The coming uneven, messy, confusing end of the COVID pandemic

Last Update: Saturday 2/27/21

Today's media are abuzz with talk about the light at the end of the long pandemic tunnel, a sighting enabled by the widespread distribution of multiple vaccines. Unfortunately, our exit from the pandemic will probably be as uneven, messy, and confusing as our entry. Why? Because our current roster of medical policy advisers are misapplying the same national framework that caused their predecessors under President Trump to call for a national lockdown in March 2020 when there were fewer than 20 thousand known cases in the entire country, and those cases were located in just a few states.

Unlike cold weather fronts that can dump inches of freezing snow on every state from the West coast to the East coast, or powerful one hundred miles-per-hour hurricanes that can devastate every state on the East coast from Florida to New York, the coronavirus pandemic is always a slow moving local phenomenon because it mostly spreads via face-to-face encounters within local communities.

Our ragged entry into the pandemic via face-to-face interactions
The coronavirus sees the U.S. as a pool of 330 million potential victims grouped into thousands of clusters. Clusters are composed of people who regularly interact with one another on a face-to-face basis. The virus travels from contagious members of a cluster on the slow and gentle breezes of their exhalations to the inhalations of uninfected potential victims in the same cluster  It sometimes jumps from infected clusters to uninfected clusters when contagious members travel by car, plane, or foot from infected clusters to uninfected clusters. 

It only makes sense to describe the pandemic in terms of national statistics when there are many highly infected clusters in every state. At all other times, lower level statistics -- state, county, and city -- are far more informative. Indeed during these non-peak time frames, national statistics are likely to be highly misleading and may suggest ineffective pandemic management policies for lower level communities.

Current thinking still places the origin of the virus in Wuhan China, so it was not surprising that the first U.S. cases were detected on the West Coast, in the  states of Washington and California. However the volume of passenger travel between the tri-state New York-Connecticut-New Jersey region and Europe is far greater than passenger travel between the West Coast and China. That's why the tri-state region became the U.S. epicenter for the virus soon after it appeared in Europe. It quickly spread from cluster to cluster in this, the most densely populated region in the country. It also jumped from the tri-state region to a few other urban areas, especially on the East Coast, to which the region had strong business and social ties. Conversely, its migration to inland urban and rural areas was much slower, so much slower that for many weeks and months some of the residents of those states honestly believed that the virus was a hoax because none of their friends and associates had contracted the virus, nor had any of the friends and associates of their friends and associates. Their disbelief is discussed in another note on this blog:

• "Trump supporters who reject masks and other mitigations are not stupid and/or crazy." Last update: 11/18/20

Our ragged exit from the pandemic via herd immunity

Just as the virus did not infect every state at the same time, so too herd immunity will not be achieved by every community at the same time. Herd immunity will be achieved cluster by cluster, city by city, county by county, and state by state. The immunity of a community -- a state, a county, or a city -- equals the percentage of the community that has been vaccinated and/or infected by the virus. Note that each member of a community should only be counted once even if they were infected and vaccinated. It should also be noted that some experts suggest that the number of people in a community who have been infected is actually three or four times as many as the number who were tested and were tested positive due to extensive asymptomatic spreading.

Dr. Fauci recently revealed that he estimates that at least 90 percent of a community will have to be immune before the community achieves herd immunity:

• ''How Much Herd Immunity Is Enough?", Donald G. McNeil Jr., NY Times, 12/24/20

If we look at statistics at state, county, or city levels, we should expect to find the highest levels of immunity in states, counties, and cities where a high percentage of the population has tested positive AND a high percentage have been vaccinated. Conversely we should expect to find the lowest levels of immunity in states, counties, and cities that have the lowest percentages of infections and vaccinations. Communities having other combinations will fall somewhere in between. 

This framework suggests that the communities that were most heavily infected during the coronavirus surges will be the first to attain herd immunity if they also vaccinate a high percentage of their residents. The highly immune states, counties, and cities will exhibit sharply declining positive tests, hospitalizations, and deaths before comparable declines are experienced by other states, counties, and cities.

Unfortunately, as highly immune communities exhibit low virus activity, the national statistics that summarize virus activity in all of the nation's communities might show no decreases, or perhaps may still show increasing activity. Nevertheless, the governors, county executives, and mayors will recognize their communities' achievements and may begin to remove social mitigation restrictions before these removals are endorsed by the president's medical policy advisers who might still be fixated on national statistics.