Just tellin’ it like it is COVID-19 Series #3: When is it really over?
Note: This is a repost of my original LinkedIn article published on November 26, 2020.
We finally got some good news on the several positive COVID-19 vaccine results these past few weeks. Although I am skeptical that the lofty effectiveness levels will hold in the real-world, vaccine rollouts will nonetheless turn the chapter of this miserable book towards a more hopeful narrative.
All the while, I keep getting asked when it will be over. Everybody has their own hopeful guess. But will COVID-19 really be over when the vaccines arrive?
Just like that?
Will we be able to proclaim sometime in late 2021 or 2022 that SARS-CoV-2 is no longer a threat to humanity and COVID-19 is but a tragic memory?
(Disclaimer: This is an analytical series, yes, but healthcare is far from a rational subject. Being mindful that I wish to maintain an apolitical stance (“just tellin’ it like it is”), healthcare is something that everyone wishes deep down to be free in time of need but also one of the most lucrative industries in the world due to its essentially infinite demand. (Another pandemic, anyone? And never count out the incredible ability/stupidity of humans to reliably inflict self-harm))
In order for any infectious human disease to be eradicated – like over, over - the only pathogen reservoir must be humans. This was the case for smallpox and the reason polio is also on its way out. Unfortunately, SARS-CoV-2 does not fit this bill.
Details are still being investigated, but the consensus is that SARS-CoV-2 started out from animals but somehow jumped to humans. Now the virus has found another comfortable brooding ground in minks, mutating like business as usual. So this sucker is not going away. Ever. And yes, perhaps it may mutate itself out of contention, but just as Ebola and bubonic plague occasionally rear their ugly heads up here and there, humanity now has another permanent thorn in our side.
So then what? When is it over?
The way I see it, this is where the basic, instinctual cruelty of humanity crosses with natural psychological desensitization.
Some facts first: None of you will be surprised if I tell you that tuberculosis and diarrheal diseases are among the top 10 causes of death globally (2016; source: WHO), but how many of you knew that influenza and/or pneumonia rank 7th in the US, 6th in Canada, 6th in the UK, 3rd in South Korea, 2nd in Singapore and 3rd in Japan (source: respective official national sources) and have been a fixture on top 10 killer lists for at least a decade?
The amazing part? All of these developed countries have influenza vaccination programs and also have pneumonia vaccines approved and available. Flu and pneumonia are incredibly simple to prevent too. Just look at the incidence rates right now (late Dec. 2020) in the thick of COVID-19 with all the restrictions and mask mandates in place, compared to the previous season. Do you know what this means? It means that we, as a society, chose to passively let die hundreds of thousands of people year in and year out in exchange for “normal” lives. We just never realized it. How could we interpret these facts any other way?
That, my dear audience, is also the same point when COVID-19 will be considered over. It will be over at a point when SARS-CoV-2 becomes a known quantity and deemed a controllable risk. It is over when we have enough dead bodies under our belts and the warm fuzzy feeling of vaccines in one hand and a treatment in another, when we finally gain an evidence-based understanding of how many people will suffer and die in the future.
It will be over when we have a death prediction.
The majority of humanity unconsciously but willingly decides at some point that the risk-benefit is tipped towards writing off deaths like an offering to the gods – acceptable attrition, if you will – in exchange for once again pursuing prosperity. From that point on, most of society will pat itself on the back every year the death toll improves and spare no blame at government and drug companies if the number ticks up. Meanwhile, countless front-line healthcare workers and families continue to be utterly heartbroken and devastated every time a patient, a loved one, a real life is lost.
To be fair, before COVID-19 I didn’t think twice about the inevitability of catching the flu or pneumonia. Any parent that rushed to the ER with their fevered toddler in arms can attest that there was rarely a feeling of rage or blame. Rather, there was a sentiment of bad luck and a whole lot of worry. Heck, it was only a few years ago that I was bracing to lose one of my children from a particularly bad infection that required emergency surgery. But it had never crossed my mind that the risk of catching a bug could be mitigated any further without being labeled OCD. The norm was the norm, just like tossing literal shit on the streets or painting homes with lead was the norm before we slowly realized they weren’t all that great of ideas after all.
We all say COVID-19 exposed and accelerated so many underlying issues. The way we approach respiratory infectious diseases is no different. We have unintentionally proven that flu and associated pneumonia incidence can be crushed. No, I do not think lockdowns, movement restrictions and mask mandates should continue beyond what is absolutely necessary. But we are ever the cunning and greedy bunch. Now that we know we can, I think we can figure out another practical and profitable way to replicate the current success of influenza and pneumonia suppression. Anything has got to be better than playing Russian roulette with dear grandma’s life during the next holiday family gathering.
Death is inevitable. Unless it is preventable. Knowledge is power. Now that we have established that we can, we need to start thinking of cost-effective ways of emulating our current achievement (silver lining, people) especially since the roster of deadly respiratory pathogens just added its newest member. We need to do it not only to get over COVID-19 and return to normal but also to simultaneously improve outcomes with our familiar foes of flu and pneumonia.
Better is better, after all.
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