A Reasonable Approach to COVID in 2022

A pandemic is a confusing event, as we have discovered.  It is science in real time.  Much has been said about the sometimes puzzling and occasionally even contradictory messages coming from governments and scientists.  But our understanding of COVID-19 and its ramifications is constantly evolving, and it is extremely difficult to chart a perfect course of action and recommendations.  We should all be extremely grateful to the scientists and medical professionals who have worked tirelessly to confront this crisis.

Europe now appears to be entering its fourth wave of infection.  If the past two years are any guide, the USA will follow in a month or two.  Vaccinations have reduced the relative number of hospitalizations and deaths, but there are still large numbers of unvaccinated people and there is almost zero probability of achieving true ‘herd immunity’.

Should we view COVID-19 as an endemic disease now?  Should life go on as normal with a few basic restrictions?  These are difficult questions, but I believe there are a few basic guidelines that make sense.

First, vaccinations should be strongly encouraged for everyone and even mandated in certain areas (healthcare and retirement communities for example).  There is enough data available now to prove that the risks of any vaccine side effects are vastly lower than the risk of COVID in an unvaccinated adult.  Any responsible leader should emphatically endorse vaccination.

It is reasonable to raise the question as to whether instituting or continuing draconian shutdown measures may have more negative impact than the virus itself at this stage in the pandemic.  It was, however, unreasonable and highly unethical to argue against those measures at the outset of the pandemic.  The ultimate metric for those decisions is clearly the burden on the healthcare system.

When hospitals and healthcare workers are overwhelmed by serious COVID cases, as they were at the onset of the pandemic and several other times in the past two years, society must do everything in its power to reduce that burden.  A full breakdown of the healthcare system - doctors and nurses dying or abandoning their practices from fatigue or discouragement – is a catastrophic event with very long-term consequences.  Moreover, such an event will precipitate higher death counts because of the saturation of available ICU’s and ventilators. 

The UK data from before and after the vaccine gives us some encouragement for hoping that we can treat the pandemic with more moderate measures.  It is a good test case because the country is highly vaccinated (over 90% in adults over 40 - see the chart below) and has essentially eliminated all protective measures in the general population.

The UK CFR (case fatality rate) for the period from late November2020 to late February 2021 was about 2.5%.  For the post-vaccine period from late June to today, the CFR was about 0.3%, or about one eighth as much.  That is a dramatic decrease in the death rate.  This is especially interesting because the average daily number of new cases in the latter period was significantly higher (35k/day) than during the earlier period (29k/day). 

The USA will have a more difficult time unless vaccination rates improve dramatically.  During the same time that the UK had a CFR of 0.2, the USA had a CFR of 1.1, more than five times that of the UK.  This can only really be interpreted as an emphatic endorsement of the vaccine.  Sadly, our political polarization has made the vaccine a tribal litmus test for many in this country.

Whether the UK healthcare system is still under tremendous pressure is difficult for me to discern in a quick look online.  My guess is that there are pockets of distress and that the future will be a whack-a-mole game of employing vaccines, surgical shutdowns or protective measures and new treatment regimens to minimize the hospitalizations and deaths while allowing life to go on as close to normal as possible.

In my opinion, the reasonable way to proceed is to recognize that our healthcare systems must be protected at all costs.  Life can go back to semi-normal, but the minute we see a region where the healthcare system is in grave danger we must act decisively and initiate whatever measures are necessary.