Is this the end, my friend?

The current coverage of the COVID-19 pandemic of late has been a bit of a ‘Tale of Two Cities’ situation.

“It was the best of times, It was the worst of times.”

Depending on who you read, we are in two distinct camps. One says we are mere weeks away from the end of the Coronavirus pandemic and are about to emerge into a candy-coated, mask-free world full of boozy brunches and concerts. Let the roaring twenties begin! The other says we are about to be swallowed whole by the dark spectre of the variants, condemned to yet another year of harsh lockdowns. And we’ll get another after that if we don’t do what we need to do!

I’ve always said that honesty does not live in the extremes, and that is absolutely the case here. Do I believe the COVID epidemic is over? No, not yet. But for the first time in a long time, I have hope.

Heck, I had enough hope that I actually got off my ass and wrote an article!

Considering that I’m an eternal pessimist though, let’s start with the bad news. There IS going to be at least one more significant wave of COVID in the United States. Our vaccination efforts aren’t going fast enough to stop it from happening. In fact, if you look at the graph below, you can see it has already started.

The recent downward trend in COVID-19 infections has begun to reverse due to the new B.1.1.7. variant.

Despite vaccinations going up, and cases of the original COVID-19 virus going down at a steady clip, cases of the B.1.1.7. Variant or the “UK Strain” are on the rise. This variant is somewhere between 30-70% more transmissible than original COVID-19, which is exceptionally bad news, and why you hear more talk about “double-masking” lately. Apparently, it also takes a smaller dose of the virus to make you ill, because it is better at binding to the ACE2 receptors in your respiratory tract than original COVID as well. Lovely.

The enhanced level of contagiousness in B.1.1.7. means that the virus’ reproduction rate is now faster than our ability to slow it down with our current mitigations and vaccinations. Even worse news, is that B.1.1.7. is on track to become the most common form of COVID on Earth, eclipsing the original virus.

So, dark spectre? Condemned to more endless lockdowns? Not quite.

The good news is both of our current COVID Vaccines are able to effectively deal with B.1.1.7. Not as effectively as they deal with the original virus, to be sure, but more than well enough. Even better news, Johnson & Johnson’s vaccine candidate (which is also effective against B.1.1.7.) was approved today and we can expect 20 million more freshly vaccinated people within the month of March, on top of the millions more who will be vaccinated with Pfizer and Moderna.

Unfortunately, it no longer appears our vaccines will be effective enough to stop everyone from getting sick with COVID due to the variants. (I know, this is supposed to be the GOOD news section, don’t worry, we’ll get there.)

Here’s the thing. I don’t think that bringing COVID cases down to zero should be our goal. It’s unrealistic. Let me explain.

All of the research we have so far, shows that while the vaccines still do reduce your chance of getting sick from COVID, they all but ELIMINATE your chance of being hospitalized or dying from COVID. That, right there, is the victory.

There will be many a person who will scream about rising case numbers in the next few months. That is a foregone conclusion, and if we had no protective measures, I would be among them. But if our current knowledge holds, even as cases may rise, hospitalizations and deaths from the new wave should start to plateau and fall as the majority of Americans are finally vaccinated.

Many pundits will go on about how we have not yet reached “herd immunity” and that reopening is irresponsible because there are still cases happening all over the country. The fact is, I think herd immunity in the case of COVID is a pipe dream. COVID simply mutates too quickly for herd immunity to take hold. We never reached herd immunity on the original variant of COVID, and now we have multiple variants floating around that escape the natural antibodies from previous infection. Even herd immunity through vaccination seems like a stretch. Most studies show that the best we will ever be able to do in our vaccination campaign is approximately 60-65% of adults. That isn’t going to cut it. Herd immunity can not be the goal here. It’s an impossibility, at least in a country like the United States.

Eventually, I think case numbers will cease to mean anything at all. As hospitalization and death numbers drop due to vaccination, it will be difficult to argue that we should continue locking down our society over cases of a virus that are no longer killing large numbers of people or sickening them badly enough to require hospitalization.

We have even had our first bit of evidence in favor of this. A nursing home in Spain had an outbreak of B.1.1.7. among its vaccinated residency a few weeks ago. 14 people tested positive and had symptoms. But none had anything worse than a mild illness, no one required hospitalization, and no one died. Remember, this is a nursing home, this is among the most vulnerable members of our population. If vaccination worked this well there, it should work this well EVERYWHERE.

Let me put this another way. In the placebo-controlled, blinded, randomized trials for 6 different vaccines, involving over 175,000 people there were ZERO hospitalizations for COVID in people who successfully completed the vaccination protocol. Not just zero deaths, zero hospitalizations.

That’s pretty damned incredible.

Even better, is that there have also been ZERO reports that I can find about anyone getting any of the horrible “Long COVID” symptoms after infection post-vaccination. In fact, there is a bit of a build up of anecdotal evidence that people who had been suffering for months with Long Covid symptoms have gotten relief from many of them after having been vaccinated. Which I think deserves some study.

Eventually, if the future worst case scenario for people who get COVID is that they feel like they got hit by a truck, have to take a couple days off of work, and maybe get some dexamethazone or an albuterol inhaler at the urgent care, in the grand scheme, that’s not too bad.

So are we heading toward a candy-coated, boozy brunch, roaring twenties world? Also, no. At least not yet.

Vaccination rates are still abysmally slow in the US and around the world. And while they are picking up pace, we have a very long way to go to get everyone vaccinated. Also, vaccine hesitancy, and an overall lack of vaccine supply are big problems. There are going to be a lot of people who could have gotten vaccinated, who are going to get sick and die from COVID in the next few months, simply because they were either unwilling or unable to get vaccinated. That is a tragedy almost too great to bear.

Thankfully, we will get there eventually. Soon enough, anyone who wants a vaccine will be able to get one, and a person’s vaccination or lack thereof will be their own personal responsibility. But we aren’t there yet. Not even close.

Looking forward, we have booster shots coming from all of the major manufacturers to deal with the current variants as well. This may turn into a once yearly, or once every other year shot you have to get, depending on how fast COVID mutation ends up being when the epidemic is finally under control. But that remains to be seen. Those shots though should be much more effective at eliminating sickness from COVID entirely, and that would be very nice.

I also hope to see mask wearing become more ingrained in our culture going forward. We have basically eliminated the flu season this year due to our social distancing and masking measures. And that usually kills between 30,000-60,000 people a year! That is a tremendous victory that goes un-celebrated. It would be nice to see people being able to stay home when they don’t feel well, or at the very least wearing a mask when they feel under the weather as a courtesy to those around them. Personally, I know I’ll never fly without a mask again. Who wants to get the crud on vacation?!

What needs to be done now, is for the governments of the world to start to set up a concrete plan for what triggers the full reopening of our society. We need a firm and concrete metric of where the finish line is. We know herd immunity is realistically not it. We shouldn’t have states chasing that goal, and the potential of having 50 different finish lines would be a nightmare of conflicting rules and regulations. So where is it? What level of deaths and hospitalizations is “acceptable”? Do we go by numbers of vaccinated?

These are exceptionally hard questions that are going to need to be answered soon, because I’m starting to see the light at the end of the tunnel. How soon we get to the other side, is up to us.