One thing I hope this epidemic has taught everyone is that things are generally complex and simplistic notions or explanations aren’t good enough for understanding a situation thoroughly and devising sound public policy. This is particularly true when thinking about concepts like “infected”, “infectious”, “population immunity” and “adaptive immunity”, and the vaccine-aided subset of adaptive immunity. Nothing is magic, absolute or bulletproof; it is all shades and subtlety.
The virus itself is highly infectious, which may be due to low dose needed to cause infection, strong binding affinity to the receptor and some capability to down-regulate the immune system. The apparent high infectiousness may also reflect very high testing levels which pick up “infections” that would be ignored in regard to any other pathogen. Like any virus, CV-19 mutates frequently. Notwithstanding the hysteria, there is no evidence yet that any of these mutations are making the virus more lethal or dangerous.
The epidemic has been occurring for over a year. In several areas, multiple case waves have been experienced. Those waves suggest that there is a narrow set of environmental conditions which favor transmission. When those conditions are right, spread occurs almost without regard to mitigation efforts. I believe it is fair to say we don’t yet fully understand the reasons for the acceleration and deceleration of spread. We can say with some assurance a few things that aren’t likely in regard to transmission. Surface transmission doesn’t occur often at all. Outdoor transmission is pretty much non-existent. Transmission by infected but asymptomatic persons is unusual. Transmission by aerosolized virus does appear to occur with some frequency.
Exposure alone doesn’t make a person “infected”, even though they might test positive if they happen to be swabbed at the right time. Infection occurs when the virus is inside cells and replicating. A person is infectious when they are expelling viable virus that could be transmitted to another person and cause an infection in that person. A person who becomes exposed typically shows signs of infection within 5 days or less. An infected person is infectious on average for no more than a week or so of developing symptoms. A most critical aspect of tracking the course of the epidemic is to identify how many persons may be actively infectious at any one time and what the trend in that number is.
Testing for CV-19 has been poorly designed and executed. Both PCR and antigen testing appear to have significant accuracy issues. PCR testing has led to identification of large numbers of false and low positives. Antigen testing appears to be wildly inaccurate, especially in a low-prevalence environment. The testing policies have also overwhelmed contact tracing efforts.
In addition to defective testing and resulting unreliable data, information on other aspects of the epidemic has been untrustworthy. Hospitalizations and deaths have both been extensively over-attributed to CV-19. This feeds media and political panic programs. At no point have hospitals been overwhelmed, or indeed, even beyond normal capacity utilization. Most people said to have died from CV-19 had multiple conditions or frailty which made them vulnerable to any additional health issue.
The epidemic has been extremely bifurcated, with far higher rates of serious illness and deaths occurring among the elderly than the young. The bifurcation is even more extreme when considering residents of long-term care facilities versus the general population. The epidemic may also be front-loaded, in terms of attacking the most vulnerable first, which can give an appearance of higher fatality rates than would be true in the population as a whole. Due to this factor as well as improved treatment, fatality rates have steadily declined and if all infections were known, and deaths attributed in a rational manner, would be in the range of a serious flu year.
The political response has been abysmal at best. Reliance on bad models and data, herd mentality, obsession with lowering cases due to CV-19 regardless of effects on other health issues, and generally ignoring the overall welfare of the population have characterized that response. Children in particular have been devastated by the response, losing educational opportunity and enduring social deprivation and resulting mental health issues.
How does this epidemic end? The virus is not going to disappear. At some point enough of the population has some form of immunity to limit transmission opportunities and drop cases to a background level. It currently appears that adaptive immunity from seasonal coronavirus infections or even general immune defenses may limit infections. According to the CDC, 91 million Americans have been infected. That is over a fourth of the population, and much higher in some areas. That number is sufficient to begin slowing transmission opportunities. Infected persons almost universally have been shown to develop memory B and T cell responses that would prevent or limit subsequent infections. These adaptive immune responses seem to be lasting and durable. In addition, we now have vaccines that should create adaptive immunity. At this point, in most places we are unlikely to see another serious wave of cases.
But politicians and public health “experts” love their power, so will they stop the damage they are imposing or will they milk the situation as long as they can to exert their totalitarian will? I would bet on the latter, exacerbated by a new administration full of people who think they all know better than the rest of us what is good for the citizenry.