Inflection point

How badly do we want to be rid of COVID-19?

In a previous post, I wrote about the emergence of variants of SARS-CoV-2, the virus that causes COVID-19. In the four weeks that have passed since that essay, we have learned much more about the significance of these emerging variants.

The initial B117 variant described in the UK is now considered to be both more transmissible AND more lethal (and maybe somewhat resistant to vaccines?). The variants described in South Africa and Brazil have been found to have mutations that change the spike protein of the virus to at least partially evade immune response—whether that response has been generated by recovery from natural infection or immunization—a so-called “escape mutation.” A US home grown variant in California has also been found—significance unknown as of this writing. All of these variants have been detected in the US. In my home state of Minnesota, the Brazil P.1 variant was detected on a random screen—not targeted at the traveler (who had a negative COVID-19 test when they boarded their flight from Brazil). This Brazil variant is especially worrisome, as it emerged from Manaus, Brazil after so-called “herd immunity” had been established—about 75% of the population had already been infected.

While vaccines are starting to be deployed, it is clear that those nations with uncontrolled virus transmission, are in a race between between vaccine deployment and escape mutations that will be resistant to vaccine. Of course, pharmaceutical companies like Moderna and Pfizer/BioNTech assert that they can create a booster vaccine directed against these escape mutations—but new vaccine again will take time and resources to be redeployed.

In some ways, we are at the False Summit I had previously described. Just when you think you have reached the mountaintop, there is quite a bit higher to go. Yet, it does not mean all is lost.

We have the capacity to learn, and there are examples around the world of what doesn’t work—and what does.

What doesn’t work is “letting it rip”, sometimes called the Swedish approach, as promulgated by the Great Barrington Declaration (GBD). The notion was that if we just let the virus run through a community, natural immunity will build to point where the virus stops transmitting because of herd immunity. If we can protect the most vulnerable from exposure during that transmission period, then after the transmission burns out, the most vulnerable won’t have to worry. In the meantime, there would be less disruption of daily activities. Unfortunately, rampant transmission also leads to rampant viral transmission, rampant viral replication and the development of escape mutations. Additionally, it is hard to protect the most vulnerable, and economic activity can still be limited—you can’t force people to go out and spend money if they are truly concerned about catching an infection. GBD has been countered by the John Snow Memorandum.

Then there are methods that DO work—if we can accept them. “Everyone can learn from us, but not all are willing to learn,” said Dr Ian Mackay, a virologist in Australia. Australia, New Zealand, Taiwan (a province of China) have shown little if any transmission over the last few months. How? They have made the hard, but effective, choice to basically lock down new arrivals to their countries through monitored quarantines after arrival. Not relying on a negative COVID-19 test (as there is a significant false negative rate), but instead going with prevention of infectious people from entering into the population. Canada is also going into quarantine for inbound air travelers, albeit for shorter duration.

Not spicy enough for you? Want to go rougher? Lock down all long distance interstate passenger travel—planes, trains, buses—for several weeks—or months. That would further slow the cross country transmission of variants that are home grown.

While these methods would be effective—they appear to have worked in China—it is doubtful that Americans could/would stomach the infringement of travel that we so many enjoy. Yet, if we don’t act aggressively, and consistently, 2021 looks to be a repeat of 2020, with continued rolling waves of viral transmission, missing group activities and slow business.

Let’s try something new this year.