Where We Are With COVID-19

If you’re hoping to go back to normal, it’s not going to happen. The normal of November 2019, before SARS-CoV-2 got a foothold in the human population, will not return. There will be a time when COVID-19 is no longer one of the top causes of death in the United States and a primary topic of concern around the world. But we can’t know when that will be. I’m guessing it’s at least two years away.

Because of negligence by leaders, particularly President Donald Trump, the virus is everywhere. It will take serious effort to bring it under control. The United States has handled the pandemic almost uniquely badly, but even countries that have minimized cases continue to be affected as well. Vigilance must be constant to keep the virus from returning with travelers. Where there are outbreaks, they will have to be tamped down with isolation, testing, and tracing.

After the long, hard slog to where virus cases and deaths are few, repercussions will continue. Some people continue to have symptoms for months. Because we have only seven months’ experience with the virus, we don’t know how many people will suffer virus-related disabilities, how long they will last or if they will flare up again later.

The virus is now distributed across the United States. Hospitals are strained in a number of hot spots. Other hot spots are likely to appear unless stronger measures are taken.

We are in this situation because of an incapable president, news outlets that support him at all costs, others that don’t care to learn the most elementary science, and citizens who don’t want to be inconvenienced. What they all have in common is glossing over the hard stuff and hoping the virus will magically disappear. We’ve done some experiments now, referred to as “opening up the country,” and it should be obvious that that is not a viable strategy. We have to face up to reality.

All the experts said that it was too early to lift restrictions. Some were circumspect, as experts are in the face of their ignorance, and the political pressure was heavy, from the president on down. Armed men occupied the Michigan capital to protest with no resistance from law enforcement. New Mexico’s Restaurant Association is fighting restrictions in court. Congress has voted inadequate financial aid. Even now, with evictions looming for many people, the Republican Senate has no bill and will not consider the one passed by the Democratic House.

AS more people become homeless, the disease will spread further and spiral the economy down. This is the disaster scenario.

We will be vulnerable to uncontrolled spread of the virus until immunity levels are high enough to slow the spread. Stopgaps before we get there could be treatments that minimizes covid’s damage to the body and cut transmissibility and symptoms short; or getting case numbers down to levels where testing and tracing can isolate outbreaks. All of these will be necessary; there are no silver bullets. We are far from any of these.

In New York City, with a high transmission of virus, 15-20% of its people show some immunity to SARS-CoV-2. That will slow down transmission somewhat, but something like 80% is necessary to end transmission. Other parts of the country have lower immunity. Getting to 80% without a vaccine will require much more time and illness, and probably several hundred thousand more deaths.

The “gee whiz” articles about vaccines are derived (sometimes copied) from press releases by the companies that hope to make gazillions of dollars from those vaccines. Because President Trump chose not to lead an international effort to develop and distribute vaccines, and because he has undercut the World Health Organization (WHO), the effort is fragmented among many companies. Every development that can be spun as good is hyped to increase stock prices. We have no way of knowing which press releases are accurate.

The federal government is shoveling money out to selected companies (selection criteria not available), ostensibly to be ready to produce vaccines in large quantities. Many different approaches are being taken to developing a vaccine, and production methods will be different. It’s a good idea to have production facilities ready to go, but we need more transparency about these grants.

Let’s assume that development of a vaccine proceeds with minimal difficulties. A few vaccines are now going into Phase 3 trials, for effectiveness and safety in large numbers of people. There are several ways these trials can fail. If they go smoothly, they may have results by fall. If preparation for production goes smoothly, vaccines may be available by the beginning of 2021. But smooth preparation is seldom the case, particularly for the firms that have no experience in this area.

Then there’s distribution. Once upon a time, America had a public health network. We don’t any more. Will distribution be prioritized to health workers? Teachers? People in retirement communities and prisons where covid has been spreading?

How effective will the vaccine be? Will it be more effective for some people than others? Will there be an anti-vaccine movement? How effective will they be?

Perhaps mass vaccination can be in place by mid-2021. Enormous numbers of people will still be infected and have to recover. The non-vaccine interventions of lockdown and mask wearing will have to continue in parallel with a vaccination campaign. It’s likely to take until the end of 2021 to damp down transmission to where we can think about gradually removing those interventions.

Plans are available that could break the virus in two months or less, so that we could be back to a very cautious normal in time for a football season and return to schools. But I see no indication that anyone is willing to try, and the strong probability that President Trump would sabotage it.

Cross-posted to Balloon Juice

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