This Week in the Pandemic, March 12, 2021
Happy Anniversary! It was a year ago that the World Health Organization (WHO) declared COVID-19 (covid) a pandemic. At the time, expectations ranged from “This will blow over” to “This will kill us all.” Since that time, we have a little more information and, SURPRISE!, reality falls somewhere between those 2 extremes. Combined with a paper recently published in JAMA, I’ve been thinking a lot about what Life With Covid might be like.
Epidemiologist often answer questions with “It depends.” The only appropriate follow-up to that is “On what?” With covid, the correct answer to that is still “It depends.” The future of covid depends on at least the following things.
- Variants
- Vaccination
- Human behavior
- Immunity
Within each of those there are about a dozen categories of other factors that could make a huge difference or could make no difference at all in the future of covid.
Variants
Viruses mutate a pretty predictable rates. Not all viruses mutate at the same rate, but a given virus’s mutation rate can be predicted fairly well and the number of people a virus infects can help us. In very simple terms, since there have been over 100 million cases of covid and we have multiple variants spreading, it’s not unreasonable to expect that with an additional 50–100 million cases there would be more variants that have real differences from previous variants. So, we’ll probably continue to see new variants emerge every few months to every year.
That doesn’t mean the effects of those variants can be predicted at all. That’s a big “It depends” that no one knows. No one could possibly know. Anyone who tells you otherwise is selling something.
If a variant emerges enough to be detected by microbiologists, it will probably be more contagious. It might cause more serious symptoms or it might cause fewer symptoms. Either one could benefit the virus, which is the typical driving force behind viral evolution. It also might cause different symptoms, which would allow it to sneak past humans undetected, which would, again, give that variant an evolutionary advantage.
So beyond expecting more variants, there isn’t much more we can probably say about that.
Vaccinations
Currently we have 3 vaccines approved for use in adults in the United States. I honestly don’t know about other countries, which is one “It depends” that would need to be considered to know the future of covid. These vaccinations are very effective at eliminating serious infections, hospitalizations, and deaths. That we know.
What we don’t know is how long immunity lasts or how well the vaccines will work against new variants. Currently-emerging variants are something of a mixed bag. Future variants are a complete unknown.
The good news is that mRNA vaccines, which is what Moderna and Pfizer are using, can theoretically be altered, tested, and manufactured very quickly. I say “theoretically” because those are the first 2 mRNA vaccines ever invented so we don’t really know. But if, say, a new variant emerged that was more contagious and rendered current vaccines ineffective, we could optimistically have a new, updated vaccine for it in 6 months. Then it would be a simple matter of vaccinated or revaccinating everyone. #sarcasm. Which leads us to…
Human Behavior
So far, I’ve seen estimates of anywhere from 40% to 75% of adults in the U.S. want to get vaccinated. There are about 255 million people over 18 in the U.S., so that means somewhere between 105 and 180 million people might get vaccinated, leaving between 150 and 225 million of the 330 million Americans unvaccinated. That’s not good enough for “herd immunity” but that’s another complicated issue we won’t get into. Suffice it to say, lack of herd immunity will encourage more variants. Kids might get vaccinated to help us out, but that won’t happen until trials in kids are complete and those probably won’t be until at least another year.
All of which is to say: Please get vaccinated!
Absent huge numbers of vaccinated people, society may need to depend on other mitigation strategies. These include the horrors you’ve been dealing with for a year now. Limited indoor gatherings. No State Fairs. Smaller crowds at sporting events. No concerts. Closed bars.
Dogs and cats living together! Mass hysteria!
…Distance. Learning. <shudder>
All of which is to say: Please get vaccinated! It’s for the children!
Immunity
We can only know what we’ve had time to know about immunity. At best, we can know that immunity lasts 8–9 months. At least 1 study suggests that. Immunity to the vaccine may be as long or longer. Again, it needs to be studied to be sure. News from other coronaviruses indicates that it’s possible immunity to covid will wane, so that’s what I’m mentally preparing for.
My Prediction
Through a combination of waning immunity and virus mutation, booster vaccines may be needed annually or every 2 years…or every 6 months. As time passes, those booster shots and occasional exposure to the virus might render older people more resistant and less likely to be hospitalized or die than what we’ve seen for the past year. That, at least, is a hopeful idea.