Returning to normal living by leveraging the background immunity of local communities

Last update: Saturday 2/12/22 

Within the last few days, the governors of New Jersey, California, New York, Connecticut, Delaware, and Oregon abandoned mandates that required masks in schools and/or other venues.  Mainstream media quickly flagged their decisions as political rebellions against the Biden administration's mask policies as articulated by CDC guidance, a rebellion that was all the more surprising because these states are among the most highly vaccinated in the nation. Nevertheless, this blog note will argue that Dr. Fauci's notion of "background immunity" suggests that their high vaccination rates may make these states the best role models for other state's striving to provide their residents with science based off-ramps from the pandemic to a new normal.

The blue states that abandoned masks are noted in the following articles.

• "Dropping Indoor Mask Mandate, New York Joins Blue States Easing Covid Rules", Lisa Lerer, Luis Ferré-Sadurní and Astead W. Herndon, NY Times, 2/8/22 ... Lisa  Lerer discussed the findings she and her colleagues reported in this article in a NY Times podcast ("Why Democratic Governors Are Turning Against Mask Mandates. Is this a watershed moment in the pandemic?", The Daily, 2/10/22)
• "Masks Come Off in More States, but Not Everyone Is Grinning", Mitch Smith and Shawn Hubler, NY Times, 2/9/22  

Normal living under seasonal flu (individual responsibility)

During flu seasons there were no mandates, so some people wore masks; most didn't. Some people kept their distance from others in public places; most didn't. Some people avoided large gatherings; most didn't. Some people washed their hands frequently; most didn't. Some got vaccinated; most didn't. Vaccines were not highly effective against new infection, so breakthrough infections commonly occurred; each new season required new vaccinations because the flu virus changed from season to season. Antivirals, like Tamiflu, cured some infections.

• Bottom line ==> 50,00 or more people died each year from seasonal flu, but the survivors (the vast majority) accepted these deaths as the price of normal living.

Background immunity

Now that Covid fatigue has given way to widespread discontent, many people wonder how we can move from treating Covid on an emergency basis to managing it like a seasonal flu within the context of some kind of new normal for the vast majority of the population.

• "Americans Are Frustrated With the Pandemic. These Polls Show How Much.", Nate Cohn, NY Times, 2/8/22 

In a recent podcast interview with the New York Times, Dr. Fauci suggested that a community could formulate its pandemic management efforts within the framework of the community's background immunity. Background immunity is the sum of the immunities gained by the residents of a community from infection and recovery, from vaccinations, and from booster shots. If a community's  background immunity is high enough, then it could abandon most (all??) mandates and rely on appropriate testing and antiviral medications to keep the level of hospitalizations within the limits of the local health care system's access to sufficient medical staff, ICUs, ventilators, etc. 

• The podcast audio for Dr. Fauci's interview with the NY Times, "We need to talk about Covid, Part 2", 1/31/22, can be found ==> Here
  Note: This page contains a link to a transcript of this interview.

Of course it goes without saying that residents of these communities would be free to continue wearing high quality masks (N95s) if they were more risk averse because of concern for themselves or for members of their households who were elderly and/or had compromised immune systems ... and/or for the next few months, their households contain unvaccinated children less than five years old.

In his interview, Dr. Fauci repeatedly underscored his belief that "we were not there yet" on a national level. However background immunity, access to test equipment, antiviral drugs, and available hospital resources (e.g., staff, ICUs, ventilators) would vary from one community to another. Indeed, Dr. Fauci's insistence that we were not there yet as a nation probably reflected his awareness that some of our communities have such low levels of background immunity that would to pull the national average down to unworkable levels. Low levels of background immunity would require more tests, antiviral drugs, and hospital resources than were available in these communities.

But what about the communities with high levels of background immunity? The remainder of this discussion will only distinguish between state and national levels. This should not imply that states with high overall levels of background immunity could not contain regions whose levels were too low to allow them to abandon mandates at this time. Conversely, some states that have low overall levels of background immunity may contain highly immune regions. 

The most appropriate states to pioneer this no mandates approach are the ones that are most highly vaccinated ... AND have adequate access to test resources, antiviral drugs, hospital resources ... and N95 masks for their highly risk averse residents. 

• Bottom line ==>  XXX deaths per year, with hospitalizations as the leading indicators, where the acceptable size of XXX is determined by local political consensus ... not by the CDC or by any other national entity.

New normal leveraged from background immunity (individual responsibility)

The new normal under Omicron (and successor variants that are about as lethal, but more transmissible) should be very much like the old normal in the context of endemic seasonal flu. 

During Covid seasons there will be no mandates, so some people will wear masks; most won't. Some people will keep their distance from others in public places; most won't. Some will avoid large gatherings; most won't. Some will wash their hands frequently; most won't. Most will get vaccinated; but some won't. Vaccines won't be highly effective against new infection (but will be highly effective against severe infections), so breakthrough infections will commonly occur; each new season will require new vaccinations because the Covid virus will change. Antivirals will cure some infections if caught within a few days of infection.

However, if any successor to Omicron is more transmissible than Omicron but substantially more lethal, then all bets are off ... :-(

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Links to related notes on this blog:

• "Background immunity" -- A new pandemic management goal suggested by Dr. Fauci", Last update: 2/1/22