What to Do if COVID-19 Is Here to Stay

Yves here. This is a critically important question that politicians and curiously even public health officials seem to be avoiding, which is what do we do if Covid-19 isn’t beaten back any time soon?

Even non-scientists like this humble site picked up early on passing mentions of the fact that there is no long-duration immunity to any of the current major coronaviruses. The common cold confers immunity of only about six months. MERS confers the longest-lasting immunity, about 34 months….with also a 34% fatality rate. Vaccines rely on creating antibodies without triggering a full-blown case of the disease, but if the antibodies don’t beat Covid-19 for all that long, the best we’d be looking at is regular vaccinations…and that assumes it does not mutate too much in the meantime.

By Chryssi Giannitsarou, Reader in Macroeconomics and Finance, University of Cambridge and Flavio Toxvaerd, University Lecturer, University of Cambridge. Originally published at VoxEU

We do not yet know whether individuals who recover from COVID-19 can be reinfected. If immunity wanes, the disease will become endemic, in sharp contrast to a model in which recovery confers permanent immunity. This column considers the possibility that immunity is indeed only temporary, and derives a stylised optimal containment policy to reduce the initial wave of contagion and then manage persistent infections. In practice, this means that partial lockdowns and social distancing measures may be the norm for years to come.

It is now almost four months since COVID-19 was declared a global pandemic. As the epidemic was unfolding in February 2020, with little information about the new coronavirus SARS-CoV-2, scientists from across disciplines offered projections of the epidemic and proposed optimal policy measures that had one target in common: getting through the worst phase of the epidemic and flattening the curve.

Early contributions attempted to quantify and simulate optimal policy measures, and broadly proposed a two to three-month strict lockdown to be imposed some weeks into the epidemic. Some analyses recommended a severe 60% lockdown starting at two weeks after the outbreak and lasting for three months (Alvarez et al. 2020). Others recommended an even stricter lockdown of 67% for a bit less than two months (Gonzalez-Eiras and Niepelt 2020). More recently, Gollier (2020) shows that uncertainty about the basic reproduction rate means the optimal containment policy is less severe than a setting in which the reproduction number is known.

Four months on, uncertainty around COVID-19 persists. Global daily confirmed cases are steadily increasing and global daily deaths have plateaued at about 4,500-5,000 per day for most of June and early July 2020. While strict lockdown measures are being lifted in many countries, new infection spikes have appeared in others, as the world wakes up to the fact that this coronavirus is likely to stay for a long time.

One great unknown about COVID-19 is whether individuals who recover from it can be reinfected. At the emergence of any new virus, it is impossible to know whether immunity is permanent or wanes, until enough time has passed for longitudinal studies to take place. At the moment, and with limited available data, medical scientists and epidemiologists are instead comparing SARS-CoV-2 to related coronaviruses, such as HCoV-HKU1 and HCoV-OC43, which are known to exhibit waning immunity. An early contribution by Kissler et al. (2020) assumed that immunity to SARS-CoV-2 wanes in approximately 45 weeks. A recent medical study (Long et al. 2020) found a significant drop in specific antibody levels after three months. Nevertheless, the duration of immunity in general is still far from understood.

Optimal Containment Policy With Waning Immunity

In Giannitsarou et al. (2020), we explicitly consider a setting in which immunity is temporary. We derive a stylised optimal containment policy and contrast it to policies assuming that once recovered, individuals are forever immune.

We work with a flexible epidemic model known as SEIRS (Susceptible-Exposed-Infected-Recovered-Susceptible). The model allows for natural births and deaths, disease induced deaths, a pre-symptomatic state in which individuals are exposed to the virus and can be infectious without exhibiting symptoms, and importantly, waning immunity.  In such a framework, because immunity may slowly disappear from recovered people, there is the potential for a second (and even third) wave of infection.

An important feature of this epidemiological model is that with waning immunity (the SEIRS model) the disease becomes endemic. This means that if left uncontrolled, it will never be eradicated, in sharp contrast to a model in which recovery confers permanent immunity (the SEIR model). In the SEIR model, the disease will be always eradicated in the long run once herd immunity is achieved, even when left uncontrolled. This observation has important implications for the design of optimal policy while we wait for a vaccine or other pharmaceutical interventions to become available.

Our policy analysis assumes that a vaccine or medical treatment is not currently available, but will become available in six years from the onset of the epidemic.1 The only instrument available to the policymaker is a broadly defined measure of social distancing which, within the context of the model, simply reduces the contact rate between susceptible and infectious individuals.

We calibrate the epidemic model and optimal policy problem to the most up-to-date estimated population and epidemic parameters from the US, and then perform comparative analysis with different assumptions about the waning period.

Figure 1 shows the number of infected individuals over time when the disease is left uncontrolled (top panel); when the disease is optimally controlled using social distancing measures (middle panel); and the path of optimal social distancing (bottom panel). In each, the light blue line shows the model with permanent immunity (SEIR) and the red line corresponds to the model with immunity waning in one year.

Figure 1 Infections and optimal social distancing with and without waning immunity

When immunity is permanent, the path of optimal social distancing is straightforward and looks a lot like policies that have been used so far across the world to control the evolution of COVID-19: in the beginning of the epidemic there is little social distancing; it sharply increases as the peak of the epidemic approaches; then sharply decreases as infected individuals recover, gain immunity, and remain healthy thereafter. We note that at around the peak of the epidemic, optimal social distancing in the SEIR framework reaches its maximum level of about 25.5%, however this lasts for a short period and is completely phased out by week 40.2 The effects of the social distancing policy are, as expected, a flattening of the curve and a slightly lengthier epidemic. Under the optimal social distancing policy, about 20% fewer individuals are infected than for the uncontrolled model.

If immunity wanes, the optimal social distancing policy is quite different. While restrictions start out at a higher level than in the SEIR model, the level never reaches more than 16.5%. These measures are sustained at a relatively stable level for about six months from the start of the epidemic, and then dropped temporarily, only to be increased again intermittently when the second and following smaller waves arise. To make sense of this different policy design, we note that when immunity wanes, all those infected in the initial wave of the epidemic go through the phases of the disease only to become susceptible to infection again. In this sense, policy efforts to severely supress the first wave of the epidemic are ineffective: the optimal policy now primarily aims at delayingas much as possible the different phases of the epidemic, while also dampeningthe disease incidence. Overall, the optimal social distancing has two main phases: an initial phase with suppression that is not as aggressive as in the SEIR setting, and a second phase characterised by a varying low-level management of subsequent infection waves. Here, the number of infected individuals under the optimal social distancing policy at the first peak of the epidemic is about 8.5% smaller than in the uncontrolled model. But the optimal policy now also flattens future waves of the epidemic and ensures that the long run endemic level of infected individuals is lower than in the uncontrolled model.

Some Closing Thoughts

In summary, we find that if immunity to SARS-CoV-2 is temporary, the disease will become endemic. The optimal policy will make an initial effort to reduce the first great infection wave and then engage in a permanent low level management of the persistent infection in the population in order to keep it under control. In practice, this means that partial lockdown or social distancing measures may become the norm for some years to come.

Our analysis assumed that, currently, the only policies at our disposal are broad-based non-medical interventions such as social distancing and lockdown measures. At the initial stages of the COVID-19 pandemic, such policies proved to be extremely costly from social, economic, and health care perspectives. But going forward, we expect that individuals, businesses, and governments are likely to adapt how they do things and operate to mitigate the costs of this initial dramatic shock. People may become more cautious in everyday dealings, businesses may come to depend less on third parties or off-shoring, while other organisations such as schools, transport, intermediate goods producers, and local governments may find innovative ways to become more flexible and resilient in the ways they deliver services and products. We hope that with creativity and resourcefulness, humanity will learn to navigate and live with the disease, should it turn out to be here for the long term.

See original post for references

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121 comments

  1. vlade

    Well, I suspect that the permanent impact this will have will include:
    – way less travel. In Europe, where due to popular pressure (on both sides), travel restrictions were lifted, they are starting to create more infection clusters. And that is with a lot of people traveling using individual modes (aka cars). There’s very few junket business trips, which was the majority before COVID.
    – more WFH. A lot of companies I know are basically counting on WFH till the end of this year – no point in sending people back in Sep if a second wave comes in Oct and they have to rehash. Better to wait till Jan and see.
    – attempts to control crowds, like more spaced out restaurants etc. which will have impact on their profitability (and employed labour).
    – taken together, IMO it will remove a lot of low (and even some not so low) paid jobs, as those are often where a) you have to be physically there b) you have a lot of contacts with others. It may also move towards more automation of those, not because of cost of staff (fewer jobs there = it’s going to be even cheaper), but because the less human interaction your clients get , the less likely they are to get infected and potentially close you down entirely (because I doubt we’ll see mass lockdowns, it’s more likely local lockdowns IMO).
    – which, unless the social situation of those is addressed in some way, will cause massive social problems.

    If a migration from middle east/Africa/LatAm will continue (as it likely will, due to climate changes/wars etc), it will cause yet more social stresses.

    I’m not a great optimist for the next few decades.

    Reply
    1. Lambert Strether

      > more WFH

      – much more digital intermediation generally. Off the top of my head: More Zoom + chat, cashless, drone delivery, personal services (therapy, religious ritual, sex)

      – fewer interactions with strangers (more bubbles). And the converse–

      – nesting (UV, air purifier, domestic comforts)

      – revaluation of real estate; if head count per square foot decreases, does value (rent)? decrease? Office space down, warehouses up? Unsure.

      In short, a neoliberal dystopia. Well played, all.

      Reply
      1. vlade

        TBH, not sure whether any regime could deal with it well (because, ultimately, it’s not only about one government, but all of them), as it may boil down to essentially two choices:
        – darwinian, i.e. how the mankind always dealt with pandemics (part of population, potentially a very large one, dies, the rest that has gentically some advantage survives)
        – we keep in social distancing and similar. Which, as we’re social animals, is bad for us as a society especially over long time (until someone finds a real cure, which is “if ever”), with unknown and unpredictable results.

        pick your armageddon.

        Reply
        1. Otto

          If CV19 infected people only have 45 weeks of declining immunity and CV19 mutates in the manner of HIV, it seems to me, in 20 years or so were all dead. That’s part of Darwin as well. Is it really possible to delay forever keeping those infected from those who are not. No, not over a long enough period of time. At least with the ‘core values’ (Jared Diamond) that we have now. I’m not sure China at its brutalist can accomplish a safe ‘outcome’.

          I keep tabs on what is going with genetic science and if you combine it all, it’s possible to do some kind of Sci-fi thing to stop CV19. The problem I see, which is the same for climate heating, is that of declining resources. Every year going forward there’s going to be less money/energy and more demand for it, but less ability to provide it.

          Reply
      2. Krystyn Podgajski

        All those half measure will be no help.

        It would only take three to four weeks to eradicate the virus with a complete lock down so that is what needs to be done. I would love to live in a town where they had a three week quarantine to enter during and after they eradicated all the cases with a complete lockdown. Maybe that will be a reality. Give everyone supplies for a month and free internet. It’s the American dream.

        But what can YOU do? Stop stressing, get your serum zinc and copper tested, eat better (for you), eat less, attempt to get off all medications, and move away from people.

        It is not a mystery why people are dying from COVID19. Everyone that succumbs to the virus has a pre-existing condition which makes them susceptible.

        Reply
              1. juno mas

                KP, it’s not just the mortality that matters. There is evidence that CV-19 is hammering the body of most everyone in different ways. Too little is known about the virus and its long term impacts.

                Whether people die from the virus or not, the real strain that it puts on the healthcare system is problematic. I had to plead with my local Urgent Care system to see me, as my PCP was booked for two weeks out.

                Coming down with CV-19 in the U.S. is strain on relatives as well as your bank account. Restaurants are surviving by moving tables outside in my tourist town, but that will end with colder weather. There is a new Normal coming.

                Reply
                1. Krystyn Podgajski

                  The majority of people who are infected with SARS-CoV-2 have mild or no symptoms. That is a truth.

                  Reply
                  1. Jeotsu

                    CV-19 is more dangerous to those with co-morbidities.

                    A high fraction of people who get severe (but non-lethal) cases of CV-19 end up with persistent health problems. How will they fare if 9-12 months later they get the disease again?

                    My main concern is rolling pulses of mortality, where each successive infection cycle has an ever increasing CFR.

                    Year one it came for the 70 year olds.
                    Year two it came for the 60 years olds.
                    Year three it came for the 50 years olds, and people finally started taking it seriously.

                    Reply
        1. Susan the other

          I’m sure you’ve answered this question, but I’m lost in all the info – why not monoclonal antibodies as a periodic treatment?

          Reply
          1. Krystyn Podgajski

            It is just not close to a certainty at this point, so best plan for the worst.

            But I am talking about eradicating the virus, not living with it.

            Reply
    2. Clive

      I spoke to all three of my older (70+) relatives over the weekend. All of them had become first-time supermarket home delivery service users since March. None of them will be returning to in-store shopping on a regular basis, if at all, any time soon. Apart from shielding, they’ve become accustomed to the convenience. And that’s in summer — winter will be even more of an incentive to have someone else trudge round the physical premises. And the quality of fresh produce was reported to be far better than than typically available on the shelves. Most of the big supermarkets here have dedicated distribution centres so they get much higher turnovers of fresh produce and more frequent (usually daily) from producers.

      As a result of what is fairly graphically intensive web browsing, all have either or are planning to upgrade their laptops or PCs (they are or were running “pension Windows” kit — really old and creaky hardware that was previously described in the face of my suggestions they needed something better that it “was fine for what they needed” i.e reading the Daily Mail or BBC and the odd email). I was asked about whether higher speed packages for broadband (50-60 mbps) were “worth it” and the availability of fibre-to-the-premises, costs etc. as a serious likely-to-purchase consideration. Laptops, currently their preferred form factor were being ditched in favour of PCs with larger screens.

      There is, in this cohort, a large amount of potential demand pent up. All had an unspent £5-10k holiday budget in the bank looking for something to do (none wished to travel overseas and all pronounced cruise holidays as gone and not coming back events to them). Replacing cars was mused, but not that seriously — travel is generally curtailed with no desire to go where hordes of other people were also likely to go st the same time. Plus, most of their vehicles were less than five years old anyway.

      Smart TVs and better cable / satellite packages were also being investigated.

      Reply
      1. CanCyn

        Recently retired relatives of ours are travellers, taking a couple trips per year even while they worked. Retirement to them meant even more travel. They are in the midst of spending their 2020 travel budget on home and backyard improvements.
        Two neighbours have had backyard pools installed. Summer vacation will be in the backyard for many, this year at least.

        Reply
        1. Clive

          Yes, in my neighbourhood three of the older residents (out of seven who are retired) have hired gardeners on a maintenance contract to keep up with the yard work and, it has to be said, do it to a higher standard. My next door neighbors are changing the carpets and flooring and planning more significant redecorating. The house next door them are remodelling and substantially enlarging the kitchen / family room and have permanently put on hold plans to sell and move.

          Fellow shirkers from home at my TBTF are discussing custom home offices. Especially in the upper ranks of the management greasy pole, having a Teams call from what’s obviously your grownup kid’s bedroom is a negative status indicator. Everyone wants to look like the people in the finance elite on Bloomberg TV do when they do Zoom interviews.

          Another colleague has also succumbed to a full on midlife crisis and bought a Jaguar convertible which was silly enough in terms of purchase price, never mind its V8’s insatiable thirst for petrol.

          As vlade alluded to, there’s a lot of inequality here in the U.K. (which is a separate issue) but there’s no shortage of people (say, the top 10% in the managerial elite-gladhanding class and well-off older people) with money looking for things to spend it on but they won’t or can’t spend it on the things the economy is currently configured to supply. Whether the economy can adapt quickly enough is the big, big question.

          Reply
      2. Dr. John Carpenter

        I wish I could convince my mother to use delivery services, or even curbside pick up, rather than going in stores. She’s had two massive bouts of pneumonia in the last few years and hasn’t exactly been the ideal patient since. It’s not money that’s the issue or availability or anything like this. I think, since my father passed, it’s more of the social aspect (she lives in a fairly small town.) That and she’s just stubborn. I’d settle for keeping her out of the restaurants really.

        Reply
        1. Clive

          Same with my mother-in-law initially. I had to literally do everything — create the user account, specify the order details, choose a delivery slot, payment for the order then sit on the phone and make the inevitable changes as the delivery date approached. Even then, it was like pulling teeth. If it had been up to her, I think she’d still be eeking out tins in the store cupboard and the frozen food. It was only the possibility of running out of cat food and litter that sort-of convinced her to Do Something.

          It is ever so slightly easier now a little familiarity has been acquired, but I still have to answer a lot of queries and remote-desktop onto her PC to sort out whenever a bit of confusion arises. Fear of actually going into a crowded store keeps her using online ordering though, so at least it’s not like your situation where you have try to stop someone’s doing potentially unwise things.

          Reply
          1. David

            And of course it’s precisely those most at risk, including the elderly, the poor and the marginalised who will have the least access to the Internet, and the least capable tools for using it. We had an early taste of this in France over the last few years when schools in many areas went over to paperless interactions with parents. Fine if you have a desktop Mac, but less easy if all you have is a cheap and out of date Android phone. 15% of the French say they never use the Internet – rising to three quarters of the over 75s. Where do you even start? And if you are living on a pension of €1000 a month, then after paying rent, shopping, utilities etc. another €20 for a bare-bones internet connection may not be a great priority.

            Reply
            1. Clive

              A massively underestimated concern (the media doesn’t help, you hardly if ever see any references made it it; it’s just assumed “everyone is on line”).

              It’s all-too-easy if you’re comfortably middle class to miss this point. As an illustration, I pay here nearly £50 a month for a 60mbps broadband package with unlimited data and a performance guarantee. The advertised costs are, as I’m sure most here find, an at-best partial reflection of the real ongoing costs. You need line rental and this also ends up bundling in a voice service in addition to whatever the broadband cost is. This is just-about-adequate in the real world usages to support my work VPN with a Teams conference call running that doesn’t suffer lag and stutter. Fire up document collaboration and you wish you have 100 mbps+ (500 mbps is £62 / month with no voice call support once the teaser rate ends). And, of course these speeds are fine in urban areas like mine but fugedabout it if you live in a really rural area where 10 mbps is about the realistic limit you’ll get. Most websites work okay with that speed but some of the supermarket sites are just-about fast enough to quickly do a grocery order and can pick from a previously-ordered list (i.e. you don’t need to browse through dozens of items to find what you’re looking for if you’ve not purchased that item before). No supermarket website here has a “low bandwidth” version of their site — they are all very graphics-heavy (to make their produce look nice and enticing on screen).

              The UK state pension is c. £600 / month (let’s call it $750 US) — no way is anyone on the lowest level of retirement income going to spend c. 8% of their total income on decent broadband (assuming they can get it where they live). You might get means-tested benefits to bring it to a subsistence level of, say, £1,000 a month. But that only applies if you’ve little-to-no capital in savings. If you’ve no savings to speak of or have very little put by, you’re hardly going to blow £500+ every few years staying ahead on the computer hardware curve.

              Reply
              1. TimH

                My DSL is 3Mb down 768k up, and I have no problem video conferencing on Teams or Zoom or Webex while reading email, checking websites etc at the same time.

                I have no interest in video streaming…

                Reply
              2. Synoia

                Well, if a number of families go together and ran some cat 6 cable, they could share a single connection.

                Very possible in row houses…

                Reply
              3. rtah100

                I agree with your point, Clive: fixed incomes are not going to stretch to keeping up with the IT Jones’s.

                However, we are as rural as it gets in Devon apart from the middle of Dartmoor (Torridge District Council, lowest number of cases in England, nobody but cows for neighbours, 20 miles from a supermarket) and I can get unlimited fibre broadband for £30pcm at 50Mb/s. In all seriousness, you should check out a different ISP. We use Zen because their customer service is excellent (no call centres in India, all in Lancashire). They are slightly more expensive than the competition but worth every penny. I keep trying to persuade my elderly mother to abandon PlusNet but she believes the advertising with the down-to-earth Yorkshireman and cannot smell the rotting stench of zombie BT beneath.

                On the anecdata of how the retired spend it, my mother has been through the four stages of cruise grief and is now considering splashing the cash on a new car! What is most enlightening is the behaviour of her friends, all of them merry widows and some of them as rich as Widow Croesus. My mother is the only one, despite much heavy prompting by her, who is paying her cleaner during lockdown / shielding. We’ve done the same for our cleaner and gardener. It is our choice that they stay away and our own expenses are down so we cannot in good conscience not pay them – it’s their livelihood. The stereotype of the selfish Baby Boomer seems accurate….

                Reply
              4. rtah100

                PS My mother is about to enter the IT arms race. She is working from home (medical secretary, loves her job too much to retire but vulnerability means she is avoiding the office). She can only work via VPN into the server and it badly needs an upgrade. She also has lousy Plusnet.

                The net result is she has gone back to a five day week from four days (“What would I do on my day off, at home…?”) because the lag in response means typing up letters, filing patient notes now takes 25% longer!

                The job has changed greatly in the last few months. The surgeons’ operating lists are now booked as one surgeon in a theatre all day (no half day lists) with the same theatre staff (anaesthetist, nurses etc.) to reduce cross-infection. Massive productivity loss. Patients and their household have to isolate for 14 days beforehand. Patients wait in their car; consultant collects them and takes them into consulting room. Medical secretaries now working on site in rotation, only one to a room at any time. So it’s not like she’s missing much social interaction at home!

                Reply
            2. ambrit

              Your figures are ‘enlightening.’
              Here in the North American Deep South we pay roughly 50 Euros per month for a ‘bare bones’ cable connected internet. That includes 1229 GB per month of data at a download speed of 25mbps. Upload speed is 2.4 mbps. Nothing else. Basic television would be an extra 50 Euros per month.
              Hang on to what you have! If needed, give Macron “le chop.”

              Reply
              1. JBird4049

                Over fifty dollars for very basic internet here. Yet something else that divides the wealthy/poor urban/rural areas even in California. The United States has the most expensive, generally the slowest, with spottiest availability of any “first world” countries on Earth.

                Then there is the reality that many people could get access, often very good and free, at the public and school libraries which are now problematical right now. It can be a lifesaver. I guess some in the city – county – school – college administration are happy about not having to pay for that now. The destitute, the homeless, or car dwellers can just lump it I guess. The wonders of the free market. /s

                Reply
            1. JBird4049

              Yet something else that divides the wealthy/poor urban/rural areas even in California. The United States has the most expensive, generally the slowest, with spottiest availability of any “first world” countries on Earth. Then there is the reality that many people could get access, often very good and free, at the public and school libraries which are now problematical right now. It can be a lifesaver. I guess some in the city – county – school – college administration are happy about not having to pay for that now. The wonders of the free market. /s

              Reply
      3. Rob Dunford

        I will tell you one thing, John Lewis are sold out on curtains and lighting (save only for the uber expensive stuff)

        Reply
    3. TimH

      Companies with a lot of WFH staff will consolidate offices, hot desk etc, and eventually realise that staff growth can be from *anywhere*. So for engineering, I expect an uptick in staffing in places like Romania with competent pools and low salaries.

      No-one has really discussed the transfer of ‘office support’ to the WFH person. Printing, electricity, internet costs… will that be tax deductible in USA for permies?

      Reply
      1. Peter from Georgia

        I believe it would be tax deductible in the USA if those expenses were paid by your employer and the employer took the deduction.

        Reply
      2. Otto

        Actual anything not paid to you by your employer such as setting up, supplying, and maintaining a home office is deductible and if your clever and use an LLC, you can receive tax credits as well. It is the IRS though, so one needs a lot of patience in doing seemingly meaningless paperwork. Which Lambert would say is by design. But, if you can over come the obstacle the benefits can be substantial.

        Reply
  2. Biologist

    >Even non-scientists like this humble site picked up early on passing mentions of the fact that there is no long-duration immunity to any of the current major coronaviruses. (…) but if the antibodies don’t beat Covid-19 for all that long, the best we’d be looking at is regular vaccinations…

    As usual, NC was way ahead of the curve.

    The Guardian is now picking up on this point, as now an empirical study has come out that studies immune aspects in recovered Covid-19 patiets. It’s a pre-print (non-yet-peer-reviewed scientific study) from King’s College London (https://www.medrxiv.org/content/10.1101/2020.07.09.20148429v1). So, in addition to the modelling discussed in the article above, there is now some empirical data.

    In the study they measured levels of neutralising antibodies in people confirmed positive for Covid-19 for up to 90 days post symptom onset, and found that in some cases it decreased to undetectable levels after an initial peak. While this suggests that immunity is lost, it may still be the case (though this is unknown and they didn’t study this) that the low levels are still sufficient to mount a potent immune response to new infection, and there’s also the possibility that other immune mechanisms (e.g. T cells) might play a role, but again this is unknown.

    The other crucial bit of new data from this study is that the severity of Covid-19 illness predicted how the levels of neutralising antibodies decreased post-peak. People who were severly ill didn’t generally have their levels drop to undetectable levels. It was the people with mild symptoms who had their antibody level drop to low levels.

    I’ve not read either article except very quickly, but thought it might be of interest to readers here.

    Key bit from the Guardian article that doesn’t come as news for NC readers:

    There are four other types of coronavirus in widespread circulation, which cause the common cold. “One thing we know about these coronaviruses is that people can get reinfected fairly often,” said Prof Stuart Neil, a co-author on the study. “What that must mean is that the protective immunity people generate doesn’t last very long. It looks like Sars-Cov-2, the virus that causes Covid-19, might be falling into that pattern as well.”

    Importantly:

    Prof Jonathan Heeney, a virologist at the University of Cambridge, said the study confirmed a growing body of evidence that immunity to Covid-19 is short-lived. “Most importantly, it puts another nail in the coffin of the dangerous concept of herd immunity,” he said.
    “I cannot underscore how important it is that the public understands that getting infected by this virus is not a good thing. Some of the public, especially the youth, have become somewhat cavalier about getting infected, thinking that they would contribute to herd immunity. Not only will they place themselves at risk, and others, by getting infected, and losing immunity, they may even put themselves at greater risk of more severe lung disease if they get infected again in the years to come.”

    Reply
    1. Ignacio

      I think that what J. Heeney says is sensible because he is highlighting the risks of Covid-19 which are large. Nevertheless we cannot say if immunity to Covid-19 is short lived or not and you have discussed above some of the unknowns about this starting with the cellular response and following with what has been found about antibody levels dropping sharply in some but not all cases.

      Regarding the first paper (and interesting read, thank you) what it says is that upon infection, the humoral response is proportional to the severity of the infection and mild infections result in relatively low level of antibodies that in many cases go relatively soon below detection levels suggesting no humoral-response immunity and that this could be a general case for CoVs.

      Regarding vaccines, the general wisdom is that the intensity of antibody production and the duration strongly correlates with protection. In many cases, repeated vaccine shoots are needed to have strong and durable protection. As a more general rule, we can say that what yields a strong and durable humoral (antibodies) protection is a repeated exposure to the antigen while the plasma cells that produce these antibodies are still there available either in the spleen or the bone marrow. If I recall correctly when plasma cells move to the marrow is when you have such durable strong protection.

      Some vaccines resemble CoV infection: those that use attenuated virus. All these evidences in the article you cited suggest that vaccines based on this strategy (there are a couple of Chinese candidates based on this) will probably produce low antibody levels and will possibly yield short-lived protection. Some other vaccines are based on viral vectors, for instance Adenovirus, and these could give quite different results. In fact the experience of Adenoviral vectors is that they usually give strong cellular responses and these could be quite durable and give strong immunity . It is as if by using other virus you avoid the tricks CoVs could use to avoid triggering strong immune responses. Other vaccine candidates will have different properties. Some other vaccine strategies could yield strong and durable humoral responses, stronger that SARS CoV 2 infection itself.

      What I mean to say here is that the results observed in Covid-19 infections are not necessarily good predictors of vaccine efficacy except possibly in the case of attenuated CoV vaccination.

      But i think that all the evidence mounting with Covid-19 suggests that SARS CoV 2 is able to stablish different types of infections possibly with successive acute and persistent phases. And this possible ability to go persistent in some cell types could explain many of the “weird” cases of long lasting diseases that progress even when there is immune response. The micrograph pictures that showed some types of cells forming virus-filled protuberances that can reach and infect neighbour cells supports this: that is why you are not detecting it (no virus release) and that is why humoral response is transient, because there is not continuous exposure of plasma cells to the antigens.

      Reply
      1. Old Jake

        Ignacio,

        Your ability to explain what these scientific papers are saying and further elucidate this material is, to me, outstanding. I may now be even more exemplary of Dunning-Kruger, but at least I think I can sound coherent when repeating what you said! I look forward to reading your interpretations every time someone brings up what looks like new material on this pandemic. Once again, I learn more from reading NC comments than almost everything else I see on the net. Thank you.

        From what I had been seeing and my interpretations, I had developed the idea that a vaccine is unlikely. I see here that I was a bit overly pessimistic, even though I believe it will be a year or more likely a few years before we see something useful. I look forward to learning more.

        Reply
        1. Ignacio

          The good thing we can say is that there are many (may be too many) vaccine candidates that use different strategies some of them are classical and some others are quite novel. Yet the reasons why sometimes the immune response is “faulty” or short-lived are not completely well understood but there are hints and some of the strategies being developed deal with these.

          I wish I had a more comprehensive vision of the vaccine world.

          Reply
    2. Anthony G Stegman

      This study from the UK ignores the part that T-cells play in our overall immune system. Even as coronavirus antibodies wane T-cells (with memory) remain, so immunity may last well past 90 days, and may in fact be permanent or nearly so.

      Reply
  3. PlutoniumKun

    If this is so, it creates a real dilemma for countries/regions which have managed to eradicate it, or at least have come close to it. This would include China (assuming they are telling the truth about having it under control), and NZ, Taiwan, etc. Some regions, such as Norway and Denmark have been very successful so far at keeping it out of the general population. Scotland may well be Covid free in a few months, while it could be endemic in England/Wales.

    Those countries/regions will then have a decision – either keep themselves largely isolated from areas where it is endemic (i.e. tightly restrict travel and movement on a permanent basis), or essentially behave as if it is endemic, and allow ‘normal’ movement with most of the rest of the world. There won’t be any easy answers – at least not unless someone can come up with a very fast virus/antigen test that could be applied universally at airports/borders.

    Reply
    1. vlade

      As the Australian outbreaks show, there are no half-way houses.

      And, realistically, while say NZ is more self-sustainable than a lot of other countries (by the virtue of having large spaces and a small population), the question is not whether but when it would succumb – short of closing the borders totally. Which it can’t really, as it doesn’t have enough resoures to patrol the all of its coast absolutely, and most people would not accept as the price to pay (they would if it was ebola-like virulence, but I don’t believe the would now).

      100 years ago people routinely died from small cuts due to infection and sepsis (it was, indeed, the most common cause of death outside wars). Then antibiotics came, and it looked for a while like mass external-agent diseases were thing of past (replaced by civilisational diseases). Well, we may (or may not) be dying of microbes as much as we used to, but viruses are still with us, and in a way it was IMO a question of time. Except our society IMO is unprepared for it. The crude mortality rate (deaths/population) halved in the US between 1905 and 2005 (from about 1.66% to about 0.825%). No country run excess deaths of 100% (even as as sample, never mind extended), which we would need to have the same crude mortality.

      We get used to good things easily, and break with them way harder. Especially when the good things are things like living longer, better lives.

      I’m not saying that we’d not go for that, but maybe the last 70 years (from the end of WW2) could be more of a historical abberation (in more than one way) than the unchecked progress everyone (including me) assumed it was .

      Reply
      1. PlutoniumKun

        I’d add to all those the sheer terror of TB and Polio. I’ve mentioned it before, but I grew up seeing older relatives visibly flinch at the mention of either disease, especially polio. One aunt refused to visit my mother in her nursing home because it had once been a TB hospital – she just couldn’t bear the idea of going near it. Both diseases were endemic and were particularly horrible because of the toll they took on children and young adults. Covid is small beer in comparison.

        Reply
        1. Susan the other

          Speaking of TB, yesterdays links about GCB as an acceptable treatment/preventative is good news and also early this morning on the BBC a quick rundown of Covid in Africa saying in every country except South Africa Covid is relatively “under control.” They attribute this to a “young population.” But since TB is endemic in Africa, it could also be that GCB is a good prophylactic. As well as TB itself.

          Reply
      2. Jeotsu

        My take on the NZ zeitgeist right now is super-conservative in relation to keeping borders shut. That being said neoliberal forces are running near-constant op-eds in some publications (stuff.co.nz most notably) pushing for reopening of borders, cruise ships, etc.

        The outbreak in Melbourne has been very clarifying for many people here. And anyone who is in regular contact with friends or relatives in the US or the UK is continually reminded how lucky we are.

        I would hope that many businesses here will end up putting continuous pressure on the government to keep the borders closed, as they are recovering. What is the point of pretending to restart tourism when such a high % of people are still self-restricting that the tourist numbers would b economically unhelpful in any regard (and the cost of letting the disease back in would wildly overwhelm any advantage of the tourist $ generated).

        I’ve heard plenty of people say “we’ll be fine (keep the virus out) is Labor is re-elected, but probably screwed if National gets in” come the September election. I think it helps Labor that for all the problems in the border isolation here we look like olympic champs compared to Melbourne.

        Reply
        1. ChrisPacific

          Yes, we will effectively have a chance to vote on it in a couple of months – although both parties are paying lip service to the idea that we can have both, it’s clear that if push comes to shove Labour will prioritize public health while National is much more concerned about possible economic impact from an extended closure.

          I think public sentiment is very much on the side of safety right now (after 4 weeks of one of the strictest lockdowns in the world, we’re very aware that our current freedoms shouldn’t be taken for granted). National is about to undergo yet another leadership change and may have time to pivot on the issue, but it will be hard to undo all the past statements and convince the public that they can be trusted to protect them – even more so because they don’t even seem to recognize the need, and are trying to run as trusted stewards of the economy (which lots of people will parse as ‘open the borders’).

          Reply
    2. berit

      Swedes are not admitted unless quarantined. They are in effect shut out, soldiers controlling border crossings to Norway, Finland and Denmark. German tourists are to be allowed in presently, to huge relief of our hard hit tourist industry. There’s been very little contamination where I live at the coast in southern Norway, but this may quickly change as travel restrictions are being lifted. I could not go up north to Bodø until recently, as there was an internal border not to be crossed for us southerners across the country at the mountain Dovre, south of Trondheim. But with glorious summer days, vacation and no internal travel restrictions for natives, small southern towns and villages are now crowded with tourists who forego usual destinations in southern Europe, Florida, Thailand… No one knows how things are going to play out, social distancing much harder to keep up, especially for the young, than hand washing and disinfectants. How quickly things changed to the worse for the many poor and marginalized by intolerably bad government.. the likes of Trump, Johnson, Biden too, I think

      Reply
  4. The Rev Kev

    Gunna establish a contrarian position here due to what I have been seeing on the news but here goes. Can we get real now? I have been thinking about how most governments have been responding to the pandemic and now I recognize what it is. It has been a holding action. Most governments have decided to hold a line while a “magic” vaccine is developed to save our economies. Not the people, as they are expendable, but our economies. So instead of going for eradication, we have been going for mitigation in order to have all the businesses go back again. And now all those business are shutting down yet again and that this will be a way of life for them again and again until the virus is eliminated.

    So what have we got? New Zealand went full Godzilla on this virus and wiped it out in their country. And so most of their lives go back to normal so good on them. They get to go out in public without masks, gather in crowds, go to the movies, go to the footy – all of it. Australia went for mitigation and we were told that we would have to accept the occasional outbreak. Well there is a helluva outbreak in Victoria right now which has spilled into New South Wales and the resources of the entire nation are being committed along with the army to fight in back down – just so that we could have businesses open up early. If we had wiped it out, those businesses could have opened up for good.

    So I will say it plainly. You cannot negotiate or compromise with this virus. You get on top of it or it gets on top of you. It is one or the other. There is no third choice and as it is certain that you can get infected again and again, I know which way I want the fight to go. So that means shutting down your country, social distancing, mass and gloves and the full magilla. You clear it out State by State until you wipe it out from your country. How does that play out?

    You have more and more countries that have cleared the virus out forming trade and travel bridges to each other. And that growing incentive motivates other countries to take this virus seriously. Either that or stay a pariah nation. Sure you have a bunch of whingers complain about masks because of rights. OK. But they do not get to go into stores, government offices, public transport, restaurants, etc. without one. Their rights to be comfortable do not trump other people’s right not to get infected. Does this sound too hard to do? Tell that to the people that twice had to give everything up to fight a world war last century. It can be done so long as the will to do so is there.

    Reply
    1. PlutoniumKun

      You were the first here to predict a sort of air bridge between ‘clear’ countries and at least in the medium term I think that was a very accurate prediction. I think this is the way many of those countries will go. If I was in tourism I’d be promoting direct Taiwan to NZ holiday flights.

      This is already happening informally. I heard this weekend that a Northern Ireland University chartered a 747 to fly Chinese medical school students direct from Shanghai to Belfast for the start of term. They did this to assure them a sate hub-free trip (on the assumption that the Ireland of Ireland will be Covid free by September (I’m not so sure they’ll succeed). The cost is considered negligible considering the extortionate fees they are charged.

      There is already talk in the aviation industry of a fundamental shift to direct long distance flights, replacing the hub and spoke model, which should be called now the virus incubator model. The obvious focus for them is on direct connections between Covid free areas. Taiwan, incidentally, has some lovely and relatively unspoilt surf beaches in the south.

      Reply
      1. David

        Yes, hub and spoke was a lousy idea just from the point of travellers, but it could have been purpose-designed to spread viruses. Bring back the A380?
        The problem, of course, is that air bridges require not only completely clean countries domestically, but also completely clean airports and crews, and checks on people coming from elsewhere. It’s hard to see how any country with a land frontier could ever be part of an air bridge network, unless everyone was tested before being allowed entry to the airport, or onto a train or coach going there. Anything else would be too late.
        And heaven alone knows how we are going to handle the problem refugees and migrants, from Libya and elsewhere.

        Reply
        1. Basil Pesto

          It could be a boon for the 787, assuming Boeing can overcome their myriad other problems. Qantas had used this aircraft to launch a Perth to London route, an astonishingly long flight and the first direct from Australia to Europe. Possibly also a Sydney to NYC route but I might be wrong. Until then, hub and spoke has pretty much been the only way to do things for Australians who want to visit far flung locations (and vice versa of course)

          Reply
        2. John Anthony La Pietra

          It’s hard to see how any country with a land frontier could ever be part of an air bridge network, unless everyone was tested before being allowed entry to the airport, or onto a train or coach going there.

          And doesn’t that imply basically instant tests with no false negatives?

          Reply
    2. cnchal

      > So I will say it plainly. You cannot negotiate or compromise with this virus. You get on top of it or it gets on top of you. It is one or the other.

      I agree. The dumbfuckery on display is stunning.

      A small example from my corner of the woods. There is an outbreak in Leamington Ontario from Canada’s version of gastarbeiter, working on the corporate farms in the area. While we are trying to eradicate this thing, the businesses that exploit the gastarbeiters are flying the disease in. Profits uber alles. Who picks up the tab to deal with this? Not the corporate creeps that cause it.

      Jawb one is do not get it. Everything else flows from that, on a personal or country level.

      Reply
    3. John Beech

      I’m with TRK on this one, we go the full magilla . . . and in my opinion, sooner rather than later.

      Reply
    4. Krystyn Podgajski

      I agree and with I had read you comment before I posted mine about. Everyone thinks we can continue in some kind of normal state for a while but what we need is to live in a totally and extremely abnormal state for a month.

      Reply
      1. polecat

        The problem with this is that, even for a month or so, the multi-hydra that is the ‘security state’ (varying of course, in form/function .. depending on what level of power they play/hold) will use ANY quarantine to gain even more control over their respective captive populations .. through the use of distraction, propaganda, and ratcheting force, to maintain and hold that iron grip! Look at how things have been projected/’handled’ this last 6 months. The ones who run the Show are not too convincing, as seen from my lowly perch.

        I mean .. after all … the $pice • Must • Flow … ‘focused gloriously upward – always and forever, virus or no!

        Reply
    5. Otto

      But if it’s true that those that were infected can be infected again, then no one is ever safe as long as there is one infected person. “Life, Uh, Finds a Way” as uttered by the character Dr. Ian Malcolm in the 1993 science fiction adventure drama film Jurassic Park, i.e., CV19.

      Reply
  5. Ignacio

    It is almost certain that Covid 19 has come to stay. It is already all around the world and it has become so widespread in a very short span and, accept it, it has already become endemic. Some dozens of millions have already been infected and this cannot be beaten even by de PR of Chinese leadership which IMO is almost certainly under-reporting infection data for the sake of the ego of the Strong Man In Control. According to the propaganda, any new case in China comes from abroad. IMO, this is as false as a 13$ note, and it is part of the internal narrative trying to state that the virus wasn’t originated in China in the first place. Contrast China 1.400 million inhabitants currently reporting about 20-30 cases daily with South Korea, 52 millions, reporting about 30-50. Is it true that the Strong Chinese Leadership is able to reduce, compared with SK, the incidence of Covid by about 30-40 times (by population)? I don’t think so, and I think that Chinese PR is counterproductive in the sense they falsely try to give the impression the disease can be controlled. Given the excellent response in SK, by their insitututions and by the population at large, so willing to control the disease they can spontaneously quarantine and have an excellent disposition to take precautions en masse I simply don’t believe that China can do it 40 times better. The history of the epidemic do not favour China that had many more cases than SK and the lockdowns had passed long ago.

    Then, what to expect? Epidemiological theory says that once the disease has infected a large majority of the population it will tend to become less virulent as milder strains will have advantages over the most virulent. Anyway we are far from that situation and so the question is how to manage this in the meantime. The solution is vaccine, vaccine, vaccine so it will all depend on how efficient and safe result the vaccines being developed and how fast can be these deployed to the world population at large. It will indeed take some time but this is our best hope. There are worries about the duration of immunity but yet it is vaccines, vaccines, vaccines!

    Reply
    1. vlade

      There is an additional problem with the more virulent/less virulent thing.

      Is the virus less or more virulent if you survive it, but have significant long term consequences? Will people quarantine each other because you may no feel that great but generally ok (like a very mild flu), but don’ tknow whether it’s flu (so not that much of long-term consequences), or CV with a lot of long term consequences?

      Reply
      1. PlutoniumKun

        This is the key question – I don’t think anyone has the answer yet. If long term health impacts are common, then that changes things fundamentally.

        Reply
      2. PlutoniumKun

        I should add that another huge unknown is what the consequences are for a healthy person of getting a second infection of Covid. With some viruses – for example Dengue – the second infection is frequently far worse than the first.

        Reply
      3. Ignacio

        This is a difficult question for which I think nobody has a good answer though it is possible to speculate. The results we are seeing now are the effect of a new virus infecting lots of people of which some unknown proportion are fully succeptible (no specific immune response) while some others might be more or less resistant depending on, again unknown factors, like having being vaccinated in the childhood with BCG (this has not been demonstrated but could be) or having been infected more or less recently with another CoV that left in their bodies cellular immune response that could give some or much immunity against SARS CoV 2. To these complexities then add all those related with the physiological state of the body in the moment of entry, the variable speed and quality of specific immune responses, and the variable speed of disease development through our body. As you say, in many cases the spread within our body goes on despite an immune response and this arises difficult questions on how the immune response protects all organs and tissues equally or not. For instance I believe that during the summer our nasopharyngeal mucosae being in better shape that in winter will help in many cases to reduce the severity of the disease.

        My guess is that if you already have specific cellular and humoral immunity (because you have been infected before or you have been vaccinated), the probability of SARS CoV 2 progressing systemically to produce such long and extended diseases will be very much reduced. But bear in mind not all immune responses are equal and there is not such a clear YES/NO dichotomy regarding immunity. There are many grey zones.

        The reasons why milder strains tend to become prevalent when specific immunity is widely spread is that strains that multiply and spread fast, causing more damage, are more readily detected and battled by the immune system while those that are slow and do not progress so much could still have some opportunity to remain before triggering the response.

        Reply
        1. Krystyn Podgajski

          Yes, this. Most people do not realize you can get chicken pox again, if you had your first case of chickenpox when you were less than 6 months old, your first case of chickenpox was extremely mild or, you have a weakened immune system.

          I said this before but we need to make ourselves a healthy host FOR the virus if we are not going to lock down. Letting it replicate enough in us to gain immunity but keeping the immune system from over reacting at the same time.

          Reply
        2. The Rev Kev

          Ignacio – there is one thing that worries me about the efforts to get a vaccine and it is this. The other day I saw a Peak Prosperity video called “Yes, You Can Get Covid-19 Twice” and it was mostly about one case as an example. The wife was a 41 year-old ‘health nut’ for the want of a better term and she got it bad-

          https://www.youtube.com/watch?v=qhyEBIpaIaM

          The thing is, she got another load only three months later, also equally bad. Would this imply that any vaccine would have to be administered only every month or two or would it depend on what sort of vaccine is developed? If people had to get it only every month or two, it would be a more harder thing to get people to do than getting people to wear masks.

          Reply
          1. Ignacio

            Not necessarily. As Covid infects hundreds of millions with a wide variety of outcomes from a short mild almost unnoticed thing to deaths and with also many cases consisting in a quite long and debilitating disease it is even difficult to distinguish between a real re-infection or an infection that remained latent for some time. A friend of mine got infected in March and had a long lasting disease. As for today she still doesn’t feel as well as before though her health has improved by a lot and this is 5 months after she developed Covid-19. When a disease is so debilitating your immune response can be there but might be somehow muted or faulty and it also could be the case the protective effect does not reach some “remote” places where Covid has become resident.

            This, suggests that having adaptive immunity BEFORE having been infected is highly desirable to avoid such outcomes. These “reinfection” cases say nothing on the efficacy and duration of vaccines. For me the first important question is WHEN will these be available, second will be the duration but all these articles, reports on particular cases don’t say much about this. I hope and guess it will be more durable than vaccines against RSV based on IgA stimulation in children (very short lived protection in many cases). If a vaccine gives good humoral IgG and cellular response it will probably protect for a reasonable amount of time, that is what I expect (and hope).

            Reply
            1. Susan the other

              So far: BCG; some AIDS meds; zinc with hydroxychloroquin; interferon given early; plasma; short term vaccinations (sounds like there is a variety in the pipeline) – maybe a squirt up the nose? – some say remdesivir doesn’t even work at all, some say it’s good when Covid is in its most murderous phase; vitamins C (if you have a strong stomach or can get it intravenously), and D3. Please delete and/or add to the list.

              Reply
              1. Susan the other

                for instance just this morning a blurb on a drug to treat the auto-immune disease of psoriatic arthritis and/or psoriasis being considered for Covid19.

                Reply
              2. Yves Smith Post author

                Progesterone per research at UCSF. And an MD I saw today said the juice of half a lime daily. Not for the Vitamin C, I didn’t hear clearly what was specific to the lime.

                Reply
              3. gone sailing

                To add to the treatment list, Budesonide (inhaled cortisone, mostly used for asthma) delivered via nebulizer. Dr Richard Bartlett of Texas says in an interview that he has had great success treating covid patients with budesonide inhaled via a nebulizer. But he declined to state how many people he has treated, or dosage. Interview is at https://youtu.be/eDSDdwN2Xcg

                As someone who has taken inhaled budesonide and other corticosteroids for decades (for asthma) without side effects, I’d like this to be true, but desire and reality are not always the same :)

                There is a study starting in Oxford, UK to see if inhaled budesonide early in treatment can reduce hospital admissions, https://www.news-medical.net/news/20200707/Asthma-inhalers-being-trialed-for-treatment-of-COVID-19.aspx

                Reply
      4. Amfortas the hippie

        covid vs flue
        I think we’re fixing to run that particular experiment starting in october.

        Reply
        1. PlutoniumKun

          This is the next big problem coming – I was talking to doctor relatives over the weekend who are now enjoying a respite from the first wave of Covid – but the planning for flu season is in full flow already. The projections are that because they are both transmitted similarly there is every chance of a double-strike of flu/covid hitting hospitals which could easily overwhelm them. And who knows what happens when people get both at the same time. They warned me to get my name down for the very first round of flu vaccines.

          I did ask if all the restrictions on movement might stop a flu arising or spreading from China, but the epidemiologists think this is unlikely.

          Reply
          1. jcmcdonal

            Well hopefully flu is less bad from a prevalence perspective this year, what with more masking and hand washing in general. If people are getting both at the same time say goodbye to our age 80+ population…

            Reply
          2. fajensen

            And who knows what happens when people get both at the same time

            That Might actually have better outcomes, as long as one gets the flu first.

            I read in a research paper that one of the things Covid-19 does is to switch off Interferons 1 and 3. These are natural antivirals, so, if one is already infected with another virus, Covid-19 will meet an immune system that is already producing toxins against it and maybe this will limit its potential.

            The kids in kindergarten and the adults working there are always steeped in “bugs” and germs, which could be one of the no doubt many reasons that we did not see the mass infections that one would expect from kindergarten.

            My wife is a nursery teacher, she got it (we think) mildly in mid September, she was down for 5 days with fever, I got it also and I was Ill for 6 weeks!

            I still have something which we (doctors and I) think is Ischia. Which messes up my running, which pisses me right off!

            Reply
    2. Thuto

      Ignacio, i’m not sure I’m in total agreement with your conjectures re: China but I’m also well aware that neither of us has the hard evidence to prove the validity or lack thereof of what you posit. Not to get sidetracked, my main point is on the issue of vaccines as a solution, I’ve got growing skepticism that success in this area is going to put all of this to bed, and the reason has nothing to do with the technical aspects of successfully developing and distributing a working vaccine. The anti-vaxxers are achieving considerable success muddying the waters and sowing doubt in the minds of people about voluntarily taking a vaccine.

      I saw one report saying 1 and 6 people in the UK will not take a covid vaccine when it becomes available, and I suspect the numbers might be higher in the heartland of the anti-vaccine lobby I.e. the USA. I’m afraid even here in SA this sentiment is resonating with a not insignificant percentage of the population. We may say what we will about people falling for the seductive allure of conspiracy theories but the reality is they are gaining traction, with the result that the resistance to state led efforts they induce has real potential to torpedo any efforts to eradicate this virus. The socio-political environment within which we are fighting this pandemic becomes more complex everyday, especially in so-called Western liberal democracies so in a strange twist of logic, it may be the so-called authoritarian regimes that stand the best chance of wrestling this thing to the ground (but of course you and others may doubt their official narrative, but that is a different story altogether).

      Reply
      1. lyman alpha blob

        If I lived in South Korea for example I would likely take a vaccine as soon as it became available. But with the broken healthcare system in the US? Well, someone else can go first.

        Reply
        1. marku52

          Yes, they are skipping a lot of safety testing in the rush to be first. And make the most money.

          I don’t think I trust the FDA or the US pharma to have my best interest at heart.

          Reply
          1. JBird4049

            Nor should you trust them. For something like this I would normally run to get my shot, but like with lyman alpha blob, I will some others play the Guinea pig.

            That’s unfortunate. Not in terms of my safety, but what this nurse’s son thinks about the current medical-congressional-pharma-complex. I’m sure that the legislation giving the vaccine makers complete immunity is already written up for a vote.

            Reply
      2. Ignacio

        Regarding of what I said about China this is just an opinion. The problem with China is that nobody can tell if what they report is the result of an extreme control of the disease or extreme control of the narrative, but somehow their reports are at odds with what we see elsewhere, even in NZ, which can be more readily isolated than China.

        Reply
    3. Otto

      Ignacio – Mostly agree, but I’m not sure HIV is any less deadly or put another way it’s still pretty deadly. It may be anti-virals, anti-virals, that save the day. Sadly you are completely right about China. They must be doing this for internal reasons because no one outside of China believes them.

      Reply
      1. Thuto

        Just out of curiosity, why do we believe say, Sweden, and not China (or Iran, which is also often characterized as probably covering up this or another thing)? More to the point, why do we believe a government that starts wars and whips its population into a frenzy by shouting WMD, mushroom clouds and the like to gain public support for such military adventurism? Why do we believe the numbers coming out of say Israel when they have a record of lying about big things (remember when Netanyahu shamelessly produced that drawing as evidence of Iran’s nefarious nuclear activities). I’m not defending China, and yeah maybe their numbers are fudged, but who’s to say the numbers coming out of e.g. South Korea aren’t. Most, if not all governments, lie, including the democratic ones.The more powerful the government the bigger the propensity to tell lies.

        Reply
        1. Oh

          It’s easier to bash China since most people have been conditioned to doubt them after years and years of propaganda.

          Reply
          1. J.k

            Vietnam, close to 100 milion population. Less than 400 cases. 0 deaths.

            Communists! Authoritarians! Must be lying as well.

            Or maybe they took it seriously from day 1 and mobilized successfully despite relatively few resources at their disposal.

            Reply
  6. Amfortas the hippie

    This is the scariest part of all this…which is why i risked the pitchforks and torches and crosses burning in my yard to send a letter to the editor of my little local paper…which i include for your scrutiny:

    “When the happiness or misery of others depends in any respect upon our conduct, we dare not, as self–love might suggest to us, prefer the interest of one to that of many. The man within immediately calls to us, that we value ourselves too much and other people too little, and that, by doing so, we render ourselves the proper object of the contempt and indignation of our brethren “-Adam Smith

    Everyone is yelling about “The Economy”.
    Demanding extraordinary measures to “Save” it…either from the various levels of Government, a la FDR…or from Individuals.
    But in this hysterical cacophony, everyone seems to have forgotten what it is.
    “The Economy” is not the Stock Market…indeed, some 80% of the Stocks and Bonds and all the zoo of “Exotic Investment Vehicles” are owned by less than 10% of the population, and the bottom 70% of the income distribution owns none of that, at all.
    “The Economy” also doesn’t consist of what’s on the shelves at walmart, what’s in the underground tanks at Short Stop, or what’s in those trucks rumbling along the highway that, in our “Just In Time” short sightedness, replaced the warehouses and stockpiles.
    Nor is “The Economy” a stone effigy of some grasshopper god, that we must continually sacrifice our children and old people to, as some apparently would have us believe.
    “The Economy” is not a thunderstorm, nor an Holy Mountain, existing in abstraction, outside of Human control and artifice.
    “The Economy” is Human Beings.
    It cannot exist without Us.
    So if you want to “Save the Economy”, you must first endeavor to save the Humans that constitute it.
    You may have heard that there’s a Novel Coronoavirus afoot in the world. The Novel Part is important…it means that it’s new…that Humans have never encountered it before last October, and therefore have no immunity.
    It looks more and more, based on a careful examination of the Science of the thing, that Immunity might not be conferred on those who have had it…at least not long term.
    This terrible possibility should put to rest the reckless gamble regarding “Herd Immunity”….and indeed, it calls into question the very possibility of a vaccine…at least as far as we, as a species, currently understand such things.
    This is a terrible position to find ourselves in, as evidenced by the 50 million or People out of work, and the Millions of People—your Fellow Americans—soon to be evicted and bankrupt and living in cars and going hungry in the streets.
    But if a Vaccine, or Herd Immunity, are potentially not possible, what is to be done?
    There are few options available.
    To save the Economy, one must Save the People who constitute it.
    This entails, necessarily, preventing the Spread of this Virus.
    The most Ideal Method available….which is hardly Ideal at all…is to lock down for 2 months or so, call the Troops home to deliver the necessary goods to those who need them…and track and trace and treat those who are already infected, and make certain that they do not infect any more.
    This should have been done in March….or at the very least, April…this mess would be behind us, by now…and the Virus would now be extinct.
    It will be much, much harder to accomplish, now…given the extent of the spread…a quarter million cases in Texas, alone…but it’s still the best of many bad options.
    Or current trajectory merely prolongs the suffering and uncertainty, and will leave “The Economy” in even worse shape than it would be if we did this Hard Thing.
    All my life, I’ve been preached to by all and sundry about “Responsibility”.
    What better time to apply that?
    You want the “Economy” back in working order?….Save the Humans who constitute it.
    Wear the Mask, Stop the Spread.
    Stop providing this virus with Hosts.
    Then we can talk about the economy.

    “How selfish soever man may be supposed,there are evidently some principals in his nature, which interest him in the fortune of others, and render their happiness necessary to him,though he derives nothing from it except the pleasure of seeing it”-Adam Smith, Theory of Moral Sentiment

    Reply
    1. Carla

      “call the Troops home to deliver the necessary goods to those who need them”

      Yet per the Military Times link provided above, Covid-19 cases are growing at twice the nationwide rate.

      With the complete lockdown proposed by Krystyn and others, who can supply those locked down? How will food continue to be produced? Ditto electrical power?

      Maybe I’m being too literal. I guess I’d like to see a definition of “complete lockdown.”

      Reply
      1. polecat

        It’s the deployment of those ‘goods’ that I’d be wary of .. especially in the control-freak hands of our ‘purple party’ betters!
        “Let no good crisis ……..

        Reply
      2. Grumpy Engineer

        @Carla: No, you’re not being too literal. Asking for the definition of “complete lockdown” is a reasonable request.

        I say that because we cannot lock down 100%. Utility workers must still report to work. [Would anyone really advocate doing a multi-week lockdown without electricity or running water?] The companies that supply fuel to power plants and chemicals to water treatment facilities must continue to operate. Some portion of medical workers must continue to work so that anybody who develops a medical crisis during the shutdown can receive assistance. Soldiers or police would have continue to work to enforce the lockdown and address any looting that might arise.

        Each place or organization that is deemed essential and kept running represents a place where new infections could continue. Infections that might outlast the lockdown.

        [And your comment about food production is particularly important. Would we shut down agriculture for multiple weeks? Here in the US, we grow stupendous amounts of food. Over 7000 calories per person per day. We turn a bunch into bio-fuel, export a bunch, waste a bunch, and still manage to eat more than we ought. (Thus America’s obesity epidemic.) We could probably get by if we shut it down for a couple of months, though distributional issues could cause some real suffering. But other countries could not. They don’t have nearly as much extra food. Agriculture would have to continue. As would the associated opportunities for continuing COVID-19 infections.]

        Reply
        1. Carla

          Thanks, G.E. Can you clarify, would a “complete lockdown” mean people could not leave their dwellings except in an emergency? Would it mean that food and prescription drugs would have to be delivered to everyone? I mean, I take it would be much more comprehensive than the shutdown we experienced in mid-March to late April.

          Reply
          1. Grumpy Engineer

            @Carla: As for whether or not a “complete lockdown” means people can exit their homes, it depends on who you ask. It could be done either way, I suppose, though I’ll note that a locked-in, delivery-only approach would make enforcement more obvious.

            However, I’m not convinced that a second “even tighter” lockdown is the right approach at all. Everybody seems to have a resurgence after their lockdown (as seen with even South Korea and Hong Kong), and the prospect of endless vacillation between locked-down and not-locked-down sounds deeply depressing to me. We need something that is livable for the long term so that people can adjust to it and get on with their lives.

            Reply
            1. vlade

              Indeed. But that won’t happen until people accept that we have to adjust and can’t (short term, maybe even medium) go back to what was there before w/o significant problems.

              Reply
    2. marym

      “Wear the Mask, Stop the Spread” is a good slogan. Much better than Wear the Mask, Mask Up, etc. which state the requirement, not the benefit. You should run for office :)

      (jk on the latter – I admire your choices for family and a sustainable way of life)

      Reply
      1. Amfortas the hippie

        “You should run for office :) ”

        lol.
        hell no!
        1. likely pic/vid evidence. I get nekkid at the drop of a hat.
        2. what sane person wants to leap headlong into a meat grinder. take greg abbott,lol…as far as texas repubs go, he’s really not that crazy and terrible…but he has to pretend to be, lest the Radio Preacher eats out his throat. No thank you…I’ll happily be the teabilly whisperer, well behind the throne.

        as for slogans…it occurred to me that a ply board sized american flag with “”Wear a Mask for America”…or Uncle Sam pointing “I want You…” etc. (I might just do the former, put it out by the highway at 4am…got all the material laying around)
        if only we had some kind of moneyed, organised opposition to the cruel and crazy party….

        Reply
        1. Tom Bradford

          “You should run for office :) ”

          lol.
          hell no!”

          Best qualification for office I can think of.

          Reply
          1. The Rev Kev

            There is a tradition in the Australian Parliament that when they choose a new Speaker for the Parliament, that they are dragged to their post by their elbows from a member of each of the two main parties.

            Reply
    3. Olivier

      Not true that the bottom 90% should be unconcerned by the stock market: pensions funds are heavily invested.

      Reply
      1. ambrit

        The “bottom 90%” are not equaly or comprehensively covered by pension funds. From my vantage point, “in the trenches,” I’d say that pension funds are an artifact of the top 30 or 40 percent of the population. Most of us ‘down here’ never invested in pension funds because we never made enough to have the disposable income necessary to invest.

        Reply
  7. David

    I think it’s worth asking ourselves what “endemic” means in this context , and what the consequences will be. The layman’s interpretation is that there will, for the foreseeable future, be an unknown number of people, many asymptomatic, ready to spread the disease to others and that, once that happens, the disease will spread rapidly and often without anyone realising. And even if the disease is eradicated in 99% of the world (and you can never know) a single passenger from an infected country, transiting another, infecting someone from a third, can start the whole thing off again. Without vaccines (and can you vaccinate the world?) I don’t think we’ll ever go back to mass gatherings, sports matches, demonstrations, concerts, … or indeed groups of people just getting together. The social and economic consequences of that are so enormous that it makes the headache even trying to think of them.

    Reply
    1. CoryP

      I’m not even that social a person but I don’t think I’d want to live in a world permanently bereft of gatherings and concerts.

      Reply
    2. Juneau

      My understanding of “endemic” in this context is that it means that Sars NCov 2 can’t be eradicated. Sort of like HIV or Malaria. It can be managed but not eliminated. The asymptomatic spread and aerosol spread insure that part IMO. So it will be a recurring issue unless immunity persists for many years +/- a great vaccine. A little like flu but sadly not seasonal. Time will tell I guess. I agree mass gatherings may never be the same (I SO miss Broadway).

      Reply
  8. cocomaan

    If testing was available that was rapid and accurate, you could easily figure out who has it and compel (socially or de jure) lockdown.

    Instead, at least here in the USA, the tests seem to be clunky, they take a long time to resolve, and there’s little compulsion, even socially, to stay at your home.

    I think this is because the USA is entirely geared toward an extroverted lifestyle. Social capital centers around Seeing and Being Seen.

    Reply
    1. ObjectiveFunction

      >The USA is entirely geared toward an extroverted lifestyle. Social capital centers around Seeing and Being Seen.

      Fascinating point. Although I’d argue See and Be Seen rituals are pretty universal in human societies: girls and boys gotta meet up and pair off somehow, priests must take the omens for the harvest, the land barons need to agree where to go raiding, etc. All taking on layers of ritual and ceremony over time, to build solidarity among the in group and exclude the rest (women, slaves, metics, etc.)

      Reply
      1. Cocomaan

        Definitely true that we have lots of social rituals. Graduation/coming of age, marriage, funerals… But the US has taken it to a wild degree.

        For instance, more than once I’ve had to travel for business, spending hundreds and thousands of company dollars on plane and hotel and dining costs, all to have a one hour meeting. I’ve gone to profession org conferences where we gathered hundreds of people from across the country for only marginal benefit to everyone in terms of knowledge transfer. It was more of an excuse to drink.

        Reply
    2. DJG

      cocomaan: May I turn your observation in its head?

      The U S of A isn’t geared toward an extroverted lifestyle. It is geared toward displays of money. Many meetings and conferences that I have been at are perks for the loyal employees, who are generally underpaid, over-supervised, required to like the regimentation, and give standing ovations during the speeches by their betters: But there is a candy table at break time, a four-o’clock cookie bar, and a long happy hour before dinner. Consider it the company’s way of spending money as it wants to spend money, getting some extra work out of everyone.

      The question becomes: When people don’t have to show up at the regimented U.S. office to be scent-marked by management or at sales meetings to give pats on backs all around, what is the business class going to do when independent thinking “rears its ugly head”?

      Why, white-collar workers may even think of unionizing. (I won’t hold my breath.)

      Reply
      1. calltoaccount

        Elderberry ok for averting common cold, but not recommended for Covid because may increase cytokine storm. Specifically, elderberry increases the release of a cytokine called IL-1B which is a part of the inflammatory reaction to COVID-19 that can result in acute respiratory distress. For this reason, to minimize the possibility that elderberry could aggravate the inflammatory “cytokine storm” associated with the more severe COVID-19 infections, it is recommended to stop elderberry at the first signs of infection (fever, cough, sore throat) and/or if you test positive for the virus.
        https://integrativemedicine.arizona.edu/COVID19/FAQ.html

        Reply
      2. cocomaan

        “Scent-marked by management,” hilarious!

        Your point is well taken. And the preening at conferences is as much a display of power as of money.

        I am having all kinds of rebellious thoughts from my home office. I do know that the rest of my office is loving the work from home and will be resisting going back. Many are immune compromised or live with someone immune compromised.

        Reply
  9. Herb

    I think it’s highly likely that some combination of very high dose vitamin C, vitamin D sufficiency, zinc, elderberry and other herbs and Hydrogen Peroxide nebulization can either prevent or minimize the risk of severe disease. Unfortunately there are very few trials In place of those substances individually and particularly in combination.

    There is a doctor in Michigan who has treated over 100 cases with no one being hospitalized and everyone fully recovering, but he was required by the FDA to remove a description of his protocols from his website.

    Reply
    1. jcmcdonal

      The point here is sure, maybe a rich country can do this. But not everyone can, and as long as it’s out there… We’d have to permanently closed borders and *somehow* prevent people from ever crossing any of these borders.

      It’s clearly going to be endemic in many places – eg. India is not going to be able to lockdown sufficiently to get rid of it. So what then? Obviously though the US could do with aggressively reducing the case count at this point, but it’s likely to be less effective than in March/April and the situation is already much worse.

      Reply
    2. Grumpy Engineer

      @tongorad: Unfortunately, I suspect jcmcdonal is correct. We’re unlikely to achieve a lasting solution with “a proper lockdown”.

      Heck, even New Zealand didn’t completely eradicate the virus with their lockdown. They still had infections going when it ended. Fortunately, those infections were very few, and they could trace contacts and quarantine those final few individuals that were infected or known to be exposed. And they’ve had to keep their borders closed since eliminating COVID-19.

      Here in the US, we’d be starting from a much larger number of infections, so the lockdown would have to last longer. The larger geographic distances would make contact tracing harder (as would our various governments’ disorganization and lack of competence). US citizens have less respect for authorities and would break lockdown rules more often. And closing the border? Hah. We’ve never been able to completely close our borders.

      And the US isn’t the worst here. There are other countries with even greater government incompetence, even less respect for authorities, and more poorly controlled borders.

      [Correction: New Zealand has not eliminated COVID-19, per https://www.worldometers.info/coronavirus/country/new-zealand/. After a 4-week gap (May 23rd through June 15th), they’re reporting infections again. Hopefully this is infected New Zealand citizens returning from elsewhere and being quarantined, but I don’t know the details.]

      Reply
  10. farmboy

    Although having had open heart surgery over 7 yrs ago. I told my cardiologists I couldn’t take meds, i.e. metropolol after 2 months. I don’t have a regular MD, but a naturopath. She recommends a cocktail of vitaminD, VitaminA, and a combination of mushrooms with some other herbs. As an allergy sufferer and being exposed to carbon monoxide levels twice that inhibited respiration, essential oils helped return breathing to normal. Scoff if you will, but being responsible for our own health can take many different looks, fulltime farmer converting to organic so it’s all of one life take.

    Reply
  11. sam

    Like many seniors since early March we have been minimizing social contact, avoiding public transport, transacting online as much as possible, using our homemade masks when shopping etc. Those strategies have worked so far but may become less effective as the general infection rate increases in the US. Without real PPE any exposure to others will carry increasing risk but few have the ability to fully self isolate. As noted in other comments this will go on for a long time if the vaccine tooth fairy fails to appear.

    But I’d like to know more about the alternatives. Is contact tracing even possible with so much community spread? Is self quarantine workable in shared living spaces? What would a lockdown solution look like and how would it be enforced without exacerbating current tensions re police use of force? What would be the exit strategy assuming no vaccine?

    Reply
  12. Synoia

    We humans believe Covid 19 is a plague.

    However, if we look again, we humans could be the plague, and Covid 19 nature’s resolution.

    Reply
    1. nycTerrierist

      ‘The earth has a skin and that skin has diseases; one of its diseases is called man.’

      – Friedrich Nietzsche

      Reply
  13. Expat2Uruguay

    Uruguay is doing very well, and we are between Brazil and Buenos Aires. We have binational cities with Brazil and are re-establishing ferry service with Buenos Aires soon. We have very good Health Care, that comes to your house to test you for covid-19. We have an excellent tracing system that puts the time and effort into tracking down all contacts. And then those contacts are isolated and the people that they live with are tested and isolated. We have a government that is advised by scientists, and respected by the Population. This is how we keep our number of cases very very low.
    The rest of the population is careful and there is a lot of compliance with masking and social distancing. I am very fortunate in my decision to move here. It is surreal to read about the rest of the world while living in a place that is so calm and tranquil.
    Something that shocks me about the people I talk to in the US is that they say they stay in their house and never leave, unless it’s a monthly shopping trip. This is crazy, because people need exercise. Vitamin D and fresh air are important to fighting this disease, but good underlying health is also required. Obesity is a risk factor, and yet people don’t seem to understand the value of walking about outside. It can be done while maintaining social distancing, and is not dangerous. Maybe things are much different in the US, but here we go out have good exercise in the sunshine. And we are in winter now. There is very little cold and flu as well.
    We have dense living situations in the capital city and many people use the bus system. We have a large Aged population, and yet we are doing very well.
    my prediction of A future possibility for a continued endemic disease is that there will be a great deal more unhealthy obese people who fail to exercise properly. Our human bodies were not made for this Modern Life of sitting on the couch watching Netflix and working from home on our computers. We were made to run and dance and live. We cannot pursue Health without looking at the totality. Those who survive longest will be those who adopt the healthiest lifestyles.

    Reply
    1. juno mas

      So there it is. . .more _g l o a t i n g_ from the the expat :). Prescient or lucky, it doesn’t matter. How Uruguay can minimize CV-19 while adjacent to Bolsonaro’s Brazil is the real trick.

      Next thing you know the expat will be extolling the energy independence of Uruguay!

      Reply
      1. ObjectiveFunction

        Nonsense! There is no ‘gloating’ in this, or any of E2Us other comments. Only some occasional sadness that Americans must emigrate to afford the lifestyles and social services we used to be able to get at home.

        A diversity of standpoints and life experiences is what makes this Commentariat good daily reading. If you have a different experience, we’d be glad to hear it. Don’t just throw rocks.

        Reply
  14. Pelham

    I was watching Tucker Carlson on Friday (don’t shoot me) and the doc he has on there regularly said one of the vaccines being developed has shown particular promise because it generates a much more potent immune response to Covid that even that generated by having the disease.

    So maybe that’s something. Just throwing it out there.

    Reply
  15. Sutter Cane

    This is a disease with a pretty large disparity in terms of effects on those who are infected – some barely notice, some feel like they have a mild cold, while some end up hospitalized or dead.

    In the absence of a vaccine, if it turns out that some people are just genetically unaffected by covid-19, then eventually some sort of genetic testing will probably allow people to find out if they are one of the people for whom it will be no big deal, or if they are one of the people who will end up in the hospital on a ventilator. This might create a society stratified less by wealth than by genetic response to a particular disease. People genetically predicted to suffer no, or very mild, symptoms will feel comfortable resuming normal life, and going to the bar, attending large gatherings, etc. without worry. Those who are more susceptible will be unable to do so.

    Of course, this will present some difficult problems. What happens when one spouse or family member is highly susceptible, while another is risk-free? What will happen to the grocery store worker who finds out that they have a genetic predisposition to a severe case, but can’t find a job that doesn’t involve dealing with the public? Conversely, how will our ruling classes react if they find out that they have the genetics that would make a case of covid-19 fatal for them, and all the money in the world won’t do anything to change that?

    Simply too many unanswered questions at present, best to do everything possible to avoid infection and hope that science can provide clearer answers.

    Reply

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