We Are Making Some Big Bets

One more time, the coronavirus is here and is widespread.  It is likely to continue infecting people into the indefinite future.  Mitigation measures, and this is why they are called mitigation, are only designed to slow that spread of infections.  There are two primary purposes in slowing the spread.  One is too protect medical resources from a surge in demand that they cannot meet.  These resources include hospital beds, ventilators, other supplies, and, most importantly, health care workers, who are themselves extremely vulnerable to infection.  The second purpose is that we are making a big bet that we can actually somehow stop the virus from spreading.

How would the virus stop spreading and infecting?  Here are the ways–

1.  There is a spectrum of spread slowing tactics.  It simply isn’t clear that even the relatively extreme ones we are using will make a serious dent in infections and deaths that would otherwise occur.  There are even more extreme mitigation measures that could be implemented. Make everyone stay in their home and never come into contact with anyone else.  Obviously not feasible and assumes the virus doesn’t have non-human hosts or isn’t capable of long-range airborne transmission.
2. Another very extreme mitigation measure.  Everyone wears a face mask all the time for the rest of their lives to limit airborne transmission and never touches any surface.  We constantly disinfect every surface everywhere.  Also obviously not feasible.
3. If the virus is seasonal, like many coronaviruses, when we get to warmer and more humid weather, it will naturally diminish, although it will likely expand in the southern hemisphere.  This does not result in permanent eradication or suppression of the virus and it will return when weather returns to more favorable conditions.
4. Develop a vaccine that protects people from infection.  Several are under development, but are likely months from being ready for widespread use.  The universality of a coronavirus vaccine is dubious, as is the case with influenza vaccines.  And vaccines don’t work as well for older people, who are a particular target for this coronavirus strain.
5. Enough of the population has been infected and developed antibodies so that transmission allowing the virus to find new hosts is difficult, referred to as “herd immunity”.   Note that due to generally weaker immune systems, for the at-risk older population, these antibodies may be weaker and less efficacious in preventing re-infection.

Most of these don’t have any realistic chance of actually eradicating or fully suppressing the virus.  At most they delay infection rates.  Our current mitigation efforts are largely more moderate variations of 1 and 2.  But the big bet we are making is on 3 and 4.  I believe that officials are hoping they can just get us to a point where seasonal variation causes a natural decline in infections.  Otherwise, if we let up on the lockdown we will see a continual stream of new infections until 5 finally occurs.  And in the mid-term, I think they are betting on 4, that there will be an effective vaccine that protects a large percent of the population.

We should understand too, that everything we are doing under 1 and 2 is only delaying 5 and increasing the period in which the virus finds it relatively easy to reach new, uninfected human hosts.  One hopeful aspect here may be the low infection rate I have mentioned several times.  If that is accurate, that many exposed people do not even become infected, we really need to know why.  If it is because they have some pre-existing antibody that is effective against this cornonavirus, then we may not need a huge percentage of additional infections to break or limit that transmission chain of new hosts. But because it is the older, frail population that is particularly at risk, and for those people vaccines and natural antibodies are going to be less effective in limiting the risk of infection, we are likely going to have a constant, seasonal, coronavirus infection issue in this group, just as we do with influenza now.  Realistically, we are going to have to figure out how to accept and live with that, just as we do with influenza.

And the really important decisions we need to make now are what are we going to do if there is no seasonal decline in coronavirus infections?  I do not believe there is any way we can endure the economic effects of continuing the current shutdown.  It has already gone on too long.  But our “leaders” should be clear in telling us that no seasonal decline is a possibility and what their plans are for that eventuality.  Second, even if there is a seasonal decline, there almost certainly will be a resurgence of the virus when more favorable weather conditions return, likely by late fall.  Are we going to go into lockdown mode again?  We need to know what the plan is now, because if the bets we are making on 3 and 4 don’t pay off, we are right back where we are now.