Dr. Fauci and "loose" American vs. "tight" Chinese strategies for "ending" the pandemic

Last update: Monday 5/2/22 

Most people have heard about Dr. Fauci's comments on the PBS "News Hour" a few days ago that we were “out of the pandemic phase”. He edited these misleading words on NPR the next day to a more correct rephrasing that we were “out of the full-blown explosive pandemic phase”. Yes, we are ... assuming, of course, that the virus doesn't develop more transmissible variants that evade our vaccines and are more lethal. In a subsequent interview with the Washington Post he commented that “We’re really in a transitional phase, from a deceleration of the numbers into hopefully a more controlled phase and endemicity”. Yes, "controlled phase" being the key words.

• "U.S. no longer in ‘full-blown’ pandemic phase, Fauci says", Joel Achenbach and Bryan Pietsch, Washington Post, 4/27/22 

The American gospel of "herd immunity"

Readers will recall that back in 2020 the Trump Task Force and the CDC preached a dogma that went something like the following:

• Our fundamental goal must be to save as many lives as possible from the virus
  
• If people become severely ill they must be treated in hospitals
• So we need to slow the spread of the virus, i.e., reduce the number of new people getting infected each week. This will prevent our hospitals from becoming overwhelmed
• Various  mitigation procedures -- wearing masks, maintaining social distancing, frequent hand washing, avoiding large groups, isolation, quarantine, and lockdowns -- will impede the spread of the virus until we develop highly effective vaccines
• Only a small percentage of the people who are vaccinated with highly effective vaccines will become become infected.
• When a high enough percentage of the population becomes vaccinated, we will achieve "herd immunity". At that point, only a few more people will become infected, so we can stop mitigating and go back to normal living.

The criteria we actually specified for approval of vaccines were more modest; we only required that vaccines be highly effective in preventing severe illness; they were not required to prevent new infections. In other words, we were never trying to eliminate all infections, hospitalizations, and deaths.

Breakthroughs under Delta and then Omicron cancelled herd immunity

The Delta variant's sudden rise to dominance in the summer of 2021 entailed a substantial percentage of so-called breakthrough cases, i.e., infections of persons who were fully vaccinated. Herd immunity was no longer possible. 

• "Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings — Barnstable County, Massachusetts, July 2021", CDC, 7/30/21   

Worse still, when the super transmissible Omicron variant become dominant in late December 2021, breakthrough cases became the norm. Vaccines and booster shots were now repositioned to being our most powerful forms of mitigation. Other mitigations, like masks, distancing, and quarantine had to be invoked from time to time.  Our new de facto goal became the substantial reduction of severe illness and death while we learned to live with continuing endemic levels of infection. This is where we are today.

• "Omicron will infect ‘just about everybody,’ Fauci says", Andrew Jeong and Ellen Francis, Washington Post, 1/12/22  
• "Omicron’s impact better measured by rising hospitalizations than cases, Fauci says", Bryan Pietsch and Jennifer Hassan, Washington Post, 1/3/21  
• "As Omicron Crests, Booster Shots Are Keeping Americans Out of Hospitals", Apoorva Mandavilli, NY Times, 1/21/22 

Note that the development of highly effective antiviral medications has greatly reduced the significance of new infections. Although most antivirals must be administered within a few days after infection, some new antivirals promise to become effective treatments after infection has become severe illness. 

• "F.D.A. Clears Pfizer’s Covid Pill for High-Risk Patients 12 and Older", Rebecca Robbins and Carl Zimmer, NY Times, 12/22/21 
• "New Drug Slashed Deaths Among Patients With Severe Covid, Maker Claims", Roni Caryn Rabin, NY Times, 4/11/22  

And beyond all treatments, a high percentage of our population has become boosted and/or infected; so there is sufficient background immunity in our society to anticipate that future surges in infections won't disrupt our lives like the surges in past months. All of these considerations in the context of President Biden's COVID.gov with "Test to Treat" initiatives support Dr. Fauci's guarded optimism that we are on the verge of controlling the impact of the virus.

• "The Coronavirus Has Infected More Than Half of Americans, the C.D.C. Reports", Apoorva Mandavilli, NY Times, 4/27/22 *** 

The Chinese gospel of "Zero Covid"

Whereas the U.S. has "lived with" thousands of COVID deaths per month throughout the pandemic, the Chinese government has imposed a zero tolerance "zero COVID" policy almost from Day One. Its official goal has been no infections, so no deaths.

Whereas the U.S. is fast approaching an ominous one million deaths from COVID, the Chinese have only reported 15,122 deaths to the World Heath Organization as of 4/30/22. There is considerable reason to doubt that China would be able to report such an incredibly low figure for a country whose population is ABUT four times as large as the population of the U.S. if it were applying the same counting methods as employed by the U.S. Perhaps a U.S. type count would be ten times as high. But given the brutal mitigations, especially the prison style lockdowns of millions of people from time to time that have been imposed by the Chinese government compared to the relatively toothless mitigations recommended by our government, reasonable minds would have to expect much, much lower deaths per 100,000 people in China compared to COVID deaths per 100,000 in the U.S. 

The U.S. has counted on the rapid development and deployment of highly effective vaccines to provide our ride back to zero infections, beginning with the Trump administration's successful Operation Warp Speed. By contrast, the Chinese government, whose vaccines are much less effective than ours, has always relied on the imposition of the harshest mitigations. Here's a representative set of links whose headlines tell the tales:

• "Over 100 Million in China’s Northeast Face Renewed Lockdown", Bloomberg, 5/18/20
• "Wuhan Tests Millions in 12 Days as China Fears Second Virus Wave", Bloomberg, 5/26/20
• "Beijing’s Partial Lockdown a Sign of the World’s New Normal", Chris Buckley and Keith Bradsher, NY Times, 6/13/20
• "China Reports Biggest Virus Spike Since End of Wuhan Outbreak", Bloomberg, 7/26/20
• "Facing New Outbreaks, China Places Over 22 Million on Lockdown", Steven Lee Myers, NY Times, 1/14/21
•  "Ravaged by delta outbreak, Southeast Asia shifts away from China’s vaccines", Shibani Mahtani, Washington Post, 8/10/21  
• "Near-Daily Covid Tests, Sleeping in Classrooms: Life in Covid-Zero China", Vivian Wang and Joy Dong, NY Times, 11/5/21 
• "Surge of Omicron Infections Prompts Lockdowns in China",  Keith Bradsher, NY Times, 3/14/22 
• "China’s economy pays a price as lockdowns restrict nearly a third of its population.", Alexandra Stevenson, NY Times, 4/14/22  
• "Shanghai’s covid siege: Food shortages, talking robots, starving animals", Lily Kuo, Lyric Li, Vic Chiang and Pei-Lin Wu, Washington Post, 4/15/22
•  "Covid Outbreak in Beijing Prompts Order for Nearly Citywide Testing", Keith Bradsher and Chris Buckley, NY Times, 4/25/22 
• "China’s Covid Lockdown Outrage Tests Limits of Triumphant Propaganda", Vivian Wang, Paul Mozur and Isabelle Qian, NY Times, 4/27/22
• "Under Lockdown in China", Agnes Chang, Amy Qin, Isabelle Qian and Amy Chang Chien, NY Times, 4/29/22  
• China, "Inside China’s Zero-Covid Fortress, Xi Admits No Doubts", Chris Buckley, NY Times, 5/1/22  

Whereas Dr. Fauci has reason for guarded optimism about the U.S. gaining control of the impact of the virus, the last seven 2022 headlines just listed provide reason for guarded pessimism about the Chinese government's capacity to maintain control.

____________________________________

Links to related notes on this blog:  

• "Putting six million lives lost to Covid into perspective", Last update: 3/9/22
• "Undercounts at the COVID Olympics", Last update: 4/18/22