When will we return to normal living? With a few critical improvements on President Biden's COVID.gov page, we're almost there

Last update: Sunday 4/10/22 

Maybe our communities are on the verge of returning to normal living via  background immunity plus  tests and antiviral medications easily accessed via COVID.gov

Herd immunity against infection

Back in the day, before Delta, breakthrough cases were so rare that persons who were fully vaccinated could live their lives without masks or other mitigations for many months without fear of being infected again. In those bygone times, herd immunity was achievable in principle. If a high enough percentage of the population of a community was fully vaccinated, then the small percentage of unvaccinated persons in the community would be surrounded by fully vaccinated persons who were immune. 

An infected "stranger" would have difficulty finding the vulnerable unvaccinated persons during the few weeks during which he or she was contagious because they would be "hidden" behind "walls" of immune vaccinated persons. Over time, however, the efficacy of the vaccines would fade; herd immunity would be eroded until booster shots were administered. 

Background immunity against severe illness

Unfortunately, so many people in this country refused to become vaccinated that achieving herd immunity was never more than a remote possibility, a remote possibility that was cancelled in mid 2021 by the sudden rise of the more transmissible Delta variant. 

Delta increased the occurrence of breakthrough cases, i.e., infections of fully vaccinated persons, from rare to substantial; so breakthroughs could infect unvaccinated persons, instead of protecting them. The far more transmissible Omicron variant that followed Delta in December 2021 amplified the occurrence of breakthroughs to the point that they became the norm. 

• "Most Covid Infections May Soon Be Breakthroughs. Here’s What That Means.", Eleanor Cummins, NY Times, 12/19/21

The good news about our highly effective vaccines under Delta and Omicron was that they remained highly effective in preventing severe illness -- which was their fundamental purpose. So Delta and Omicron maintained the attainability of a different kind of immunity that Dr. Fauci would later call "background immunity" in an interview with the NY Times.

• 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: The linked page also contains a link to the transcript of this interview.

Background immunity is the sum of all of the immunities that the members of a community have acquired by vaccinations, boosters, and recovery from infections. Whereas herd immunity protected unvaccinated persons from becoming infected, background immunity protects a community's hospitals and other healthcare facilities from becoming overwhelmed by severe COVID infections because severe illness from COVID would be rare occurrences in communities whose background immunities reached very high levels. 

Back in 2020 our communities opened a toolbox of social mitigation practices to prevent our health care facilities from being overwhelmed by severe COVID. We had hoped that highly effective vaccines would allow us to close the toolbox, i.e., return to normal living. Ironically, the emergence of breakthrough variants meant that we had to add vaccines to our toolbox, albeit as our most powerful tools. So now we redefine "normal living" to mean mitigated living without invoking our most odious tools, which for most people means no masks and no lockdowns.

Background immunity + tests + antiviral meds

Suppose that only 70 percent of the members of a community were fully vaccinated and boosted? Would the community's healthcare facilities be overwhelmed by severe COVID cases? The answer would depend on the size of the community's healthcare resources. Wealthy communities would probably be OK, but less affluent communities might be challenged. 

At this point we should assume that background immunity is more or less fixed in most communities. Why? Because there's not much reason to hope that enough unvaccinated members could be persuaded to finally take the jabs that would raise background immunity to high enough levels, high enough to sufficiently reduce the burdens that large future surges might impose on healthcare resources.

Fortunately, the same biosciences that gave us highly effective, game changing vaccines have also given us highly effective, game changing antiviral medications that should soon become the second most powerful set of tools in our toolbox. 

• "Pfizer’s Covid Pill Works Well, Company Confirms in Final Analysis", Carl Zimmer and Rebecca Robbins, NY Times, 12/14/21 

For good or for ill, ours is a pill-popping culture. The bad news is our catastrophic addiction to opioids; the good news is that we should anticipate little or no resistance to anti-covid pills. The most strident anti-vaxxers will barely grumble. "Just give me a couple of pills, Doc, and I'm good to go." If most of the  newly infected persons swill the pills shortly after they test positive, the vast majority of these pill-poppers won't become severely ill, so our hospitals and other healthcare facilities won't be overwhelmed. 

President Biden issued the following tweet on Wednesday 3/30/22: "Today, I announced a one-stop to get any and everything you need to deal with COVID ... Go to COVID.gov ... All the information is there." The subsequent announcement of the implementation of the President's one-stop "Test to Treat" initiative means that  COVID.gov now provides easy access to the two most powerful tools we have to control the virus: highly effective vaccines and highly effective antiviral medications.  

• "One-stop Test to Treat", HHS, 4/5/22 

Unfortunately, the Devil is hiding in a couple of unknown knowns:

• First, are Pfizer's antiviral pills highly effective for all subgroups of the population? This is a legitimate question, given Pfizer's failure and the failure of the CDC and the FDA to recognize in late 2020 that the original Pfizer and Moderna two shot vaccines failed to provide adequate protection for the most vulnerable groups, i.e., persons who were immunocompromised and persons who were 65 and older.
  
  
• Second, what happens if a new variant arises that is more transmissible than Omicron and substantially more lethal?

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Links to related notes on this blog:  

• "U.S. Pandemic Who's Who ... and what's what", This news page is updated on Fridays.
  
• "Omicron Defense", This news page is updated on Wednesdays and Thursdays.
  
• "Returning to normal living by leveraging the background immunity of local communities", Last update: 2/12/22
  
• "In praise of COVID.gov, Lord of the Game Changers!!!", Last update: 4/6/22