Pandemic Endgame: Final Chapter

Victory for the vaccines

{Author’s note: This essay is from a US perspective. Forgive me for this parochial view. Other parts of the world are experiencing their own timeline.}

Over a year ago in April 2020 I started publishing a series of blog posts on the pandemic endgame. We had been in lockdown for some weeks, people were dying by the thousands in New York and New Jersey, and economic activity was at a standstill. Worst of all, as we tried to understand what “flatten the curve” meant, we could not see a way out at the end. I offered a vision of how the story would wrap up. As I revisit that first post here, I’m happy to see I wouldn’t change a word.

I explained then that the most likely “endgame” for the SARS-CoV-2 coronavirus pandemic was a truce between us and the virus. Some degree of immunity in enough people would stabilize the rate of infection and death to some acceptably low level whether or not we maintained social distancing. The gigantic unknown was, how would we get that immunity? Would it be by widespread natural infection (and millions of deaths in the US), or would it be by vaccination? Was a vaccine coming soon, years away, or impossible?

Hallelujah, praise to God and all that is holy, scientists invented a vaccine. Not just one, either. Multiple vaccines. And not mediocre vaccines, but vaccines that are safe and effective to an astonishing degree.

Now we know how the pandemic ends. Look at these data. (Source: NY Times COVID tracker, May 19, 2021)

When did the curves of new cases, hospitalizations, and deaths all peak? Mid- to late January.

When did vaccination begin in the US? Mid-December.

How long does it take the vaccine to work? Two to six weeks.

Beautiful.

If we weren’t so messed up with our fears and our tribes, this reality should’ve prompted unanimous rejoicing.

I really don’t understand how some people argue against the value of the vaccines. Vaccination has decreased the daily number of COVID deaths in the US from about 3,300 to about 600 so far. That’s 2,700 parents, spouses, friends every day who are alive because their fellow Americans got vaccinated against COVID-19. Even if we can’t guarantee that the vaccines won’t have any rare side effects, we can guarantee that universal vaccination will save thousands of times more lives than any potential vaccine side effect might harm.

Hindsight is 20/20 vision

A year ago, we were debating whether to loosen restrictions for less-vulnerable people (like healthy 20 somethings) or even to intentionally infect some of them in an attempt to get herd immunity going and save some of us from lockdown. This was a logical debate because we did not know whether an effective vaccine would ever be found. In the long term, without a vaccine you can’t stop the COVID deaths, you can only spread them out over time.

With vaccination we are now permanently preventing COVID deaths, not just pushing them into the future.

Some countries worked really hard–and successfully–to halt the pandemic within their borders. Places like South Korea, New Zealand, Taiwan, and Japan experienced only a tiny fraction of the death rate we had in the US. Essentially, while we were building some herd immunity the hard way, they gambled that if they could just hold on until a vaccine was available, they could save lives. Ironically, they might now be victims of their success: citizens less enthusiastic about vaccine uptake because they don’t feel threatened. But their ultimate scorecard will likely be a “win” in terms of total lives lost.

Is this the end?

The pandemic certainly isn’t over in the US (and definitely not in the rest of the world.) About half of Americans of all ages have at least one dose of vaccine; almost 40% are fully protected (CDC). That leaves over a hundred million people still to go (including children 0-11 who are not yet eligible). Blue-state America is ahead of red-state America in percent of citizens vaccinated. That gap is likely to persist. 

If one in three Americans ultimately lacks the trust to get vaccinated, how will that affect the endgame?

I expect daily deaths to continue to decrease but they won’t go to zero. Maybe we can get them down to the low hundreds during the summer season. How low? Depends on how many people ultimately get the jab, and on how many of the refusers are immune because of natural infection over the past year.

Expect a slow increase in deaths in the fall, however. As our relationship with this virus evolves, I predict we will see more winter/summer seasonality like we do with the flu.

Soon every American (over age 11) who wants to be protected will have the vaccine. Among that group, COVID deaths will become extremely rare. COVID deaths among those who refuse vaccination are a side effect of reality. In my opinion, a steady state of say, one or two hundred COVID deaths per day, does not justify a state of emergency. Come autumn we should treat COVID the way we used to treat seasonal flu: get your shot, and go about your business as usual.

Booster shots?

Not enough time has passed for us to have a data-based answer to this question. I know there’s been a flurry of recent media either promoting or complaining about booster shots being likely within a year, but it’s too soon to tell. Yes, we should prepare for the possibility that immunity could fade. But we don’t know yet. The answer is somewhat circular: if too few people get vaccinated and the virus is still circulating widely, then boosters are more likely. If we get enough herd immunity this summer, then we might not need booster shots.

Did we ever really resolve the arguments about how to manage the pandemic? Did we plan a national strategy to balance public health vs the economy? Did we even agree on how much of a threat the new coronavirus posed?

(For the record, almost 600,000 Americans have died of COVID. Go back and tell that to the deniers of March 2020, some of whom argued that it was all overblown and we’d never see even 10,000 deaths.)

(Also for the record, COVID hasn’t been “just like flu.” An estimated 34,000 Americans died of influenza in 2018-19.)

We didn’t really figure anything out. We stumbled along until the vaccines arrived like a deus ex machina. Rolling out the vaccines created new arguments about priority and equity. Facts on the ground quickly outran those arguments. In the span of just four months, vaccine doses have become plentiful in the US. Some counties and states are declining part of their allotment because they don’t need it all. With the recent FDA approval of an emergency use authorization for the Pfizer vaccine in 12-15 year olds, every American over the age of 11 is now eligible for a vaccine and should be able to access one soon.

No going back

Masks, distancing, and air filtration are all helpful but vaccines are the key. From a social perspective, we’re done with non-pharmaceutical interventions. People are still dying but crisis mode is over. Most of us are hugging, gathering, eating out. Enough of us are vaccinated that we’re not going back. So it’s as important as ever to push for universal vaccination against the coronavirus, because vaccination is quickly becoming our only defense.

With vaccines, Murphy was wrong

I can hardly believe we’re at this point today. So much that could have gone wrong ended up going right.

It makes me proud and grateful to be an American, and a scientist.

Please recognize the miracle you’re living in. Notice what it took to invent, manufacture, and distribute the vaccines. (I’ll help you with a forthcoming post on that.)

If you’re as amazed as I am, support investment in basic science research. Support science education. Read good science journalism. And most of all, extend a bit of trust to experts. They’re not always right but they do know a few things that you and I do not.

Have you been vaccinated yet? Every American age 12 and up is now eligible.

Visit https://myturn.ca.gov/ to find appointments for a FREE vaccine near you.

Amy Rogers, MD, PhD, is a Harvard-educated scientist, novelist, journalist, and educator. Learn more about Amy’s science thriller novels, or download a free ebook on the scientific backstory of SARS-CoV-2 and emerging infections, at AmyRogers.com.