Updated 3.10.2021
One of my first posts was What to do in a pandemic? At the time I posted in October, we were about 7 months into the Covid-19 pandemic, and things were a mess. I got most things right, and we have some clarity about some other things. I also got some things wrong. So here are the clarifications and corrections. I will leave the original blog post here so you can read it if you like.
I was right in general about the characteristics of the virus and risk of infection and death. These are things that science had already confirmed. We know now that mortality due to Covid-19 is 10 times higher than for influenza, and the hospitalization rate is also 10 times higher. I was right about the risk of travel. Community surveillance has shown that travel, including staying in a hotel is high risk. We also know that new variants of the virus have been spread around the world and around the country because of travel. Community surveillance has also shown that getting together in groups spreads infection, regardless of hygiene and social distancing in those groups. Some of it is because you cannot really practice social distancing in a group. There are too many chances to break the rules. In terms of rates of transmission, Covid-19 is again not like the flu. One person with the flu may result in transmission to about 50 other people over two months through community spread. One case of Covid-19 is likely to result in the infection of more that 2000 people through community contact. In addition, you have the problem of asymptomatic spreaders, who don’t know that they should not even be with a group. That is a result of the longer asymptomatic incubation period of Covid-19. As a result, you have higher rates of infection associated with visiting a restaurant or a grocery store, even if you try to follow hygiene and social distancing recommendations.
Because of surges after the holiday periods, we were able to confirm that the number of cases would begin to rise about 10 days after an event, and then because of continuous community spread, surges last for about 2 months.
Community surveillance has confirmed the benefit of wearing masks. This is no longer just a theory. It appears that wearing a mask may not only keep you from spreading an infection, but may also protect you from infection – especially if you double mask. So, there is no excuse for not wearing a mask in public.
I believe that I was right about keeping schools closed. Knowing what we know about Covid-19, there is no reason to put anyone at risk in a group setting for up to 8 hours (remember that we know that spread occurs in groups even if they are practicing hygiene and social distancing). We do not need to risk 2000 additional infections because one child went to school with no symptoms. Again, the focus and the money should be in getting kids back to their grade level once this pandemic is over.
I also believe that I was right about unnecessary testing. We spent a lot of money on community testing that accomplished nothing positive. It did have negative effects. A negative test gave individuals a false sense of security, when the test may have been a false negative. They may then have gathered in groups or traveled spreading the infection. There were also some who used the rate of positive tests as a marker of the rate of spread in the community. This marker is completely unreliable when you do not know the characteristics of the people being tested, or that the group tested on one day was in any way similar to the group tested on a different day. The positive test rate should certainly not be used to guide public health recommendations.
Happily, what I really got wrong was the timing and speed of Covid-19 immunization. I commented before that the Food and Drug Administration had been doing a tremendous job approving new drugs during the pandemic. This is probably because the FDA is full of scientific-minded, obsessive-compulsive perfectionists. They are clearly immune to political persuasion. I was surprised at the speed by which the FDA granted emergency use authorization for the Covid-19 vaccines. I was also surprised that the FDA approved the use in the entire adult population, not just those at high risk. This is not something that scientific-minded, obsessive-compulsive perfectionists usually do. There was a risk of unproven safety with these new vaccines. But I would agree that the safety risk was overcome by the seriousness of the pandemic.
Finally, vaccine manufacturers really came through by committing resources to vaccine production. And finally, the Biden administration has helped by actually creating and executing a plan for vaccine distribution. I think that the vaccine manufacturers could have probably done this on their own, but we are finally on track in any case.
We are not done yet. We need to keep restrictions in place until all high risk individuals are vaccinated, and until the community transmission rate allows for effective contact tracing. Be respectful of others and wear a mask. Read Pandemic Update 3.
Waterloo to Austin 