By Kevin Roche
The human toll of this epidemic has been enormous, but it hasn’t been the virus and the disease ensues from infection that has caused the most harm, it is the self-inflicted global wound of lockdowns and other misguided or just plain stupid mitigation of spread measures. We don’t see it sitting here in the relatively rich United States, but people are starving in poor countries and rates of really bad diseases like tuberculosis and malaria are rising. If we look even in our own country, the mitigation measures have done immense health, economic, social and educational damage.
But if you ignore that for a moment and just try to think about what we are observing and why, this is a fascinating epidemic, which has revealed the shortcomings of traditional infectious disease and epidemiologic thinking and allowed people with greater data analysis and thinking skills to come forward with new models and understanding. The geographic pattern continues to be intriguing and not well understood. What are the exact meteorological or behavioral or even biochemical factors that could explain it? It is interesting to observe the pattern in my neighborhood, the Upper Midwest, and some of the adjoining Rocky Mountain states. It is not the largest population centers that are necessarily making the heaviest contribution to the swell of new cases. It is often the secondary cities or large towns. This suggests two things. One is that population density does play a role, even outside the largest urban areas. And it indicates that in the early and mid-spring wave, the largest cities in these states had enough infections to substantially slow transmission now.
I accept the more sophisticated modeling that finds transmission could be very significantly slowed at infection rates of 20% to 40%, even leaving aside issues of pre-existing immune response. I have made this observation before, but Minneapolis is a good example. We have a large and very active set of business and personal travelers and an airport that has very high levels of traffic. With all the travel in and out of Minneapolis in early 2019, we almost certainly, as the Wall Street Journal article finds, had multiple seedings and a large number of cases before any actions were taken or any real awareness existed. Since these travelers, and their families and frequent contacts, are generally younger and healthier, most infections were almost certainly asymptomatic or mild. Then it got into the elderly population, especially in long-term care facilities, and that is when the serious cases and fatalities became apparent. But because of this, the Twin Cities probably has had enough infections to limit the potential of any “second wave” here.
The other ongoing mystery is the methods and routes of transmission and the hardiness of this virus. I am convinced it has secrets we haven’t unraveled yet; some ability to hide and then almost magically pop up again and start spreading. I wish there were better studies on this topic, both at an individual and population level. Whatever these secrets are, they make a mockery of all our mitigation efforts–stay at home, close the schools, close businesses, ban larger gatherings, social distance, wear a mask (there is a good joke)–nothing really seems to matter, and some likely exacerbate transmission. The notion that the virus can be crushed in contiguous countries on a large continent is laughable. Maybe in New Zealand, for a short time, but only if you literally become a completely isolated island and crush your people’s souls and economy. And you are constantly in fear of re-introduction of the virus.
Go on the internet and look at the videos and photos of people who have traveled to Sweden–no masks, normal shopping, dining and other experiences. I know people tire of hearing me say this, but how sane and smart do they look now, while other European countries still battle high case counts and worry about second waves. I am jealous.
What else do I feel pretty confident about? People who are infected have a durable adaptive immune response and can be removed from the pool of people available for infection and, most importantly, infectiousness. This response is driven as much by T cells as B cells and antibodies and may force a broader re-evaluation of how the immune system copes with infectious agents. And it is very clear that many people’s prior experience with seasonal coronavirus has left them with adaptive immune responses that are at least partly effective at suppressing infection or serious disease from CV-19. That is tremendous good news which most traditional epidemiologists have ignored. Forget the notion of population immunity, just think about what slows transmission, and what slows spread the most is having more people with a lot of contacts having been infected. In many areas of the country we probably have enough people in that category to dampen down truly high levels of transmission.
I think that when the seasonal coronaviruses first jumped to humans there must have been bad epidemics that were unrecognized because at the time, likely hundreds or even thousands of years ago, our understanding of disease was so limited. We developed immune responses, viruses mutate in their reaction, and we see the result. If this were the first coronavirus to infect humans widely, we would be in truly deep doodoo. With our dense population and global connectedness, and no prior immune system experience with this type of pathogen, it would be a slaughter. So we are fortunate that it is a more lethal mutation, not a novel agent.
A truly pan-coronavirus vaccine would be great, but I think most people have a misapprehension about how effective a vaccine can be against a respiratory pathogen. Influenza is the obvious example. Coronaviruses may not yet have the rate of mutations that influenza viruses do, but they obviously in the last 20 years have three times been able to become significantly more lethal, and now, more transmissible. CV-19 will become endemic even with a vaccine and every year there are going to be cases and serious illness. That is the realistic perspective.
One final note, I know not every reader appreciates my rant commentaries, and I understand why. People have different political perspectives and different perceptions of appropriate commentary. I hope people come mostly for the science and data, and obviously the commentary stems from my own perspective on the epidemic and frustration at the stupidity of most government actions. It is unlikely I will stop the commentary, but I don’t intend to offend anyone, and obviously don’t want anyone to stop reading. I also want to assure people that my writing is not politically driven; I try to avoid overt political messaging and I have said before that my main political leaning is to have a very healthy disdain for the complete lack of leadership and intelligence shown by just about every politician. So I will try to warn people when a post is a rant, and those who might not appreciate it, can then avoid that post. My main focus will always be to try to present as much science and data as possible and give readers a big picture sense of what is happening and what may happen. Thank you all again for reading, I truly appreciate it.