(Personal opinion; not a doctor; edited because I accidentally published the draft)
In a few months, the US should stop being careful around COVID. For the vaccinated, most of you should stop being careful now.
We’re in a new era of COVID. We have some amazingly effective vaccines that highly reduce both transmission and severity, so the emergency is effectively over for the nation (after another month or two for everyone to get a chance to take the vaccine, which they certainly all should). Cases will linger, but the point of the lockdowns and precautions of March 2020 was to buy time—to try to get a vaccine, and determine if long-term side effects were crippling—and we’ve done those things.
Now there is debate about whether we should go back to normal—both personally and in government policy. I’ve been dismayed to see headlines like “Planning on opening up? Not so fast…” Even my acquaintances sometimes make comments about whether it’s safe for me to visit a friend, despite that I’m vaccinated. I called up all my friends in March 2020 to tell them to lock down before the government did—but the people now arguing that we or the nation should stay careful are, in my estimation, missing the bigger picture.
Whether or not we take more precautionary measures, the people still susceptible to COVID are going to get it *eventually*. (Both those that didn’t take the vaccine and those that didn’t have a strong enough immune response.) We aren’t going to magically save them by continuing to be careful. We’ll eventually hit herd immunity one way or another—the only question is how much we flatten the curve. We have to flatten it enough to maintain hospital supplies, as before, but I don’t think we should do more.
And for individuals, the people who have gotten vaccinated aren't really going to get any more safe anytime soon. Rates of COVID might go down a little, but it could be years before the remaining un-immunized population hits herd immunity.
Now, there are some benefits to being careful. It won’t be *you* who gave someone COVID. If people get long COVID or die from it, it will be months later than it otherwise would have happened. But the benefits are very small in relative terms if most of the susceptible people will get it anyways, and absurdly small if the careful person is vaccinated.
The benefits are small in relative terms because the costs of continued precautions is extremely high.
The standard way to measure the costs is to look at how much people would trade to avoid them. I know people I’ve talked to said they’d pay on average about $30k to avoid getting COVID—I don’t actually know what they’d pay to avoid a year of lockdown, but my guess is something similar. Even for people who can’t afford paying much money, I still think they’d probably trade about 1:1 between getting COVID and spending a year in lockdown. Note that, aside from considerations about hospital supply shortages, this means over the last year the US already ended up having made a questionable trade.
Probably we won’t have many more lockdowns. But we will likely continue to have mask mandates, and certainly peer pressure to publicly social distance and wear masks. My guess is that people would pay about a 10% chance of getting COVID for a year of this (assuming you can still hang out with friends privately unmasked). For it to be worth social distancing and wearing masks, this would have to be saving us about a 1% chance of COVID per month. (Current rates are claimed at about .4%/month, so plausibly about 1%.) But if you’re going to get COVID at some point, it doesn’t matter too much if it’s now or a year from now! I think people would pay a lot less in mask-wearing to push it back a year. I certainly would pay little. Half the country isn’t wearing masks now, and clearly would pay almost nothing. It already seems like a bad deal to keep wearing masks after everyone’s had a chance to get vaccinated.
But none of this accounts for the fact that much of the badness doesn’t seem to be captured by trade-willingness—it’s either externalities or things we don’t notice at the time. The three main categories I see here are surprising personal costs, social fabric decay, and government overreach.
First, I’ve seen a lot of bad stuff happen to people this year that doesn’t seem like it would have happened if not for the precautions taken against COVID. Fights, mental breakdowns, lack of inspiration, reduced vitality with downstream effects on everything. I don’t want to exaggerate this—a ton of bad things happen to everyone in an average year, making this pretty hard to measure—but I think there was a lot of real damage done in retrospect. And aside from counterfactuals, there's something real about how we didn’t even get a chance to have the non-COVID-related disasters, we just got the useless COVID ones instead.
Second, I think there were some very bad and subtle externalities. People sometimes talk about the social fabric, which is a thing I don’t understand that well, but I do think an important thing tethering it is the expectation of continued social interaction. Without this, it seemed like a lot of things the social fabric supports—i.e. lots of society and our habits—took a hit. I’d be unsurprised if we look back and find that 2020 was a serious contributor to a number of bad events in the future involving political turmoil and cultural disintegration.
I think this damage is ongoing as we fail to escape back to normal societal dynamics. Even mask-wearing everywhere seems like a bad norm for social fabric. Certainly the fear of other people is. I want my friends to stop being overly concerned about COVID because of this. I know it’s hard to get out of the mindset of the past year, but when this whole pandemic started we had to quickly go from Default Safe, Must Prove Unsafe -> Default Unsafe, Must Prove Safe; now we must make the leap in reverse.
Last, I think legal mandates for continued precautions are especially bad compared to recommendations, because the lack of added efficacy and the cost of government overreach precedent.
Our legal system explicitly works on precedent, but our policy system and social acceptability system implicitly do too. Again, I think the initial lockdowns were entirely worth it, like Cincinnatus in Rome—but your dictator is supposed to clearly step down after a year, not say that he’s staying just a little bit longer until more defenses are built, or that he’ll step down as dictator but through the revolving door as a lobbyist.
This fear about continued government overreach is necessarily vague, but there are some clear examples. For one, the travel bans seem especially harsh—in the US with high rates of COVID, there is less likelihood of getting it in another country than there is if you stay here! It makes more sense to have border closures *in the other direction*. But even those are a bit crazy—if you calculate it out, it’s strongly net-negative from a trade perspective, and even net-negative just from the host country’s perspective in most cases!  (I advocated for this in April while working for Epidemic Forecasting as well, so this isn’t even hindsight nitpicking.) Anyways, I think travel bans became more likely to recur in the future in dumb situations because of the precedent set here.
But the real example is totalitarian usage. Dictators are well-known to take advantage of crises for increasing state control—luckily Trump neither ended up on the pro-precautionary side politically nor was dictatorial enough to leverage the lockdowns or other mandates into increased personal/state control, but it’s not too hard to think of how this could have gone or how it could go in a future pandemic—lock down the industries and regions that don’t politically support you, nationalize some critical infrastructure to “keep it functioning safely”, arrest political opponents who violate your selectively enforceable mandates in the name of national security, claim military transgression from countries you want conflict with who had any role in increasing the pandemic’s scope...
I definitely think these concerns about government overreach are overblown by many, and you can fill in various arguments about whether or not there's much counterfactual impact from the current measures. But I do think the concerns are about something correctly identified as real. And when there’s a real concern that has already mobilized half the country and there’s evidence the pendulum is already on the wrong side, that’s a very good opportunity to help it be taken seriously. A great start would be to pass resolutions to end the State of Emergency, and not legally limiting people’s interactions outside of the Emergency.
It’s not like we shouldn’t make good laws—but we’re not correctly avoiding the unnecessary ones. Because the saddest thing about the legal requirements is that they don’t do very much. Sure, at the beginning we got a lot from mandated countermeasures, as people needed to be mobilized and taught new norms if we were going to hold off the virus. But a few months in and the control system was well-established: people act more cautious when rates go up. There might be a paper somewhere proving I’m wrong, but I don’t think that the 2nd/3rd/4th waves were very affected by legal requirements compared to private actions in the control system and even government recommendations. The legal mandate just pissed a lot of people off and caused them to get a lot better at sneaking their mask under their chin. (I think a prominent deviation from this is schools and businesses: it’s a lot more reasonable to fight a principal-agent problem and make these institutions not coerce their subjects than to coerce your own subjects.)
But should I personally stay cautious a few extra months? (ETA)
Assuming you're vaccinated and not highly at-risk, I really don't think so.
(Unless you have the J&J vaccine, which seems much worse but I haven't looked into—I'm assuming all vaccinations are Pfizer or Moderna. Obviously, get vaccinated.)
Finally the argument “it’s like the flu” can actually apply. The flu is about 60x less risk than COVID if you expect COVID's long-term side effects to make up 2/3 the cost of contracting it; people in our age group have probably 1000x less risk after vaccination, and even older people probably have 20x less risk after vaccination. If you're in a highly risky subgroup with immune problems, you may also have only about 30x less risk (I'd be surprised if it were over 100x or under 10x, unless you literally don't have immune adaptation). So that's about 3x as much risk as the flu if you're very at-risk. Maybe worth sometimes wearing a mask or avoiding packed indoor events in the winter, but it seems most people aren't very afraid of the flu for good reason.
There's some small chance that you'd want to be cautious now because in time the rates will drop due to the vaccine. But this seems very unlikely: as soon as we start opening up for real, they'll go up again. And you know we won't just let this happen. At half-vaccinated, the US will likely be bobbing up and down for at least a year before rates never again hit .3% as they are now. Unless your risk calculations are dramatically different than mine between getting COVID and spending a year being cautious, there's no way you should do this for something like a 1% decreased risk of getting COVID (20% of people get it total, you have 20x less risk).
Regarding new strains, it seems some might have slightly worse outcomes, but as far as I know this is a rounding error for the estimations above. The obviously larger issue is if they are vaccine-resistant. It looks like both the B.1.351. and P.1 variants are still quite protected-against by vaccination, but the more vaccination the more selection pressure there is for future resistance mutations. I do think this is one of the strongest challenges to my thesis, and there are ways this could change the calculus, like if we had cycles of new booster vaccines and remained cautious off-cycle—but you still run into the issue of it not being reasonable to trade COVID for many more months of lockdown. I think in a dynamically antibody-resistant COVID world, as hellish as it would be, it would be best for most of us to take a 20% chance of COVID each year and stay open, but this claim probably deserves a more Fermi-heavy essay. If your caution depends on staying away from people for a large fraction of your future life, I think you should look hard at whether that's a tradeoff that would be long-term sustainable.
I might be missing something else, as often happens when you're confused by many people—perhaps you have some better idea than I about what crux you might learn by waiting, and also haven’t been very negatively affected by lockdowns. And of course, if you’re directly interacting with someone in the most at-risk subgroups who you’d try hard not to give the flu to, maybe it makes sense to wear a mask.
But in general, it's hard for me to picture a world where a healthy vaccinated cautious person is glad they stayed cautious, twelve months down the line.
Here is my personal list of which precautions I think should be kept in the policy playbook as mandates or as recommendations (I have not thought these through in detail, but still want to share):
- Lockdowns / stay-at-home order: Shouldn’t be a legal mandate or recommended
- Curfews: Shouldn’t be a legal mandate or recommended
- Gatherings limited to X people: Shouldn’t be a legal mandate, could be recommended
- Border closures: Shouldn’t be a legal mandate or recommended, except in extreme circumstances
- Masks: Shouldn’t be a legal mandate, fair to recommend to the unvaccinated
- Businesses suspended: Could be a legal mandate
- Schools closed: Could be a legal mandate
- Testing: Seems fair for corporations to ask people to do this in many cases, not especially abusable
- Vaccine passports: Probably fair, seems fantastic for public health and, while highly abusable, not at all an abuse in this actual case
- Visiting sick family members: I think this has been adequately covered as totally inhumane to ban, but it’s worth noting that these cases were hospital policies and not laws, to my knowledge
- State of Emergency: Should be reserved for actual emergencies, which we are no longer in
Again, there are some limited benefits to continued caution. But we have to go back to normal at some point, and I think outside of strained arguments that time appears to be [about a month or two from] now. We may have to artificially flatten the curve, but we may not. And I think we should be very wary of using mandates to do this instead of recommendations.
For the time being, if you’re vaccinated, I think you should abandon caution unless you're extremely at-risk. And even if you do stay cautious, I think it's important that we go back to normal interactions as normal people.
 Fermi of travel risk: say you take a one-week vacation from a country that had .3% rate at a given time. Your chance of giving it to someone else would be about .3%/4 (since infections last about 4 weeks; and since the actions of the people in the other country are probably about the same as in your country, since R is similar, though this is somewhat complicated to check). So even if you’re 4x more risky than others in your country, your weekly rate of transmitting will end up being about .3%. If you’re willing to pay $50k to not get COVID, you’d pay $150 to avoid this risk of COVID, which is substantially less than most international travel costs in the first place and would be willingly paid given the consumer surplus, so the trade is positive-sum. But even from the perspective of the host nation, substantially more than $150 is gained from per capita tourism; and it happens that tourism is a high-gross-margin industry (40%?), so just adding up all the producer surpluses is probably at least 30% of total, meaning if you as traveler paid more than $500 for things in the country they would still be making a beneficial trade despite paying for the risk. Only in cases where the host country has COVID almost fully contained and a single case would cause them huge costs, which we only saw in the merest handful of countries this year, would it make sense to close borders.
 Fermi of precautionary benefit over the next few months: vaccine effectiveness in the US is about 95% on average, 99% in the young, 90% in the elderly. Unfortunately this was measured during lots of precautions; it’s possible that with fewer precautions, it would be somewhat less effective due to higher initial viral loads. I vaguely expect in typical circumstances the risk is only a factor of 3x higher, something like 85% average, 97% in the young, 70% in the elderly. When transmission does occur to a vaccinated person, the virus is likely to have a much lower peak viral load, meaning much of the damage from death or hospitalization or long-term effects is blocked; based on reduced hospitalizations even in the J&J vaccine I'd vaguely estimate this at average 90% (varied with age). There is a rumor that vaccinated people can somehow still transmit the virus without being detectably infected themselves, but this seems hard to fathom when thinking through the mechanics so I will ignore it. (If it does happen it’s likely very rare and would result in a very low viral load anyways.) So for a youngish person who gets vaccinated, I estimate that risk of any activity drops about 99.9% (1-.03*.05); for an old person, about 96% (1-.3*.15).
Notably, this huge amount of difference means there is a lot of moral hazard if we make everyone take precautions. The benefit of the vaccinated people following it will be like 100:1 less than the unvaccinated, and total benefit will also accrue 100:1 in favor of an unvaccinated compared to a vaccinated. If the population is about half vaccinated, the per-person ratios also apply to the population. I am all for helping people who won’t help themselves, but definitely at a lower cost to myself than if the person does help themselves.
Second, this means that you really have to have massive behavioral differences for vaccinated people to be much of a risk. If you are vaccinated, socially distanced at a store, and deciding whether to wear a mask, you change your cost to people from about 0.01 uCOVIDs to 0.02 uCOVIDs, which for healthy people is equivalent to something like $.0001->$.0002. You have to be doing things like hanging out indoors for hours and laughing before it even registers as a similar amount of risk to what we were willing to take before.