Covid-19 is here to stay

Below is an excellent article that gives the big picture of the pandemic but with many important details The original article is a delightful, witty interview with this doctor. I have summarized it to facilitate wide sharing with others. My comments are in italics.

The Doctor Who Eliminated Smallpox Says COVID-19 Is Here to Stay

1. TOTAL DEATHS U.S. COVID-19 deaths will soon surpass the domestic toll from the great influenza of a century ago. This despite very effective vaccines. In other words we cannot wait for vaccines. When a pandemic strikes we must be prepared without vaccines.

2. UNLIKELY TO BE ERADICATED A virus that infects multiple species, animals as well as humans, and has multiple new variants (some of which could re-infect people) is unlikely to be eradicated. Twelve different species have been infected with COVID-19. Yellow fever has not been eradicated because monkeys get it.

3. QUICKER  RESPONSE It took over 200 years after there was a vaccine before smallpox was eradicated. Seventy years after the polio vaccine, we began a global polio program. "by January, a year from the day that COVID-19 began, we had started a global vaccination program. That is astonishing progress; we should feel really grateful."

4. INEFFECTIVE VACCINES. Already one vaccine, AstraZeneca, when matched against the beta variant becomes 90 percent ineffective. "This should be a big flashing red light for us. We could get a variant that renders all vaccines ineffective. This is not a high probably, not fifty percent but maybe five percent!"  In other words every person and institution needs to plan now for the possibility of a variant that will require a far better response than we had to the original variant. 

5. HOW MANY UNVACCINATED PEOPLE IS THE IMPORTANT NUMBER If thirty percent of Americans are not vaccinated, that’s 120 million people. That is plenty potential for another wave, even a large wave from a super variant.

6. CLUSTER BUSTING TEAMS. Therefore we need to have a defensive system of cluster-busters, a Japanese term for teams that are mobile, with highly computerized systems that detect variants. We should be be doing sewage and environmental sampling. It’s very inexpensive once it’s set up. This will identify infected areas  This has already been done with polio. Syria, supposedly free of polio, had causative viruses in the sewage. The polio variant it was identified. The lesson of the original virus is that we were always behind because of the asymptomatic cases. We cannot wait for case identification to contain the virus. 

7. EXPOSURE NOTIFICATION SYSTEMS. We should be using exposure notification systems. even though an article in The New York Times has said how bad they are. Nevertheless exposure notification systems, when compared to human contact-tracing systems, found twice as many contacts for people who were exposed and found them two days earlier. "Exposure notification systems tell us who to test, who to isolate, and who to vaccinate." We are unprepared because we are not willing to deploy cluster busting teams and exposure notification systems. These are the only things have promise other than extensive lockdowns.

8. EARLY DETECTION AND ISOLATION. New vaccines always take time. On the day that a novel virus leaps out from a chimpanzee or a mink to a human,, the only thing we have is early detection and isolation. Lockdowns will always be essential. The only question is can we use cluster busting and exposure identification to localize lockdowns.

9.ANIMAL PROTEIN Animals and humans are living in each other’s territory now in a way that we haven’t done. Sixty percent of the animals that we had 50 years ago are gone, because humans are eating animals including monkeys and rodents. Thirty years ago in China, the number of pigs and cows that were available for food was a fraction of what it is now. This strongly suggests that we need to move toward vegetable rather than animal protein diets.  

10.SUMMER TRAVEL Summer travel last year caused the explosion in the fall. If a third of the population is not vaccinated and not wearing masks, and there are fast spreading variants in the United States then another wave is likely to happen.  What drives a virus is the 120 million Americans who are not vaccinated, not wearing masks, not practicing social distancing, but are congregating. 

11.ANOTHER SOUTHERN SURGE? "I am extremely worried that the Halloween, Thanksgiving, Christmas, New Year cadence will bring about another wave this year. I look at Texas, Florida, Alabama, Mississippi—the states that have been tepid about wearing masks, anti-vax, late to close, and early to open. That’s a formula for creating risk."  As surges develop they do and will spread even into better vaccinated parts of the country both through travel and through rural less vaccinated areas.

12. WHERE IN THE WORLD We have to worry about the parts of the world that are densely populated and largely unvaccinated. South Africa became an explosive outbreak almost overnight because of  a new variant. Getting as many people as possible around the world vaccinated is essential to slowing down the virus. The more new cases, the greater the chances for new variants, and that the low probably vaccine resistant variant will arise.  

13. AIR TRANSPORTATION H1N1, the virus that caused the great influenza, went around the world four times in one year. We did not have commercial airplanes then. Air transportation almost guarantees that a dangerous variant will be here before we know of its existence and its danger.

14. LAB BREAKOUTS Back to 1975, we thought we had eliminated smallpox. We decided to wait two year before declaring it eradicated. Before the two-year clock had run out, we had our last case in Birmingham, England. It was a young woman whose photographic studio was located above a smallpox lab. The virus got into the air conditioning system, infected her and she died. If we were so careless that the last death from smallpox was a lab accident, a lab accident could happen anywhere. 

15. R naught is really critical. It is defined as the number of secondary cases that come from a primary case. The virus travels at exponential speed; R Naught is the exponent. In the case of measles, one case gives rise to 10 to 12 others. In the case of influenza or Ebola, one case gives rise to about 1.2 or 1.3. cases. Smallpox was 3.5 to 4.5 and COVID-19, initially was thought to be 2 or 3. In retrospect, since we were missing all the asymptomatic cases, it was originally 5 or 6. Below is a table which gives the percentage of the population that must be vaccinated for each R naught value. As the variants become more transmissible the percentage of vaccinated people needs to be higher to prevent its spread. 

Percentage of Population Vaccinated Needed to Stop a Given R Naught Virus
R Naught	10	9	8	7	6	5	4	3	2
Vaccinated	90%	89%	88%	86%	83%	80%	75%	67%	50%