Saturday, April 17, 2021
Overheard today: “During the pandemic, we used to . . . ” It’s so natural right now, right here, in southern California, to feel like it’s over. Vaccines are being given, restaurants are opening up, cases and hospitalizations are down. Our governor says the economy is posed to “come roaring back.” I earnestly hope so. We need positive thinking. Pandemic news is focused elsewhere for the time being. Unless you look outside our bubble.
The world is not back to normal. India, Brazil, Thailand, France, Canada, Iran, big countries, small countries, are struggling with Covid. The U. S. is not back to normal. Michigan is still struggling with Covid. 38 states have seen an increase in hospitalizations this week.
Countries which have Covid under control enforce severe entry limitations to maintain their success. Israel will welcome vaccinated group tours as of May 23, 2021. Australia and New Zealand plan to open up quarantine-free travel between their two countries starting April 19. The quarantine-free flights between the two countries will carry only vaccinated pre-screened passengers between the two countries. No passengers from other countries will be aboard. This is not normal.
What does “over” mean to you? Is it eradication of the coronavirus? Is it controlling the spread to keep it down to acceptable levels? What is an acceptable level? If we can agree on what an acceptable level is, can we agree on the methods it will take to get us there? The heated exchange between Rep. Jim Jordan and Dr. Anthony Fauci this week shows how far apart we are on a consensus for defining the goal and the means required to achieve it.
Is eradication possible? Some believe it is. The Zero Covid Alliance (https://zerocovidalliance.org/) is a coalition of international groups that promotes total eradication of Covid from the community level up. The top item on their list of essential actions is: “Get Everyone on Board.” But getting total commitment to the measures needed to achieve eradication–society, politicians, epidemiologists–that would be the hardest step of all.
What about “herd immunity”? I don’t find this a useful concept in regard to COVID. The JAMA article (below) states that herd immunity is a theoretical construct which postulates that in a population of equally susceptible individuals who encounter each other with equal frequency, transmission of a single disease will die out when immunity reaches 1- 1/R, R being the number of individuals each contagious individual infects. This theory was originally designed for managing immunity in cows and sheep. But people are not equally susceptible, they do not mix randomly, we don’t know who’s contagious, and we now have a multiplicity of Covid variants with different degrees of contagion, so the R factor is a changing denominator.
The new coronavirus is likely to become endemic, i.e. always around. Control may be achievable, but even then we will have to reach a consensus about what we are willing to live with. Paul Offit, a virologist cited in the Atlantic (below), suggests fewer than 100 Covid deaths a day might be an acceptable risk, based on a rate of flu deaths of 55-140 a day. We accept flu deaths by default, that is, we think we know how many deaths there are because they are shown on neat-looking charts and we are not motivated to fight it at that level.
Actually we don’t know how many flu cases or flu deaths there are because we have no accurate way to measure them. Check out the CDC page “Frequently Asked Questions About Estimated Flu Burden.” (link below) Some of the issues: Flu is not a reportable disease. Tests are not accurate and not widely used. A person who gets a severe case often develops a secondary infection or succumbs to a condition they already have, so that if they die their cause of death is not recorded as influenza. The CDC gets reporting from a few sources and then uses a mathematical model to extrapolate the number of flu deaths.
Fortunately we have better tests, better reporting, and better vaccines with Covid. We are working toward more targeted mitigation strategies. We are developing better treatments. Combining this knowledge with some of the things we know about flu might help us manage COVID-19. Flu has taught us about the threat of mutations, the futility of relying solely on herd immunity, and the concept of having a yearly vaccination to keep up with variants. We’ve also learned the importance of identifying genomes and sharing information about variants on an international level with databases such as GSAID (https://www.gisaid.org/). Hospitals are familiar with the seasonal increase in flu infections and expect a higher patient population in flu season. While we don’t know how much seasonality is a factor with Covid, I expect that hospitals are already more prepared to manage it going forward with equipment and trained staff.
One way or the other, we will reach a balance of infection and management and living with the presence of a new virus and its variants, which will continue to spin off and spread as long as Covid is uncontrolled anywhere in the world. The question is, what level of Covid is acceptable? To paraphrase the legend on my Hamilton poster:
Who lives, who dies, who decides?
Today’s Notable Headlines
“A Simple Rule of Thumb for Knowing When the Pandemic Is Over,” The Atlantic, Feb. 23, 2021. https://www.theatlantic.com/health/archive/2021/02/how-know-when-pandemic-over/618122/
“Spring wave of coronavirus crashes across 38 states as hospitalizations increase,” Washington Post, April 15, 2021. https://www.washingtonpost.com/health/covid-cases-rising-hotspots/2021/04/15/d04ffc8c-9cae-11eb-8005-bffc3a39f6d3_story.html
“New Zealand, Australia To Create ‘Travel Bubble,’ Resume Quarantine-Free Travel,” NPR, April 6, 2021. https://www.npr.org/sections/coronavirus-live-updates/2021/04/06/984639171/new-zealand-australia-to-create-travel-bubble-resume-quarantine-free-travel
“We Must Start Planning For a Permanent Pandemic,” Bloomberg, March 23, 2021. https://www.bloomberg.com/opinion/articles/2021-03-24/when-will-covid-end-we-must-start-planning-for-a-permanent-pandemic
“The Potential Future of the COVID-19 PandemicWill SARS-CoV-2 Become a Recurrent Seasonal Infection?” JAMA Network, March 3, 2021. https://jamanetwork.com/journals/jama/fullarticle/2777343
“Frequently Asked Questions About Estimated Flu Burden,” CDC https://www.cdc.gov/flu/about/burden/faq.htm#:~:text=Also%2C%20flu%20illness%20is%20not,illnesses%20in%20the%20United%20States.
Why am I doing this?
The coronavirus pandemic will be indelibly written on our memories just as the Great Depression or the Battle of Britain left their mark on past generations. I intend to journal the pandemic experience from three perspectives: as a retired medical technologist, as a historian (Ph.D., 2014), and an ordinary person living through an extraordinary world crisis.