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What is the Ultimate Goal of Virus Transmission Mitigation Efforts?
Everybody is going to come into contact with the Wuhan virus at some point, unless the person chooses to live the life of a hermit, the virus is not likely to just disappear. Efforts to mitigate the transmission of the virus can at most delay contact with the virus, those efforts cannot prevent for all time contact with the virus.
The probability that a person not already living in a nursing home will have serious medical consequences from contact with the Wuhan virus is extremely small. Very few people who come into contact with the virus will suffer significant negative medical consequences.
Governments, businesses, organizations, and people have imposed or implemented many virus transmission mitigation efforts including closing businesses, schools, churches, public events, and social activities, preventing travel, forcing people to remain physically distant from one another, and building physical barriers to separate people from one another, including extra walls, face masks, etc. These virus transmission mitigation efforts have and will continue to impose significant costs on society and on individuals. “Costs” are not just monetary, but also medical, psychological, and social.
The early justification for strong virus transmission mitigation efforts was to spread out over time the number of people who had serious medical consequences from contact with the virus so that they wouldn’t all show up in the medical system at the same time. If we spread the transmission of this serious illnesses over time, the medical system would not be overwhelmed. But it now appears unlikely that the number of people with serious medical consequences from the virus will overwhelm the United States medical capacity.
Now I hear as justification for continuation and enhancement of those virus transmission mitigation efforts a need to “stop the virus.” Politicians and others speak as though the virus can be eradicated. But that’s an impossible goal. The virus now exists in so many places that eradicating it is not a possibility.
Other times I hear the justification is to “slow the spread of the virus.” What are the public health benefits of slowing the spread of the virus?
Politicians and media often use “total case count” or “active cases” numbers when justifying virus transmission mitigation efforts. But those numbers are almost meaningless from a public health standpoint. “Public health” is (or should be) about serious medical issues, not people testing positive for a virus that causes them no significant consequences. Such a small fraction of people who test positive (and thus become a “case”) have any significant health consequences that public health policies implemented based on the “total case count” or the number of “active cases” are not likely to be focused on the real health risks.
Slowing the spread of the virus may keep people who are likely to have serious medical consequences from contacting the virus until after a vaccine is developed, assuming an effective vaccine is developed. I recognize that several developers of vaccines are confident that an effective vaccine will be developed and widely distributed in a matter of months. But it also appears that a large portion of the population is likely to resist taking the vaccine. So, waiting for the widespread taking of a potential vaccine may not be the ultimate solution.
Doesn’t slowing the spread of the virus delay the time at which society achieves “herd immunity”? I understand there is a lot of uncertainty about the conditions at which “herd immunity” will be achieved. But isn’t “herd immunity” the ultimate long-term solution?
The early disease prediction models predicted millions of deaths would occur before “herd immunity” set in. Those models now seem inaccurate. There is some evidence that locations that did not impose some of the severe virus transmission mitigation efforts early on may now be achieving some type of “herd immunity.” Sweden is sometimes cited. Sweden is not representative of the rest of the world (Sweden has a small, relatively isolated genetically, culturally homogenous population with a strong social history), so results in Sweden might not be replicated elsewhere. But it’s a piece of information.
Many of us have mocked New York Governor Andrew Cuomo’s recent bragging about the reduction in Covid-19 deaths in New York as compared to the very high death rate in March and April. Some of us have even joked, “Of course the death rate is going down in New York. They already killed off the most vulnerable people early on.” Well, what if that joke is actually the truth? What if those people who died in the early days of the pandemic were going to die when they encountered the virus anyway, whether that contact was in April 2020, or would have been in October 2020 or in April 2021? Did Gov. Cuomo’s early policies really increase the total number of deaths in New York, or just cause them to be concentrated in time? Are our current efforts to mitigate virus transmission really preventing deaths and serious illness, or just delaying them?
I understand that politicians, heads of organizations, and especially media people are more concerned about tomorrow’s headlines than they are about real long-term consequences. But, I still think we should at least give some thought to the long term objectives of our policies. Isn’t the difference between preventing deaths and delaying deaths important in determining whether the costs of the social and economic shutdown and other efforts are really justified? The modelers at the University of Washington cited by @RushBabe49 advocated certain policies based comparing the numbers of deaths by December 2020. But, from a public health standpoint, how much does it really matter if a policy prevents a death from occurring in November 2020 if that death occurs anyway in January or February 2021? For statistical comparison purposes, cut-off dates generally need to be applied, but we shouldn’t totally ignore what happens after those cut-off dates.
See also the post “Covid-19 It’s Over, But How Do You Convince People That It’s Over? Part 2 by @Rodin just below here.
A few people have suggested that long term public health might be better served by policies that get us more quickly to “herd immunity” by letting the virus spread through the less vulnerable population (children, younger adults, the generally healthy even if older, etc.). Yes, there would be an increase in the number of recorded deaths. But, those deaths would likely occur anyway, just somewhat later. So wouldn’t we just be concentrating the eventual outcome into a shorter time frame, but then could allow society to resume operations without the costly virus mitigation efforts?
Current efforts to mitigate virus transmission will not ultimately prevent people from coming into contact with the Wuhan virus. And the people who are going to have adverse medical reactions to the virus are going to have those adverse reactions, whether now or in several months. So what is supposed to be the ultimate goal of these virus transmission mitigation efforts? What is the long-term justification for imposing the virus transmission mitigation costs on society and the people who make up our society?
Published in Healthcare
Brilliant summary.
As I (and many) have said since shortly after the beginning of this nightmare, let’s all get it, and get it over with! We don’t even have to continue testing – if we have had it and, like 95% of the population didn’t really notice, what difference does it make if you test positive now or next week or next year? Sooner or later you’ll have had it, just like hundreds of other viruses going around that never got a name so couldn’t be exploited.
I freely admit that I have Herpes simplex 1 (whichever one causes cold sores). I also have Chicken Pox – I have had outbreaks of shingles twice. Ouch – not pleasant.
If I die someday from a heart attack, and somebody notices that I happened to have a cold sore on my lip as I joined the choir invisible, I am pretty sure no one is going to attribute my death to Herpes.
This is all effing ridiculous.
Very well said. Would that you had a broader platform on which to distribute it.
One point, concerning vaccines. Have we learned nothing from past experience? Every year a new vaccine must be administered to (we hope) prevent the normal flu viruses. Is there any hope that the COVID-19 will not also mutate and require new vaccines, even if the one they are now pinning all hopes on does come about? Is there any evidence at all that this COVID will not mutate?
The cynicism that I struggle to suppress … fears that so long as the winning vaccine(s) can be sold at a lucrative price to a government that wants it to be mandatorily administered nationwide … it doesn’t really matter if it is effective in future years.
It is a golden egg-laying chicken, is it not?
Me too on the cold sores (I get them from bright sun exposure) and chicken pox (they go together) – get the new shingles vaccine if it’s indicated for repeat offenders. That’s one I actually believe in. It’s a double dose and supposed to be significant improvement over first one.
And I agree in the degree of ridiculousness on the range of symptoms called COVID. People are reporting Little Leaguers not wearing masks(!) having ice cream in Exeter. And the ice cream store not policing them. To the police. And posting pictures of said 9/10/11 year olds on media.
My bet is that it’s already done that – the range and intensity of symptoms varies so widely. It seems it’s more than one set of evil-doers on the virus train.
I’m pretty sure that’s not true, depending on how you define “extremely small”.
Other than that, good essay.
I suspect the COVID menace will suddenly subside in mid-November, pending the outcome of the election.
Yes. People die of the flu everyday……………and there is a vaccine! I want my grandchildren to live a normal life. Old people (I’m 64) can be selfish sometimes. Isolate yourself if you want to. Let others live a normal life.
There is some evidence for long-term aftereffects on infected people who have no symptoms or minimal symptoms. For example:
https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916
Bottom line: The burden of proof should be on politicians to justify restrictions, not on productive citizens to show their activities minimize risk of infection. Freedom should be the default position.
The restrictions were initially established on a combination of frightening information (foreign death counts), false information (China, WHO reports), and an abundance of mysteries (the nature of a new virus). Many questions remain, but we now know enough about the virus and its particular effects among US populations to make informed decisions. Long-term health effects remain a real possibility, but those and deaths due to overload must be balanced against the many severe problems of economic and social disruption born of legal restrictions.
Our governments must provide credible and regular explanations of why hospital overload remains a probable outcome to justify continued restrictions. Otherwise, they have exceeded their authority and set government against its fundamental purpose to facilitate life. If politicians force people to choose between life and law, then rule of law will disintegrate as people do what they must.
Let me go on record that I choose later, even though I know my death will occur anyway.
Early on Mrs Rodin was saying just let the virus go and suffer the consequences quickly whatever they are going to be because it won’t be stopped. She is not a foolish person, just someone who because of training and experience knows that society as a whole can’t practice effective infection-control protocols. If our immune system isn’t up to the challenge then we are going to be sick, possibly very sick and die. Watching how this has played out it is hard to fault Mrs Rodin’s (and Sweden’s) logic.
That’s so cute. What century did you grow up in?
I’ve tried to make this argument with people I work with: at some point we’ll all have been exposed and then we can drop all these precautions and carry on just like we used to.
They look at me like I’m crazy.
I read someone who said that New York City, given the rapid spread early (probably because of the subways and population density) had essentially adopted the Swedish approach without ever acknowledging it.
Well, all else being equal, as an individual I would too. But if the costs of extending my life a bit would damage the lives of my children and grandchildren for decades, I would skip the extension.
Public health policy is about statistics, not individuals.
I think that writing off people to “inevitable” virus death is something that people who think they are not at high risk do.
The chance that a person who exercises reasonable caution will go without coming into contact with the virus is actually pretty high. The large majority of people in the U.S. have already gone for several months without being exposed, and those who manage to avoid it until a vaccine is available will be home free, assuming a reasonably safe and effective vaccine.
Those who choose not to be vaccinated, well, that’s on them. Darwinism in action, perhaps, but a certain proportion of the population that goes un-immunized can benefit from widespread population immunity conferred by immunization. Herd immunity does not imply that 100% of people are immune, only that enough people are immune that virus spread is very low.
The situation isn’t really comparable to the seasonal flu since a new flu strain to which most people are not immune appears every year. Coronavirus doesn’t mutate as rapidly as the seasonal flu or else we’d still be dealing with the SARS that appeared in 2003.
Yes, Darwinism in action. Why would anybody advocate that others take vaccines that were rushed through design and production, and rushed through testing and may have serious side effects, and then may be only 50% effective?
I think I’d prefer to stock up on HCQ and zinc, and Vit-C. :)
Now if you want to restrict air travel to only those who have been vaccinated, well, then maybe the vaccine is worth the risk.
That assumption is doing a lot of work in that sentence.