Community Insights Opinion The Pandemic

Our Excruciating and Ongoing Dilemma With Covid-19

Governments worldwide face an impossible challenge. The public wants them, expects them, to save them from Covid-19, but there is no way to do that.  

All policy seems based on the certainty that a miracle will occur. The media is focused on a vaccine as that miracle, and there are over a hundred vaccines in development.

However, I have never heard any claims that a vaccine will be more than 70% effective, a level that could lead to genuine societal protection and mass immunity. Most talk is for effectiveness rates of around 50%, though a vaccine may or may not make infections less severe.  We won’t know that for years with any certainty.   I don’t think having a vaccine will result in instant behavior change, and among many of my friends and people I observe, I suspect it will result in no change at all.  This is bad news for the economy.

I would guess the Western world has somewhere around 20-30% too much capital deployed today for our new behaviors–money invested in office space, hotels, transit, etc. There will be a lot of bankruptcies. This will take at least a decade to resolve.  

The number one thing that would enable faster recovery is cheap, rapid testing. The biggest obstacle to that is the medical community and government, because the health authorities want to be involved in every test so they can track the infectivity rate. This is not without merit, but it means that a 10 cent urine strip test which would let everyone test everyday, even if it were available, is not likely to be authorized. But if we did let people test themselves, I think they would be responsible, and that there should be liability or criminal penalties if they knowingly infected someone. Politicians have to fight this, because the medical community is so opposed.

The second thing we need is treatments that minimize the impact of an infection. We recently discovered that there is a second infection path for Covid-19, which may explain why heparin seems like it might be an effective tool to help the body fight infection. This cheap drug, 40 years old, is safe and can be administered by nasal spray. The report suggested it effectively made the virus no worse than the common cold, and is supposedly now going through formal trials in hopes of conclusively demonstrating that. The drug Trump was given, by contrast, may work well for most people if given early, but it is scarce, expensive and more difficult to administer.  

The third thing we need is effective prophylactics. There are nasal sprays (one using New Zealand seaweed) that are in trial. The claims are that it may block an infection for up to 6 hours.  There are new reports, though, that the mouth is also an entry point, so I am not sure such preventive measures will work out.

For humans, precise answers drive out vague answers regardless of the merits of the question.  Here the vaccine is the precise answer that is getting attention and resources. Everyone assumes that it must be something new, though it may turn out that BCG, an inexpensive vaccine used widely against tuberculosis,  or MMR, another vaccine for measles, mumps, and rubella (German measles), may be effective.  At least one study found that BCG stimulates an immune response against Covid-19.

But any successful vaccine will likely be a huge business forever, so everyone wants to own it.  By contrast, existing drugs do not generally have an economic champion.  In the U.S., many if not most top doctors have financial ties to big pharma.  

The problem with lockdowns is that they do not provide a cure.  They postpone the need for effective reliable remedies.

I doubt we will see a complete cure for this virus, ever.  It will become endemic. We will have to learn to live with it.  I am old enough to remember what we had to do with smallpox. We will have to adapt our behaviors to accommodate the risks posed by Covid-19. We will ultimately reduce the mortality rate with both old and new drugs and better treatment, but the virus will be with us forever. A vaccine, even a 50% effective vaccine, will help, if broadly administered. Indeed, I would argue we have proof of that with BCG, a vaccine widely administered to protect against tuberculosis, which appears also to help slow the spread of Covid-19.  However, even in countries with mandatory BCG vaccinations there has been carnage. I think it will be little different for us with a new vaccine.

Every 110 seconds or so, someone dies of Covid-19 in the United States.  That is awful.  But in those same 110 seconds 10 people die of something else.  Covid-19 is the third leading case of death. In the worst of the pandemic 11% of hospital beds were occupied by Covid patients.  The media leaves you thinking it is the leading cause of death by a huge margin, and filling the hospitals.  In the spring when we were putting people on ventilators (and maybe killing them), we had a specific capacity shortage, but it seems that is gone.

What can a government honestly say to its people?  It can say this:

Nature has declared war on us.  The enemy is invisible.  The transmission vector is the air.  We cannot eliminate that.  Our medical community is trying as hard as it can to find a miracle to help us tame this disease, but that miracle may never come.  We can and will get better at treating the disease, but we all will have to change our behaviors to reduce the spread.  Unfortunately, nature has given us a new pathogen that increases the death rate, and unfortunately again we are going to have to learn to live with that too, at least for a while.  Some people are going to be much more vulnerable than others.  We as a people have to make some very hard choices between the risk of death versus less fulfilling lives and economic hardship.  We will have to forge a new social contract.  We cannot live in lockdown forever.”

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