When Will We Be Able to Live a Normal Life?

Doctor zhou December 14, 2022

At lunch, my son told me that five of his six subject teachers have gone down. The math teacher stuck on fever patches to teach them, these senior-year students (truly dedicated, it's touching); the Chinese teacher was severely ill and told everyone to study on their own—do the homework if you can, don't force it if you can't; anyway the Chinese teacher had no strength left to grade. My wife tested positive in a pool, yet was still sent to work, because she still had the strength and could run around, and someone had to do the school's work.

I'm responsible for cooking for them, and I charred the pork hock; at noon everyone ate my charred pork hock. The reason is simple: I can barely spare the time even to cook. Many patients and families I haven't contacted in ages are urgently seeking me out, wanting me to help break their family members' fever. We ate the charred hock with gusto, which shows our appetite is unaffected—our taste and smell are still sharp.

Many couriers in Beijing have fallen ill, so parcels are neither picked up nor delivered normally, and courier companies can't hire people even at double wages. Medical staff now all stay on duty despite mild symptoms, working while sick; today I saw a notice that Beijing's community hospitals will also start seeing fever patients. The number of fever patients is climbing fast, though most don't need a doctor and can get through at home. But medical staff are the walking placebo for patients; many people, when sick, just can't feel reassured without seeing white coats.

Many people are bewildered and ask me: when will we be able to live a normal life? Actually, if you have no symptoms right now like I do, you can live a normal life immediately. Beijing has been windy these two days and my work is busy, so I can't get out; otherwise I'd go cycling. Beijing's streets are safer than homes these days. There's aerosol transmission in residential buildings, while the roads are nearly empty of pedestrians and have far less aerosol—so the chance of infection outdoors is actually lower than at home.

This state of affairs will continue a while; once most people have been infected, society can gradually return to normal. In September 2022, Kyodo News reported that Kado Ryo, an assistant professor of urban planning at Osaka Metropolitan University, and his team, after studying the association between foot-traffic changes and infection numbers in Osaka, Kyoto, and Hyogo from March 2020 to September 2021 across six kinds of venues—"food shops and pharmacies," "parks," "workplaces," "residential districts," "retail shops," and "public transport"—found no major association in any of them.

So the team concluded that once an epidemic reaches a certain stage, restricting movement does nothing to slow it; rather, factors like mask-wearing and room ventilation may have affected infection numbers. So in the present situation, if wearing masks lets us dodge it, we can; if masks can't, then it's our lot to be infected.

Given where Beijing's epidemic now stands, sheltering at home is no longer of much use. Transmission within the community is far faster than outside; the wet market, aerosols through pipes, and shared public spaces are all good transmission routes. Hunkering long-term in the community not only fails to prevent infection but easily causes many psychological problems. So I think people in basically good health should go out more now. If you know how to take care of yourself, you can be infected completely asymptomatically. Only the frail need better self-protection.

In the future, repeated infection for most people is inevitable. A study by U.S. experts, published November 10, 2022 in Nature Medicine, analyzing data on nearly 6 million people, found that whether unvaccinated, vaccinated, or boosted, compared with those infected once, reinfected people had more than double the risk of death and more than triple the risk of hospitalization.

But this study has been widely criticized by peers, because its subjects were mainly elderly people who generally have many underlying diseases; repeatedly infecting any pathogenic microbe raises the death risk. Singapore's statistics show that, across society as a whole, the severe-illness rate was only 0.2% in reinfected people versus 0.3% in first-time infections. So the conclusion that reinfection doubles the death risk holds only for specific age groups; young people generally have milder symptoms on reinfection than on first infection.

So scientifically we can draw three conclusions: first, under an opening-up, sheltering at home is no less risky than being out in society; second, most basically healthy people have milder symptoms on reinfection than on first infection and a lower death risk; third, the elderly with underlying diseases really must protect themselves better and avoid repeated infection, because their repeated infection does carry higher mortal danger.

Some of our experts say that only a small minority will be reinfected, to comfort the public; this is wishful thinking. The Singapore government statistics show that when the XBB variant circulated in Singapore, the reinfection rate reached 18% of the total population; 18% of 1.4 billion is over 200 million—not a small number. New immune-evading variants will keep emerging, and the reinfection rate differs by variant. Some of my friends overseas have been reinfected three or more times as a matter of course, but most have milder symptoms each time, until later they just have an occasional tickle in the throat.

We will certainly have to get used to repeated infection from now on; perhaps many people will be reinfected two or three times a year. Some people have a low death risk on reinfection, others a high one. The public has a right to know these truths and to take appropriate precautions and choose a lifestyle suited to their own situation.

Concealing the truth does not truly comfort people, nor help them—what is scarier than deception is collective deception. If all experts evade reality and refuse to tell the truth, the public cannot make correct decisions.

Humans are only one member of the biological kingdom and cannot escape the fate of birth, aging, illness, and death; half of fortune and misfortune is up to heaven. How to live should be decided by each person. Everyone is not only the first person responsible for their own health but also the first responsible for their own fate. When people know all the facts, they can make the decisions best suited to their own wishes and interests. The core duty of scientists is not to soothe people with lies but to provide society with the truth, so that all can make rational judgments based on it.

Long COVID will be a very widespread social problem; the global medical community is now focused on it, searching for treatments. Because even if only 1% of people have long-term aftereffects, nearly 100 million people worldwide will suffer from them.

But everyone need not be especially sensitive to the words "aftereffects." In my first year of high school, infected by some germ I never identified, I got pneumonia; after treatment by our village barefoot doctor, I was left with a cough—whenever I overexerted myself for a while, I coughed nonstop. Now nearly thirty years later, it still hasn't resolved, and I still can't overdo it.

I remember there was also a classmate surnamed Tao who coughed nonstop just like me; he took patent medicines like Jizhi Syrup and Zhike Pipalu year round. I don't know how he is now, but he probably hasn't recovered either. Our class was only forty or fifty people, and we had two long-term-aftereffect patients—a rate over 4%, far higher than COVID's.

So many years on, this aftereffect hasn't killed me. I gradually adapted to it, learned how to protect my body, and keep a more regular routine than most; in the end it actually made my body better than most people's in other ways. Only those who have lost health value it more; if so many illnesses hadn't plagued me, I wouldn't have become so fascinated by medicine or studied it so tirelessly after growing up.

If I live another 50 years, within my lifetime the COVID pandemic will never end. Nor will tuberculosis, measles, syphilis, or AIDS. Humans and infectious disease have always coexisted on Earth. From a public-health standpoint, the goal of zero-COVID is right—we should eradicate all infectious disease—but human ability is limited and we cannot reach zero. The only virus we have truly eradicated is smallpox, yet its variant monkeypox has begun circulating among people again.

Antonie van Leeuwenhoek, the inventor of the microscope, once said that if the ladies of his household were shown through his microscope the vast array of disease-causing microbes all around their lives, those cleanliness-loving women would never live in peace again. For whether in our food, our clothes and quilts, or even on our skin, there are multitudes of microbes in motion.

Everyone must break the illusion that the pandemic will end, learn to adapt to the COVID virus and its endless variants, and learn to turn their attention away from the epidemic. Once people have adapted to the presence of COVID, we can live normal lives—until the next new infectious disease that gives us a fright appears.

I told my family: from the moment the country opened up, go and live normal lives! I'll use the knowledge and skills I have to protect you from suffering as much as I can (and I share this knowledge with my readers too), but I won't let you give up the lives you want anymore. Especially my underage son: the future of this world is theirs, and we have no reason to block their normal growth, even if that growth carries some risk. They need human contact, travel, and all kinds of life experience; we cannot restrict them forever. Human society has no perfect decision; every beneficial decision has a harmful side, and all decisions are merely choosing the lesser of two evils.

Once over half the people in a region have been infected with Omicron, the social chaos and paralysis can bottom out and rebound. Because by then, as more people recover, every industry can develop for the better. More people will go out to work and students will gradually return to campus. An earlier study showed that the great majority of mild patients who caught and recovered from COVID felt their pandemic-related anxiety, fear, and depression ease considerably all at once. Once the whole population has been infected, at least 90% will achieve psychological recovery, and the body's immunity to COVID will strengthen.

Under natural transmission, Omicron cases roughly double every three days, increasing a thousandfold in a month. If 1.4 billion people were infected naturally, the whole population would basically be reached in under three months. But with everyone masked and carefully protected, the speed is far slower.

Even so, China's first-tier cities can basically regain their vitality within three months of an outbreak. Big cities will have about three months of labor pains; small cities, a shorter time. For the whole society to fully return from the epidemic to normal may take years; the shadow three years of pandemic have cast in people's hearts will take years to fade. The world economy may, as I said in my article "The Post-Pandemic Era", need a long period of adjustment.

But for someone like me, little affected by the outside world, normal life has already begun. I hope my readers can also walk out of the pandemic's shadow right now and return to normal life.

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