Vaccines versus Variants?

While most seem fixated on vaccines, I am fixated on the variants. I have even become concerned that too much attention to vaccines can obscure our very present (if admittedly unclear) vulnerability to the variants.

Three variants are of particular concern (more). Each is more infectious than previous strains.  Each of the variants has been confirmed in the United States. One or more of these variants are likely to be widespread — even prevalent — in the United States by the second half of March.

It is not yet possible to assess the comparative lethality of these variants. Some early studies have not, however, been encouraging. In any case, all other elements being equal, a more infectious variant will increase case counts, which will increase hospitalizations, which will increase fatalities.  When and where hospitalizations overwhelm clinical resources, quality of care can suffer and incidence of death will increase… even if the variant is not innately more virulent.

Since the variants began to circulate only in recent weeks, it may well be two or three weeks before we see US case counts climb.  It will then be another two weeks — mid-March — before we see hospitalizations increase.  By mid-March it will be too late to undo the consequences of transmission from today until then.

Despite tight slow-down and shut-down measures since mid-December, Denmark reports that 27 percent of those who tested positive for coronavirus during the first week in February carry the “new” B117 strain.  Denmark has developed the ability to track these shifts with much greater accuracy than most countries.

Earlier this week the German government chose to continue rigorous Non-Pharmaceutical Interventions to mitigate circulation of variants. The German Chancellor explained that despite a recent decline in hospitalizations and deaths, the variants must be mitigated now.

In Denmark the current covid fatality rate per million persons is 1.95. Germany is at 5.88.  While the US covid death rate has slowed compared to early January, on February 12 the fatality rate was slightly above 9.0 per million.  If during January and early February the United States had a fatality rate closer to Denmark’s at least 65,000 fewer Americans would have died. Covid was the cause of at least 90,000 US deaths in January, our worst month so far.

Overall population circulation, as measured by cell phone data, is down over fifty percent in both Germany and Denmark. Compared to pre-pandemic patterns, US population circulation is down about one-third.  Commercial restrictions intended to discourage circulation (and therefore disease transmission) are much tighter in Denmark and Germany than in most US jurisdictions (see Danish regulations). Meanwhile, with Iowa’s current covid death rate at about 9.0 (admittedly a huge improvement from December’s peak of over 20 per million), the state’s mobility pattern is about 27 percent pre-pandemic, and on February 5 the governor lifted most covid-related public health restrictions.

Despite official warnings (more) and recurring media attention, I perceive a wide-spread tendency to overestimate how vaccines will flip-the-switch — near-term or long-term — and to underestimate the value of care-giving self-restraint to protect the community.  Near-universal face coverings, avoiding interior crowds, better ventilation, physical distancing, more testing, and much more effective tracing and public health interventions will — along with whole-population vaccination — significantly reduce covid related disease and death. With this reduced risk, social interactions, cultural life, commercial activity, and economic bustle can again approach pre-pandemic patterns… with positive adaptations.

There is, I perceive, an urgent threat facing us today. We do not — yet — have sufficient vaccine supplies to significantly reduce the escalating variant threat. How many will die in March and April depends on the care each of us practice today and in the next few weeks. Then as future variants of covid ebb and flow, consistently cultivating the same simple habits that protect ourselves and others will generate significant health and economic benefits for years to come.  “If not now, when?”