Pandemic Update for 2022-01-10: Endemic — 4 Comments

  1. While I agree in principle with the “endemic” papers, most of their proposals will never happen. In addition to the “individualism” factor Keith mentioned, there also is a huge “states’ rights” issue. The Bill of Rights exists mainly to keep the Federal government from being able to interfere with what Americans do within their own states. Calls for Federal action need to be tempered with recognition of those limitations. In particular, national mandates — vaccines, masks, quarantines, shutdowns, etc. — are unlikely to survive a court challenge, no matter how scientifically reasonable they might be. Federal surveillance programs could easily run afoul of privacy concerns. And the current makeup of the US Supreme Court doesn’t bode well for attempts to soften the Constitutional boundaries.

    In addition, there is a legitimate policy question around the Federal government having to increase its deficit to fund the recommended programs. Programs that can’t be shown to be cost-effective could be difficult to get enacted. Perhaps projected savings to Medicare and Medicaid might be sufficient justification.

    I’d like to see the experts give us some ideas of what we realistically can do.

    • I wasn’t really aware that endemicity has been a right-wing talking point for almost two years. They used it as a cudgel against any and all public health measures intended to slow the virus. Here is FL’s Ron DeSantis on the subject now. Back in the final year of The Former Guy, right-wing radicals rallied around the Great Barrington Declaration, which essentially said: let the virus rip through the population until everybody is immune.

      • I think those ideas about letting the virus run wild were fundamentally based on the notion of herd immunity. In My Opinion, herd immunity was always a pipe dream with this virus. SARS-CoV-2 became contagious so quickly after being contracted, there was little hope for sterilizing immunity. But the experts disagreed with me, and as recently as a month ago they were still talking about herd immunity being the desired end-point.

        With Omicron becoming contagious even sooner — contagion perhaps starting within a day; the serial interval in South Korea is estimated at 2.2 days (preprint) — the likelihood of sterilizing immunity is even lower. A couple of days ago, Dr. Fauci finally acknowledged that “ultimately… just about everybody” is going to be infected by Omicron, and in that interview he didn’t talk about herd immunity at all except to say, “We don’t want [Barrington] to happen.”

        A study published in The Lancet last month found that people who received both doses of the Pfizer vaccine had higher levels of IgA and IgG antibodies in their saliva if they’d contracted the virus prior to vaccination. The assumption is being made that salivary IgA and IgG levels are an indicator of defense against infection. But the levels were still quite low, and no arm of the study looked at people who’d been vaccinated first and then contracted the virus, nor at people who’d received a booster dose. That paper’s authors basically concluded that we shouldn’t declare “mission accomplished” with the current vaccines, because we need new vaccines that can provide sterilizing immunity.

        • Right you are, herd immunity definitely went out when Delta came in (if not, as you suggest, before). Even before that I was hearing 90%, 95% bandied about as the HI threshold — a level impossible to achieve (in this country at least) by vaccination. The assumption in HI (and in Great Barrington) has always been that a survived infection conveys protection. With Omicron, that completely breaks down.

          Permanent sterilizing immunity is not going to happen against this virus. Robust protection against severe disease and death is the best we will do, and that is a lot.

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