The winter of our COVID discontent is upon us. The U.S. has suffered over 28 million cases and 500,000 deaths during the pandemic year. But now we are at a crossroads, with the situation on the ground currently at odds with the one in the air, both metaphorically and literally.
Many virologists and epidemiology experts forecast, with some confidence, that the next few weeks will see the worst of the pandemic, primarily the result of new viral mutants, more contagious and possibly more lethal. These new strains are appearing with greater prevalence in several states. Experts predict we are in for the long haul with COVID, and these pessimistic forecasts have prompted the Biden administration to consider tighter restrictions on domestic flights and businesses. But there is another angle to the situation.
Running counter to those dire expert predictions are the current downward trends in the overall viral spread, which have been considerable (and underplayed in the news media). In the U.S. in the past month, COVID cases have dropped by an average of 150,000 per day, more than 60 percent. Hospitalizations have decreased by nearly 50 percent and intensive care cases and ventilator use have also dropped steadily since mid-January. While deaths have not fallen off as drastically as COVID cases – there is a 14-28 day lag between the two–they have begun a downtrend. With the drop in cases, deaths will almost certainly fall further, perhaps dramatically in the next month.
This is unquestionably good news and it comes in conjunction with greater attention to vaccine rollout by the Biden administration. Vaccination rates are increasing and the U.S. is currently second only to Israel in the percentage of the population completely vaccinated (albeit a distant second). Along with the plummeting cases and continued mitigation efforts, a plan designed to maximize the number of people vaccinated in the shortest time is the best strategy to suppress mutants – no transmission means no viral multiplication means no mutants and no fourth surge.
In this respect, with several suppliers making more vaccine available, the question of who goes first in a situation of limited supply takes a backseat to maximizing the numbers vaccinated. The current tier system represents guidelines, not rigid mandates, and it would be a mistake to wait for the completion of one tier before moving to the next. We must move through the tiers as quickly as vaccine supplies allow, with the realization that the last 20-30 percent of each tier could take 70-80 percent of our effort. So we should proceed with the most fragile and at-risk populations and move quickly to the next tiers, with the goal of vaccinating as many as possible, as quickly as possible. In this instance, that is the surest way to achieve healthcare equity.
The public should be aware that current conditions suggest that even at high vaccination rates, the well-publicized target of herd immunity might not be achievable. Complete herd immunity may be unlikely because of vaccine hesitancy, the limits of vaccine effectiveness, and future mutant strains that may not respond to the vaccine. This is not a reason for pessimism, nor is it a reason to forgo vaccination. It presents a strong case to continue near-term mitigation efforts, especially social distancing and masking.
Our goal for vaccines – and it is certainly achievable – should be to curtail viral spread to the greatest degree possible and prevent severe illness in those who contract the virus. In that respect, besides vaccination, we must continue to develop new treatments for COVID and deploy the ones we have more effectively including, for newly infected at-risk outpatients, monoclonal antibodies, a drastically underused therapy throughout the pandemic.
Does the possibility of not reaching herd immunity mean the coronavirus will never go away as some experts fear? Possibly, but no one can say for certain. Like other microbes, it will do what it is going to do. But we should be confident we can develop the resources and muster the will to manage the pandemic and re-establish normality.
In this vein, the essential reopening of our schools deserves special mention. Returning to in-person instruction is well supported by science, epidemiology, and the experience of school systems globally. The real risk for teachers and students is not in properly managed schools; it is in the activities pursued outside of school.
In a moving scene in the Charles Dickens classic, “A Christmas Carol,” Ebenezer Scrooge cowers in front of the Spirit of the Future in the graveyard and raises the question of whether the future is preordained, “Are these the shadows of the things that Will be, or are they shadows of things that May be, only?…men’s courses will foreshadow certain ends, to which, if persevered in, they must lead, But if the courses be departed from, the ends will change.”
The optimist in us hopes that the experts have overestimated the impact of the coronavirus variants. There is certainly a chance, worth hoping for, that the combination of vaccination, mitigation efforts, and virus burnout will permit us to return to normal lives as early as the summer. But as someone observed, we will not be done with the virus until the virus is done with us.
