Wednesday, November 03, 2021

America Has Lost The Covid Plot: Yet These mRNA Jabs And Jab Passports Keep Rolling Along....,

theatlantic |  We know how this ends: The coronavirus becomes endemic, and we live with it forever. But what we don’t know—and what the U.S. seems to have no coherent plan for—is how we are supposed to get there. We’ve avoided the hard questions whose answers will determine what life looks like in the next weeks, months, and years: How do we manage the transition to endemicity? When are restrictions lifted? And what long-term measures do we keep, if any, when we reach endemicity?

The answers were simpler when we thought we could vaccinate our way to herd immunity. But vaccinations in the U.S. have plateaued. The Delta variant and waning immunity against transmission mean herd immunity may well be impossible even if every single American gets a shot. So when COVID-related restrictions came back with the Delta wave, we no longer had an obvious off-ramp to return to normal—are we still trying to get a certain percentage of people vaccinated? Or are we waiting until all kids are eligible? Or for hospitalizations to fall and stay steady? The path ahead is not just unclear; it’s nonexistent. We are meandering around the woods because we don’t know where to go.

What is clear, however, is that case numbers, the metric that has guided much of our pandemic thinking and still underlies CDC’s indoor-masking recommendation for vaccinated people, are becoming less and less useful. Even when we reach endemicity—when nearly everyone has baseline immunity from either infection or vaccination—the U.S. could be facing tens of millions of infections from the coronavirus every year, thanks to waning immunity and viral evolution. (For context, the flu, which is also endemic, sickens roughly 10 to 40 million Americans a year.) But with vaccines available, not every case of COVID-19 is created equal. Breakthrough cases are largely mild; 10,000 of them will cause only a fraction of the hospitalizations and deaths of 10,000 COVID cases in the unvaccinated. The more highly vaccinated a community is, the less tethered case numbers are to the reality of the virus’s impact.

So if not cases, then what? “We need to come to some sort of agreement as to what it is we're trying to prevent,” says Céline Gounder, an infectious-disease expert at New York University. “Are we trying to prevent hospitalization? Are we trying to prevent death? Are we trying to prevent transmission?” Different goals would require prioritizing different strategies. The booster-shot rollout has been roiled with confusion for this precise reason: The goal kept shifting. First, the Biden administration floated boosters for everyone to combat breakthroughs, then a CDC advisory panel restricted them to the elderly and immunocompromised most at risk for hospitalizations, then the CDC director overruled the panel to include people with jobs that put them at risk of infection.

On the ground, the U.S. is now running an uncontrolled experiment with every strategy all at once. COVID-19 policies differ wildly by state, county, university, workplace, and school district. And because of polarization, they have also settled into the most illogical pattern possible: The least vaccinated communities have some of the laxest restrictions, while highly vaccinated communities—which is to say those most protected from COVID-19—tend to have some of the most aggressive measures aimed at driving down cases. “We’re sleepwalking into policy because we’re not setting goals,” says Joseph Allen, a Harvard professor of public health. We will never get the risk of COVID-19 down to absolute zero, and we need to define a level of risk we can live with.