COVID confused? Pandemic fatigued? Read this

We all prefer clarity and simplicity. How nice it would be if life offered us simple either/or, good/bad choices. We crave simplicity so much that we impose it on complex situations and people: these kind of people are wrong, these kind are right. Or, they must be hiding something. They’re doing this to drive their agenda. Experts are phony.

Sorry folks. Reality is one big messy pile of ambiguity and complexity.

So if you’re frustrated that the media, political voices, and public health officials are giving you mixed messages, I’m sorry. They do make mistakes, and they could do a better job—but they cannot make it all easy and unambiguous. We’re working with probabilities and future projections—shades of gray. Not black and white. Whether you choose to grapple with this reality or to reject it will not change the reality itself. 

Let’s grapple.

The limits of vaccination

Don’t tell me “vaccines don’t work.” See my previous post for data on the profound effectiveness of vaccination to prevent COVID deaths.

But “work” has multiple definitions, and the excellent American mRNA vaccines have shortcomings. In a perfect world, vaccines would do even more than save our lives. They would make our bodies so hostile to the virus that vaccinated people would never get so much as a COVID sniffle, nor ever test positive for carrying the virus in their noses.

The current vaccines just can’t do this, especially against the variants. I don’t have a quantitative measure, but breakthrough infections are not uncommon. A breakthrough infection is a positive COVID test (with or without symptoms) in a person who is up to date with their vaccination. Presumably most of these are due to the omicron variant. There is no doubt that people who are up to date with their COVID vaccination can unknowingly transmit the omicron variant to others.

Nevertheless,

• Vaxxed people with a breakthrough infection are less likely to experience symptoms and their symptoms will be of shorter duration than unvaxxed people
• Vaxxed people with a breakthrough infection are probably infectious for a shorter period of time than unvaxxed people, especially if they got the US-made mRNA vaccines.

Vaccine requirements

Thanks to the omicron variant, vaxxed people can still be infectious for periods of time. As a consequence there is now more individual benefit to getting vaccinated but less community benefit. Vaccination can save your life but if vaxxed people can still spread the virus, the benefit to the community of your vaccine is reduced. Requiring vaccination at large group events can still help but the group protection is not what it used to be. In my opinion if you want to avoid an outbreak at an event or gathering in the era of omicron, vaccine requirements are less important than rapid COVID testing of participants.

The Omicron Surge

The omicron variant is highly contagious, maybe multiple times more than delta which was multiple times more contagious than the original virus. (Good WSJ article on what omicron infectiousness means for you.) I’m writing this on December 27, 2021. The number of new cases in the US is in extreme exponential growth. I predict we will soon see the largest number of new cases of the whole pandemic—even more than during the biggest previous wave, around the holidays last year. See the graphs here.

BUT–preliminary reports from South Africa, Scotland, and England (NYT article) show that omicron infections more often result in mild illness than earlier variants of the coronavirus. At the very least, it does NOT appear that omicron makes people sicker than other variants do. This is excellent news—the vaccines will continue to do their job in the next few difficult weeks.

Because the next few weeks will indeed be difficult for hospitals in some places, and for unvaccinated people everywhere. Masks, tests, and isolation can flatten the curve a little, but they will not save people from exposure to the virus forever. Even with low fatality rates, many unvaccinated people will die of COVID because so many will get infected. (The fraction of vaccinated people who will die is much smaller: see my previous post for numbers.)

On the positive side, I predict the terrifyingly swift rise in cases that we’re experiencing now will be mirrored by a similar decrease in a surprisingly brief period of time—possibly less than the two-month cycle we’ve come to expect from coronavirus surges. Omicron will burn hot and fast.

The Endgame is Endemicity

The omicron variant is our COVID climax. We’re in the endgame, folks. I’m not worried about another, more contagious variant emerging. Omicron is that variant. A kind of herd immunity is emerging. Already, the majority of Americans have immunity from vaccines. Large numbers have immunity from natural infection. The omicron variant will mop up most of the rest.

Everybody is going to be exposed to the coronavirus, whether next week, next month, or next year. And once everyone has been exposed—and either lives or dies—a natural equilibrium will be reached. With omicron sweeping the planet, the timeline for that exposure has been greatly accelerated.

This is what the endgame of COVID looks like: a virus that is always with us (endemic). We may need annual vaccination to keep up with mutations, as with influenza. Elderly people will always be at some risk, and some thousands of Americans will die of COVID every year, probably in the winter. Just like with influenza, we will accept this without making drastic adjustments to our lives. (A few thousand or tens of thousands of deaths in a bad year, by the way—nothing like the 800,000+ who have already perished in this pandemic.)

Should we worry about case numbers?

Earlier, the pandemic metric that mattered most was the number of cases. The number of newly diagnosed COVID infections told us the future: what to expect with hospitalizations in the next week or two, and deaths over the next month. 

Vaccination, new antiviral treatments, and more widespread naturally acquired immunity in the population have weakened the link between cases and deaths, and cases and hospitalizations. Our health care system can now tolerate a much higher number of new cases because a larger fraction of those cases will never need medical care.

The early pandemic doubters who in 2020 made such a fuss about how “cases” somehow did not matter, are finally going to be right. With widespread vaccination and community immunity, in 2022 our schools and workplaces can pay much less attention to positive tests.

We have one more surge to get through, however. Right now we should be concerned that hospitals in parts of the US will be impacted because a substantial number of Americans are not fully vaccinated. These people will make up the overwhelming majority of hospital admissions for COVID. Vaccinated people could be affected if they need health care for any reason and their local health system is swamped.

Masks

You’re pissed off because you dutifully got vaxxed and now you still have to wear a mask in public. I’ve heard multiple people use this reality as evidence of incompetence or hidden motivations from officials. Do you now understand why your vaccination both “works” and “doesn’t work”? Your life has been saved by your vaccination. Other people’s lives might be saved by your mask.

As has been the case since the start of the pandemic, there is a difference between “what’s good for me” and “what’s good for my community.” Because of vaccination and my age, I may not be at risk for COVID death. I have no personal reason not to run around doing as I please. But my actions might enable the virus to reach a vulnerable host.

“Masks don’t work”

Any face covering can somewhat decrease the chance that the tiny droplets of water in your breath will enter another person’s lungs. That homemade fabric thing you grudgingly wear is barely better than nothing. Instead of complaining about the uselessness of masks, you need to get a better mask. Buy some KN95’s or FFP2’s. Compared to hospital-grade N95’s, these are comfortable. (source) {I like these: amazon affiliate link}

Masks are a cheap, easy tool to help protect the most vulnerable. But they’re of minor value compared to vaccination. I predict most Americans will abandon their masks by summer 2022, but masking in some circumstances will continue indefinitely. This will be a permanent cultural shift in the US; it was a common practice in Asia before the pandemic. It’s a reasonable hygiene practice during cold and flu season.

What you should do

• Get vaccinated against the coronavirus that causes COVID-19 and keep your vaccination up to date with evolving recommendations
• Pay attention to COVID case rates in your community. Your choices can be different depending on how prevalent the virus is. Adjust your precautions as needed. Don’t stay on maximum (or minimum) alert.
• If there’s a surge in your community, wear a KN95 mask when indoors with a large number of people. Use COVID tests before gatherings to protect elderly people in your group.

Hang in there. Though the virus will never go away, our relationship with it is entering a final phase.

Questions? amy@amyrogers.com

Amy Rogers, MD, PhD, is a Harvard-educated scientist, novelist, journalist, and educator. Learn more about Amy’s science thriller novels at AmyRogers.com.