Policy junk -- Old COVID policies overcome by new data

Last update: Thursday 9/30/21

A previous note on this blog referred to the "fog of war" to describe the conundrum faced by pandemic managers who must make important judgement calls based on unreliable data. Another martial insight also has unfortunate relevance for our mishandling of the COVID pandemic: 
"fighting the last war". Significant new variants have become new enemies with new advantages. But at times, our pandemic managers have continued to press old policies even when data about the new variant has signaled the start of a new kind of war that must be waged with new policies. This note considers two examples. In 20-20 hindsight one was understandable;  the other was an unforced error. 

1. Infected persons are only contagious after they develop symptoms

People who became infected in previous respiratory epidemics, e.g., seasonal flu, were not contagious until they displayed symptoms of their illness, e.g., coughing, fever, etc. So President Trump's task force and the CDC initially assumed that the same would be true for the coronavirus; this was a reasonable judgement call; but it was wrong. Acting on this judgement, they initially limited the use of our relatively scarce test kits to persons who were symptomatic. 

To their credit, the task force and the CDC immediately changed their testing policies upon learning the first of many surprises that the original coronavirus and its successor variants would pose. People who were infected were contagious a few days before they showed any symptoms. Worse still, some people never developed any symptoms, but they were as contagious and for as long as those who did develop symptoms.

2. We can achieve herd immunity

By the end of 2020, significant coronavirus variants began to appear that were substantially more infectious than the original variant that had been dominant in the U.S. since the start of the pandemic. Fortunately some remarkably effective vaccines were approved during this same time frame. The vaccines were also highly effective against the new variants in preventing hospitalizations and deaths. However the appearance of these variants warned us that we had to vaccinate as many U.S. residents as possible in order to achieve herd immunity. If we took too long, newer variants might appear that might evade our vaccines.

This optimism was questionable in the context of persistent vaccine hesitancy that reflected the nation's deep partisan divide, a divide the erupted in a seditious attack on Congress in January whose purpose was to halt the counting of votes that would transfer power from President Trump to President-elect Biden. Registered Republicans were as firm in their rejection of the vaccines as they were in rejecting the legitimacy of Biden's presidency. Experts who were politically astute acknowledged that these divisions posed insurmountable obstacles to our vaccinating the required very high percentage of our population required to achieve herd immunity. 

• "Reaching ‘Herd Immunity’ Is Unlikely in the U.S., Experts Now Believe", Apoorva Mandavilli, NY Times, 5/3/21 ... Podcast of Mandovilli discussing her article and why she wrote it, The Daily, 5/7/21

Unfortunately, most of our pandemic managers clung to the illusion that herd immunity was still achievable. The optimists were so encouraged by our initial success in vaccinating almost half of our population that President Biden and the Director of the CDC encourage everyone to celebrate the July 4th holiday as our independence from the virus by abandoning most mitigation procedures

• "Vaccinated Americans May Go Without Masks in Most Places, Federal Officials Say", Roni Caryn Rabin, Apoorva Mandavilli and Noah Weiland, NY Times, 5/13/21 

The highly contagious Delta variant suddenly became dominant during this time frame and generated huge surges in hospitalizations and deaths in the weeks following July 4th in most states, especially in the GOP states in the South. However the most disturbing outbreak occurred in Provincetown, Massachusetts, wherein 70 percent of the 900 infections were Delta breakthroughs.  

• "‘It’s Nowhere Near Over’: A Beach Town’s Gust of Freedom, Then a U-turn", Ellen Barry and Beth Treffeisen, NY Times, 8/1/21
  
  
• "How Provincetown, Mass., stress-tested the coronavirus vaccine with summer partying and delta", Hannah Knowles and Randy Dotinga, Washington Post, 8/5/21

In other words, herd immunity is not just unlikely; it's impossible. Unvaccinated persons will not be "protected" if they are surrounded by breakthroughs. Breakthroughs would not nullify herd immunity if they really were, as the CDC has claimed, "rare" or only a small percent of new infections. However the large cluster of breakthroughs in Provincetown and in the other communities noted in the following links undermines claims of rarity or small percentage. 

• "More than 200 staff members at 2 San Francisco hospitals have tested positive, most in breakthrough Delta infections.", Eduardo Medina, NY Times, 7/31/21 
  
  
• "Cruise Passenger Dies From Covid, Testing Industry Plans", Ceylan Yeginsu, NY Times, 8/23/21 ... Note: the passenger was vaccinated
  
  
• "COVID-19 Cases in Fully Vaccinated Individuals", Massachusetts Department of Public Health, 9/14/21 .
  ..
• "‘We Are a Complete Outlier’: HBS Moves Some Classes Online Amid Covid-19 Outbreak", Claire H. Guo and Christine Mui, Crimson Staff Writers, The Harvard Crimson, 9/28/21 ... Note: HBS = Harvard Business School ... All students, faculty, staff, and researchers must be vaccinated

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Related notes on this blog:

• "Protecting ourselves as our 18 month pandemic fades into a "forever" endemic", Last update:  9/12/21