Covid-19 in 2021: Threat of Dangerous Assumptions.

2020 is regarded by many as ‘anus horribilis’. Enter 2021 and the hope for better, however dangerous assumptions, including that with a vaccines and a new year all will be fine, create a very real threat that 2021 may be no better than 2020.

We come into 2021 armed with vaccines, but with Covid-19 case levels higher than ever. Much has been learnt since I first wrote back in January 2020 how the then unnamed new coronavirus would very likely take the world on a wild ride.

Dangerous Assumption Types

Wrong

This is when people assume something, even though it is known to be invalid. Wrong assumptions are driven by belief, or simply by what seems logical. Being known to be wrong, these are are not assumptions made by experts, but by possibly significant numbers of people and can still affect behaviour.

Misunderstood

For example, vaccines are effective, but the effect is often misunderstood with people assuming that all vaccinated people cannot spread the virus. Misunderstandings can also be dangerous.

Uncertain

There are outcomes that are likely, but not guaranteed. Where there are unknowns, all that can be done is to assume the likely outcomes, however, when the ‘likely’ is also the ‘best case’, it may pay to take steps to mitigate alternative outcomes.

Dangerous Assumptions

Wrong: Not ill means not infectious.

We know that various people are very unlikely to become seriously ill with Covid-19:

  • people who have been vaccinated
  • people who have recovered from Covid-19
  • asymptomatic cases of Covid-19
  • children under 12

The fact that you’re vaccinated does not mean you still cannot transmit the virus to other people. At this point, it is still unclear if the vaccines can prevent the spread of the coronavirus. That’s one of the takeaways from an interview Pfizer’s CEO Albert Bourla had with Dateline host Lester Holt. Another piece from the NY Times confirmed everyone’s worst fear. “The new vaccines will probably prevent you from getting sick with Covid. No one knows yet whether they will keep you from spreading the virus to others,” NY Times wrote.

Pfizer CEO said it’s uncertain if the vaccine can prevent transmission of coronavirus

Current vaccines prevent the an infection progressing through to illness. Specifically, vaccines have been verified in trial measuring levels of the respiratory problems that cause infected people the worst immediate outcomes. If everyone magically everyone was instantly vaccinated, deaths should be almost eliminated. Note impact of the vaccines on ‘long-covid‘ and other effects of the virus such as ‘Multisystem inflammatory syndrome in children‘ are simply not known. Nor is any impact on transmission. I saw one interview where the Pfizer CEO guessed that there could be a 50% reduction in spread, but it was only an estimate.

It is know that with SARS-Cov-2, people who do not display symptoms can also spread the virus, and this can include children, who are almost always asymptomatic. Whether cases without symptoms have the Covid-19 illness is debatable. With almost all other viruses, ‘asymptomatic’ cases are said to not have the disease, but with almost all other viruses, these people do not spread the disease either.

If vaccinated people can still spread SARS-Cov-2, and vaccines are effective because they produce the same immune response as having been infected, then logically those who have previously had Covid-19 will, as with vaccinated people, be able to transit the virus and infect others. Getting Covid-19 a second time seems to be extremely rare, but I have not seen data on resistance to a second infection that is controlled and thus results in an asymptomatic infection.

Kluge told his audience that the WHO does not recommend the use of immunity passports for people who have previously tested positive for Covid. The Geneva-based organization has previously said there is no evidence prior infection will protect people from catching Covid again. 

rt.com

Misunderstood: Immunity Passports

Given that immunised people, or recovered cases of Covid-19, can still spread the virus, what is the point of Immunity Passports? With almost every other disease, only people who are ill spread the disease, but not with Covid-19. This results in wrong assumptions. An immunity passport for Covid-19 can indicate the bearer is less likely to become ill, but to quote WHO:

“There is no evidence that any of the vaccines are confident that they can prevent people from actually getting infected and thereby infect them. I think. “

“We must assume that vaccinated people will need to take the same precautions until they have some degree of herd immunity. This is the driving force of an evolving field.”

WHO warns quarantine could be required for vaccinated travellers

The fact that there is no reason that an ‘Immunity passport’ should allow avoiding quarantine, does not stop those would profit from supplying them, feeding the media with stories. The problem is these stories are all about seeking to profit from reinforcing wrong and dangerous assumptions.

A future where ‘immunity passports’, enabled by future technology new types of vaccinations, is entirely possible. The suggestion that immunity passports could replace quarantine today is just dangerous.

Uncertain: Vaccines will stop the spread

The key point made above, is that there is a difference from falling ill with Covid-19, and being infected SARS-Cov-2. The extremely unusual thing is that with SARS-Cov-2, ill or not, you can still spread the virus, and that is one key that factor that has made SARS_Cov-2 such a threat.

I have already quoted sources from WHO and Pfizer on how vaccines may not prevent spread, and how this can be a threat to those not yet vaccinated. Now consider that even when everyone is vaccinated, if vaccines, for example, reduce spread by 50% but not completely, if people then stop socially distancing and wearing masks, the virus may be more prevalent than ever before. Note that masks alone are said to reduce spread by 50%, but just wearing masks did not prevent spread.

This result may sound like the common cold. A virus spreading to a significant percentage of the population, without people dying or even being seriously ill. The difference is even without a vaccine, the cold virus does not kill anyone, while with SARS-Cov-2, a continuous immune response would be required to prevent people dying. This dangerous virus would still be inside more people than ever before, with potential long term effects even beyond those we already know about in terms of ‘long-covid‘.

This is only in the ‘uncertain’ category, because there are vaccines that it is believed may stop the spread. It is just unknown if any vaccines will be successful at stopping the spread yet. Eventually we we can hope for vacines that prevent spread, just perhaps not in 2021.

Wrong: It will all soon be over due to Vaccines

It depends on the definition of ‘soon’.

Anthony Fauci, the nation’s top infectious disease expert, predicted on Thursday that normal life would not resume for most Americans amid the coronavirus pandemic until as late as next fall.

That timeline, he warned, will be contingent upon the U.S. “efficiently, quickly and effectively” implementing vaccination programs that have thus far lagged behind schedule, as well as “a rather strict adherence” to personal mitigation measures such as hand washing, mask wearing and social distancing.

Fauci predicts normal life won’t return in U.S. before fall 2021

So at best, in the US, there is still 8 months before things can return to normal. The US is one of the richest and most technologically advanced countries in the world. How many countries can we expect to do better than what the US can achieve ‘at best‘?

This means at best, 4 months of relatively normal life in 2021, compared to many countries having normal life until March in 2020.

Wrong: 14 days quarantine blocks introduced cases.

14 days quarantine is sufficient to in theory detect 99% of cases, therefore, with perfect testing, 1% of cases would not yet test positive. Except that even then, the lowest value for false negatives from the most accurate PCR tests is 2%. That adds to at least 3% of cases will not be detected by 14 day quarantine.

97% of cases being detected sounds good, but that means for every 97 cases detected in quarantine, 3 cases will get through into the community undetected. Only a small percentage of people in quarantine will actually be infected, so the percentage of infected people getting through quarantine will normally be far lower than those already in the community, unless, like states of Australia, or New Zealand for example, there are zero cases in the community other if not cases get through quarantine. How many people in quarantine are infected? It is hard to find statistics, but I found an article quoting 19 cases in one day detected for Australia. At that rate, as many as 3 infected people could pass through quarantine undetected every 5 days.

Update( March 2021) : New virus strains may increase quarantine time.

Wrong: Covid-19 was a 2020 thing, now it is 2021 we are over it.

2021 is starting with more daily infections worldwide than ever before, and likely to be 8 months before vaccines can bring life to normal. Yet visit the forum of any sport an you will see an expectation that 2021 will be a return to normal from the outset. The world tennis championship is played in many countries and provides insight in how many countries plan to host tournaments in the first half of 2021, despite cancelling those same tournaments in 2020, when case number were far lower.

Uncertain: Vaccines will prevent all damage from SARS-Cov-2

No tests have yet ascertained vaccines prevent ‘long-covid‘ or other effects from Covid-19.

Uncertain: Vaccines will still be effective in six months time

Firstly, there is the simpler question of how long protection from the vaccine should last:

What I can tell you is that the first people to get the new vaccine back in March in the initial safety trial are still protected. So, a minimum of nine months, fingers crossed, three to four years. That would consistent with the animal data we have on other coronavirus vaccines. I realize that three to four years doesn’t sound very long, but in the middle of the pandemic, it feels like an eternity.

How long will this new vaccine protect an individual?

So at least long enough to vaccinate everyone before boosters are needed, and hopefully much longer.

However, it may be that more than one vaccine should be administered to everyone.

The other risk is that vaccination will be infective against a mutation of the virus. If a mutation can thrive in a vaccinated population, that mutation may thrive. There has never before been an attempt to vaccinate a disease a prevalent as Covid-19 out of existence. Yes, we succeeded with smallpox, but that was a disease without asymptomatic spread, present in far fewer individuals at one time than SARS-Cov-2. Those huge numbers increase the risk of mutations that are ‘fittest’ in a vaccinated population could take hold.

Already there are tests to verify vaccines against new strains of the virus that have evolved even before survival of the virus might mean resistance to a vaccine.

Wrong: Covid-19 mutations will not complicate solving the problem

In recent weeks there have been mutations that are believed to result in increased spread detected in the UK, South Africa and Nigeria. Despite very real reasons for concern, it is not clear how much increased spread results from these new mutations, simply because it is too early to be certain. Although it is expected these strains will still respond to current vaccines, these current vaccines should be retested against the new strains. The biggest concern is that there are so many mutations taking place that three have been detected in rapid succession. All of these new strains show evidence that they are have spread more that previous virus because in evolutionary terms, they are ‘fitter’ by way of being better at spreading. If we keep throwing lockdowns and distancing at SAR-Cov-2, without successful eliminating the virus, how long before a strain evolves that still spreads despite our social distancing and lockdowns?

In fact, it is yet to be proven that none of these current mutations will not continue spreading even in the face of our current ability to impose lockdowns.

Social distancing measures that worked against earlier strains of the virus were insufficient to control the spread of the new variant, the study found.

Faster-Spreading Covid Strain Affects Young the Most, Study Says

There so many copies of this virus around the world now, even in species other than humans, that the potential for even vaccinating a percentage of the population will create the environment for a strain not prevented by the vaccine, will evolve. A strain that without the vaccine have no advantage, if resistant to the vaccine will then have an evolution advantage.

The Threat

The USA

As discussed above, it will likely take the US around another 8 months before vaccines even have the potential to return things to normal.

The USA enters 2021 with almost an average of 1,300 deaths from Covid-19 per day since April 2020, and at least double that rate during December, with peak daily deaths well over 3 thousand. But that is not all, far more people have died from other causes than would be expected. There are many reasons, included some undiagnosed Covid-19 deaths, but that does not explain it all. Other reasons included economic stress, and that when the medical system is under stress, more people die.

Note that so far there are already not just the 355,000 Covid-19 deaths, but over 400,000 deaths beyond what would be expected. And this is nothing like what could take place in January and February. After a holiday season of travel and meeting up amid an already climbing case ratio, not only will Covid-19 cases rise, but the medical system in many states will be overloaded to far higher levels. All combined with cases of the new more contagious virus strain from the UK now being present in the US.

Overall, due to Covid-19 or other causes, deaths beyond expectations could pass a 5,000 per day average for January and February and even pass a peak of 10,000 per day in total once both direct Covid-19 and what would have been preventable deaths if not for an overloaded medical system are combined. Total deaths could 1,000,000 in total before vaccines have a chance to have a serious impact.

Even back in May of 2020 it was clear the Covid-19 death toll would be over 300,000 due to complacency at that time, and while a change of government may reduce complacency, it is now hard to see the US escaping with less than 1,000,000 total deaths.

Europe

With no pandemic, fraught talks with the UK or an American president as anti-European Union as Donald Trump, Brussels might finally find space to address issues that have long undermined the bloc — though it won’t be easy.

2020 was a terrible year for Europe. 2021 is unlikely to be much better

Even without Covid-19, Europe has problems. However, Europe is not without Covid-19. Overall, things are worse than ever, and again the there is a history of complacency that lead to the current resurgence and there is the risk this will continue as complacency that ‘vaccines will fix it’. Again, while vaccines may fix it, it will take a similar time as it will in the US.

Low Covid-19 Countries, e.g. Australia and New Zealand

Some countries have, during 2020 managed to contain Covid-19. Initial lockdowns continued until cases were practically eliminated, followed by quarantine for international arrivals and aggressive action in response to any cases that do escape quarantine have so far been quite effective. There are still two critical assumptions that could unravel such strategies in 2021. Firstly, 14 days quarantine will not always be sufficient, and secondly, mutations that either require longer quarantine, or mutations that spread despite current measures, are likely to eventually get through the barriers. The countries currently with very little Covid-19, are also not safe until the virus in under control, which will at least take most of 2021 for these countries.

Elsewhere – The Rest of the World

Sadly, the raw data largely speaks for itself.

Conclusion: Complacency is still the enemy.

Back when the first waves reached peaks while societies were under lockdown in most of the western world, in reality it was clear that these were only ‘lockdown peaks‘, and that as there was more usually more virus than at the outset of the first wave, once measure relaxed, nothing would prevent a second wave. The second wave was created by complacency. People decided it was over, when it was not.

In 2021, complacency could again be the enemy. Again deciding it ‘is over’ too soon would again be costly. Both in lives and economics.

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