The Pandemic Is Over When I Say It's Over

Thursday, January 06, 2022

Or: Has the Pandemic Run Its Course?

Over at Issues and Insights is a piece noting that deaths due to Covid seem not to be tracking cases of the disease in the same way they did earlier in the pandemic. Its title cites a chart showing this, and at least concedes that the chart isn't probatory. I am cautiously optimistic about the omicron strain, but wish to take issue with a few points.

First, although I have heard of data suggesting that the omicron strain is less lethal than previous ones, I am not sure that that possibility has been proved conclusively:

If this outbreak had been like the previous ones, COVID-related deaths would have started climbing weeks ago.

What does this mean? Most likely it means that the disease is getting less lethal as it gets more transmittable, which is how viruses work.

As an article in New Scientist explains, "In time, virologists predict, the virus will become more benign, following an evolutionary pathway previously taken by four other human coronaviruses that today cause nothing more than the 'common cold.'"

If this is in fact what's happening right now, why isn't this news being shouted from the rooftops? [link omitted]
It is true that evolutionary pressure on the virus favors it being less deadly and easier to catch -- in the long run. But evolution is random: It is not some semi-divine, purposeful watchmaker. A given new strain will not necessarily be less deadly, for example. On top of that, the fact that many people are already vaccinated or previously infected can confound the data on how deadly this strain actually is, since the main point of vaccination for this virus is to make it less deadly.

Either of these reasons alone would warrant not shouting Omicron is just a cold! "from the rooftops," and both could be true. (Note that this is a whole separate issue from the fact that our news media report everything in apocalyptic tones. So, yes. Assuming the strain really is less deadly, as I also hope, I won't hold my breath waiting for some evening newscast to report it first, either.)

Second, although I am no fan of Anthony Fauci, I think the speculation to the effect that he is actively covering up good news for nefarious reasons is ridiculous, and makes this usually perspicacious outlet look like it is pandering to the worst populist-conspiracist elements currently posing as part of the right.

Acknowledging risk and handling it properly is apparently an underappreciated skill. (Image by NASA, via Wikimedia Commons, public domain.)
One last point: I wish the thinking of some fellow travellers -- notably Ben Bayer and Amesh Adalja -- were more prevalent: Too many people are confounding the pandemic as a public health emergency with the pandemic as a threat to one's own health. These are distinct, albeit related issues.

For example, Bayer makes a good, selfish case for wearing masks during the earlier phase of the pandemic. And Adalja notes that "abstinence-only" public policies have caused some individuals to ignore the pandemic altogether and others to fear any and all risk from Covid. Both of these groups end up failing to make risk assessments that could prevent illness or improve the quality of their lives.

And this brings me to my title. As the above -- and as a recent article titled "The End of the Pandemic Will Not Be Televised" -- would indicate, determining "the" end of the public health emergency phase is nontrivial, even when considering past pandemics.

But what of "the pandemic" as an issue of your own health and of those you care about? In one sense, it will never be over because Covid will be endemic after the pandemic dies down. But in another, once one incorporates risk assessment as it pertains to this disease into one's life, it will be over as far as you're concerned.

In my case -- if I may be fast and loose with what constitutes the public health emergency phase -- I am cautiously optimistic that the threat of massive government disruptions is over for me, as I live in Florida. My last concerns regard whether (a) a less-threatening omicron strain might still fill up hospitals with unvaccinated people in my general area, and (b) how likely I might be in a crowded area to get enough viral load to nullify the advantage of having been vaccinated. In other words, I'm mostly back to normal, but avoiding places like packed bars for a little longer.

My guess is that within a few months, omicron will take care of those who won't take care of themselves, and the risk of having large numbers of sick people around me at once will be low enough in most situations for me to be comfortable. And then, as far as I am concerned, the pandemic will be over, even though the virus will still be around and worth being aware of.

-- CAV

2 comments:

SteveD said...

Gus, I would not say evolution is random. In fact, I remember my evolution professor making this point explicitly. Mutations are semi-random wrt phenotype, but most are negative because it is easier to break a complicated machine then make it better. Evolution, however, is directed by natural selection (as you mentioned) with contributions from genetic drift (and possibly epigenetic inheritance). As far as the evolution of pathogens go, they generally evolve to be more contagious and less lethal over time although I think modern models are somewhat more complicated than that. The evolution toward lower lethality isn't a perfectly linear trend either. It is quite possible that a new variant will temporarily arise which is much more lethal before the bacteria or virus commences further evolution toward lower lethality. I believe that is one hypothesis for why the second wave of the Spanish Flu was so much more lethal than the first (but the third was much less lethal).
Given that the global IFR of Covid is 0.15% which is not particularly high (the danger of Covid seems to be mostly that is terribly contagious not terribly lethal), my guess is that lethality does not constrain the virus very much. Most of the spread would be early in the infection cycle. Therefore, lower lethality may not give Covid much selective advantage.
The good news is that almost all the reports of Omicron suggest that it is less severe including those from South Africa. In fact, as of a few days ago, the WHO hadn’t confirmed a single death. Importantly, at least one study has shown that it infects less in the lungs and more in the bronchus that either Delta or the original strain which would make it definitively less severe.
A more contagious but less severe strain would be very good news. It was always realistically the best (perhas the only) way the pandemic could end.

Gus Van Horn said...

Steve,

Thanks for the catch. Yes: the MUTATIONs on which evolution depends are random.

Perhaps, since outright lethality is only a marginal issue with this virus, and perhaps with many or most, the trend towards lower lethality is a by-product of the advantage of a pathogen causing less-debilitating symptoms. Someone who survives a virus, but is in bed with it soon after he catches it won't be out and about as much to help it make more copies of itself -- a selective disadvantage.

Gus