Our Collective Long Covid

We hate to play our regular role of being the (early) bearer of bad tidings. For some time, we’ve been pointing to information and developments that suggest that efforts to contain Covid are having only limited success. That means Covid will be with us a very long time. Yet there’s still a tremendous amount of wishful thinking and denial which has the potential to make this bad situation worse.

Ambrit’s take yesterday: “The Pandemic is not even slowing down, yet, a false sense of triumphalism holds sway on that front” is consistent with by a Bloomberg article last week, When Will Covid End? We Must Start Planning For a Permanent Pandemic. In other words, even as the idea that Covid will be with us for years at best is moving from the fringes to a legitimate viewpoint, more and more people (outside the EU and UK) are acting on the assumption that normalcy is nigh.


Poor countries denied Covid vaccines until 2023. That means virus will keep circulating there. Even if these countries get to be very successful at identifying and distributing prophylactics, they have to be administered regularly, which is even more difficult logistically than administering vaccines, so there are certain to be large gaps in who will get these treatments. That insures that variants will keep developing.

Only temporary immunity. Pfizer is already salivating from the profit potential of annual Covid shots. Immunity to other common coronaviruses lasts anywhere from 6 months to 34 months. Various studies, like the large-scale periodic surveys in the UK, have suggested immunity lasts six months, and some have argued at least eight months. But then we come across datapoints like this one: SARS-CoV-2 seropositivity and subsequent infection risk in healthy young adults: a prospective cohort study:

Seropositive young adults had about one-fifth the risk of subsequent infection compared with seronegative individuals.

The “healthy young adults” were Marines undergoing basic training. Of the ones who had tested positive, 10% tested positive again during a six-week follow up. The reinfections were of the same strain. And the Daily Mail layperson translation stressed:

Researchers say the three negative tests during quarantine helped ensure that infections diagnosed during basic training were not persistent infections but rather new infections.

We don’t know how much the vaccines reduce contagion. Given the concerted effort to vaccinate nursing home residents and staffs, the impressive decline in cases there points more to vaccine success among the vaccinated than in reducing transmission. The assumption has been that the vaccines will reduce disease spread since they considerably reduce the number of severe cases, and lower viral loads and fewer Covid coughs ought to mean less disease propagation. We’re flying even blinder in the US than we ought to be because in the US, the push for vaccinations has pulled resources away from testing.

But we now also know that mild and asymptomatic cases can spread the disease, and can also produce lasting damage, to lungs, kidneys, the heart, as well as long Covid.

Uncertainty about effectiveness of existing vaccines will be with new variants. mRNA vaccines are touted for speed of development, so it should come as no surprise that Pfizer and Moderna are looking into whether a third shot will be necessary to contend with new variants.

Vaccination levels won’t be high enough tamp down the disease. This is not new news but it bears repeating. From Bloomberg’s “permanent pandemic” piece:

In the case of SARS-CoV-2, however, recent developments suggest that we may never achieve herd immunity. Even the U.S., which leads most other countries in vaccinations and already had large outbreaks, won’t get there. That’s the upshot of an analysis by Christopher Murray at the University of Washington and Peter Piot at the London School of Hygiene and Tropical Medicine.

The main reason is the ongoing emergence of new variants that behave almost like new viruses. A clinical vaccine trial in South Africa showed that people in the placebo group who had previously been infected with one strain had no immunity against its mutated descendant and became reinfected. There are similar reports from parts of Brazil that had massive outbreaks and subsequently suffered renewed epidemics.

That leaves only vaccination as a path toward lasting herd immunity. And admittedly, some of the shots available today are still somewhat effective against some of the new variants. But over time they will become powerless against the coming mutations.

Of course, vaccine makers are already feverishly working on making new jabs. In particular, inoculations based on the revolutionary mRNA technology I’ve previously described can be updated faster than any vaccine in history. But the serum still needs to be made, shipped, distributed and jabbed.

And that process can’t happen fast enough, nor cover the planet widely enough.

And from a newer story in Bloomberg:

What that means is that new Covid cases will likely emerge in younger age groups. That occurred in Israel, where infections were recently plateauing despite the country’s world-leading immunization program. It turned out that cases among young people were surging, even as infections dropped in the 50-and-older crowd.

Mind you, the problem of variant development within and outside the US alone is enough to defeat getting infection levels down any time soon, even before you get to the wee problem of 30% to 40% of Americans being either anti-vaxxers or vaccine hesitant.

Lack of will to take stringent enough control measures. South Korea has shown how to get Covid down to a low enough level to allow for normal life to continue: impose strict quarantines for all incoming travelers, track and trace any new infections, and require those exposed to quarantine. In the West, we’ve only done leaky lockdowns and our quarantines have almost all been jokes (see New York as an example). By contrast, a friend’s significant other went to Poland to see her family. She was under a strict quarantine at her parent’s home, not even allowed out in the yard, with cameras on the house and the neighbors enlisted as spies. The fine for a first violation was 5,000 euros; for the second, a 15,000 euro fine plus six to 12 months of incarceration.

But not only are US infections generally too high for contact tracing to work, but we also lack the capacity do do enough testing and decades of telemarketing (and now identity theft) abuses means many people won’t respond to a call or text from an unknown sender.

Inadequate official action compounded by optimism bias and compliance fatigue. Lambert and the Institute for New Economic Thinking both have warned that the CDC’s failure to take aerosol spread as a serious risk and its biased reading of other data have led it to recommend school reopenings without implementing adequate safety measures or pumping for improved ventilation. Here in Birmingham, the mask mandate has been lifted even though less than 13% of the public is fully vaccinated. Conventions are set to start again in Las Vegas in June.

It’s deeply unpleasant to consider that Covid restrictions might go on and on…that the US relaxed spring might lead to another wave of lite or tougher lockdowns. But the cost of Covid isn’t just death and disease, it’s also experienced professionals quitting, both in medicine and increasingly in schools. A short section from ‘I just feel broken’: doctors, mental health and the pandemic in the Financial Times last week:

Emerging research from countries including the UK, the US, China, India and Italy has shown alarmingly high rates of mental health disorders among front-line healthcare workers during the pandemic.

In February, a group of academics led by Talya Greene of the University of Haifa and Jo Billings of University College London published a paper in the European Journal of Psychotraumatology which found that, during the first wave of the pandemic, 22 per cent of all UK medical staff met the diagnostic criteria for post-traumatic stress disorder, 47 per cent for anxiety and the same number for depression.

Monica Durrette, a clinical psychologist in Virginia, says, “I have had physicians in tears during sessions, because they’re so exhausted, angry, frightened. And I’ve had people say, ‘This is breaking me, I just feel broken.’ It’s heart-wrenching.”

For many of these health workers, the bleak reality of their daily battle contrasts painfully with glowing narratives of heroism propagated in the media and local communities. It also illustrates a deeper crisis that long predates the pandemic, an undercurrent of burnout and mental illness plaguing a profession that should be uniquely placed to look after itself.

According to Gary Price, president of the Physicians Foundation, 300-400 doctors took their own lives every year in the US, even before the pandemic — the highest suicide rate of any profession. “That translates out at a conservative estimate to about one million patients losing their physician every year just to suicide,” Price says

The article describes at length one of the common features of post-traumatic stress disorder, that of moral injury, a feeling that they’d violated their own fundamental values, and how many Covid doctors are afflicted by it:

In addition to witnessing extraordinarily high volumes of death and suffering over the past year, many have been forced to make unprecedented ethical decisions that they would never have been faced with in normal practice, such as choosing which patient gets a ventilator and which doesn’t….

Natalia Guzman-Seda, a resident anaesthesiologist at a teaching hospital in Brooklyn, says the case numbers during the first wave were so overwhelming that she and her colleagues barely had time to restock their supplies to keep up with the influx. At the peak of the first wave in early April 2020, New York City had more than 6,000 new cases a day.

“I would go to intubate a patient, and then go back to the [operating room] to restock, and then I would get another [call] and I would say, I feel like I’ve been here before,” she says. “And I realised that I’m intubating the neighbour of the patient that I had intubated earlier. And that one was already dead.”…

As New York City’s case numbers started to climb again later that year, Guzman-Seda began experiencing panic attacks, as well as a paralysing sense of guilt about her actions during the first wave…

In particular, she was fixated on the idea that she had assured patients she was intubating that they would be OK if they allowed her to insert the breathing tube into their airway – necessary for them to be placed on a ventilator – despite knowing that very few would survive. “I felt like, Who am I to take away hope from them?” she says. “But at the same time I feel very conflicted… I felt, in a way, I was lying to them.”

It’s not just that there are no easy answers. There are also no good answers. We live in a complex and highly interdependent society. We blew the chance to do a hard lockdown, restrict transportation, particularly internationally, unlock state by state, region by region, when infection rates got low with test and trace and possibly a resumption of restrictions as necessary. We ignored South Korea’s lesson to our peril.

Large-scale, leaky restrictions mean some businesses and workers suffer acutely, yet we don’t really strangle infection numbers down as far as we could even with this approach. And legitimately increasing the rejection of this approach, and the US and most other countries have done a terrible job of keeping the hard-hit afloat and making it easier to stay at home, particularly for those who are asked to quarantine. Yet if we keep going as we are, we’ll see so much attrition among doctors and nurses that getting adequate turnaround at the ER in years to come will be even dicier, and even worse area crises like earthquakes or fires.

So keep wearing your masks. It’s the least you can do. If nothing else, it shows solidarity with the medical community.

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  1. Halcyon

    Sobering reflections on where we really are at this stage. The desire amongst almost everyone for a Return to Normalcy is definitely leading to an awful lot of wishful thinking.

    Here in the UK I just cannot see how the political situation will permit another lockdown. This one has only been possible because of the “carrot” of mass vaccination and an end to the pandemic. An awful, awful lot is going to depend on how much the vaccines are capable of working against any new variants. If deaths and very serious illness can be somewhat limited I imagine they will accept everyone being sick with COVID more often as a trade-off.

    Given the government’s increasingly authoritarian moves to crackdown on protest and control media outlets (in particular the BBC), would it surprise anyone if at some stage – perhaps after “full unlock” or the initial vaccination programme is completed this summer – they simply stop publishing statistics, declare the pandemic over, suppress any information about new outbreaks, and dare anyone to make a fuss?

  2. Isotope_C14

    And now it’s going to be endemic in the mice, minks, and who knows what other wildlife. Free to mutate and cause massive suffering for some, and massive profits for a very few.

    I’ve realized that my odd health issues over the past year only make sense in that I must have had long covid myself. I had extremely sleep-disruptive lower leg muscle twitching, and occasionally in other places too, but the muscle twitching in the legs was super constant. Heart palpitations, blood pressure surges, random chest pains, it’s been a real treat to be alive over the last year. I expect that I’ve likely had heart damage, and that will be permanent. I don’t think I had a particularly symptomatic start to this all, and have no idea how I was infected, as I have very little contact with people. At least my back itches again. Now that it’s started, I realize my back *wasn’t* itching for the last year. Add that to the bizarre symptom list.

  3. PlutoniumKun

    A couple of weeks ago I was actually uncharacteristically optimistic – the vaccine results (in terms of reducing infection) seemed to have to promise to reduce Covid to a background infection. I thought that with luck, there would be one more surge with B117, and then we could look forward to more normalcy from the summer on.

    But I’m not so sure now, for all the reasons outlined above. There seems to be increasing evidence that we will need annual jabs and that new variants will cause increasing problems. If it turns out that even ‘mild’ infections can result in the long term health impacts we now know are part of Covid we will never be able to treat Covid as if it was just a bad cold or annual flu.

    To make it worse, its increasingly obvious that politicians just haven’t learned. In the UK there is an absurd amount of optimism around the vaccinations – they are starting to release restrictions already and the school reopening are not taking full account of the need to improve ventilation. Europe seems determined to try to (again) have a ‘normal’ vacation summer, despite all evidence that any unnecessary travel is a terrible idea. Brazil is a disaster zone. The US has still to have its B117 wave, which must surely hit soon.

    And WHO is still clinging ridiculously to its hesitancy over aerosol transmission. I see on twitter that those who got Covid badly wrong – scientists like John Ionniades – are now resorting to insulting or patronising those who called things correctly from the beginning. Anyone who follows the arguments on science twitter will see that there is a lot of gaslighting going on.

    On one specific point – here in Ireland there has been a growing movement led by some doctors and scientists to push hard for a zero covid strategy. As an island (well, sort of), this is achievable, if very difficult. This would require far more aggressive quarantine and probably a night time curfew for a few weeks. It would be nice if there was a open and public discussion in it, but the medical/scientific/political establishment who have gotten things regularly wrong are just not engaging at all.

    1. cocomaan

      To me it seems the triumphalism is completely wrapped up in realpolitik. Politicians are desperate to show that they’ve moved the needle on covid and restored things to “normal”.

      I think the possibility of any further lockdown is long past. Everyone has been primed to resume what they were doing before.

      This entire thing has been a public health disaster. Hopefully there will be some lessons learned for the next time.

      1. ambrit

        This is Covid, a new ‘beastie’ in the bestiary of malignancies. This is the “next time.”
        Many are hearkening back to the Great Flu Pandemic of 1918 for lessons in treatment and prophylaxis. I’m thinking that we should look even further back for those lessons, say, to the epidemics of typhus and typhoid, etc. that ravaged Terran human populations in the pre-big-medico era. Back then, most epidemics lasted several years. The big pandemics, such as the Black Plague outbreaks of the fourteenth and seventeenth centuries lasted decades. Heaven forbid that Covid become as virulent and deadly as the Plague, but, we have set up a near perfect “open air laboratory” to see what the virus can come up with. So much of our future prospects now depend on blind luck.

        1. semiconscious

          “The big pandemics, such as the Black Plague outbreaks of the fourteenth and seventeenth centuries lasted decades. Heaven forbid that Covid become as virulent and deadly as the Plague, but, we have set up a near perfect “open air laboratory” to see what the virus can come up with…”

          i’d say we still have quite a ways to go before we get there: https://www.visualcapitalist.com/history-of-pandemics-deadliest/

          1. ambrit

            Point taken, but modified to reflect the extent to which “medical science” has been politicized. We could still “get there” through sheer stupidity and incompetence.

            1. Anonapet

              We could still “get there” through sheer stupidity and incompetence. ambrit

              Or the economic necessity of an economy based on pervasive rent, debt and wage slavery?

              Btw, “Heaven forbid” and fear of “blind luck” appear to me to be contrary notions.

              1. ambrit

                “Btw, “Heaven forbid” and fear of “blind luck” appear to me to be contrary notions.”
                Indeed they are, but stop to consider the fact that, for as long as elites have striven to tell everyone else what to do, mentally accepting two contradictory concepts as true at the same time has been optimized for ‘success.’
                As for ‘wage slavery,’ see such heavyweights a Marx and Engels, or further back to the original Liberal Philosophers for cogent arguments on that subject.

                1. Anonapet

                  I think I overstated “economic necessity” given that inexpensive fiat distributions can put the kibosh on rent and debt slavery.

                  As for wage slavery, the production problem having been solved long ago means there’s no economic justification for it.

                  1. ambrit

                    I also take your point on “economic necessity” to be a political issue, not just economic. The present neo-liberal system optimizes for the collection of “rents,” the public be d—-d. Fiat disbursement is still a point of contention, even though both logical and manageable from a public good perspective.
                    We’re closer than we realize.

                    1. Anonapet

                      Of course we need land reform too; it’s outrageous that the rich can own more than their fair share of land.

      1. ambrit

        The scientists who are at present “non persons” to the ‘official’ medical establishment.
        This is a case of “groupthink” gone wild.

      2. PlutoniumKun

        To give one example, Trisha Greenhalgh was correctly identifying the importance of masks and aerosols from very early on in the pandemic. She was constantly criticising the focus on droplets in the mainstream journals such as BMJ and NEJM. She is a prominent name, but others further down the academic ladder got a lot of abuse thrown at them and didn’t do their careers much good by pointing out the multiple errors of the establishment.

      3. JEHR

        Ans: Maybe the ophthalmologist in China, Li Wenliang, who early on warned his colleagues about a new virus that was causing severe illness and rapid death.

  4. Robert Hahl

    It’s beginning to look like a new type of forever-war. Health care workers are starting their second tour, without any rest in between.

    According to Marc Levy’s book of war stories about Vietnam and Iraq, the UK lets soldiers have two years to recover from six months of combat. The U.S. lets them have one year to recover from 15 months of combat, hence the high drug use and suicide rate.

    1. Samuel Conner

      I have similar thoughts. In wartime, “truth” is often an early casualty and there has been plenty of evidence of that from early in this “war”.

      1. ambrit

        Too true. Also, this episode has shown the truth of the old adage that, per Moltke, “No plan survives contact with the enemy.”
        What we need now is a “Cunning Plan.”

  5. semiconscious

    for your consideration: https://starkrealities.substack.com/p/study-us-medias-covid-coverage-slants

    Consider one of study’s most glaring findings: Even when Covid-19 cases were falling nationally between April 24 and June 27, major media discussed rising caseloads 5.3 times as frequently as falling ones.

    The impact was evident: A June CBS News poll found a record number of Americans felt the fight against coronavirus was going badly. Of course, news of the poll was itself another negative story, feeding a media-facilitated vicious circle of fear.

    In July, a Franklin Templeton-Gallup poll found Americans had a poor understanding of the risk of Covid-19 death for different age cohorts:

    Participants said people aged 55+ accounted for a little over half of the deaths, when the actual share was 92%.

    Those under age 25 accounted for just 0.2% of deaths—participants overestimated the share by a factor of 50.

    The results aren’t surprising, given the media’s compulsion to accentuate rare occasions when teens and twentysomethings fall victim to the virus.

    1. Yves Smith Post author

      Sorry, among the people I know personally and have actually seen in the flesh since the start of Covid (as you can imagine, a very small #, and I am excluding MDs and store personnel even though I see a few of them regularly), there are 2 people one degree of separation who are under 30 who have died or will die of Covid. One was the 30 year old husband the niece of one aide. The other is the 29 year old policewoman daughter of another. Now on a respirator and kidneys failing. Neither had pre-existing conditions.

      And plenty of coverage that you are choosing to ignore of:

      1. Variants hitting younger people harder than original Covid

      2. Morbidity, like lung, heart, kidney, and brain damage that does not appear to spare the young.

  6. Kurt Sperry

    f you want to see the likely efficacy of vaccination, look at countries like the UK and Israel who are leading in getting it done. Their success or failure will probably presage results elsewhere who are lagging behind.

  7. IM Doc

    We hear alot about the Flu of 1918. This is a very bad analog for our current issues for any number of reasons.

    There is indeed an analog that we can look back to – the “Russian” or “Asiatic” flu of the 1890s. From its inception – the physicians of the day realized that it was much different than any other influenza – read William Osler’s first textbook of internal medicine in the flu section written in the first decade of the 20th century for an idea on that. And it almost assuredly was not a FLU or influenza at all.

    Modern research and genetic/virology studies have shown it almost assuredly was Coronavirus OC43 – that is still floating around with us today.

    More than 100 years after the initial pandemic, this organism causes upper respiratory infections in millions/billions every year, and is responsible for the deaths of hundreds/thousands globally each and every year – mostly old and infirm.

    The organism had its way with humanity in the 1890s – coming back wave after wave after wave – likely representing variant drift until we as a species and the viruses settled into a new relationship and a new reality.

    Humanity did not know what viruses even were then – this illness was blamed on “Miasma”. But they tried everything known to medicine at the time to stop it – social distancing, quarantines, recuperation facilities, even masking (to a much smaller degree than we are now) and NOTHING worked.

    But things eventually settled down. But not without the social, political and economic chaos that almost always accompanies pandemics.

    I am afraid this is where we are today. Unlike the 1890s, we have the possibility of anti-virals and the possibility of vaccines ( the jury is still out on both – the verdict on the vaccines will be coming in the next few months – again the studies showing case number reduction is what we have – and is worthless – morbidity, hospitalizations and death are what are important – and the data there is completely unclear ).

    One thing is for sure – this is going to be an interesting ride the next few years.

    I discuss with my patients dozens of times daily – the things we know will help – GET LESS FAT, GET LESS DIABETIC, EXERCISE like a FIEND, VITAMIN D , SUNSHINE and plenty of sleep.

    And we as a society – must somehow find ways to begin tried and true public health issues – like vigorous testing and quarantine. We have had a clear fail on this up until now.

    Buckle up and be safe everyone.

    1. SE

      I understand that quarantine, social distancing, lock down and testing are not working in Western countries in the feeble way that we are doing them. But they are working in Asia. Some of this is due to…perhaps too much control…but I lived in China during the SARS outbreak and saw how seriously people took infection control. Masking and empty streets without ANY mandates from the government. When it is done well people see the benefits and get behind the procedures and are willing to take part. Here we just have long-haul half-assery with no plan that feels pointless even for people who supported lockdowns at first. I feel this is because vaccines were the only plan, through both administrations.

      In terms of morbidity, I am worried that….as many of the damages that have come with asymptomatic infections (lung damage, heart damage) often require someone to be looking for them, it will be a long time before people start doing this in asymptomatic, or mildly symptomatic vaccinated individuals. Another question I have…is that I have read plenty talking about the risk of the spike protein itself as a target due to its potential to do harm on its own, without being attached to the replicating virus. Will we ever look for this? If something like this were to occur, would to take years to turn up? I am interested in understanding the real safety profile of these vaccines, but I don’t have a lot of hope of the work being done to bring that to light. I feel there is no societal motivation to know at the moment. Do you have any thoughts on this, IM Doc? I would appreciate your insights.

    2. CuriosityConcern

      Your mention of the 1890 virus a month or two ago, and how there are not any samples prompted me to research if there were any Everest deaths with unrecovered bodies in that time frame. Couldn’t find anything promising in the one source I checked.
      Great comment on Yves’ great snapshot summary post.

    3. PlutoniumKun

      Thanks Doc.

      The Russian Flu of course got its name primarily because it spread so rapidly using the new railway lines across Siberia and into Europe. The mix of railways and steamships meant it spread far faster than any previous pandemic. This is another lesson that was lost.

      1. kareninca

        I was a strict “health food vegan” for 19 years (for ethical reasons) and ended up with pretty bad cardiac calcification in my mid-50s. I would not personally recommend a “plant based diet” to anyone. I now eat fish and dairy and eggs and small amounts of beef. I hope that anyone who reads that book consults his or her physician before embarking on anything.

    4. JohnMc


      Ha! good luck getting the medical industrial complex behind those prescriptions. if it can’t be monetized you might as well forget about it.

      a few years ago i went through a 30 page document on the latest in diabetes management. basically 29 pages of pharmaceuticals and one page on ‘medical nutrition therapy’ which is a fancy way of saying stop eating so many carbs.

      Virta Health has been running a diabetes reversal program for more than a couple years now using a silly phone app and ‘coaching’ which again does little more than tell people to cut the carbs but the app and coaching gives them a way to do some health insurance billing.

  8. Yeti58

    Just wondering why no mention of treatment options outside of vaccination, there has been much talk on the web about the efficacy of Ivermectin but little talk in mainstream media. It appears to drastically reduce length and morbidity of all strains of Covid-19 and is cheap. Maybe that’s why, no money in it. Some respectable people are trying to put it out to mainstream to little avail (see FLCCC). Just a thought.

      1. marku52

        Trial Site News has an interview with Dr Tess Lawrie, who on her own hook, did a meta-analysis of the effectivity of Ivermectin. She was astonished at how good the data is.

        Also, she noticed, that neither she, nor anyone else, can get their data published.

        “I’ve never seen publication rescinded. Maybe for fraud, but this is not that. I’ve never seen anything like it….”


  9. another-scientist

    The only thing that surprises me is how much hypotheticals are being invoked here. We knew early on that this was going to go endemic, and that it will take many years to find a (Darwinian) equilibrium in the population.

    As an example, a long form interview with a pandemic expert, posted a year ago:

    The future he discussed in that video is still accurate. And with the mutations happening as quickly as they are (because nobody thought in the early days everyone would just sit back and let millions of hosts be provided), we will absolutely need vaccination probably 2-3x a year until we start outpacing the variants. We will absolutely need booster shots because none of our current vaccines comprehensively cover all circulating variants, and the ones people aren’t immune to will just quickly supplant the ones that they are immune to.

    At work, nobody thinks we’ll be changing anything with precautions until next year at least… if that actually marks the point at which everyone who is capable of being vaccinated (so, not babies and those with certain health issues) has been vaccinated against ALL circulating strains of covid… so really who knows. Basically we’re going to be doing some version of this for a long time. I think things will get less risky over time as more and more people are immune to more and more strains… but yeah… I don’t honestly know what the exit ramp looks like, other than that we’re nowhere near there yet. Regardless of wishful thinking.

    Meanwhile the situation with variants in US /Canada is about to get very dire, and virtually nothing is being done to even acknowledge that we’re going to be facing a situation like the EU has been in the middle of, but with far less protection and organization.

    1. Ignacio

      I think you get the picture quite right in some senses. There has been a belief, at least in media, that the disease could be eradicated or would somehow evaporate, as it appeared, given prophylactic measures taken. We have to admit that this virus has come to stay so the best we can do is try to accelerate our exposure via vaccination and this will change the evolutionary game that Homo sapiens and SARS CoV 2 are playing once a large majority of the former are no longer naive to the virus. This is crucial in my opinion. We cannot wait to 2023 to get some countries vaccinated and the fact is that if we want to, we can do it much faster. Yet we are self-imposing arbitrary limits such as IP protection and the like preventing true global scale production and deployment of vaccines.

      I totally agree, as you wrote, that things will get less risky over time though nobody can foretell how this might unfold. How fast and how low comes the risk. But if there is a way to accelerate this is through massive vaccination at global level or we can sit idle and wait for some years until >80% of humans have been naturally infected and tolerate a high death toll every year. I am not that worried with variants, from the point of view of vaccine deployment ,but some have already shown to be more virulent and deleterious so, if anything, masks are now more necessary than last year.

    2. kareninca

      “we will absolutely need vaccination probably 2-3x a year until we start outpacing the variants”

      Do you seriously think most people will be willing to be vaccinated 2-3 times a year??? I’m not sure I want to be vaccinated at all (and I have the usual advanced degree and read what I can on the topic); I’m waiting until I see case fatality rates rise significantly. There are plenty of people like me. And isn’t mass vaccination itself going to put a lot of evolutionary pressure on the virus? To create more variants? To require more tweaks to the vaccinations?

      I talked with a relative the other day who was utterly disgusted when her doctor told her that she (the doctor) thought my cousin’s vaccination would only be effective for about three months. No-one had warned my cousin of that, and she felt scammed. It’ll take a lot of persuading to get her to take another vaccine – and she was reasonably willing to take the first round.

      I have met so many people who have a “vision” of how things will work out, vis a vis vaccinating Americans. They don’t even begin to take into account the preferences, beliefs and concerns of these prospective de facto mass test subjects. The presumption of some scientists and researchers is staggering. Often they think others can just be coerced into being vaccinated. I wouldn’t count on that.

      1. Ignacio

        By no chance 2-3 vaccinations a year will be necessary to get Covid under control. As simple as that. Multiple/serial vaccination is not wise at all and the problems that could arise with that would probably overcome the risk of disease at some point. It is far more important to reach the most people the better rather than imagining unwise serial vaccination schemes.

        It is something like abusing with a drug. Vaccines can be abused and generate unintended consequences if administered like crazy.

  10. marku52

    On the slightly more positive side, Medcram had an interview with a virologist suggesting that his best bet was that the virus was running out of “improvements”, and possibly might be largely defeated by a South African variant style booster. Note that most all of the variants of concern contain N501Y. They all independently hit on this, so it is important. But maybe there aren’t that many more important effective variants out there.

    I think this comment was pretty far in, maybe about 46 minutes or so.


    1. Kevin Carhart

      I am unclear about this formulation of “limited moves remaining” which comes up in a few places such as a recent New Yorker story.


      “Like all viruses, SARS-CoV-2 will continue to evolve. But [Jason] McLellan believes that it has a limited number of moves available.”

      Dr. Campbell said something similar recently. And it seems important to nail this down.

      How can mutation be said to be over or waning if the environment is also dynamic? I would like to understand how this squares with, let’s say, the famous schoolbook examples of mutation. There were white moths in the north of England during the Industrial Revolution. Factories were letting out a lot of soot so that some background surfaces in the habitat were increasingly black over time. So, mutation churns along in the moth population and the ones whose mutations happen to have given them a phenotype “dark” have an advantage because they can camouflage against the sooty tree and whatnot, and be less likely to get eaten by predators. But the churn doesn’t stop. It just made a good anecdote for textbooks as of that moment, but time marches on. Suppose fifty years later the pollution has abated and new generations that happened to have a phenotype “light” now have an advantage instead. The thing that constituted “important, effective” had changed. Is there something about the specific case of human beings vs. virus that distinguishes it from the moths story, such as the slow timeframe of how often we pass on mutations relative to the fast timeframe of a virus?

      1. Jason

        I often notice that the most thoughtful questions – such as this one – don’t receive any answers. They are simply ignored. In my experience, this means you’re onto something.

      2. J.

        The variants have changes in the spike protein, which is on the outside of the virus and is the major target for your immune system.

        However, the spike protein also has some jobs to do for infection to happen: it binds to the ACE2 receptor, then gets cleaved by a protease and changes conformation, which triggers membrane fusion and gets the virus into the cell.

        If the spike protein has too many changes it won’t work correctly any more; it might not bind well, or its conformation might not change correctly and membrane fusion would not work any more. This is why some scientists are saying Covid-19 has almost run through its repertoire of variants.

        As far as the environment being dynamic: once you have an immune response to the old version, and an immune response to the new version, reverting back to the old version has no benefits because your immune system detects it just as well. If the next potential human host has been vaccinated against both the old and new versions, reverting back has no benefits.

        If the virus could get established in something that lives around humans (e.g. mice) you might see a different range of variants appear because mice have different ACE2 receptors.

  11. A.

    “We blew the chance to do a hard lockdown, restrict transportation, particularly internationally, unlock state by state, region by region, when infection rates got low with test and trace and possibly a resumption of restrictions as necessary.”

    This is not correct. The hard lockdown is by definition scale-invariant because it relies on the natural mechanics of exponential growth/decay. (Compare to hospital capacity, or vaccination, which have linearly scaling mechanics.) Besides the increasing difficulty of actually implementing a lockdown, it simply does not matter whether you’re announcing 100, 1000, 10000, 100000, or 1000000 cases a day. If a 10x-Wuhan showed up in Chinese numbers this hour, they would immediately implement a lockdown the next hour, and they would succeed. Let us hope this never happens for Chinese folks, but if it did, I would happily take $10k bets on the outcome.

    Therefore it only matters that your lockdown is actually hard, and that you plan for the contingencies such a plan entails. This is also what the COVID-fumbling world is fumbling at. Of course, you also need the political will to actually implement one, and not be a slave to corporate interests.

  12. Mikey Joe

    In New Jersey stores are replacing signs of
    “Masks required to enter.”
    “Masks are required to enter, including those who have been vaccinated.”

    1. kareninca

      If I had a nickel for every person whose told me “I’m vaccinated, so you’re safe around me” where I volunteer, my organization wouldn’t need to do our fundraising sales. When I tell them that it is still likely that they can catch and transmit the virus, despite being vaccinated, they get glazed looks on their faces. That possibility confuses them.

  13. KFritz

    Did anyone else read the Bloomberg permanent low-level pandemic link and identity the concluding paragraph as Panglossian cheerleading?

  14. Edward

    Russia may have developed a terrific Covid vaccine, CoviVac. RT reported on this vaccine recently:


    …The vaccine is based on the most traditional technology that has been around for a long time and is widely used throughout the world, Aidar Ishmukhametov, the director general of the Chumakov Scientific Center, told RT.

    “Globally, almost 100% of vaccines contain either deactivated or live pathogens,” he said, adding that the one developed by his center contains an ‘inactivated’ (dead) coronavirus. This type of vaccine simulates a natural infection process, introducing the immune system to the virus and “teaching” the body to fight the pathogen without the risk of it spreading through the body and causing disease, he explained.

    …“Since we are talking about a whole-virion vaccine, the deviations in the genetic sequence – something one is calling different strains or different variants – are insignificant and amount to less than one percent. So… it would be weird to think that a whole-virion vaccine might fail to work against new strains, considering how small the differences are,” he said.

    CoviVac received national approval in Russia while still in the second phase of clinical trials. It now has to go through the third phase so the developers can precisely assess its effectiveness, according to Ishmukhametov. However, the first trials have already shown that it has no side effects, he said.

    “The most important thing is that at this point we have a vaccine that definitely has no side effects,” he said, adding that, out of 300 volunteers, none reported any symptoms except for occasional soreness around the injection site.


    Unfortunately, CoviVac probably won’t be available in the U.S.

    1. IM Doc

      I would take that vaccine in a flash if it were available here – and I would be encouraging all around me to do so.

      I do not have the same feeling about our current options – and have wondered why we are not working on something similar to this.

      And you are right – Hell will freeze over before a Russian vaccine is available here. Especially if folks like Rachel Maddow are still allowed on the national airwaves.

      1. Cuibono

        I sure wish i could learn about your more detailed observations about this matter.
        Is it based primarily on the longevity of this approach to vaccination?

      2. ProNewerDeal

        IM Doc, could you opine on adenovirus viral vector type of vaccines in general &/or the Johnson&Johnson vaccine in particular?

    2. fajensen

      I think it is very optimistic to jump from testing on 300 people to claiming “… definitely no side effects”!

      1. Edward

        Admittedly, 300 is less then the thousands that have tested the other vaccines. On the other hand, according to the article, CoviVac uses an old, tried-and-true technique. What I like about this vaccine is it does not have a live component and only uses a dead coronavirus. It sounds less intrusive then the other vaccines.

  15. Edward

    As long as we are discussing U.S. Covid failures, I would like to bring up an aspect of this that isn’t discussed a great deal, namely the U.S. failure to promote international cooperation. The attitude in Washington seems to be their job is not to save lives but to score points against Russia and China, as if we are all five years old. Recently, for example, the U.S. tried to prevent Brazil from acquiring the Sputnik vaccine. Not only is the U.S. not cooperating, it is actually trying to obstruct anti-Covid efforts in other countries that involve Russia or China. Washington actually whines about Russia’s success. I think this hasn’t been discussed much because nobody expects much from the U.S.; the feeling is probably, “What’s new?” However, I think this issue is still worth raising.

  16. MarkT

    Early on in this pandemic, mainstream media latched on to the idea that vaccines would return everything to normal.

    Here in New Zealand there’s been no mention of Sputnik. We are getting Pfizer.

  17. MarkT

    The New Zealand government (bless their dear hearts) is still very cautious of opening up free travel between NZ and Australia. (There’s another community outbreak, this time in Queensland). “Scotty from Marketing” has sent jibes to the NZ government via NZ commercial media re opening up places like Queenstown, which are withering due to lack of foreign tourism. He probably has mates in the tourism business /s.

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