by James A. Bacon
Here’s a question my wife and I have been asking ourselves recently: What if COVID-19 doesn’t go away?
From the beginning of the epidemic, we assumed that we (along with the rest of the country) were enduring a temporary inconvenience. We’d hunker down, restrict our social interactions, wear masks in indoor public places, avoid airplanes, and the like, and in a few months — by the end of the year at latest — it would be over and we could return to normal.
Now it is August, and the virus is spreading with no sign of respite. Our thinking has swung to the other extreme. We’re wondering, what if nothing works? What if the much-touted vaccinations are only partially effective? What if antibodies confer only temporary immunity? What if the virus mutates? What if all our efforts at “flattening the curve” do nothing but delay the inevitable and everyone — including us, and those we love — gets exposed to COVID-19 eventually?
Will there ever be a return to “normal”? And, if not, how long can we sustain the partial shutdown of our economy, the shuttering of public school buildings, the gusher of government red ink, and the helicoptering of relief dollars, all of which were predicated on the assumption that the virus would be tamed and all emergency responses would be temporary?
Over the past four months, we have learned much about the virus — but huge unknowns make life as uncertain as ever.
On the positive side, (1) we have a much clearer idea of how the virus is transmitted, (2) we have a better understanding of to reduce the risk of transmission, and, perhaps most important of all, (3) we are getting better at treating the virus. The death rate from COVID-19 has declined significantly, and will likely continue to decline as new therapies are introduced and as front-line doctors gain more experience. If we get the virus, as most of us probably will eventually, we will enjoy better odds of surviving it.
Other positive developments: We have surmounted the logistical shock of the early days. No longer are masks, gloves, hand sanitizer, ventilators and other equipment in short supply. Also, we have ramped up our testing capacity, and upgraded our contact-tracing capabilities.
On the negative side, there is still room for improvement. If someone could come up with a “spit test” that yielded instant results, everyone could fine-tune their behavior to reduce the risk of transmission. But no such test exists. Furthermore, testing backlogs of a week or more are helpful only in measuring the prevalence of the disease, not in altering our behavior on an as-needed basis.
There has been much discussion of the potential for a given population to reach “herd immunity.” Once enough people have been infected, recovered, and developed resistance or immunity to the virus — a percentage widely said to be about 70% — the spread of the virus will slow dramatically. It may not disappear entirely, but it will cease to be a public health threat. In theory, development of a vaccine will help us reach that herd immunity.
My big question is how effective the vaccines will be. One clue may come from comparing the effectiveness of flu vaccines. States the Centers for Disease Control, “Recent studies show that flu vaccination reduces the risk of flu illness by between 40% and 60% among the overall population during seasons when most circulating flu viruses are well-matched to the flu vaccine.”
Presumably, there will be a good match between COVID-19 and a vaccine designed specifically to combat COVID-19. Let’s say, for purposes of discussion, that the COVID-19 vaccine is 80% effective. What will that change? Will we suddenly say, oh, there’s only 20% of the risk there was before, therefore we can end the shutdowns and return to normal? Or will we say, holy moly, there’s still a 20% chance of getting the virus, being hospitalized, and dying! We have to hunker down forever! More importantly, what will the media and political class say? Would the introduction of an 80%-effective vaccine be sufficient to induce governors and school boards to reopen schools? Would college administrators reopen their campuses? Would restaurants reopen at full capacity? Would hotels reopen meeting rooms and conference halls again?
Another uncertainty is how fast the virus mutates. Preliminary evidence suggests that COVID-19 is evolving, but slowly. However, at least one mutation, the so-called D614G mutation, has made the virus more infectious. Back in mid-June, researchers had identified had identified some 14 virus variants. There is widespread hope that a vaccine will be effective against all known variants as well as new variants that might arise in the future. But we won’t know for certain until we introduce the vaccines.
Of greater concern is how long resistance/immunity to COVID-19 lasts. The immune system has a terrible memory for flu viruses, and the immune response lasts only a year, according to sources I have read. If that’s the case with COVID-19 — and we don’t know one way or the other — humans may never develop lasting herd immunity. Everyone will be to get vaccine shots every year. But what if the vaccine has negative side-effects? What if there is widespread resistance to the vaccine? What if half the population never gets vaccinated?
I have no answers. But I don’t get the sense that our political leaders are even asking the questions, much less seeking answers. Their time horizon extends no farther than next month. I question whether our current policies are appropriate for world in which COVID-19 never goes away. We cannot hobble our economy, our schools, our colleges, and other institutions forever. We cannot continue borrowing multiple trillions of dollars a year to keep the system going. We have to find a sustainable response.
President Trump’s it’s-all-going-to-get-better platitudes are not helpful. Cable TV’s apocalyptic hair-on-fire hysteria is not helpful. Those of us who are not invested in political polarization need to think things through.
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