COVID Chaos on the Home Front

Is Living with COVID destined to be a smooth transition or SNAFU?

The past week’s COVID landscape seems well summed up by a line from Dylan’s My Back Pages: “My existence led confusion boats, mutinied from stern to bow.” Anyone could be forgiven their confusion about whether they should be receiving a second booster. In announcing the authorization for the fourth dose Rachel Wallensky of the CDC said people over 65, and those over 50 with immune compromising conditions, would benefit the most. Asish Jha, the Whitehouse COVID co-ordinator said the data is clear people over the age of 60 should take a dose, and Dr Fauci said that people over the age of 50 should get it. Recognizing that any small increase in protection from infection lasts only a short time, various experts have been weighing in, saying that people should perform their own risk analysis in determining the best timing of a second booster. That analysis would include whether you have some travel or larger social event planned several months from now that would increase your baseline risk. Also factor in your general medical condition, your association with compromised close contacts, whether your have had a recent infection, the prevailing burden of disease in your community and your personal risk tolerance—is there a refresher course in statistics or an app for that?. As far as the current amount of disease in your neck of the woods goes, the CDC really doesn’t have a clue now that most testing is privately done rapid antigen, so you can look at hospitalization rates locally, which are a lagging indicator.

The Federal Court decision regarding the mask mandate for public transportation and the Biden administration’s reaction to it is another source of confusion. Compliance at airports around the country had already gone way down during the week prior to this ruling, which is a sure sign that many people are reading their own tea leaves of personal risk and are no longer on board with masking. At this point people’s behavior may be tied more closely to their perception of local disease frequency and severity than public health directives. Philadelphia resuscitated their mask mandate, only to reverse it in four days. The Health Department claimed that changing metrics were the reason, which frankly seems absurd. There is no denying that the politics of upcoming mid-term elections are having a profound effect on public health policy, and “follow the Science” extends only as far as the local voting booth. Unfortunately, inconsistent messaging and apparent random abrupt changes in direction can only have a further negative impact on the public’s trust of government public health authority.

Meanwhile the SARS2-Cov19 virus continues on it’s own trajectory, oblivious of whether we are tired of the pandemic. Cases have continued to increase in New York and a number of other states including Texas, Minnesota, Florida, California and Colorado. In the last 3 weeks nation wide there has been a 75% increase in the average number of new cases. The current doubling of cases from week to week in New York appears to be largely due to the Omicron lineage variant we discussed last week, BA.2.12.1. Current data suggests this variant has a 25% transmissibility advantage over the parental, Omicron strain, which was already one of the most contagious viruses ever seen. Obviously the BA.2 wavelet is being propelled by the combination of an even more transmissible virus and suddenly reduced mitigation efforts. As I predicted with the emergence of Omicron, China’s zero COVID policy is poised to collapse, despite their continued use of draconian lockdowns on giant cities. Videos of Chinese citizens looting grocery stores for food, which the government has failed to supply them with in quarantine, are filtering past the Chinese censors. Looting a store in China is a pretty big deal—it’s not Los Angeles or Chicago, there could be consequences. Other countries continuing to see BA.2 fueled case increases include: France, UK, Germany, Italy, and Ireland, with South Korea— once a stand out for COVID success—now still seeing 85,000 new cases a day. That’s actually not bad considering they were at 400,000 per day a few weeks ago. Korea’s maximum daily deaths during the Omicron wave reached 400 per day, prior to that the highest they had seen during the entire pandemic was 70.

I think the recent events may help give an intimation of what “Living with COVID” may be like, at least in the near term. The virus is evolving so rapidly, it’s level of transmissibility has reached such incredible levels, and we don’t have sterilizing immunity from vaccines or infection; that it would be foolish to assume that Omicron or BA.2 or BA…. will be the last variant to cause mass infection around the globe. Mounting “partial herd immunity”, and the direction of recent variant evolution suggests to me that we will have to accept a virtual certainty of a, generally non-life threatening COVID infection, perhaps repeatedly— unless significant progress is made on more effective sterilizing vaccines. Will COVID evolve into a seasonal yearly disease like Influenza? Perhaps that’s the ultimate result, but for quite a while I think we are in for randomly timed epidemics resulting from the unpredictable appearance of successful variants. We can almost certainly be guaranteed winter waves of disease in the Northern Hemisphere. We might see a variant with both the high level transmissibility of the current Omicron offspring and the increased virulence of the Delta strain, or worse. It’s nice to imagine that our exposure to a sufficient variety of COVIDS and vaccine has given those of us with normal immune systems sufficient protection from severe disease, but to deny this virus could surprise us again would be another, “We didn’t see it coming moment”.