Three years into the Covid19 pandemic, we have heard from many public health experts that the ultimate goal for protecting ourselves was to reach herd immunity. Now we realize this is virtually impossible due to emerging variants and the relatively short protection provided by both vaccines and natural infection. What have we learned as we have endured Covid 19? We are seeing multiple variants many of which are highly transmissible but have progressively become less virulent.
Is Covid19 endemic? Not really since we are not in a steady state of infections but certainly Coronaviruses have been with us for decades waxing and waning. What seems now a realistic goal is to maximize vaccination which when combined with natural infection has led to 95% of the population with some degree of immunity. Normally this degree of population penetration would provide herd immunity but as noted variants and short duration of immunity have made this impossible.
We have become comfortable with yearly influenza variants and yearly vaccination with deaths ranging from 20K to 60K per year and it seems likely we are moving in that direction with Covid19. It is clear we need to focus our public health resources on the most vulnerable at the highest risk of significant morbidity and mortality. One of the unknowns moving forward is the extent and natural history of long covid19 symptoms. There are many similar conditions which seem likely to be post viral syndromes such as chronic fatigue syndrome and myalgic encephalomyelitis. More research is needed into these conditions with remarkably similar symptoms. Tragically some have categorized these conditions as psychosomatic when the real answer remains unknown.
Note should be made of the highly disparate public health approach of the USA and China toward containing Covid19. China adopted a zero covid policy and invoked draconian measures including population based quarantine/lockdown with severe impact on personal freedoms. The result for China just over 5000 deaths nationwide with a population around 1.4 billion while in the USA a much more laissez faire approach with non pharmaceutical intervention has had well over one million deaths with a population of around 330 million. Which approach is correct is hotly debated but the societal norms and tolerance of central governmental directives is widely divergent. Is the freedom to avoid regional lockdowns worth the loss of over one million citizens?
The pandemic highlights a host of public health debates and the fundamental differences in the relationship of the individual to the government. The philosophical underpinning of the social compact warrants analysis and reflection. Hopefully we have learned much from the tragedy of Covid19 and will be prepared for future public health challenges
Contact Nicolas Argy MD JD at nargy @nicolasargy.com
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