Covid-19 is here to stay

This is an excellent article that gives the big picture with all its details. The summary below is a draft of what I intend to put out on the Cleveland Commonweal Community website. The original article is a delightful almost witty interview with this doctor. 

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 even as widely available vaccines have worked wonders.

2. UNLIKELY TO BE ERADICATED A virus that infects multiple species, animals and humans, and has multiple new variants (each having the potential to re-infect people) is very poor candidate to be eradicated. Twelve different species have been infected with COVID-19, usually from humans. We have been unable to eradicate yellow fever because monkeys get it.

3.  QUICKER  RESPONSE It took us well over 200 years after we had a vaccine before we could eradicate smallpox,. Seventy years after we had a vaccine against polio, we began a global polio program. And 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. We already have one vaccine AstraZeneca that, when matched against one variant, the beta, becomes 90 percent ineffective. In trials, its effectiveness was reduced to 10 or 20 percent. 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! We should take into account even that low probability. 

5. HOW MANY UNVACCINATED PEOPLE IS THE IMPORTANT NUMBER We should realize that if 30 percent of Americans are not vaccinated, that’s 120 million people. And that’s plenty for the virus—the ancestral virus, let alone a novel virus, let alone a super-variant—to come in and create another wave, and a large one at that.

6. CLUSTER BUSTING TEAMS. Therefore we need to have a defensive capability, a system of cluster-busters. This is a Japanese term for teams that are mobile, with highly computerized systems with a situational report that can see where every variant is. We can find asymptomatics. We need to be doing sewage sampling, environmental sampling. It’s very inexpensive once it’s set up. We need this to find out which countries are infected. We’ve done that in the polio program—this is not new! In the polio program, when we found out that Syria, which was supposedly free of polio, had causative viruses in the sewage, we sequenced the viruses to find out which polio variant it was. We did this 15 or 20 years ago—this is not science fiction. We should, all over the United States, have sewage sampling now.

7. EXPOSURE NOTIFICATION SYSTEMS. And we should be using exposure notification systems. I know there was a big article in The New York Times a few weeks ago about how bad they are. They’re not bad, they’re wonderful. Exposure notification systems, when compared to human contact-tracing systems, found two times as many contacts for people who are exposed (four, compared to two) and found them two days earlier. Then we’ll know who to test, who to isolate, and who to vaccinate

8. EARLY DETECTION AND ISOLATION. But you are never going to have a vaccine on the day that a novel virus leaps out from a chimpanzee or a mink to a human. On that day, the only thing you have is early detection and rapid response and isolation. .

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 40, 50 years ago are gone, because humans are eating animals, including monkeys and rodents. And thirty years ago in China, the number of pigs and cows that were available for food was a fraction of what it is right now. 

10.SUMMER TRAVEL Summer travel last year caused the explosion that we saw in the fall. If a third of the population, 30 percent, is not vaccinated, not wearing masks, and we’ve already got the variants in the United States—what do you think’s going to happen? Remember, what drives a virus is not how good we’ve been at vaccinating 60 percent. It’s the 120 million Americans who are not vaccinated, not wearing masks, not practicing social distancing, and who are congregating. And it only takes one little virus, 

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. 

12. WHERE IN THE WORLD We have to worry about the parts of Africa that are densely populated. South Africa is an example of a country that became an explosive outbreak almost overnight because of  a new variant.

13. AIR TRANSPORTATION H1N1, the virus that caused the great influenza, went around the world four times in one year. What did they not have then? Commercial airplanes. You don’t want to underestimate your adversary.

14. LAB BREAKOUTS Back to 1975, we worked so hard and we declared smallpox eliminated, and then we began the clock ticking. We weren’t going to declare it eradicated until two years would have passed after the last case.  Before the two-year clock had ticked, we had our last case. Our last death was in Birmingham, England. It was a young woman who was a photographer. Her photographic studio was located above a smallpox lab. The virus somehow got into the air conditioning system and floated up from the smallpox lab and infected her and she died. If we were so careless that the last death of smallpox was a lab accident, a lab accident could happen anywhere.

15. R naught is really critical. Is defined as the number of secondary cases that come from a primary case. Because this virus is going to spread at exponential speed, it tells you what’s 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. These are laggards; measles is the most transmissible. Smallpox was 3.5 to 4.5 and COVID-19, initially was thought to be 2 or 3. In retrospect, now that we know 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. 

R	Vaccinated
10	90%
9	89%
8	88%
7	86%
6	83%
5	80%
4	75%
3	67%
2	50%