emergence of effective medicinal therapies such as Pfizer’s Paxlovid—which according to the FDA can reduce the likelihood of COVID-19-related hospitalization or death by 88%—is cause for celebration. The possibility remains, however, that a future SARS-CoV-2 variant will combine Omicron’s incredible contagiousness with Delta’s virulence and challenge human health and society anew. Endemicity entails this risk in perpetuity. The question is how to live with it more realistically and sustainably than we are living with it now.
In probability theory, the expected value of an outcome when multiple outcomes are possible is determined by summing the value of all outcomes after each one is multiplied by the probability of its occasion. This is simpler than it sounds. If I proposed a game in which you would earn $20 every time a flipped coin came up heads but would lose $10 every time it came up tails, the expected value to you of each coin flip would be $5 (or one half times $20 plus one half times negative $10). Your expected earnings after 10 coin flips would be $50. You would want to play this game as often as you could—but the terms of the game would no longer be favorable if tails cost you $20, and they would be decidedly unfavorable if tails cost you $30.
We run expected value calculations constantly, often unconsciously, in our daily lives. We are all veteran cost-benefit calculators and risk managers, and yet present circumstances confront us with how poorly we sometimes do the math. Writing in the New York Times earlier this week about Omicron’s relative mildness, David Leonhardt observed that, for vaccinated individuals, COVID-19 “increasingly resembles the kind of health risk that people accept every day,” and yet we continue to calculate today’s expected outcomes using yesterday’s numbers–as though a flipped coin that lands on tails still costs us as much as it did before.
If the epidemiological risks of COVID-19 are proving susceptible to overestimation, the educational and developmental risks to children are not–and they are increasing. McKinsey & Company published a study in July seeking to quantify “unfinished learning” among K-12 students through the pandemic, a term that they used “to capture the reality that students were not given the opportunity to complete all the learning they would have completed in a typical year.” Among their findings were that students on average were five months behind in mathematics and four months behind in reading by the end of the 2020-21 academic year, and that 35 percent of parents were “very or extremely concerned” about their children’s mental health. In October, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association went so far as to publish a joint Declaration of a National Emergency in Child and Adolescent Mental Health to draw attention to the burden of the pandemic on children.
For K-12 students, the expected value of ongoing COVID-19 transmission mitigation measures in schools—the benefit of heads relative to the cost of tails—is unfavorable. Dr. Joseph Allen of Harvard’s T.H. Chan School of Public Health wrote in late December that “the argument for keeping schools open rests on two constants ever since the pandemic began: the risk of severe outcomes to kids from coronavirus infection is low, and the risks to kids from being out of school are high.” He argues for more nuanced policy responses in view of these facts. “We need to stop quarantining entire classrooms when there is a positive case and instead establish so-called test-to-stay policies as the default.” (I should note that we are evaluating a test-to-stay program at MICDS, the implementation of which would depend on greater supply of COVID-19 tests in the marketplace than is presently available.) Dr. Allen also argues for optional masking in school settings. “To think that two years of masking has no impact on socialization, learning, and anxiety is shortsighted. Kids are resilient but not endlessly resilient.” Nevertheless, he emphasizes that “anyone who wants to wear a mask should be allowed to do so,” adding that “if children are vaccinated and wearing a high-performing mask, their risk is about as low as it gets in life.” Their expected value calculation, in other words, is exceedingly favorable.
In another of his New York Times columns this week, also engaging his inner probability theorist, David Leonhardt noted that “children face more risk from car rides than COVID.” He then posed an essential question: “Should children suffer to protect unvaccinated adults—who are voluntarily accepting COVID risk for themselves and increasing everybody else’s risk, too? Right now, the U.S. is effectively saying yes.”
The difference between “pandemic” and “endemic,” between 2020 and 2022, must be the difference between reactivity and proactivity if we are to achieve a sustainable coexistence with this pathogen and the generations of variants that it will inevitably spawn, especially on behalf of the learning and growth of children and adolescents. “Our best case future,” wrote Martin Sandbu earlier this week in The Financial Times, “is one where ‘normality’ can be shifted to a crisis regime at the flick of a switch, when contagion intensifies”—but only as an exception, not as a rule. A constant “crisis regime” is paralyzing. We must become better at determining what does and does not constitute acceptable risk, and for which populations, and in which settings. We must become better probability theorists.
As confident as I am in “endemic” as a Word of the Year candidate for 2022, so far I am drawing a blank on Album of the Year, Book of the Year, and Movie of the Year nominees. Maybe I will have some ideas for you next week?
Always reason, always compassion, always courage–and, as this opening week of January draws to a close, happy new year one last time! I wish you a joyful weekend with your families.
Head of School
This week’s addition to the “Refrains for Rams” playlist: All Things Must Pass by George Harrison. In the first episode of the recently released documentary series The Beatles: Get Back, Harrison brings an early draft of this song for John Lennon’s, Paul McCartney’s, and Ringo Starr’s consideration. He ultimately released it himself on a solo album of the same name in 1970. “A cloudburst doesn’t last all day… / It’s not always gonna be this grey.” (Apple Music / Spotify)