COVID - Now what?

Is a wave coming? Does it even matter?

It is now crystal clear that COVID is VERY seasonal.

For reasons that are not entirely understood, there are four distinct seasonal stimuli hitting the US at different times of the year and in different places. Below was my attempt to summarize those last May:

Based on this and what we had been seeing in Europe, I had been predicting that we would have a sizeable Spring wave in the NE. That seems to be happening, kind of, but at a much smaller scale than I was expecting. So what is happening?

I believe there are two reasons for what we are seeing:

1. People are not getting tested, or when they do, they are using at-home types. I visited NYC last weekend, and I was surprised to see that they have several (maybe one in every block) free COVID testing sites. I was more surprised to see that there was literally nobody getting tested. And this is despite the alarm bells from the usual suspects about an incoming wave, which would normally cause people to run to get tested at every sniffle. If this is the case in NYC, I cannot imagine people getting tested in other places.

2. There is now sufficient population resistance to keep even Omicron in check. Seasonal forces interact with population resistance to cause waves. If the resistance is high enough, R0 will not go above 1 even with a moderate seasonal stimulus, which is what we have in Spring. The chart I put together in August 2020 depicts this (below). As the chart shows (using hypothetical numbers), when seasonal favorability is the lowest (the bottom line), R exceeds 1 only when there is a significant majority who is susceptible. That line is probably February/March 2020 for COVID. When seasonal favorability is the highest, even the lowest % susceptible will cause R to exceed 1 - think every seasonal winter virus.

   

The future of COVID is now another common cold. Because protection against infection wanes fairly quickly (as we now know), which I believe is the case with the other four coronaviruses causing common cold as well, a sufficient % will always be susceptible to cause winter waves. However, because protection against severe disease remains strong, which is also the case with other coronaviruses, people will not be hospitalized except for very frail (which is also the case with other coronaviruses - the common cold kills many people in nursing homes every year). This of course assumes that we don’t actually get a new variant that is somehow causing more severe disease and has significant immune evasion, which I believe is a fairly safe assumption to make in the absence of an entirely new virus.

More importantly, though, at this point, none of this matters. I predict that even in the Fall and Winter, only the craziest localities will attempt to bring restrictions back. Lockdowns are not even a possibility. The most that will happen, in a few places, is that they will reimplement a mask mandate, and maybe some school districts will go remote for a week or two. Politicians know very well that most people are done, and if they continue serving the fears of a loud but hysterical minority (which is getting smaller and smaller), they will lose their seats.

So now is the time to stop worrying about COVID. Most people already have. Now is also the time to look back with a clear mind and conscience, and comprehend what happened. If you are one of the people who made the calls, now is the time for you to do some self-reflection and understand why you made damaging and pointless decisions for two years. If you are among those who were impacted by those decisions, now is the time to begin holding people accountable. Some structural changes are needed - our public health machinery clearly has too much power. Now is the time to begin thinking about what those changes look like and how to make them happen.

Until next time…