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It has been deeply disturbing to see how what passes for leadership in advanced economies has consigned its citizens to unnecessary Covid risks, and with that, the very real odds of significant reductions in lifespans, in the name of profit.
Virtually everyone in authority, from supposed medical experts to pols to the press, talks about Covid mortality and morbidity as if it were a one shot game. It isn’t. For instance, one case study looked at three individuals who had three Covid outbreaks each in 2020. All were under 65 with no pre-existing conditions.1
As our reader GM keeps stressing, even if one assumes that patients are scrupulous in keeping up with vaccinations, it still translates on average into multiple Covid cases for a young adult by the time he reaches 65, unless we get lucky and eventually get a near or actually sterilizing vaccine down the road. Each Covid infection carries with it morbidity risk, such as lung, kidney and heart damage, fatigue, brain fog, and inflammation. There is no good data on how lasting this sort of damage is. That means that some, potentially many patients will go into their second (and third, and fourth) Covid case in a diminished state as a direct result of prior Covid infection, independent of aging and other co-morbidities like diabetes developing in the meantime.
The Canadian Journal of Public Health published a landmark article, The year public health lost its soul: a critical view of the COVID-19 response, which we’ve cited before. It describes how Covid measures (in the West) represented an unprecedented success by commercial interests in squashing public health priorities. An extract:
Public health, as a discipline, rests on three basic tenets. First, its goal of fostering individual and collective health and well-being implies benevolence. Second, interventions ought to rest on principles tested through scientific approaches. Finally, as the discipline evolved during the 20th century, equity became its third core pillar: Interventions should aim at reducing health disparities between individuals and between groups….
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%….
In the meantime – and unsurprisingly – the balanced-containment strategies were also shown to be deeply inequitable…
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.
Campaigns for the commerce-favoring “Let ‘er rip” approach have included stunningly dishonest messaging, like “herd immunity” when coronavirus infection does not produce lasting protection, or “Covid is no worse than the flu” when flu doesn’t do lasting damage to survivors. The new version of this “Get happy with dying younger than you should have” are the new spins of “Learn to live with Covid” and trying to make Covid becoming endemic as not so bad.
A new article by McKinsey, a proud recidivist in moral dereliction, does a public service of sorts by putting many of these rancid arguments in one tidy piece, Pandemic to endemic: How the world can learn to live with COVID-19. After getting two odious meme in the headline, it goes full bore into another in the subhead: “With prospects of herd immunity fading…”
As KLG wrote:
Our local leading infectious disease doc and chair of the Department of Internal Medicine views SARS-CoV-2 as something “everyone will get, so we just have to learn to live with it.” And die with it, eventually, which is left unsaid.
Right now all I see is universal complacency, which is based on pandemic fatigue, a current seemingly manageable situation, and a “trust the science” attitude from physicians and medical students who are deeply uncritical. Just another way of saying they are lazy, have no appreciation of the scientific method, and easily convinced that Big Pharma, NIH, and CDC have this all under control.
IM Doc added:
Having an infectious disease become endemic is not the same as having a sore throat as much as our media would like to portray it that way. If COVID follows form to the previous coronavirus pandemics that have become endemic, we have literally years to go before our immune systems collectively call a truce with it.
I do not see the vaccines making a huge dent in this – especially the way we have chosen to play that game. HIV is raging in Africa but not here in the developed world….Why? We just simply do not make our meds available cheaply to them….The CEOs need to make tens of millions for their yachts. Why do people think this would be any different with COVID vaccines or therapies? Alfred Schweitzer and Jonas Salk are long gone. Today, it is all about greed. And things are going to be worlds different between HIV and COVID. COVID is going to be infinitely more difficult to contain.
I wasn’t sure I’d be able to maintain my composure for long enough to do a proper job of shredding the McKinsey propaganda. But GM, unsolicited, did the heavy lifting, so please give him a big round of applause!
Below find McKinsey text in italics, with GM’s comments in normal typeface.
It is fitting that McKinsey is dancing on the grave of public health — the MBAs did both the short-term and long-term cost-benefit analysis back in March 2020 and the decision to kill public health for good naturally followed.
And now we are at the point at which the elites can’t be bothered to even think about the death rates in the plebs population so we are declaring the “transition from pandemic to endemic”…
What’s happening now is not unusual. Epidemics end in one of two ways—either we close off all chains of transmission and drive cases to zero, as with all Ebola epidemics to date, or the disease becomes an ongoing part of the infectious-disease landscape, or endemic, as tuberculosis is today.1 Occasionally, as with smallpox, a previously endemic disease is eradicated.2 But, for the most part, endemic diseases are here to stay. The shift from pandemic to endemic entails a number of practical considerations, as we discuss in this article. But the shift is also psychological, as we will be deprived of the satisfaction that a clean pandemic end point would bring. Instead, societies will have to adapt to living alongside COVID-19 by making some deliberate choices about how to coexist.
The tiny little problem here is that right now in the human population there is only one infectious agent that is worse than SARS-CoV-2, and that is HIV. We have malaria, which is about as bad (but in the long term one will suffer more damage from COVID, because of more frequent reinfections and the expected escalating downwards spiral after sufficiently many of them; malaria does do long-term damage but not to the same extent), and we have yellow fever, which is worse in terms of IFR, but does not reinfect (and for which there is a proper single-dose lifetime vaccine), but those have external reservoirs in mosquitos and there isn’t much we can do. Trypanosomas are even worse, but it’s the same situation in terms of vectors. However, those are geographically limited.
And they are limited because we did in fact do some quite extreme things to get rid of them in the more northern latitudes, at the cost of tremendous ecological damage (i.e. eradicating mosquitos by draining swamps and indiscriminately poisoning everything with DTT). Because we wanted no part of “living with malaria”…
Nothing else other than HIV is endemic within the human population and as bad or worse than COVID. And HIV is not airborne, you can quite easily avoid catching it.
Things like pertusis and diphtheria we can treat because they are bacterial and we have proper vaccines for those anyway.
After SARS-CoV-2, the next thing in the rankings of nastiness that circulates out of control is seasonal flu.
Everything else we took care of in the civilized world by eliminating it with public health measures.
Now we are being asked to live with COVID? And the “public health experts” are mostly on board…
A complete approach to managing endemic COVID-19 requires the consideration of four interwoven elements. First, society will have to reach a consensus on what is an acceptable disease burden and use those targets to define an acceptable new normal.
Right now in the US “acceptable” has been determined to be at least 2,000 deaths a day (the peak of the summer Delta wave). We will see what levels we will reach in January and whether those will be ignored too. But in Eastern Europe right now there are countries where the death rate is the equivalent of 15,000 deaths a day in the US, and those also refuse to shut down…
First, goals must recognize the “whole of society” impact of COVID-19. Targets for the health burden of the disease remain paramount, but countries can also introduce targets for economic and social disruption.
But beyond death or severe disease, COVID-19 has affected daily activities (learning and working, for example, and mental health). As such, measures of workdays lost, business closures, and school-absenteeism rates should also be considered.
Countries are actually obliged by international law to control epidemics:
And there is nothing about “balancing saving lives with the economy” in those treaties. Of course, the US is the only country that has not ratified, but the rest of the world has, and despite that the same policies are followed there too.
And it’s not only public health experts, but also “human rights” organizations that are completely silent on the issue…
Some countries are, therefore, resetting their expectations: “For this outbreak, it’s clear that long periods of heavy restrictions [have not gotten] us to zero cases,” said New Zealand prime minister Jacinda Ardern. “But that is OK. Elimination was important because we didn’t have vaccines. Now we do. So we can begin to change the way we do things.”
Or, what probably happened, New Zealand was pressured by its “international partners” to abandon elimination because it made them look bad (plus probably some other reasons). Michael Baker (who was one of the epidemiologists leading the elimination program) has said on several occasions now that the shift in policy came without any consultation with the scientists who were working with the government on COVID policy while elimination was the goal. They were completely taken out of the decision making process, which is quite telling.
The high efficacy of today’s vaccines in preventing severe cases of COVID-19 is critical to normalizing society. Portugal illustrates the point: with 98 percent of those eligible fully vaccinated, severe COVID-19 cases are now rare and almost all public-health restrictions have been lifted.
Portugal is just two months behind where Denmark was in September, when they announced freedom from the virus. And we see how well that is going right now.
Meanwhile we may well find ourselves in a January 2020 situation at any moment with the appearance of a complete-escape variant…2
Moreover, as we transition from a heroic, one-time effort to stand up an infrastructure that put billions of doses in arms to a more routine program of booster vaccination, healthcare providers must integrate and institutionalize COVID-19 vaccinations into their broader ongoing operations.
I have yet to see anyone with a serious platform question the wisdom of staking the existence of organized society (for that is what is at stake — we would have to abandon large cities if this particular virus is out of control in the population for sufficiently long) on a very complex and fragile technology that can disappear at any moment, but which has to be used on a permanent basis to keep immunity levels high enough to avoid a collapse of the system. We will not be able to make those vaccines, at all or at the very least at the necessary scale, at some point in the future, that is near-guaranteed, because of the overall trajectory of industrial civilization. Then what?
Vulnerable populations
The final critical element of limiting death from COVID-19 is outreach to those who are most at risk. Some groups, whether because they live in crowded settings, suffer from socioeconomic disadvantage, or have limited access to healthcare, have been disproportionately affected by the pandemic to date. As the level of public attention focused on COVID-19 wanes, societies must be careful to avoid strategies that place a disproportionate burden on the most vulnerable. While some progress has been made, those with low-wage frontline jobs, those living in more crowded settings, and those with the least favorable access to healthcare have too often borne the greatest burden during the pandemic.
Another thing nobody seems to have caught on is that the vaccines actually made the vulnerable more vulnerable and unprotected. Because the vaccines don’t work that well in the elderly and the immunocompromised, but they work a lot better in the young and healthy. Where it was the lowest to begin with, without vaccines.
So the risk for the latter is minimized, which removes all incentives for them to support non-pharmaceutical intervenions (that is still extremely foolish — those breakthrough infections in the young only appear harmless — but in the short term the consequences are not obvious). Then the vulnerable are left exposed and at high risk even if they are vaccinated.
And then you end up with situations like the one in Russia now, which is an extremely scary precedent that few are paying attention to — they declared that people over 60 who are unvaccinated are not allowed to leave their homes, i.e. total lockdown but only for those people.
But what happens when the complete escape mutant arrives? Which it most likely will at some point.
At that point everybody is suddenly unvaccinated again. Will they just lockdown everyone over 60? It is only one step removed from what they are doing now…
But guess what? That is exactly the GBD proposal — “shield the vulnerable”, let everyone else get infected, but in a much less veiled form…
Widely available and rapid testing can help individuals and societies take the steps needed to limit further transmission.
Rapid testing is a ruse designed to trick people into agreeing to uncontrolled spread.
Because that is exactly what has happened wherever it is widely available. The UK is a classic example — they have had a rpaid testing for a long time, and what has that gotten them? Officially 40K cases a day, in really 80-90K infections a day, for many months now…
Yves adds: Rapid testing by itself is not productive unless those who test positive isolate and report on their contacts around the time of peak infectiousness, if they developed symptoms and can work from the onset date, or otherwise recent ones. That in turns requires support for those who hole up (income replacement, delivery of food and other needed household items; for some, child care) and contact tracing with testing and isolation requirements. Neoliberal-infested governments lack the will or competence to do anything remotely that disciplined.
The bits that GM flagged were particularly noxious. Readers with strong constitution or hazmat suits could be so bold as to look through the entire document and highlight other nasty bits in the comments section.
____
1 The article conceded some of these apparent reinfections could have reactivation rather than a new infection, but that’s not a terribly cheery alternative. And this is pre-Delta.
2 Via a separate e-mail, GM gave a new sighting as a reminder that the odds of this happening are not as remote as the “Don’t worry” though police want you to believe:
A potentially important update on the still undesignated variant from France/Congo that I think I mentioned a couple weeks ago and that is likely a complete or near-complete escape variant:
https://github.com/cov-lineages/pango-designation/issues/297
It was first sequenced in Congo (Brazzaville) in late September. Then there were several clusters in France, and it also showed up in the UK, Italy and Switzerland.
Then Congo reported a bunch of additional sequences yesterday. They don’t sequence much there, but other than this one it is all Delta there, i.e. right now it is not at all clear that we are not in a situation in which this thing is replacing Delta rather than the other way around.
And now it’s already in California too (Delta was first detected in the US there too):
First USA sequence (California):
EPI_ISL_6095997So this thing is spreading quite widely already and very fast too. Again, this is first detection in Congo (where they don’t sequence much anyway, and then within a month it is all over France, in multiple countries in Europe, and in the US too).
And everyone is asleep…
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