This is a follow up to “mid 2021, can we live with Covid-19”, as significant further information has become available. Currently updated as at August 22nd.
- Will Vaccines end the Covid-19 problem, or is it an ongoing threat?
- Risks vs Optimism: A range of futures is possible.
- Looking on the bright side.
- The Worst That Could Happen?
- The Warning Signs.
- There is no herd immunity, spread continues.
- Vaccinated people do continue to become infected.
- Infected People When Vaccinated Still Have Negative Health Outcomes.
- While there is spread, there are variants.
- Yes, ‘the worst’ may be almost here.
- Complacency?
- Will Coivd-19 just go away?
- It Only Effects the Elderly.
- Vaccines are a Silver Bullet.
- We Just Have To Get Through Now.
- The Challenge of Battle.
- Lockdowns and Delta.
- Civil Unrest.
- Conclusion.
Will Vaccines provide an end the Covid-19 problem, or is there an ongoing threat?
In summary, there is conflicting evidence.
The promise has always been that vaccines could return the world to the glory days of before Covid-19. First we had to wait while we get and approve the vaccines, then we had to wait for people to be vaccinated. Along the way, variants of Covid-19 changed the rules. There are two possible post-Covid-19 futures, enabled by vaccines:
- Society could leverage a reduced spread rate of Covid-19 as a result of vaccinations, and eradicate the virus.
- Improved health outcomes for vaccinated people could make Covid-19 a disease we can live with.
From experience with vaccinations so far we believe the following is established:
- Vaccinations do not eliminate spread.
- Spread is reduced to some degree as a result of vaccinations.
- Cases of Serious illness and deaths are dramatically reduced as a result of vaccinations.
This is mixture of good and bad, as significantly spread is reduced is uncertain, and weather the reducing serious illness and death is sufficient for living with the virus to be acceptable is also still in doubt.
There is an economic cost of eradication, but there is also an economic cost of living with Covid-19. Is it better to spend the effort now to eradicate, or to continue to pay over the longer term?
From a cynical perspective, it may depend on how economic cost is measured. Living with the virus actually creates economic activity as health care and even funerals are economic activity.
Risks vs Optimism: A range of futures is possible.
Looking on the bright side.
Positive: The UK has an acceptable outcome at the current case level?
The situation in the UK has transformed from nightmare, to a vision of utopia where a sufficiently vaccinated population has been able to cast off the shackles of Covid-19, open up, and see cases fall in the aftermath. Deaths are still relatively low, and the good news includes case numbers being lower now than when the UK fist opened up on July 19th. and even cases are lower than the peaks prior to opening up. But is the utopia only temporary?
Current data is that 94% of people in England currently have immunity to Covid-19. While even 94% does prevent spread, cases have remained below the level present on July 19. Deaths are currently on a seven day average of 100 deaths per day, and with a life expectancy of 81.77 years, and a population in 68 million, the result would be 1 in 22 chance of dying from Covid-19. In reality, chances are higher, because daily deaths are mostly from older people who originate from a smaller population, but this is still around a 1 in 20 chance that person’s death will be from Covid-19 as opposed to other causes. The current death rate is approximately 3x the influenza death rate from 2019.
Downside of the UK Situation?
The death rate of 100 per week would be 36,500 per year which is 18 times higher than the 2,000 people who die on the roads annually, and a lot of effort is exerted minimise that much smaller number, so it is not insignificant.
A concern is that the trend is that although case numbers fell immediately after July 19, they are now on the rise again.
Deaths are also on the rise.
Given that cases in the US fell in January 2021 prior to vaccinations reaching a level sufficient to explain a significant fall in cases, there is evidence that virus comes in waves that at time subside independently of vaccinations. The fall in cases in the UK, directly at the time restrictions were lifted, is hard to attribute to any peak in vaccinations or trigger. Given cases are again rising, it is too early to be certain where the long term average case numbers and resultant casualties will stabilise.
What is missing from the available data is the hospitalisation rate, which is more critical in determining the risk that some measures will need to be reintroduced, and the rate of ‘long-Covid’ which may take longer to asses.
The overall risk is that current open status with an ‘acceptable’ rate of hospitalisations will either turn out to no be tolerable due to long covid, or only an unsustainable temporary situation.
The risks individual risks I can see are:
- Cases and deaths could still continue to rise, and there is no reliable data on a stable level of case numbers.
- If cases rise, the hospital system could come under stress.
- ‘Long-Covid’ may pose a long term health problem.
- New variants could emerge given case numbers are close to those at the peak of the pandemic.
Negative: The US situation is disconcerting.
The perception of vaccines is central to the situation in the USA.
The data is:
- Vaccines have been highly effective in reducing death and serious illness, despite conflicting data on effectiveness against spread of the virus.
- Cases in the USA fell in 2021, prior to a sufficient level of vaccination to cause the fall.
This data is interpreted with a high degree of confirmation bias by polarised groups with strongly held beliefs. Interpretations include:
Vaccines solve everything:
People were vaccinated, cases fell, but now delta has arrived we need more vaccinations.
It is now a pandemic of the unvaccinated.
Vaccines are part of a conspiracy to erode freedoms:
Cases fell in January even in areas where vaccinations are low, so claims on vaccine effectiveness are false.
A problem is a polarised society, is that the with differing belief about vaccines and Vaccines have been very effective, but data on results from vaccinations in the US have seen data interpreted according to belief with a strong degree of confirmation bias.
The US dan the need for vaccines in the US
The worst that could happen?
Given the mixed outcomes we are seeing in different countries, and interpreting that data in the most cautious way, what appears to be the worst outcome we are facing right now? This is not the most likely outcome, but more the outcome we need to consider insuring against, just as we insure against a car accident even when we do not expect to be involved in a car accident.
Imagine a world where everyone, including babies in the womb, must be perpetually vaccinated levels against Covid-19.
Then, imagine that even when vaccinated, most people will spend months in hospital, even during their childhood years, and 1 in 10 or more will die before they are 30.
Although not technically the worst possible scenario, to me this sounds like a future we should insure against. Just as we insure our house against fire even though for most houses the risk is low, because it would be so terrible if the fire did eventuate.
If that outcome is sufficiently dire, the next question becomes, “is there a real threat this could eventuate?”.
How close to this reality are we?
The Warning Signs: The Reasons to Consider Insurance.
There is no long term herd immunity, spread continues despite vaccinations.
Already with the delta variant, or what I call Covid-19.4, it seems to be now agreed that, as I have suspected for some time, Covid-19 continues to spread within a vaccinated population. This is despite ‘waves’ , as in India in May 2021, or the USA in January 2021, seeing declines in cases even without substantial vaccination.
Vaccinated people do continue to become infected.
The term ‘infected’ is open to interpretation, but clearly vaccinated people can become infected.
This was backed by UNSW Kirby Institute virologist Greg Dore, who pointed to the example of Iceland to show herd immunity was “not attainable with the Delta variant”.
Iceland, which has 93 per cent of the population 16 years of age or older vaccinated, reported 2,783 cases over the past 30 days — its largest wave since the pandemic began.
Yet Iceland has had no deaths for the past 30 days attributed to COVID.
ABC 17th August.
Note that Iceland is a small country with a population of only 370,000 people, so this level of cases means almost 1 in 100 people in the country became infected within the last 30 days.
If vaccinated people who should be ‘immune’ can become infected, then clearly a person can be infected repeatedly. If there is substantial virus circulating in the community, as far as we know a person may become infected multiple times every year for the rest of their life, even if fully vaccinated.
Infected People When Vaccinated Still Have Negative Health Outcomes.
The above statistics from Iceland note that there have been no Covid-19 deaths within the past 30 days. However, data from Australia does show that vaccinated people have been hospitalised, been on intensive care, and even died during the current outbreak. Yes, of those who have died despite vaccination, they have been either elderly or had other health complications. This would suggest perhaps people who never become elderly, or never experience other health issues, will have nothing to fear once vaccinated, but even this assumption is not yet fully tested as with Covid-19 once the level of the virus in the environment rises, the severity of disease also rises. It may be still too early to have data on the impact of an outbreak amongst vaccinated people.
So far, the impact on the unvaccinated is so much worse, that the focus is on getting people vaccinated, and only then will we learn for sure the extent of the remaining problems. But what is clear, is that problems do remain even once vaccinated.
While there is spread, there are variants.
But we have progressed from the original Covid-19 to the delta variant within 18 months and the amount of circulating virus is higher than ever. What will we having in another 18 months, or an another 3 or 6 years?
Yes, ‘the worst’ may be almost here.
So with the delta virus, we already have the potential for people to become infected multiple times year after year even if vaccinated, and there are already hospitalisations as a result even when vaccinated, even if deaths are rare unless the patient also has other health problems. Possible the risk of death is low if you never contract Covid-19 and have an other health issue at the same time?
Complacency?
Will Coivd-19 just go away?
Trump was famous for declaring the virus would magically just disappear, and although it did not disappear on a schedule he would have wanted, it is still possible the virus could one day seem to do just that. What happened to the virus that caused 1918 pandemic?
“The end of the pandemic occurred because the virus circulated around the globe, infecting enough people that the world population no longer had enough susceptible people in order for the strain to become a pandemic once again,” says medical historian J. Alexander Navarro, Markel’s colleague and the Assistant Director of the Center for the History of Medicine. “When you get enough people who get immunity, the infection will slowly die out because it’s harder for the virus to find new susceptible hosts.”
Eventually, with “fewer susceptible people out and about and mingling,” Navarro says, there was nowhere for the virus to go —the “herd immunity” [also see here] being talked about today. By the end of the pandemic, a whopping third of the world’s population had caught the virus. (At the moment, about half a percent of the global population is known to have been infected with the novel coronavirus.)
Time.
Ok, if that is correct, then Covid-19 will not just go away, as unlike that explanation of what happened in 1918, there is no herd immunity as Covid-19 delta strain still spreads.
However, that does not rule out other possibilities as something at least reverses the ever increasing spread of Covid-19. Consider:
- Cases in India from May 2021.
- Cases in the USA from January 2021.
Both times there was a fall in case numbers that is not easy to correctly explain. For example, many people give credit to vaccines for the drop in cases in the USA, but examining the data clearly show the cases began falling prior to vaccinations reaching significant levels. Even though long term herd immunity through vaccination appears to be shown to be impossible, some level of short term immunity that prevents spread does seem to be possible. Either that, or the end of the coldest weather can cause a drop in case numbers.
While there are ways case numbers, even with delta, do fall, Covid-19 is not just going away by itself through herd immunity.
It Only Effects the Elderly.
It becomes convenient to adopt a belief that Covid-19 is a disease of ‘others’, and in this case, the elderly, negating the need for the young and healthy to isolate and making insistence they do isolate unnecessary and cruel.
Vaccines are a Silver Bullet.
Vaccines provide immunity that it was originally thought would result in herd immunity once vaccination targets were reached. There are still many messages, such as ‘vaccine passports’ suggesting that Covid-19 is over for those who are vaccinated. Now in the US, there are again recommendations of masks even for those who are vaccinated, but pandemic is constantly presented as a ‘pandemic of the unvaccinated’. In relative terms this may be true, but we may still find that even vaccinated cannot assume all is over.
We Just Have To Get Through Now.
Covid-19 has always been presented as something we must get through in order to be able to return to normal. That we can exists in any way near the previous normal without eradicating Covid-19 is still unclear, and rather than eradicate Covid-19, what I am hearing so far is plans for places where Covid-19 is currently eradicated to open up and allow the virus in.
The Challenge of Battle.
Lockdowns and Delta.
Australia is proving lockdowns with the delta strain are already difficult. How hard will it be it the virus continues to evolve?
Civil Unrest.
Much of society is completely frustrated with Covid-19 to the point that they demand and end to lockdowns, regardless of the consequences. Partly because lockdowns have prevented them seeing the consequences of no lockdowns. Generally, once the medical system breaks down, people then accept lockdowns, but that does nothing for eradication. Eradication requires lockdowns to continue even when cases are low until they are eliminated, and getting societies to accept that is extremely problematic.
Conclusion.
The real conclusion is that we do not yet know if we can live with Covid-19, yet no one seems to have plans to eradicate the virus in the longer term.