Pandemic Fatigue, Explained

Hey everybody, it’s Dr. Z. Welcome to the ZDoggMD show. We’re live, it’s October 19th, 3:04 p.m. Pacific. Welcome to the show, we’re heading into fall and the media all over the place is banging the drums of doom. Cases are rising in parts of the US that haven’t seen high cases yet. We’re seeing Europe have some resurgence in cases, and everybody is freaking out except for the people that are too tired of this to freak out.

And that’s what I wanna talk about today, is just a rationalist, alt-middle approach to thinking about why we have pandemic fatigue? What we should really do for the fall? Like what should you do, given all the news that’s out there that everybody’s gonna die, right? So let’s just talk about it rationally, okay, and have a little back and forth.

So this is the thing, cases have been bumping, why? Well, people are getting closer together because fall is happening in North America. And so it’s colder outside people are going indoors. that’s one thing. School has reopened in some places. Now, remember, kids can still get the COVID, the coronavirus, and they can spread it. But a lot of times, again, they are not getting that sick, all right. So these are cases, not necessarily hospitalizations and deaths. Now hospitalizations and deaths can rise usually in a delayed fashion from the cases. And that’s what really ought to worry us.

Now, remember in the beginning of this whole thing, when we knew nothing, all we saw were pictures out of Wuhan and people were dying and hospitals were overwhelmed and healthcare professionals were crying. Then we had our own overwhelm in New York had no idea what was gonna happen, so we decided, okay, based on the best data we have right now, we better do a hard reset, lock things down, buy us some time and flatten the curve. So one of my supporters sent me little Fauci bobblehead, and on the back, it says, flatten the curve. And of course he’s very flat, not very curvy at all Fauci, but generally a reasonable rational guy. At that time, it made a lot of sense.

So we stopped that and the ideal was, don’t let your hospitals get overwhelmed while we figure out better treatments, while we figure out a vaccine, while we figure out how this thing spreads, really, really get a handle on it, right? And for the most part, if the goal was prevent your hospitals from being overwhelmed, that worked, it worked really well. Only in New York, did we come kind of close, right? And the rest of the country would have their surges and beds would fill to near capacity, but we never got overwhelmed. And we started buying us some time to get PPE for frontline healthcare workers to try to keep them safe, because that was a major disaster in the beginning. So with that now it’s still not perfect. Believe me, it’s not perfect. I hear from people around the country that there isn’t enough PPE, but for the most part, it seems to have worked.

We have a little better treatments. We have Dexamethasone, we have Remdesivir, which probably doesn’t do a whole lot, which I’ve been kind of saying from the beginning, there’s more data now out of a WHO trial that says doesn’t really affect mortality. These Regeneron and monoclonal antibody cocktails and Lily and all that, and data’s yet to show that those things help. But Dexamethasone, pretty compelling data that it helps. And proning of patients, not intubating everybody. Those things have improved outcomes in the hospital.

So that it’s probably true that you’re less likely to die now than you were in the beginning of the pandemic. Now, remember when your hospitals are overwhelmed, you’re more likely to die in general because there’s not enough capacity to take care of you, whether you have COVID or whether you have a heart attack or a stroke or something else. And that was one of the big concerns early on. Now we’re past that, but we have managed to really severely damage our economy and without really mechanisms in place to ameliorate that. So we don’t really have the level of government assistance that would keep people from slipping into poverty and running out their unemployment checks and that kind of thing in fields that have been impacted directly by this, right? So we’ve really disrupted the economy. What we’ve seen on top of that is a rise in substance abuse and overdoses. People are dying of overdoses more. We had started to begin to get this whole opioid thing at least have wrap our head around it, and now it’s backsliding. There’s a 22% increase in alcohol purchases in this country. Now some of that is because you can’t get it in a bar or a restaurant, but some of it is people are just despairing.

And this is what they’re calling pandemic fatigue. Every day the news is pounding us with this on all sides. Every day, there are thought leaders out there talking about this and filtering it through their own confirmation bias. So if somebody already believes that this is the worst thing to ever happen to us, and we need to do everything we can to save every single life, they will pick any piece of data and use it to support what they unconsciously already believe. And the same goes with someone who thinks it’s overblown and it’s destroying the economy and we shouldn’t even be responding to this cause it’s no worse than flu, well, you will cherry pick data to support that. And we’re seeing it on social media. We’re seeing it on the main media. We’re seeing it anywhere, whether it’s CNN or Fox or MSNBC or Time Magazine. Time Magazine just ran an editorial about how Sweden’s approach was a complete disaster. Then you talk to the Swedes and they’re like, “No actually it’s been pretty good. “We’re generally on board with it. “Things have been okay. “We had some glitches in beginning.”

So who do you believe? What do you listen to? Then people are telling you you’re gonna die, the cases are going up right now, look, they’re surging. Look at that graph! You know, it’s like a parody of Nickelback that I’ve wanted to do forever. ♪ Now look at this COVID graph ♪ ♪ Every time I do it makes me cough ♪ I mean, it’s really a kind of a social contagion that has infected us.

It’s a real disease, people are dying. How does that affect our society and us in general? Now the excess deaths from March to August are roughly 225 or some odd thousand. Remember, that’s not as many as the 200, it’s a little more than 217,000 that were documented covered, but that’s going through til October, right, this was just to August. So there’s a ton of excess deaths compared to what we’ve had in previous years, so something’s up. Um, COVID’S real, but how many of those deaths are actually due to COVID and how many are due to the ancillary damage from economic despair, substance abuse, other kinds of missed opportunities to screen for cancer, to provide cardiac care, stroke care, those kinds of things. Those people are afraid because we’re seized with fear because if you turn on the TV or you open your newsfeed, it’s terrifying. And it hasn’t changed. It’s only intensified as we go into fall as we see cases rise.

Now cases are rising, hospitalizations are going up a bit, deaths are going up a bit, but they’re not going up at the levels we saw in the beginning. So my take on that is, and I think reasonable people may agree, and some people may disagree, that we have younger people that are infected now that are at lower risk. And so they’re less likely to be hospitalized, they’re less likely to die.

Now people say, “But it’s not just about death. “It’s about this terrifying long haul nightmare, “where it’s going to hurt your heart, kidneys, your liver, “and your brain. “And people are reporting COVID fog and having symptoms “that really corresponds “to things like chronic fatigue syndrome.” Okay, yes, I’m sure that’s going on at some rate, but what rate? what’s your risk of it? How does it differ from other known viral infections? Coxsackie virus can cause cardiomyopathy, heart damage, right? There are other, influenza can do that. So the question again becomes one of putting all this chaos into perspective. Now I’m a trained physician, UCSF, Stanford. I’ve been through research. I’ve done clinical medicine for over 10 years. I still have to really carefully weigh, what are my biases when I see a study? Oh, that confirms what I believe! Wait, stop, if it does, you better try to poke holes in it. ‘Cause the people that are easiest to fool are ourselves because we want to fool ourselves, because we wanna be right about this, right? So all this data.

So what does the average American do? Throws up their hands. They’ve seen their livelihoods affected, they’ve seen schools tampered with so that their kids are at home, bouncing off the walls, not getting an education. They’ve seen institutions like sports and stuff affected that are part of the social fabric. I’m not a sports fan, but man, you pull away something like that. Churches are affected, if that’s part of the social fabric for you. Actually we’re social creatures, so what’s happened? We don’t get to be with each other. And then there’s this controversy. Do you mandate masks? Do you ask people to wear masks? Do masks even work? And listen, I’ve had people on all sides of that discussion on my show.

I personally think that there’s a good enough chance that masks help, just reducing the inoculum, the amount of virus you get. So that if you do get sick, you don’t get that sick. That’s why cases may not decline, but actual hospitalizations and deaths may decline. And you may generate some degree of immunity that may be like a vaccination. Maybe not as good, but like of vaccination. That’s my take on it. So personally, I wear a mask when I’m out in public and I can’t distance from people. I don’t wear it on my hiking trail, except if someone’s coming up right close to me, then I’ll put it over my face. And that’s just how I deal with it, right?

And what about schools? We’ve talked about schools. You’ve got to weigh, the risk to children relatively small compared to the risk to older folks, people with comorbidities. Risk to teachers is there. Masking, distancing for teachers, take the precautions that you can. But boy, keeping kids out of school that is going to ripple out generation and generation and generation ahead. And people like, no, it’s just a year, whatever. It’s a year of a child’s life! Children are resilient, but remember they’re already behind, the ones most at risk.

And what we’re doing in our response to this is significant, right? So you now have all of this, what are people doing? They’re starting to really shut down. In the beginning, terror and fear, and a sense of unity actually drove behavior. Now people are saying, “You know what, I just don’t care.” Now here’s the thing that people are gonna disagree with. And I’m gonna say it anyways. I don’t blame them. I have nothing but compassion for people who feel that way. And I think part of the problem is we have been so busy attacking each other and our own choices. Like, okay, what do you value? All right. There’s a 0.5, let’s take the average here of what the experts think, all right? There’s a 0.5% mortality across age groups for infection fatality rate for COVID we think. Jay Bhattacharya and his colleagues think it’s lower. Other people think it’s closer to 0.8 or 1%, but really I think it’s settling around 0.5 or less, okay? That means you have a 0.5% chance of dying. And that of course goes up with age and with comorbidities.

Now that’s roughly five times the mortality of a seasonal influenza outbreak. You have to understand that some people, especially if you’re in a risk group, are gonna take that very seriously and are going to stay in their homes, are gonna wear mask everywhere they go, are gonna wash their hands, are gonna disinfect their UPS packages, are gonna disinfect their groceries, are not gonna see loved ones, are gonna try to tisk, tisk, tisk people for not wearing masks and are going to generally catastrophize about that. Because that number means that it means something to them. They’re gonna cherry pick news that supports their fear. They’re gonna cherry pick data that supports it, that this thing it does not develop immunity. Probably not true, probably does develop immunity. And it does probably last for some period of time. And they’re going to say, “I’m gonna ride this thing out until we get a vaccine.”

Not understanding the risk that a vaccine may not work, may not be effective, may not be approved, may lead to safety issues that are found in the trials if the trials are done well. It’s already been politicized, so guess what, 40% of Americans now say they would not take a vaccine when it comes out, okay? Which means you’re never gonna generate a decent level of community immunity, unless there’s also natural infection. So it’s risky to actually take that high risk approach. But it’s reasonable too if that’s what you value. If you value your life or the lives of close ones around you more than anything else, then that’s reasonable, and we should have love and compassion for people who feel that way, right?

But we should have zero-tolerance for them shaming others. Now what about the other side of the coin. For a 0.5 risk, you’re gonna lose the small business you worked your life to create. You’re gonna pull your kids out of school, which means you as a woman say, and this has been shown to be happening, have to give up the career path that you’ve chosen, where you were in a tenuous balance with your child going to school, coming back, doing homework with them, dad working or not there, but yet you’re going and you’re fulfilling your destiny in the world, whatever that is, whatever that calling is while being a mom, raising kids, doing all these things. I was just talking to a couple that are physicians as well, like my wife and I, and no matter how progressive you are, there still, we fall into our gender roles, right? Helping with the homework, deal with packing their lunches, doing these kinds of things. We try to help, but really we fall into those patterns and it falls on the shoulders of women. What has this pandemic done? Pulled the kids out of school. Who’s gonna manage the kids now? Well, not everybody can afford a at-home assistant or a nanny or a tutor. So what ends up happening mom has to cut back or quit, economic hit, personal hit, mental hit at being home with children all day, trying to manage their Zoom classes that everybody’s trying to figure out what’s going on. Man, that is a mental health hit! Ah, and there’s a 22% increase in alcohol consumption and overdoses.

Around the world we’re seeing poverty. We’re seeing famine, I mean, this is a big deal. So some people value avoiding that. And yet they will shame the people who value safety and the safety people will shame the people who value livelihood and mental health and all these things. And then those of us stuck right in the alt-middle are watching this play out and are just filled with despair for the future of our country, because we can’t appreciate where the other group is coming from. And I mean, it didn’t help that it’s an election year. Doesn’t help that all our leaders are complete clowns. I mean, listen, I’m gonna say it right now. Biden, Trump, I don’t care who it is. Nobody’s living up to the potential of what America can be, right? This is insane. And it’s fed by social media. It’s fed by other media. It’s fed by our own confirmation bias just entrenching a belief, picking a side. We’re all Americans! There’s no sides here, right?

And so what’s happening, pandemic fatigue, where people are just tired of it. It’s not unreasonable to say for a 0.5% mortality. Okay, I don’t agree with shutting things down and closing schools and the constant catastrophizing. And I don’t think it’s unreasonable that if you’re in a high risk group or you’re just worried about this stuff, or you’re a healthcare worker, or you’ve had family members who’ve died or gotten sick or have been long haulers from this thing, to say, “I’m not gonna go out without a mask. “I think other people should try to wear masks “if they’re around me. “I don’t think we should have large gatherings.” All of that is reasonable, but you know what we haven’t done? Is treated people like they are adults, largely because people haven’t behaved like they’re adults. We haven’t taught them how to do that. We haven’t learned how to do that ourselves.

So instead of valuing what people value and giving them some latitude, even though it can affect others, but you can take precautions if you’re one of those people that are affected. What are you gonna do for Thanksgiving? All right, a lot of the spread right now happens to come from family gatherings. People you trust. Crazy Uncle Eddie shows up. He’s been going to bars or traveling, not really talking about it. Has an asymptomatic case of the Rona, gives it to grandpa Bob, next thing you know grandpa Bob is prone on a ventilator, right? Talking about withdrawing support. This is how it goes down, right?

There are big events that can be super spreader events, but really it can be that. So what do you do? What are you going to do for Thanksgiving? And that’s stressful, Thanksgiving is stressful already! And remember this thing started during Chinese New Year, when people are traveling in China. I mean, this is what kicked this whole thing off, is this this kind of vector of a holiday. So what are you going to do? Well, you gotta to decide. Don’t do the news and all that. How much risk are we willing to tolerate? Should we do this outdoors? That’s better. Should we ask everyone to be tested beforehand? That’s not bad. Although you could still have a false negative or you can develop it in the interim. We’ve seen that happen at the White House. Should we do it remotely for people who are at high risk? Maybe, maybe, maybe, but these are questions that you can process with help, with calm assistance from media you do trust, your doctor or other people like that, but we don’t have to panic. We don’t have to throw our hands up and give up. And this this is what I think. Dawn says it here, “America’s gone nucking futs.”

That’s exactly right. The pig Latin of what we really wanna say. That we’ve lost our minds. And it’s not our fault. Let’s have a little forgiveness for ourselves, right? This thing is spun out in a way where we don’t tolerate uncertainty. We’re looking for answers. We won’t find them ’cause we don’t know them yet. This vaccine thing is a great example. We don’t know what’s gonna happen, right? I’m gonna be first in line for an FDA-approved, well-researched vaccine. Believe me, right? But until then, it’s a bit uncertain. We have to let the scientists do their job, right? We do have to listen to public health authorities, but we also have to not lose our minds. In San Francisco they just opened playgrounds again. And what are the rules? No more than 30 minutes at a time. If your kid is crying, you have to remove them from the playground. You can’t eat in the playground. These are kids. They’re relatively low risk compared to adults. This is their childhood. This is when they play and learn risk taking and socialization. Why do we have to be that extreme? And why would I get in trouble for even asking the question? We’ve shut down any dissenting thought? And we’ve shamed mainstream thought, like Fauci, how much crap does Fauci get? Right, he’s doing his best.

I know Fauci, I’ve been on a call with him during Ebola, a group call with public health experts. And I found him to be very intelligent and not a fearmonger, right? But he’s in his thing, he’s looking at his thing, he’s trying to do the best he can. And the same with researchers who dissent, who say the herd immunity threshold is lower. Even the words, herd immunity, oh my God! The media will attack you directly for using the term. We’ve lost our mind. So this is what I think. The way we overcome pandemic fatigue is we respect each other’s values. We understand none of the sciences absolutely clear, including on masks, we don’t know. We use our own values. My values are masks or low risk. If they help, they may help lower inoculum. Wonderful, I’m gonna wear them when I’m in public, but I’m gonna have guests in the studio that are distant. I’m not gonna shut down what I think is are important conversations because I’m living in fear, right?

I know my own risks, 47, blood clotting, genetic predisposition. Not low-risk for COVID, but I understand that the risk of not living my life for me, my values, is worse. So I’m willing to do that. And I do my best try not to infect other people. So let’s have some love in the face of what’s going on. The suffering of people who’ve lost their jobs, the suffering of people who’ve contracted COVID or have lost loved ones from COVID, right? The suffering of those overseas, who are suffering from the economic shutdown, the suffering here. And if we actually came together, we don’t have to all agree. We can have debates, we can talk about it, we could actually get through it. Now I think this is what’s gonna happen. This is my prediction and it could be wrong, but because we’re uncertain, but based on the information I have right now, and by the way, if you meet people who never changed their mind go somewhere else, ’cause you can’t trust them. You have better have changed your mind a couple times during this pandemic, at least, based on new information, that’s come out. I know I have, I’ve talked about it many times. So what I think is gonna happen is we’re gonna get a butt ton of cases in the US because we never suppressed the virus down to the levels that say New Zealand or China did, or South Korea.

Now people, I think part of the problem is people look at that and they go, “Why couldn’t we do that?” We’re holding ourselves to the standard of these guys. Now remember, we thought we were holding the Europeans to a high standard, they’re having surges in cases. So nobody’s perfect, but I’ll tell you what, you better be willing to take the compromises that the Chinese took, which is a military state telling you you cannot leave your home and an aggressive lockdown in a culture that is collectivist and is okay with that. We don’t have that here, so get over it. We just don’t. Now, I’ll tell you what, for a 0.5% mortality, we don’t have that here, we don’t! So stop pretending like we could’ve. We would’ve had to have done it so early. Shut the borders down, do all that. Stop living in that fantasy world and realize where we are. This thing is widespread. There are 8 million documented cases. And the suspicion of even CDC is that the actual prevalence is 10 times that. Which means roughly one fifth to one fourth of the US population has been exposed and infected with coronavirus 2, the sequel. This is a widespread disease, to suppress it to extinction would require shutting down in a very draconian way, and/or a vaccine that is highly effective and taken up by like 80 to 90% of the population. It’s wishful thinking!

I don’t think it’s gonna happen. And this is where I’m editorializing. What I think will happen in the fall then, is we’re gonna see a butt ton of cases, not as many deaths because we’ve gotten better at that, and it’s younger people getting infected. We will do our best to target protection to people who are at highest risk. That’s not perfect, but we’ll do our best. We are gonna try to mitigate the economic and social and cultural harms of our response, which may well cost a butt ton of lives if we don’t do this right. And I think it’s so important, right. And I do think we should start opening our schools as much as we can with measures. I think we should wear masks whenever we can, whether or not you believe they work, or you believe whatever data there is. The downside of it really isn’t high.

And here’s a tip, if you don’t like cloth masks ’cause they suck, grab some surgical masks off of Amazon. I don’t think it’s gonna impact frontline healthcare professionals like it did in the beginning. Surgical masks are comfortable. They’re less claustrophobic for people who have PTSD, in warm weather, they’re less uncomfortable. And this is my own personal experience with these masks. And they’re pretty good I think at lowering inoculum. Not like an N95 or something, but that’s not what you necessarily need when you’re just out and about. If we do that, if we start to love and respect each other and stop shaming each other. People keep sending me these memes on all sides, trying to shame each other, let’s have a good debate. Let’s stop stifling scientific discourse. And then what’ll happen is we will get through the winter. We’ll probably get to a vaccine. We will have deaths. We will have hospitalizations.

We will not overwhelm the healthcare system because that was the point, is don’t overwhelm the healthcare system. And we’ll get through this together. We’re gonna have to start dealing with the mental health fallout, with the fallout economically and the fallout for our children, and we’ll do it. It really isn’t that complicated. Wash your hands, keep some distance, avoid large gatherings, understand risk yourself and make decisions based on your values. Wear a mask when you can’t distance or you’re out in a supermarket or something like that. That’s it! And if you think your locale is immune, it’s not ’cause we’re seeing it surge in places that we thought was immune. It’s a highly contagious virus. It will go everywhere eventually. So you gotta weigh what’s important to you, that’s it. Not that bad.

All right, now here’s what we’re gonna do. For people who wanna go deeper, I’m gonna do a supporter show right after this. Maybe give me 10, 15 minutes and I’ll go live to supporters. The way you become a supporter, you click a box, 4.99 a month on Facebook, 4.99 and up whatever you wanna pay on YouTube. And you get conversations with me that aren’t accessible to the main page. Why do we do that? Well, it supports all this. I have turned down sponsorship opportunities this year, because I don’t want to look like a damn shell. And I’m tired of kowtowing to anybody that I’m not fully aligned with, a hundred percent aligned with, right. Turn down stuff that I don’t wanna do to try to raise money. And I no longer care about the clickbait and all the ad revenue and all that, because you support us by paying for content you care about. And in return, I try to go deeper. I do a give and take with you in your comments and try to keep it as real as we can. And this keeps us independent. If you like these kind of alt-middle voices, and you’re trying to fight back against the polarization that we’re seeing on the internet, just join us, that’s all. And there’ll be a little pitch at the end of this video too at some point, if we repost it on YouTube. I love you guys, I do. We’re gonna get through this. I love this country, I understand our values. I know why we’ve had a hard time. Let’s forgive ourselves. Stop trying to be somebody that we are not. Be us, but be the best version of us we can, all right? And we out, peace.