We have to prepare to accept victory over COVID-19 and move on
Karol has done an exceptional job depicting the harm caused by unscientific and arbitrary COVID-19 restrictions (especially as it relates to school closures). She is now raising alarms about the fact that even with a highly safe and effective vaccine being deployed, there’s a reluctance to acknowledge that things should swiftly return to normal.
Indeed, even as Dr. Anthony Fauci warns that vaccine hesitancy is going to be the major barrier to achieving herd immunity, he’s out there saying things that reduce the incentive for people to get vaccinated.
"There are things, even if you're vaccinated, that you're not going to be able to do in society," Fauci said in a White House briefing. "For example, indoor dining, theaters, places where people congregate. That's because of the safety of society."
The media has gotten the message, publishing a steady stream of articles downplaying the vaccine by suggesting that it should make no difference to human behavior.
“You’re fully vaccinated against the coronavirus — now what?” NBC reported recently. “Don’t expect to shed your mask and get back to normal activities right away.”
In reality, this is completely the wrong approach, especially given that we’re a few months away from having the opposite problem that we have now. That is, we’re going to have an abundant supply of vaccines and more than 100 million reluctant people who will need to be convinced to take them. For those indifferent to or skeptical of the vaccines, underselling their effectiveness and removing the reward for getting vaccinated is going to be a huge barrier to achieving the 85% vaccination rate that Fauci has most recently been pushing.
It's true that a 95% effective vaccine isn’t the same as a 100% vaccine, and there has not been significant testing as to whether vaccinated people who become exposed to the coronavirus can transmit it. But the vaccine down players are overemphasizing low-probability events while ignoring the big picture.
Even though a small percentage of people can get fully vaccinated and get COVID-19, virtually nobody with both doses has become severely ill, has required hospitalization, or died.
In fact, even the Johnson and Johnson single-shot vaccine (which at 72% efficacy in the United States., is less preventive of infections than Moderna and Pfizer), was 100% effective at preventing hospitalization and deaths.
Furthermore, for all the fears about variants making vaccines useless, Johnson & Johnson proved 64% effective in preventing moderate to severe COVID-19 in South Africa. That’s still more effective than the typical seasonal flu shot.
In addition, while inconclusive, early evidence out of Israel, which has the highest percentage of its population vaccinated, is suggestive that the vaccines also reduce the likelihood of transmission of the virus.
As some stubbornly refuse to accept that an end is within sight, it is worth remembering how far the goal posts have shifted.
In the early days of the pandemic, we were in an untenable position. It was too late for foreign travel restrictions to make much of a difference, we didn’t have the capacity to implement a sophisticated testing and tracing regime, and masks were in short supply. Also, there was very little understanding of how the coronavirus spread and the best way to treat it.
Given that the disease was highly contagious, and while harmless to most, deadly to others, it created a multi-dimensional challenge. We’ve all been forced to consider the individual element, the social element, and the government element.
The individual element pertains to people’s own assessments of their risk of getting severe COVID-19 relative to their desire to engage in certain activities. The social element refers to individuals’ desire to reduce the likelihood that they may unwittingly infect others who are more vulnerable than they are. The government element refers to policies imposing restrictions on human behavior.
The complex interaction between these different elements is one reason that it’s so hard to talk about whether lockdown policies “worked.” The reality is that some people started scaling back activities weeks before government restrictions kicked in, and many won’t engage in activities such as movie-going or indoor dining even where they are permitted to. On the other hand, in some places with harsher lockdown policies, people have been willing to skirt coronavirus restrictions and guidance based on their own risk assessments. In other words, there's a distinction between lockdown policies and the extent to which people are locking down.
In the early days of the pandemic, there was some recognition that the government was taking extraordinary and draconian measures to close down schools and businesses as a last-ditch effort. At the time, we were told that there was no way we could prevent COVID-19 from spreading widely and from killing people, but we needed to impose lockdown policies for just a few weeks. Doing so, public health officials hoped, would “flatten the curve.” This meant that the inevitable infections would be spread out over a longer period of time so that at the peak, hospitals didn’t become so overwhelmed. The experience from Italy was that once the medical system collapsed and people didn’t have access to critical care, the rate of deaths skyrocketed.
This should have created a natural limiting principle on government action. That is, government would take extreme measures to avoid a systemic collapse, but once that was not at risk, those measures could be removed, and we’d return to people making decisions based on their own individual risks assessments and social conscience. But we ignored this limiting principle. Instead, we migrated into the mindset in which restrictions wouldn’t be lifted until we met some sort of arbitrary and constantly shifting standard of safety.
As problematic as this approach was, the idea of maintaining restrictions with hundreds of millions of vaccine doses becoming available in the coming months is far more troubling.
Pretty soon, everybody over 65 will have had the chance to have obtained a vaccine that is near perfect in preventing hospitalization and death. This population has accounted for over 80% of deaths during the pandemic. On top of this, medical professionals will have had vaccine access as well as those with medical conditions that make them more vulnerable.
At that point, there will be no realistic risk that the hospital system is going to collapse with a flood of COVID-19 patients. And those who are most susceptible to severe COVID-19 will enjoy the protection of a vaccine if they want it.
To review, the three elements discussed above, at this point, there would be no justification for any government restrictions. And there is no reason for individuals to consider the social element in determining their behavior. In normal times, whenever people hop in a car, they are risking a freak accident that can kill somebody, and whenever they leave the house during flu season, they risk spreading a potentially deadly infection to somebody else.
Thus, if you eliminate the government element and social element, we’re just left with the individual element. People who are more nervous about COVID-19, even after getting vaccinated, can continue to take whatever precautions they feel are necessary. But there is no justification for imposing restrictions on others.
It’s worth recalling that very early on in the pandemic, the Imperial College of London released a highly influential and controversial report. It said that if nothing were done in response to COVID-19, the baseline was that 2.2 million Americans could die of COVID-19. The only way to reduce that number, the study argued, was through sustained lockdowns. However, the study said that such policies “will need to be maintained until a vaccine becomes available.” In other words, we’re now entering a precarious phase in which public health officials and the media are sending signals that we have to go beyond what was once considered the most draconian approach possible.
As even Fauci himself has acknowledged at times, he is not the “end all.” That is, it is his job to give advice about public health, and he is focused on getting infections down to as close to zero as possible. We can debate how effective he has been in that role and how good his advice has proven. But regardless, Fauci’s role is to be myopically focused on COVID-19. Actual policymakers and individuals have to take into account his advice and balance it against other personal and societal priorities.
People need to recognize the difference between low-probability events and zero-probability events and also stop thinking myopically about COVID-19 to the exclusion of everything else that is important. Lockdowns have destroyed businesses, exacerbated mental health issues, increased suicides, led people to defer preventive healthcare, deprived children of education and socialization, and placed a back-breaking burden on working parents.
Arguing that such policies are necessary in the short-term to prevent millions of deaths is one thing. Arguing that such policies are necessary in the long-term to prevent the low probability that somebody vaccinated can infect somebody else who has a 99% chance of survival even if infected and unvaccinated is quite another. Let's accept victory over COVID-19 and move on.
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