How This Ends. (The Pandemic)
realscience.community
realscience.community
There still hasn't passed enough time for us to make confident statements about immunity in patients who recover from acute COVID, not to mention make grandiose plans, either as a state or as a society of individuals.
A popular blog post or article circulated earlier, plotting very simple mathematical models of infection numbers based on some assumptions about the durability of immunity. But even without visual aids, mathematical intuition suggests that widespread immunity of short duration would lead to a relatively high constant number of new cases, with relatively frequent small waves. In contrast, widespread immunity of longer duration, on the order of a year or two, would lead to lower background level of infection, punctuated by larger, more severe, less frequent outbreaks, made worse if they are seasonal and coincide with the flu.
And these are assumptions, things we don't know. Which of these scenarios should we be making grand, nationwide plans for?
We saw a definitive report about an asymptomatic case of reinfection. That patient managed to get tested twice, despite being reported as asymptomatic the second time. Both times, the viral genome was sequenced, which is why we now believe this is a case of reinfection.
In the US, this patient would likely not have been tested at all. Should we update our expectations about the incidence of reinfection?
Are there differences in humoral and mucosal immunity to COVID? I don't think we have consensus yet. Do asymptomatic carriers infect others? We have some evidence that they do. Other diseases can be spread by asymptomatic carriers. As an extreme example, Typhoid Mary was a real historical figure who infected hundreds over a lifetime.
In this context, suggesting that we ship our most elderly and medically fragile members to some kind of COVID-free zone is... staggeringly whimsical.
How big a factor is this in the numbers? If the numbers are unreliable, what does this do to your assumptions?
> Don't you think if this was really occurring frequently there wouldn't be only one or two reported incidences of this world-wide?
The patient we think was reinfected was reported to have a mild case in the spring. The US, at the time, had extremely limited access to tests for anyone except the grievously ill. It is likely the patient would not have received a test in the US, and certainly not had the infection genome-sequenced.
The second time the patient tested positive, he was asymptomatic. The CDC currently recommends against testing asymptomatic individuals. It is likely that, in the US, the patient would once again not have received a test.
Basically, the US tests sparsely and doesn't seem to test longitudinally on any scale at all. Does any country in the world with more than a few thousand cases test longitudinally?
If anything, I think it's more telling that this patient was identified in Hong Kong, which only has 4.5 thousand cases total. Finding seemingly ironclad evidence in such a small pool suggests that this isn't a rare phenomenon.
> And this "do nothing" approach you are advocating for- which is what happens if you wait until everything is fully and definitively proven- has resulted in the disastrous results the US has had so far.
On the other hand, let's maybe hold off on jokes about sending Grandma to New Orleans? The photo of the elderly woman wearing sparkly bangles is the joke, but I think your suggestion right before that, that "we could send the highest risk people to the places that are the most immune so they could be shielded" is made seriously, right? Like, even moving an individual, medically fragile, institutionalized elderly person leads to complicated and often negative outcomes in the best of times, simply because of the complex and fragile support systems their well-being relies on. Shipping "the highest risk people" en masse and organizing care for them seems dramatically more complex than, again, following through on testing and mitigation strategies that we, as a state, have been paying lip service to for months now.
I'm after pointing out that a self-promoted site on the front page makes grandiose claims about public health with flimsy support.
This is the reason there will be second, third, Nth, waves with a mere 20, 30% immunity
-BUT- I think to get there, we are going to need some serious education on this matter that actually penetrates the politics that have grown to dominate the pandemic. I don't think most people see it as "containment vs keep clam and hope everything is okay." Opting instead to see it as r-v-l.
To be clear, I don't blame anyone for thinking in those terms, that is the narrative being presented. That said, I do ask that any theory hinging on "people are able to handle nuance" provide some evidence for the claim that can be directly applied to the now. In a world where individuals leer at each other for not wearing masks in wide open outdoor spaces, while others yell inside of Walmart about the constitution, it is hard to have belief in that claim.