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The Failure of Containment
Why You’ll Probably Get COVID, and Why That’s Probably OK
I haven’t written a post in many months for two very good reasons. I’ve had so much to do, and I’ve had so little to say.
But two and a half years into this pandemic seems like a good time to note two important trends, and to sift what little wisdom we might derive from them. The two trends are that COVID is getting more infectious and less lethal.
The increased infectivity is supported by lots of evidence, including your own anecdotal experience. You know lots of people who got it last winter and this summer, but you know much fewer people who got it before that. The case counts (top figure above) also support this. Each winter peak is higher than the previous winter, and each summer peak is higher than the previous summer. Obviously, these case counts are underestimates of the true number of cases, but if anything, that would understate the trend of increasing case counts, since fewer people are bothering to get tested as the pandemic wears on.
Now, I can hear you objecting, “These increased case counts are due to our decreased vigilance, not the virus becoming more infectious.” That’s true. Kids are back in school. Adults are back in offices. Congregations and audiences are filling churches and movie theaters. So it might not be the virus that has changed; it might be that we’re exposing ourselves to it more frequently. But if you’ll permit me a very non-scientific observation, we all know the person who took every anti-COVID precaution, avoided gatherings, always masked, and still got infected. That makes me suspect that both mechanisms are at play – we’re placing ourselves in the virus’s path more often, and the virus is getting better at infecting us.
But the most disappointing failure of our attempts to contain COVID is that our vaccines haven’t prevented infection and transmission. As I wrote in January, unlike many other vaccines, the COVID vaccine isn’t great at preventing you from contracting COVID or infecting others with it. (That’s also consistent with your own experience. You know lots of vaccinated people who got COVID.) The vaccine is great at preventing you from getting hospitalized or dying from COVID. As such, it is a valuable tool for personal protection rather than a public health measure. Everyone should be vaccinated against measles and polio and mumps (and many other preventable illnesses) because doing so maintains herd immunity and keeps those illnesses from circulating. Because the novel coronavirus can infect vaccinated people and can infect people who have already had COVID, there’s no such thing as herd immunity, and the virus keeps circulating.
This helps answer the question I hear all the time. “Should I get the new bivalent COVID booster?” If you’re at high risk of getting very sick from COVID, absolutely. If you’re over 65 or have health conditions that would increase your chance of being hospitalized from COVID, you should get every booster as it becomes available. If not, then decide for yourself whether the booster is worth making your next COVID infection milder.
The other striking trend is the decrease in COVID lethality. Even though case counts are increasing every year, deaths (bottom figure above) are decreasing, with each winter peak being lower than the one before, and each summer peak being lower than the one before. And while the case counts are likely an undercount, the death counts might be an overcount, since they include people who died with a COVID infection but may have died of other causes. So, especially when considering the numbers of deaths as a fraction of cases, the risk of dying of COVID has never been lower.
Now, I can hear you objecting “The falling death rate is because of the increasing use of vaccinations and the availability of medications, like Paxlovid.” True, these advances have made it less likely that COVID will kill us. But even accounting for these changes, even among unvaccinated people who don’t receive medication for their infection, there are fewer deaths as a fraction of infections. Even the avuncular COVID maven Michael Osterholm who will never be accused of understating the threat from COVID, agrees that omicron is less lethal than previous strains. Also are you going to keep objecting every few paragraphs? Jeez.
In considering these two trends, my guess (and it’s only a guess) is that we’re approaching a détente with the novel coronavirus, the terms of which are similar to the terms of our ceasefire with rhinovirus, enterovirus, parainfluenza and half a dozen other viruses that make us cough, make our throats sore, and fill our noses with snot. For our part, we’ll allow the novel coronavirus to infect most of us with regularity, like the common cold. We will congregate. We’ll stop masking. And we’ll return to the cherished tradition of greeting friends by licking their eyeballs. High risk people will vaccinate, but having vaccinated, they should feel confident that festive eyeball licking will only expose them to ten days of inconvenience and misery, not to a serious illness. In return, the novel coronavirus will hospitalize and kill increasingly fewer of us, until, in a few years we will have forgotten what all the fuss was about.
Our failure to contain COVID should disappoint but not surprise us. Life is hard to contain. Life will float off petri dishes, wriggle out of ponds, crawl up cliffs, fly across continents, and end up where we least expected it. This week NASA launched the Artemis I mission. It lifted off with the most powerful rocket ever made. It will orbit the moon and return to earth, testing equipment which will be used in future Artemis missions. Those missions will return humans to the moon and eventually build a station with a permanent human presence there. Because we are also living things, and hard to contain.
Factors That Affect Your Risk of Getting Very Sick from COVID-19 (Centers for Disease Control and Prevention)
The Michael Osterholm podcast (Center for Infectious Disease Research and Policy)
What to Do If You Were Exposed to COVID-19 (Centers for Disease Control and Prevention)
Isolation and Precautions for People with COVID-19 (Centers for Disease Control and Prevention)
Artemis I (NASA)