We had a chance to keep a new disease under control, but it's increasingly looking like humanity blew that chance. There was definitely political interference in the US, and other places, people prioritizing the success of their favorite politicians over fighting a common enemy, but I'm not sure if we would have succeeded in fighting this back even if the US and other nations with political interference had not had the traitorous attitudes.
Makes me realize how lucky we were with the first SARS and with MERS.
That's why my comment explicitly said "and other places." I agree that this needed to be a global effort to succeed, and in the past the US would have helped the cause rather than hindered the fight against the diseases. I am still absolutely shocked at the poor testing response of the CDC, both in 1) the huge lag before allowing testing by anyone, leading to the Univeristy of Washington discovering it against the wishes of regulators, and 2) completely botching the initial test manufacturing due to newbie mistakes. It was a failure mode that nobody even anticipated in planning, because it's so ridiculous that the CDCs capabilities fell so low.
I agree with your criticism but also firmly believe that once COVID started spreading beyond a few handfuls of individuals, its fate as a human endemic disease was locked in. No difference in policy by any or all countries would have changed that eventuality, other than at most modify the timeline slightly.
No... early social distancing would have dramatically reduced R0. It's exponential growth. Fewer infections => fewer mutations.
Proper masks (electrostatic or nano layer) are widely available, and they all but stop the original COVID. They cost a buck. The nano ones can be reused several times. Providing those prior to vaccines would have been cheap and effective.
Masks + vaccines + modest social distancing would have stopped it then. They would have been to rush to get vaccines to everyone, and to prioritize by exposures (e.g. service workers before WFH employees).
Plus, look at China. If we all did what China did, we'd be done.
Would love a citation on that. I think masks definitely help reduce transmission but they are hardly a magic bullet.
Anyway we can reduce R0 to zero in the short term and it wouldn't matter to my thesis. COVID circulates in animals so as soon as we would take our foot off of the brakes it would again start spreading in an unbounded fashion. And the world can't undergo a complete global lockdown while we wait years for vaccine availability. It's just impossible from any point of view: political, economic, social, etc.
The best source I've seen are the tracing studies in China. Police state meant China could follow exact paths -- from camera footage -- of who caught COVID from whom. If both sides wore surgical masks (imperfect fit, but electrostatic layer), there was almost never any spread.
Singapore hospitals were good case studies too. Hundreds of COVID19 exposures early in the pandemic, with virtually no spread.
You can do web searches for both.
Million dollar question is how this impacts delta. Delta has higher viral loads, and it's perfectly possible filtering 95% of delta will still result in more virus than the original, unmasked. Things also get more complex with both sides filtering; naive math would place filtration at 99.75% effective, but I don't believe naive math in this case beyond saying "a lot more effective."
I wish I could find the study, but back in December there was a study indicating that frontline medical workers working directly with COVID patients every day and wearing N95 masks were more likely to have been infected by social contact outside of work then at work. I remember the day because it's when I went and bought KN95 masks.
The simple fact is that unmasked, the mean amount of time you can spend face to face with an infected person (with pre-Delta COVID) before you get infected yourself is maybe an hour or two.
Many, many doctors and nurses were caring for COVID patients every day for 9 months before they were able to be vaccinated. Many spent hundreds-thousands of hours in contact with COVID patients and didn't get sick.
I am upset with the CDC too but even if we were perfect from Jan 2020 through Aug 2020 (or whatever) we'd still be getting hit with delta now.
The US just ordered 200M booster shots. Making these is pretty much cutting into the capacity of other countries to get their first shots. I am for this - they are American companies and the US should happily pay for them for its citizens. But when there 7.5B other people in the world its not really up to us when the next variant hits.
The primary fuel for evolution of new variants is the spread of infection. Every time the virus copies itself is a chance for a new mutation, another roll of the roulette wheel for the creation of a stronger sARS-CoV-2.
So by letting infections spread as far as they did, we gave the raw evolutionary fuel to create new, more contagious, variants.
If we had cut the number of global infections in half, we might be living in a timeline where a delta-like variant never evolved.
We developed vaccines in record time, but if we had a way to distribute them more quickly, maybe it would have been prevented.
It's a global fight, and every government that let it get out of control worsened our chances at containment.
That would have only delayed arrival of the delta variant by a few weeks at most. The US has always had de facto open borders with no real effective security.
Delta and other variants are not unlikely events though: the expectation is that they would emerge independently anywhere that the virus is freely replicating.
Delta is so named because using "origin of identification" kept convincing people the virus came from there, rather then was first isolated in a lab - and that relatively straight forward mutations couldn't emerge in multiple places with widespread infection simultaneously.
Both US and EU countries kept vaccine production patents for profit effectively allowing the world to go unvaccinated and the mutations to go rampart. India a vaccine production behemoth but also others asked, begged but to deaf ears. Helping other countries looks like a US and EU issue.
India [0], and with > 1B people there, that's a whole lot of opportunities to mutate, and a whole lot of jabs to manufacture, distribute, and perform. In the case of mRNA vaccines, they need to be kept quite cold until basically day of use. India is poor and hot, it's non-trivial to say the least.
As others have said, this isn't primarily a US problem; 30.7% of the world population has received at least one dose of a COVID-19 vaccine, and 16% is fully vaccinated [1]. Even if 100% of the US population were vaccinated, it'd barely move those figures.
Even if in the US we had achieved 100% immunization for the covered ages, there are parts of the world which are way behind and it would have happened there if not India, Brazil or the UK.
So it's a false proposition to say if we in the US had achieved 100% immunization it would have stopped any mutations. It would not have.
My point is, unless we had achieved artificial "herd immunity" world wide, mutations would have occurred. Since it's quite clear we could not have achieved artificial "herd immunity" mutations were going to happen regardless of what we did in the countries who had the resources for full immunization of eligible population.
There was no realistic chance of keeping this under control once it spread beyond Wuhan.
> There was no realistic chance of keeping this under control once it spread beyond Wuhan.
This is probably our main point of disagreement then. Given that many governments did quickly get it under control, I would contend that with proper testing and quarantine during travel, it could have been extremely different.
There was a lack of global coordination, and with that coordination I think this could have turned out very differently. And I fear that we are not learning the lessons to prevent another incident precisely like this one.
That said, I'm not fatalistic, and think there still may be a chance for wiping out this disease, but I think it's only going to get harder with time.
Even with a high rate of vaccination it will unfortunately be impossible to eradicate SARS-CoV-2. Unlike smallpox or polio there are animal reservoirs. And while the vaccines are very effective at preventing deaths they don't really stop the spread. Any notion of wiping it out is simply wishful thinking not grounded in scientific reality.
The most likely scenario is that almost all of us will eventually be infected no matter what we do.
I mean, is there really any point in saying what would've or not have happened anymore other than some notion of nationalism?
I was at Newberry Lava River cave, Oregon last week. There was a mandatory orientation before entering the cave which went along these lines: "this cave is a bat sanctuary. As you may or may not know, Covid is a zoonotic disease that is transmissible between humans and bats. If our bats here get infected, Covid will become endemic to North America and will never go away. I've had Covid, and I was bedridden for 6 weeks and have scars on my lungs. I would not wish this disease on my worst enemy. PLEASE do not go in if you're sick and wear masks if you do." People were walking in without masks even after hearing that. Not a peep from the multiple park rangers, because freedom, I guess.
As a species, we're pretty much just asking to be wiped out by the next pandemic.
Yes, there is a point because, as the top level comment demonstrates, faulty root cause analysis is being used to advocate for ineffective or counterproductive policy.
Also, I have to admit that message you heard is strange. I don’t believe there is evidence that humans can transfer Covid to bats, plus, if the sanctuary believes that, why are they letting anyone through at all? I would expect the consequential threat wouldn’t register as many people already believe the disease is not going away. I’m not saying wearing masks is unimportant but the cave warnings are a good example of how melodramatic speculation can be counterproductive when coming from officials. We won’t make progress by asking for perfect behavior to stave off doom.
> if the sanctuary believes that, why are they letting anyone through at all?
Good question, especially considering that they did go on to say that if covid was found in this bat population, the cave would be closed off for human entry permanently. I didn't probe further but I suspect that policy might be based on what you said about evidence of human -> bat transmission.
Still, I do feel that closing it off seems like the prudent thing to do. It seems kinda myopic to have a policy to only close after the fact while knowing full well that Covid is zoonotic and mutations can in theory occur in a bat population on North American soil. At that point, last year's exercise of pointing fingers at Wuhan effectively becomes a historic unfunny joke because it's not like the US tests their wild bats every day and what can possibly go wrong w/ reactive policies... </shrug>
My overall point though is that even if we have perfect root cause analysis, people will still choose to ignore anything from informed recommendations to even appeals to emotion. As they say, it only takes one bad apple.
It was even more challenging than that as many other mammals contracted covid-19 as well. So even if you immunized 100% of all humans on Earth, there would still be variants emerging periodically.
just a consequence of globalization, even 20 years ago the world was much less connected and things didn't spread as fast. Doesn't help that the entire planet wasted at least a month trying to contain it when rumors of something emerged in at least December 2019. Corona was being downplayed until basically the 1st week of March 2020
seems like Covid is going to be endemic like the regular flu where each year they have to try and guess which strain to make vaccines for
Just like many times in history as technology advances, such as how we couldn't stop mice/rats from spreading into other countries with ships - well before the crossing of the Atlantic/Pacific oceans reconnecting the Americas to the rest of the world.
Now there could be some small population in bats in a rural area in Asia which had some virus with a random mutation and it will no longer be isolated to those areas.
We've ultimately benefited greatly from breaking down these transportation and economic barriers and there's no going back without a serious regression in a ton of other areas (unless you want to live in a 'hermit' kingdom like NK). So it's a new reality we have to learn to adapt too.
Globalization only accelerates the spread a little. Evidence indicates that the previous major coronavirus pandemic occurred with HCoV-OC43. Apparently it started in 1889 and spread worldwide within a couple years. Even prior to widespread globalization people did travel and it only takes one carrier to spread the disease.
> We had a chance to keep a new disease under control, but it's increasingly looking like humanity blew that chance.
Vaccinating 8.5 billions of people in a very amount of time is clearly not a reasonable goal to begin with. Even without war, extreme poverty, lack of access and political chicaneries about the who and what.
Humanity's best minds have been trying for years to create a vaccine for coronaviruses that last without success. Now we've tried to do this in less than a year and we don't know the long term effects, therapeutic or otherwise; and if someone does please provide your time traveling machine to the nearest university at once.
So yeah, the virus will become endemic, variants will appear constantly. What we do now is not a decision the people in white coat or black robes can or should answer.
Delta’s rapid evolution and plausible defeat of the vaccine which was rolled out incredibly fast, on the back of unprecedented economic lockdowns implies to me we didn’t stand a chance absent a global totalitarian regime just imprisoning everyone in their homes for a year by force.
We probably would have been able to contain the wider spread of this virus had politicians shut down all non necessary air travel immediately after WHO/China officially declared a potential pandemic incoming in January 2020.
They are all culpable.
All but Jacinda Ardern, very smart government that one.
The need for speed:
“Three days after WHO declared the coronavirus outbreak a public health emergency of international concern on 30 January 2020, New Zealand began introducing disease prevention measures and continued strengthening them in the weeks that followed.”
No that wouldn't have allowed for containing the spread. All it takes is one carrier getting through from "necessary" air travel or illegal immigration or whatever and then the exponential spread starts in a new area. Thus uncontrolled spread was inevitable in most countries. The only exceptions are a few isolated places like New Zealand which can actually control all arrivals.
Fewer cases means tracking them is still feasible. Exponential growth can only happen after officials are overwhelmed with cases. Shutting down air travel probably would have relieved pressure enough to follow up on cases - doubling rate tells us beginning of February would still have bought us the necessary time. Beginning of March to mid of March it was game over already I agree.
Case tracking hasn't really been effective even in areas with limited spread. It's a failed strategy. Exponential growth starts immediately as soon as there's one contagious carrier, although it takes a couple weeks for absolute numbers to grow really large.
What about South Korea? Mask mandates? In addition to lockdowns. I mean it’s multiple things that politicians and officials had to get right of course. Unfortunately >90% really failed us on that practically everywhere.
Mask mandates can be marginally useful in slowing down the spread on a temporary, limited basis. But they're obviously unsustainable. The virus is here to stay and asymptomatic people aren't going to wear masks forever. Much of the spread takes place inside private homes where no one wears masks.
I thought we were still talking about the beginning
of the pandemic? South Korea did fend off the virus through contact tracing, mask mandates and lockdowns early on. Unfortunately most other countries did too little too late which was my original point.
The result being that by now we have a full blown ever-pandemic at hand - which includes South Korea by definition.
Why do you say "air travel" and not "international travel"? Before COVID got here, domestic air travel was perfectly safe, and a boat from China is just as capable of carrying COVID as a plane from China is.
I agree especially in dense places like Europe (thinking of Italy outbreak) early border shutdown for non essential travelling would have helped in addition down the line. I’m not sure boat travel is comparable to air travel in both mass and interconnection around the globe. It would probably have also been warranted but main driver here was globalization / air travel.
That’s assuming the characteristics of the virus were known upfront but they weren’t. The conflicting, even suppressed, information early on didn’t help.
which comes back to "politicians made it worse" - the CDC knew damn well that masks worked, that's why they wanted to reserve them for medical practitioners, and put out knowingly-false statements that the science indicated that masks didn't work.
it's not any one thing but - if Trump had told people to be patriotic and wear their masks for america, and the CDC had just told people that yes masks work but we need the medical one for the doctors so make your own (which is what they ended up doing anyway), and Trump hadn't seized PPE supplies from doctors so that JKush could auction them off for a personal profit, etc etc - the outcome would have been significantly different.
but for Trump all that really mattered was "his numbers". He didn't even want to bring in a cruise ship full of dying people because that would make "his numbers" go up, even though it was already all over the west coast by that point. He knew damn well it was deadly, and that it was spreading everywhere, he told it a Pulitzer-winning journalist in as many words.
Like, shame on Fauci for playing into Trump's game, let that be a lesson on what happens if you let a politician compromise your medical ethics, but... Trump had a huge part in kneecapping the response. Literally everything he did was exactly identical to the actions you'd take if you were trying to increase the spread. Lie about the spread, lie about the severity of the symptoms ("just the flu"), lie about masks and make up fake treatments like Chloroquine and Ivermectin, literally stealing supplies out of the hands of first responders...
it's not hard to see that the response could have been a lot more effective without someone actively malicious at the helm. But it was hitting blue areas harder, and "those areas didn't vote for him" so he actively did everything he could to encourage the spread.
it's the "stealing the PPE out of the hands of first responders to let your son-in-law auction it" that gets me, personally. Like what kind of person let alone president would even think of that.
I remember listening to the virologists at TWiV in February 2020 talking about reports coming out of China (superspreading events, etc) and all of them pretty much were betting on the virus being airborne and aerosol transmissible back then already. All of them are US based scientists, lack of knowledge wasn’t the issue here indeed. It was really a total lack of preparation by officials so they had to keep those masks ready for at least some of the medical professionals.
I'd still like to see some solid evidence on exactly when the virus started spreading outside of China. Some estimates say it was in the US as early December 2019. I say that to mean timelines are very important if we're going to look back and do post-hoc analysis.
While I certainly don't mind the blame-all-the-US-politicians game, there are several points of failure. The CCP is most to blame because of the lack of disseminated information (that we now know they had) and attempts to suppress people communicating about it. The media largely ignored it for many of the same reasons that politicians did. Then the internet mobs, conspiracy theorists, and social media sites acting on behalf of political organizations didn't help either. It's death by 1000 paper cuts.
Yes I very much agree, it would be important to know more about the origins. Still the fact is that March was the time it really went “viral” with all the excess mortality and widespread health impacts. So we lost all of February - January even if you account early warnings from WHO. Cases probably doubled into critical exponential increments only in late February / early March meaning there was enough time for fast action (see New Zealand, beginning of February).
Definitely tons of mistakes were made from the get go but FWIW CCP regime went all in with their dictatorial measures after they couldn’t hide it anymore (January/February).
Though I mostly care about my personal perspective / “realm of action” being European / Canadian so EU and NA I hold up to way higher standards basically.
Pretty much all of the governments in these regions waved away the risks even though they had all the high-caliber scientists and some press warnings early on in addition to WHO’s warnings.
It goes without saying that the “leader of the free world” wasn’t paying attention didn’t help either.
SARS1 and MERS also lived in animals, but we were able to defeat those.
SARS2 is definitely a much more difficult foe, and counterfactuals are always hard to establish, but I think we came pretty close to fighting it back. And we might still!
I honestly have some hope for eventual elimination of the common cold (actually many different diseases, not one) to a large degree. Vaccine technology is advancing at a ridiculous pace these days. There is so much we don't know about immunology, but we are also learning so fast and biotech is accelerating too.
It's really not about politics, the vaccine simply didn't roll out fast enough to the entire population of the planet. What happened in the US is actually not that relevant as the US is only about 5% of the population of the planet, i.e. it's only 5% responsible for mutations, as the rate of mutations is proportional to the size of the susceptible population.
This is actually a "shortcoming" of tech. In quotes because the tech of the mRNA vaccines is actually stunning, but it just wasn't fast enough to test and manufacture (development was pretty much instant, the vaccines were ready in January 2020).
“ We had a chance to keep a new disease under control, but it's increasingly looking like humanity blew that chance.”
???
The article says vaccinated people spread the virus; if everyone wore N95s, wildlife could still be spreading COVID so it would come back once masks were off… (unless we discover a delta vaccine that we roll out to the world over the next N years while everyone isolates and that prevents vaccinated people from spreading)
Any chance to keep the disease under control was lost the moment a carrier got on an international flight on Wuhan. After that uncontrolled worldwide spread was inevitable. Those who think containment was possible are engaging in magical thinking and fail to understand the mathematics of exponential spread.
I disagree that there was single possible outcome to all of this, and that there's nothing we can do to slow the spread of the Delta variant, or give people a better chance at surviving this. I didn't spell all that out.
To be clear, if I could have shipped all of the (idiotically) unused vaccine doses in the U.S. to India, Kenya, etc., then I would, but I can't. Would that stop the Delta variant? Apparently no, but it would save lives.
Unfortunately most of those unused vaccines require careful low temperature refrigeration. The necessary cold chains don't exist in most parts of India or Kenya.
So what's your takeaway, then? Should we have hoarded vaccine that people are refusing to take? Maybe someone could have made a quick call to Mumbai to see who had the right kind of freezers, I don't know.
The fact that the U.S. has hospitals full of unvaccinated covid patients, when you can walk into any Walgreens and get a vaccine in 15 minutes makes me insane.
Your complaints are disconnected from reality. Vaccines aren't being hoarded. It takes time to set up export and delivery cold chains with all of the necessary quality and safety checks. Giving people spoiled vaccines would be worse than no vaccines.
You could also make the argument that letting the initial variant of the virus run its course may have been wiser than society wide mandates that prolonged it. Given the low infection fatality rate, if everyone under 50 in the US caught it, we would have around 30,000 deaths (or same order of magnitude if my estimate is off) because the IFR for those under 50 is so incredibly low. Then the rest of society would be well protected as well and we would have a high natural immunity against new variants that developed. If enacted worldwide, perhaps the reduced transmission may have avoided the delta surge altogether. Note that the CDC’s projections show that a higher natural immunity would mean reducing cases for delta even with limited masking.
Also the first SARS was far less transmissible. Generally speaking as viruses mutate, they tradeoff R0 and severity. It is unlikely the first SARS would have evolved a variant that was more transmissible and equally fatal.
EDIT: Note that even though increased transmissions can mean more mutations leading to dangerous variants anyways, if the alpha variant were spreading broadly before something like delta was broadly spreading, then the delta variant would contend with a higher natural immunity in the global population, which would make it difficult for delta to take hold in the same way. The CDC’s own presentations show that even a limited increased natural immunity of 35% would mean that delta cases would reduce without new masking mandates or restrictions.
If everyone under 50 caught it, we'd have had way more than 30,000 deaths at this point because we've already had at least 30,000 deaths.
You also assume that Covid doesn't have serious long term complications arising from infections that are still being discovered. So you're basically suggesting that we yolo it during a pandemic and ignore the consequences of such.
Contrary to your myopic understanding of the topic... total exposure during a pandemic is actually not the way to manage it. 'the rest of society would be well protected' but instead we likely would have had a total collapse if everyone were to be infected at the same time by allowing the 'virus to 'run its course'.
Your numbers are way off. The CDC estimates that since the start of the pandemic the hospitalization rate has been 5% and the fatality rate has been 0.6%. Of the hospitalized patients only a fraction needed high-end medical intervention such as mechanical ventilation.
0.6% die, and some rather rubbery number end up with symptoms lasting from 6 weeks, or 6 months, or something. The rubbery number is sometimes quoted as 1/3 of people who enter hospital, which if 5% enter hospital would mean about 2% of the population die or are so incapacitated they can't work for some number of months. By comparison, just about everybody hospitalised for flu is fully recovered in 2 weeks. https://www.medicalnewstoday.com/articles/long-covid
2% is getting up there. Even if 75% avoid that fate by getting vaccinated, incapacitating 2% of the remainder will be enough to send us into a deep recession.
For every person in the hospital due to covid is another person not able to receive care.
Hospital beds aren't unlimited.
ICU beds full? Someone has a heart attack? Well, sucks to be them.
That's the part of covid everyone is ignoring: it creates an additional burden on the health care system, hospitals that normally are booked solid for surgeries can no longer handle those cases due to the emergency influx from a pandemic spreading like wildfire.
Running out of ventilators would have minimal impact on the mortality rate. Mechanical ventilation is currently only used as a last resort for <5% of hospitalized patients, and even with ventilators many of those patients don't survive.
No, that argument does not hold. The rate of mutation is proportional to the number of infected people. Every person infected over the course of the virus' spread is a single roll of the dice to see if a new variant arises. If X% of the population gets infected over the course of the virus, then you get the same number of mutations/variants regardless of the timeframe. Letting a disease spread rapidly just means that those variants all arise over a shorter period of time.
The way to decrease the number of variants that emerge over the course of a disease is by decreasing the total number of people infected over the full course of the disease. That requires widespread vaccination.
> if everyone under 50 in the US caught it, we would have around 30,000 deaths.
Personally, I value the lives of people over 50 just as much as those under 50. A lot of important people to me and to everyone is over 50.
Any non-sociopathic loss function would deem the half million people in the US that we've lost completely unacceptable.
And with even greater spread, there's greater likelihood of the rise of a variant that kills those under 50 just as much.
The only people proposing we should have let it run wild and also actually understand the consequences are absolute monsters that should be shunned and never given any authority or decision making power.
Makes me realize how lucky we were with the first SARS and with MERS.