Again and again, all over the world, we’ve seen public health officials all too willing to relax Covid restrictions too early, resulting in an eventual spike in infections and hospitalizations. As we’ll explain, regulators are repeating the same experiment and expecting different outcomes, The classic example was the May CDC “Mission Accomplished” policy change of telling the fully vaccinated they could go about unmasked, even as Delta had become the dominant strain, had viral loads 1000x that of the wild type, and not surprisingly also had a much higher unmitigated R0. Yet at the same time, the CDC also told state and local authorities to not report cases among the vaccinated ex hospitalizations. The CDC backpedaled on both policies thanks to the summer surge. But considerable damage was
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Again and again, all over the world, we’ve seen public health officials all too willing to relax Covid restrictions too early, resulting in an eventual spike in infections and hospitalizations. As we’ll explain, regulators are repeating the same experiment and expecting different outcomes, The classic example was the May CDC “Mission Accomplished” policy change of telling the fully vaccinated they could go about unmasked, even as Delta had become the dominant strain, had viral loads 1000x that of the wild type, and not surprisingly also had a much higher unmitigated R0. Yet at the same time, the CDC also told state and local authorities to not report cases among the vaccinated ex hospitalizations. The CDC backpedaled on both policies thanks to the summer surge. But considerable damage was done thanks to many of the middle and upper middle class vaccinated still seeing non-mask wearing as a perverse declaration of virtue, that they are doing so to show they are shot up, disregarding the new CDC guidance for the vaccinated to mask up indoors.
Damien Contandriopoulo in The Year Public Health Lost Its Soul explained how we got here:
Most jurisdictions in Western countries adopted “balanced-containment” strategies regarding COVID. This approach is characterized by the ambition to balance, on the one hand, the number of coronavirus infections, hospitalizations and deaths and, on the other hand, the economic and social disruptions caused by strict infection control measures such as lockdowns…
… the focus of containment strategies shifted. Economic actors impacted by lockdowns and infection control measures successfully convinced many governments to slowly push the balance of the containment strategies toward looser infection control measures and the acceptance of higher infection rates. The reference point of balanced-containment strategies slowly shifted from minimizing cases to optimizing intensive care bed occupancy rates near or above 100%. The combination of outdated and misguided infection prevention advice and looser restrictions contributed to fuel higher and higher waves of cases.
In the meantime – and unsurprisingly – the balanced-containment strategies were also shown to be deeply inequitable. Both the incidence and relative risk of death from COVID were highly correlated with income, social status and racialized status…
More efforts seem to go in controlling the political spin and rationing the information made available than in trying to correct documented deficiencies …The ambition to be a science-driven evidence-based practice continues to be daily trampled in evidence-free statements.
GM has repeatedly pointed out that trying to manage Covid simply to keep it from overwhelming hospitals was tantamount to accepting large-scale deaths and morbidity, particularly since virtually no one is thinking about the likely scenario that Covid will be with us for decades, and even properly vaccinated individuals statistically will get infected multiple times. His less forgiving assessment of the official response:
As I have noted several times before, what is happening right now is due to the fundamental political economic conflict that dealing with the pandemic requires setting extremely dangerous precedents threatening the foundations of the current order — paying people not to work and canceling debts, none of which can be allowed to even be contemplated. So mass death it is instead.
But a big reason why the medical establishment has gone along with the current plan is that properly dealing with the pandemic also threatened the foundations of the current order in healthcare (we will never know how many people exactly died because someone infected with COVID decided not to seek care out of fear of the hospital bills; as an aside, I also see very few stories about COVID hospital bills in the media, which makes one wonder whether that is a taboo topic), and also that properly dealing with it never fit within the philosophical framework of the system. It isn’t just cold calculation — people have been brought up in this environment, it has fundamentally shaped their thinking, and the Hippocratic Oath (which explicitly talks about prevention being the prime objective) is just something they gave as an obligation. When your view healthcare as a service and part of a transaction, it is natural to manage up to hospital capacity, even though that should be an absolutely abhorrent idea if healthCARE was the objective.
When I first came to the US at [famous school], a friend of mine there (also an expat) had to go to the hospital several times because he was literally collapsing from overwork (that does happen at [famous school]). So he goes to the university medical center (which was thankfully free of charge), they examine him, and eventually decide to put him on some drug, but it was more of a precaution rather than something absolutely necessary (there was a fear he was starting to develop some endocrine problems).
Then they are explaining to him the possible side effects, one of which was dysfunction of some of the key internal organ (I don’t remember which one exactly) and apparently it wasn’t simply a rare side effect, it was quite common, so he asks “What happens if I develop such an issue? Isn’t it better to think about something else?” and they shrugged and replied “No worries, you will come back and we will treat you for it”. And that was quite shocking to us in terms of what it revealed about the mindset of the system — it’s not about taking care of the overall human being, it’s a series of independent transactions and boxes to be checked…
More specifically, we know that relying on vaccines and not much else isn’t adequate to combat Covid. We and readers have cited the NIH article Increases in COVID-19 are unrelated to levels of vaccination across 68 countries and 2947 counties in the United States, specifically:
Key point: The sole reliance on vaccination as a primary strategy to mitigate COVID-19 and its adverse consequences needs to be re-examined, especially considering the Delta (B.1.617.2) variant and the likelihood of future variants. Other pharmacological and non-pharmacological interventions may need to be put in place alongside increasing vaccination rates. Such course correction, especially with regards to the policy narrative, becomes paramount with emerging scientific evidence on real world effectiveness of the vaccines.
An example of how differences in non-phamaceutical interventions apparently a big difference in outcomes:
Why so much higher in UK?
Here’s a look at what those countries are doing differently to reduce transmission:
• % of people never wearing masks has rocketed in UK but stayed very low elsewhere
• % of people attending large gatherings in UK is surging way ahead of elsewhere pic.twitter.com/nihq9HqHDJ
— John Burn-Murdoch (@jburnmurdoch) October 17, 2021
And as GM pointed out:
Take a look at this curve:
For one of the best illustration of what “we vaccinate and abandon containment” looks like
Mongolia was a ZeroCOVID country that is also geogrpahically quite well placed to avoid infecting everyone given how sparse it is. But they started having some cases in November, then, having secured vaccines for everyone, gave up on containment in 2021, had a first significant wave in April, reached 60% vaccination in early May, had another even bigger wave in May-June, now they are at 70% vaccination, and the current wave is breaking all records. They do seem to fudge death numbers though — the official CFR is 0.4% and there were some distressing videos of people lying on the pavement outside hospitals about to die which do not fit with the reported averages of 5-10 deaths a day. So it looks like a Serbia situation (Serbia’s CFR is 1%, which is 3x less than any other country nearby and excess deaths are 5-6X the official COVID deaths, so it’s clear what is going on there).
And that is before factoring in the risk of new variants independently upsetting the apple cart. As GM wrote earlier this month:
People are right now worried about AY.4.2, which is AY.4 + Y145H. The suspicion is that with the Y145H mutation it has gained a sialic acid binding site, and thus potentially a new mode of cell entry.
If true, this will be another example of viral evolution completely blindsiding us.
One of the containment measures being abandoned is curbs on overseas travel. The US is ending travel restrictions on fully vaccinated foreign visitors on November 8. This is despite the fact that the CDC knows full well that the vaccinated can transmit Covid, and their own work suggests their nasal viral loads are as high as for the unvaccinated.
Ireland has a 90% vaccination rate, 88% among the >12 year old population, had one of the longest and toughest lockdowns in Europe in the past six months, and still has good mask discipline yet is in the midst of a surge that puts it on par with the bad areas of the UK. Yet it is opening up fully next week and per PlutoniumKun, the natives are itching to go on the road:
I’m surprised at how quickly travel is returning. Yesterday a friend asked about whether I’d recommended Thailand or Cambodia for a break she is planning with her partner just after New Year. I was really taken aback that she’d even consider it and told her fairly directly that there was no way I’d even consider a long distance flight like that to Asia under current circumstances. I was told equally bluntly that she had 10 days off and she and her partner were absolutely determined to ‘really get away somewhere sunny’. Oh well.
The US is opening up to countries in the midst of surges and/or rising case counts despite high vaccination rates like Singapore, the UK, Denmark and the Netherlands (although in the latter two, from a much lower level than their last peak). Peruvians can come to the US even as Lima is showing a rise in cases. Australia’s New South Wales (with the Sydney airport) is ending its quarantine requirement for fully vaccinated foreign entrants. Colonel Smithers reports that Mauritius will open to fully vaccinated travelers this month.
It would be better if I were wrong, but I don’t expect a happy ending. The only tiny silver lining might be it would be harder to scapegoat Bubba if as with the initial Covid spread, a new wave starts from cities with major international airports.