Rolling brownouts--of workers
Between absence of mitigation and ever changing variants, COVID-19 is unstoppable. What will "living with it" look like?
“We’re in a pattern now. If somebody says, ‘You’ll leave when we don’t have Covid anymore,’ then I will be 105. I think we’re going to be living with this.” —Dr Anthony Fauci
I’m starting to lose track of the names, letters and numbers of COVID-19 (SARS-CoV-2) variants and subvariants. At the time of this writing, Omicron BA.5 is the dominant strain of COVID-19 circulating in my area. Many people who have been vaccinated umpteen times and recovered from one or more previous infections are catching it. Other variants and subvariants are almost sure to come—BA 2.75 has been spreading in India, but it is unclear if it will outcompete with BA.5. No doubt something else will follow.
While some say this “isn’t as bad” as the COVID-19 infections of 2020 and 2021, that’s mainly because there are very few people anywhere who are either unvaccinated, unrecovered from previous infection or both. More than one million of our most vulnerable countrymen and women have already died. Immunity matters, no matter how it was obtained. People are still getting sick, though, and we continue to see people sick in the hospital because of COVID-19 infection, not just coincidentally infected and admitted with another problem. Immunity matters, but so does transmissibility and immune evasion by previous strains.
This highly mutable virus continues to spread largely unchecked and there are only two ways to stop it—social distancing and masking (we tried that, couldn’t do it; China is going this route still)—or building sufficient immunity, and maybe some medications, to the point that viral replication is shut down enough to limit reproduction and get the R-naught (R0) down to less than 1. While there was hope that the initial doses of vaccines would do this, it is clearly not the case. It is also not the case that infection, or reinfection, will do this either, at least not yet
In the meantime, all we can do is reimmunize (active immunization from vaccine, as we do every year for influenza, or passive immunization from Evusheld), and deploy medications and to treat the people most vulnerable to severe progression of infection. We may be several years away from this happening. If China decides to switch away from the lockdown strategy, with their vast reservoir of people with less robust immunity, we could continue to see waves of virus come out of that country as well.
What does continued viral transmission mean for our country? The good news is that fewer people are dying or require hospitalization for severe disease. That is a win, and we can thank scientists, industry and the Trump and Biden Administrations for advancing that outcome as quickly as it did through vaccine administration. Unfortunately, vaccines shouldn’t be the only tool that we rely on.
Not just vaccines!
The bad news is that viral transmission is happening, and people are still getting sick. For industry that relies on the physical presence of workers—for example, healthcare, transportation, food service—one can expect rolling brownouts of personnel, that will strain delivery of those services. Until redundancy in staffing is beefed up, which can be expensive, expect these shortages to persist well into the fall and winter—even with vaccinations. Take that into account when making travel plans and expect plans to change on travel days.
Monkeypox is becoming even more urgent.
This past weekend, the World Health Organization added monkeypox to the list of diseases of international concern. The United States has now identified more active cases than any other country.
While this disease is rarely airborne, and won’t affect most people, controlling it will be hard. Unlike previous outbreak, this current outbreak is affecting one community more than others—men who have sex with men—with spillover to household contacts. The US government is mobilizing 300,000 doses of vaccine, but whether that will break the chains of transmission is yet to be seen. Testing is becoming more widely available, but remains constrained compared to other common infections. Treatments are also limited. The good news so far is that mortality is expected to be extremely low in otherwise healthy populations.