covid-19 – The next strain

As noted in previous post, the UK and USA are both engaged in a race to vaccinate as many people as possible before their hospital systems get overwhelmed by the more infectious strains of covid-19 that are now becoming dominant worldwide.

Both are in dire straits and taking extraordinary and risky measures such as prolonging the interval between the two doses required and hoping to be able to catch up using different vaccines for a second dose if necessary.

In the UK they do at least seem to now be fully aware of the situation and starting to lockdown seriously.

Europe is in a similar mess and all the developed countries are competing for emergency supplies ahead of the poorer countries that need them even more desperately.

My impression is that the US public is still not aware that they could be facing double the current numbers of deaths following Biden’s plan for 100 million vaccinations in the first 100 days and that this period could be the very worst part of the pandemic rather than the tail end currently expected.

There are reports sounding the alarm but I have not yet seen signs of the new administration taking even the sort of lockdown measures now belatedly taken in the UK.

Here for example is a current alarm sounded by a member of Biden’s covid-19 transition team, so the US government presumably does know:

27/01/2021 8:47 PM AEDT | Updated 28/01/2021 9:11 AM AEDT

Infectious Disease Expert Warns Next 6 To 14 Weeks May Be ‘Darkest’ Of COVID-19 Pandemic

By Lee Moran

Infectious disease expert Michael Osterholm said Tuesday that he fears the United States is about to enter its “darkest weeks” of the coronavirus pandemic yet.

The director of the Center for Infectious Disease Research and Policy at the University of Minnesota, who served on President Joe Biden’s COVID-19 advisory board during the presidential transition, told CNN’s Anderson Cooper that there could be another potential explosion in new cases if mutated, more contagious variants of the virus take hold nationwide.

“We’re down now to 150,000 cases a day, which seems down,” he continued. “Remember when 70,000 or 32,000 cases a day seemed high? And if this variant takes off here in North America like it has throughout Europe, I think we could be seeing numbers much, much higher than we’ve had to date.”

Osterholm said an eruption in the number of infections could hinder the work of COVID-19 vaccines.

“We just won’t have enough out in time,” he said. “If we vaccinate everybody that the government has said the vaccine will be available for through April, that’s only about 12% of the U.S. population. This variant could do a great deal of harm in that time.”

“We’ll have to wait and see,” he concluded. “I sure hope it doesn’t happen, but if it does it’s going to be a long few weeks ahead of us.”

Osterholm echoed those fears on MSNBC, telling anchor Stephanie Ruhle on Tuesday that “the very worst of the pandemic is yet before us,” citing the “enormous challenge” of the new variants. (Watch the clip below.)

“I’m not at all optimistic,” he said.

The coronavirus has now killed more than 425,000 people nationwide. There have been 100 million confirmed cases around the globe, with more than a quarter of them (upwards of 25.4 million) in the United States.

https://www.huffingtonpost.com.au/entry/michael-osterholm-warning-coronavirus-pandemic_n_60112bc5c5b6b8719d888159

Here’s a very recent New York Times oped:

The New Virus Variants Make the Next 6 Weeks Crucial

By Ezra Klein
Opinion Columnist

Jan. 28, 2021

I hope, in the end, that this article reads as alarmism. I hope that a year from now it’s a piece people point to as an overreaction. I hope.

Coronavirus cases are falling. Vaccination numbers are rising. We are already jabbing more than a million people a day, which means President Biden’s initial goal of 100 million vaccinations in 100 days was far too conservative. In California, where I live, Governor Gavin Newsom lifted the statewide stay-at-home order. It feels like dawn is breaking.

And that is what makes this moment dangerous. The B.1.1.7 variant of coronavirus, first seen in Britain, and now spreading throughout Europe, appears to be 30 to 70 percent more contagious, and it may be more lethal, too. It hit Britain like a truck, sending daily confirmed deaths per million people from about six per million in early December to more than 18 per million today. The situation in Portugal is even more dire. Daily confirmed deaths have shot from about seven deaths per million in early December, to more than 24 per million now. Denmark is doing genomic sequencing of every positive coronavirus case, and it says cases involving the new variant are growing by 70 percent each week.

“What we need to do right now is to plan for the worst case scenario,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told me. “And when I say ‘worst case,’ I’m potentially talking about the most likely case. Let’s not wait until we wrap the car around the tree to start pumping the brakes.”

America is doing embarrassingly little genomic testing, but even the paltry surveillance that is being conducted has confirmed epidemiologists’ fears: B.1.1.7 is here, too. And there’s evidence of another super-contagious strain developing in California. It will take some weeks or even months for these new strains to become dominant, but virologists tell me there is every reason to believe they will. The results could be catastrophic, with hundreds of thousands dying before vaccinations neutralize the threat.

This is the part of the horror film where a happy ending seems in sight, but it is obvious, to those paying attention, that the monster is not dead, and that the worst may be yet to come. We cannot let ourselves be taken by surprise.

Paul Romer, the Nobel laureate economist, told me to think about it this way: The coming months are a race between three variables. There is the contagiousness of the virus itself. There are the measures we take to make it harder for the virus to spread, from lockdowns to masking. And there is the proportion of the country with protection against the virus, either because they’ve already caught it or because they’ve been vaccinated. If contagiousness is rising fast (and it is), then the measures we take to stop the spread or the measures we take to immunize the population need to strengthen faster. Romer’s modeling suggests that if we continue on our current path, delivering one million vaccinations a day and growing fatigued of lockdowns and masks, more than 300,000 could die in the coming months.

But calamity at that scale is a choice, not an inevitability. And so I’ve been asking health experts the same question: If you knew, with 100 percent certainty, that the coronavirus would be 50 percent more contagious six weeks from now, what would you recommend we do differently?

The most immediate danger is that optimism and exhaustion will overwhelm our common sense, and we will reopen just as the new strains are quietly building momentum. “Just in the last week or 10 days,” says Ashish Jha, dean of the Brown University School of Public Health, “a lot of state officials are looking at data of numbers coming down and asking me, ‘When can I reopen my restaurants to 75 percent? Bars have been closed for months, can I reopen bars now?’ It is true things are coming down but we are at a very high level. This is not the time to start letting up. This is the time to hunker down for what is likely to be a very difficult two or three months.”

With that introduction, one might expect the rest of the article to be explaining the need for prompt and drastic lockdowns, using whatever it takes, up to and including martial law.

Instead, it continues by assuming agreement against lockdown and pretending that testing provides some magic solution:

Let’s agree that total lockdown is the most ruinous of all options, and the one we’d like to use least. We have tools we could deploy to avoid it, but we’d need to start quickly. One is rapid, at-home testing. The technology exists to produce tens of millions of cheap, at-home antigen test strips each day. These strips are highly accurate during the period that matters most — when we are infected and contagious. Used widely, they’d let all of us check, daily, if we were potentially infected, so we could then isolate and avoid infecting others. “This is a public health issue and if we don’t empower the public to deal with it we won’t be able to defeat it,” Michael Mina, an epidemiologist at Harvard, told me.

The problem here is the Food and Drug Administration. They have been disastrously slow in approving these tests and have held them to a standard more appropriate to doctor’s offices than home testing.

I was going to write about the absurdity of pretending that cheaper and less accurate tests could be a substitute for lockdowns rather than a minor supplement when that idea was suggested here in a link to a podcast advocating them. But it did not seem worth the effort. It still doesn’t. Blaming the FDA for not being able to do it fast enough won’t work either.

Quite simply the oped takes it for granted that the only known effective measure is out of the question and proposes nothing but wishful thinking.

Some back of the envelope calculations in support of this from Paul Romer indicate the problem.

https://mobile.twitter.com/paulmromer/status/1355049460225765378

Despite having a Nobel Prize in Economics, Paul Romer is by no means stupid. Yet he looks for solutions by tripling the vaccination rate and doing lots of testing and contact tracing (without any optimism). Apparently locking down hard enough just isn’t worth analysing in the USA as they cannot do it any more than India or Indonesia could (but China, Vietnam, New Zealand and Australia did).

The likely extent of the disasters elsewhere are difficult to estimate in many places that lag behind the more developed countries where people came in contact with the virus more quickly. They have much less capacity for their health systems to cope when the levels of infection do catch up.

The lockdown just announced in Western Australia lockdown for the whole city of Perth and nearby is lucky for Australia:

https://www.abc.net.au/news/2021-01-31/covid-quarantine-hotel-worker-tests-positive-in-perth-wa/13106968

There are certain to be ongoing leaks of the new strains from quarantine facilities.

Most people want to do whatever it takes to suppress them immediately rather than risk community transmission exploding as it is doing elsewhere.

The ruling class wants to take that risk. As far as I can make out this is sheer irrationality on their part. Naturally they put their asset values ahead of other people’s lives. There are bound to be sectional interests, like tourism, airlines and hospitality that could reasonably imagine that they would actually benefit from taking more risk. But all the evidence shows that the risks they loudly campaign for do more damage to the economy as a whole than the costs of not taking those risks – and therefore damage the overall interests of the ruling class as a whole.

The problem is that most “business leaders” here do not make any independent analysis. In most of the world it is simply not possible to avoid community transmission so “opinion leaders” on behalf of the ruling class are attempting to optimize the situation for their asset values without having that option. The “business community” here mostly looks to the same opinion leaders from North America and Europe rather than thinking for themselves about their own interests.

In Australia, like New Zealand, it is quite possible to avoid another wave but becoming more difficult with the new strains that are more infectious and will therefore escape more easily from quarantine and isolation facilities that were able to more successfully contain less infectious variants. Once they have escaped they are more likely to overwhelm contact tracing quickly.

Fortunately WA is in the middle of an election campaign. The government has responded in the same way that South Australia did when it wrongly believed a case of community transmission was from a more infectious strain. That over reaction in SA was an entirely necessary reaction in WA where they are reasonably certain that it is in fact a more infectious strain. They will be accused of doing it to pander to voters in an election. But whether that is the case or not it will make it much harder for the pressures from the Commonwealth Government, the media and “business” to intimidate other State governments from doing what has to be done.

So there is a still a good chance Australia could reach herd immunity through vaccination without going through another wave like Victoria’s, let alone anything as bad is happening in Europe and North America. It just depends on how incompetent they are.

It really is “touch and go” since, as I mentioned on December 2, we were then only half way through the emergency declared in the middle of last March. That was 8.5 months of the way through. Another 8.5 months would take till mid-August this year.

Although there is still talk of completing vaccination in Australia by October it looks increasingly unlikely that there could be herd immunity by then, let alone before September. As predicted, Europe and North America will not be exporting much in the way of vaccine supplies until they have dealt with the collapse of their hospital systems. That is likely to take all year by which time the disasters elsewhere will certainly be higher priority than Australia.

So apart from importing small amounts, Australia will be relying on its own new manufacturing facilities that were started late for AstraZeneca (and possibly others). Significant volumes may start to be available to the general public in April but will take many months to cover everyone who wants to be vaccinated. The small amounts imported earlier will be useful to help maintain isolation of quarantine and health workers in the frontlines. That will further reduce the risks of another wave before herd immunity, but will have negligible impact on reaching herd immunity.

There is currently no reason to expect that complete vaccination with relatively inefficient vaccines will result in herd immunity this year. However it could still result in an end to the State of Emergency before October. With a large proportion vaccinated subsequent clusters and outbreaks would be relatively easy to contain by contact tracing (in more or less the manner that the vicious liars opposing emergency restrictions now pretend is the case already). We would then just have the “normal” risks of just another endemic infectious disease until the whole world achieves herd immunity. That could be done quite quickly with rational international cooperation but there seems little chance of that so it looks more likely to take years with major disasters still unfolding in many places.

The problem the USA faces is that they already have huge numbers that are close to overwhelming hospital systems and the vaccine will not have much impact in the first few months when more than 80% of the population remain susceptible compared with the impact of new more infectious strains. That is not the situation in Australia.

No doubt Australia will keep selfishly demanding priority vaccination ahead of places that desperately need it. No doubt the Australian manufacturing plants will not give priority to saving lives in neighbours like Indonesia but it is safe to assume European and North American plants will eventually join China, Russia and India in supplying developing countries rather than diverting urgently needed supplies to countries like Australia whether the Australian government complains or not.

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