What the Next 18 Months Can Look Like, if Leaders Buy Us Time
Sweden has become an international outlier in its response to the deadly coronavirus outbreak by keeping schools open and adopting few other restrictions, as the Scandinavian nation embarks on what one health expert called a “huge experiment”.
“There is no right or wrong way," Ostergaard said. "No one has walked this path before, and only the aftermath will show who made the best decision."
There is very little we can do to prevent this spread: a lockdown might delay severe cases for a while, but once restrictions are eased, cases will reappear. I expect that when we count the number of deaths from COVID-19 in each country in 1 year from now, the figures will be similar, regardless of measures taken.Measures to flatten the curve might have an effect, but a lockdown only pushes the severe cases into the future —it will not prevent them. Admittedly, countries have managed to slow down spread so as not to overburden health-care systems, and, yes, effective drugs that save lives might soon be developed, but this pandemic is swift, and those drugs have to be developed, tested, and marketed quickly. Much hope is put in vaccines, but they will take time, and with the unclear protective immunological response to infection, it is not certain that vaccines will be very effective.
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How common is reinfection?
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What implications do reinfections have for vaccine prospects?
In an ideal world each defensive layer would be intact. In reality, however, they are more like slices of Swiss cheese, having many holes—though unlike in the cheese, these holes are continually opening, shutting, and shifting their location. The presence of holes inany one “slice” does not normally cause a bad outcome. Usually, this can happen only when the holes in manylayers momentarily line up to permit a trajectory of accident opportunity—bringing hazards into damaging contact with victims
In the absence of sterilising immunity, what effect might SARS-CoV-2 vaccines have on the spread of a virus through a population? If asymptomatic infections are possible after vaccination, there has been concern that SARS-CoV-2 will simply continue to infect as many people as before. Is this possible?
“They should wear masks until we actually prove that vaccines prevent transmission,” said Dr. Anthony S. Fauci, director of the National Institute for Allergy and Infectious Diseases.
Post-immunization cases, sometimes called “breakthroughs,” are very rare and very expected.
Even with vaccination efforts in full force, the theoretical threshold for vanquishing COVID-19 looks to be out of reach.
It’s unclear whether vaccines prevent transmission Vaccine roll-out is uneven New variants change the herd-immunity equation Immunity might not last forever Vaccines might change human behaviour
COVID-19 vaccines being rolled out in the UK are effective in preventing severe disease, but the extent to which they prevent against infection is still unclear. First modelling study looking at relaxing control measures (eg, mask wearing, physical distancing, and lockdown measures) and planned vaccination rollout in the UK suggests that vaccination alone may not be enough to prevent the spread of infection - with the R number estimated to be 1.58 even if the vaccine prevents 85% of new infections occurring, after vaccine rollout is complete and all other control measures are removed. Relaxing control measures is highly likely to lead to another wave of infection, but gradual reopening, high vaccine uptake, and a vaccine with high protection against infection can minimise the scale of infections, hospitalisations, and deaths. As restrictions are eased and infections grow, although vaccination will reduce the total number of COVID-19 deaths significantly, there are likely to be deaths in people who have been vaccinated, as no vaccine offers 100% protection.
"The advantage of avoiding another pandemic wave is clear: less so-called long COVID-19, less quarantine, fewer deaths, and reducing the impact of the pandemic on societies and economies. Finally, more infections mean more scope for the spread and evolution of escape variants, which risk a major setback for any vaccination strategy, so avoiding this eventuality will be crucial."
Telling everyone to wear masks indoors has a sociological effect. Grocery stores and workplaces cannot enforce mask wearing by vaccination status. We do not have vaccine passports in the U.S., and I do not see how we could. Places can either say “wear a mask regardless” or just accept that people who don’t want to wear one will not.In the early days of the pandemic it made sense for everyone to wear a mask, not just the sick — as the C.D.C. and the World Health Organization were recommending — if only to relieve the stigma of illness. Now, as we head toward the endgame, we need to apply the same logic but in reverse: If the unvaccinated still need to wear masks indoors, everyone else needs to do so as well, until prevalence of the virus is more greatly reduced.Even if the only people not protected by the vaccines were those hesitant to use them or who had false beliefs about them, public health principles would not allow us to say that any threat to their health is their problem, at least not while the virus is still spreading at substantive levels. Infectious diseases create risks for others.There are those who are not yet vaccinated because they haven’t managed to navigate the process, or have started late, or are concerned because of bad experiences with the medical establishment. The immunocompromised remain vulnerable. Even if the unvaccinated were all conspiracy theorists and dead-end anti-vaxxers, we would need to take virus levels into account before discounting the risks even to them.Plus, Covid-19 can still terribly burden our health resources, especially in those areas that still have many unvaccinated adults.The C.D.C. guidelines are essentially implying that the risk that the vaccinated will transmit the virus to others, including their unvaccinated children, is so vanishingly low that it is not worth worrying about. But if that’s their position, they should state it clearly and explain it, not just say that “fully vaccinated people have a reduced risk of transmitting” the virus.And is the expectation that the unvaccinated will all simply go with the guidance and stay masked? That does not fit with what we’ve observed in this country over the past year, especially with the ongoing polarization over these questions.
AbstractSweden was well equipped to prevent the pandemic of COVID-19 from becoming serious. Over 280 years of collaboration between political bodies, authorities, and the scientific community had yielded many successes in preventive medicine. Sweden’s population is literate and has a high level of trust in authorities and those in power. During 2020, however, Sweden had ten times higher COVID-19 death rates compared with neighbouring Norway. In this report, we try to understand why, using a narrative approach to evaluate the Swedish COVID-19 policy and the role of scientific evidence and integrity. We argue that that scientific methodology was not followed by the major figures in the acting authorities—or the responsible politicians—with alternative narratives being considered as valid, resulting in arbitrary policy decisions. In 2014, the Public Health Agency merged with the Institute for Infectious Disease Control; the first decision by its new head (Johan Carlson) was to dismiss and move the authority’s six professors to Karolinska Institute. With this setup, the authority lacked expertise and could disregard scientific facts. The Swedish pandemic strategy seemed targeted towards “natural” herd-immunity and avoiding a societal shutdown. The Public Health Agency labelled advice from national scientists and international authorities as extreme positions, resulting in media and political bodies to accept their own policy instead. The Swedish people were kept in ignorance of basic facts such as the airborne SARS-CoV-2 transmission, that asymptomatic individuals can be contagious and that face masks protect both the carrier and others. Mandatory legislation was seldom used; recommendations relying upon personal responsibility and without any sanctions were the norm. Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives. If Sweden wants to do better in future pandemics, the scientific method must be re-established, not least within the Public Health Agency. It would likely make a large difference if a separate, independent Institute for Infectious Disease Control is recreated. We recommend Sweden begins a self-critical process about its political culture and the lack of accountability of decision-makers to avoid future failures, as occurred with the COVID-19 pandemic.
