The "End" of the Pandemic

We seem to be trudging on and on and on.  We do not know how to find our way to the post-COVID trailhead.  We are without direction and without a guide.  We have given up, it seems, the game of speculating about the post-COVID world.  The new world.  There is nothing to write about, it seems, and no one is writing.

But we do know two things about the post-COVID world.  Two dimensions, out of many - or maybe only these two, plus the old world, will make up the new.

First, we know that the new world will contain COVID-19, because we have made so many stupid mistakes over such a long time that the virus will become endemic and it will be with us always, killing and damaging us to an extent that will still not be extreme enough to teach us some useful lessons.  One more deadly disease - but this one, for the first time, perhaps ever, has divided us in a way that may make it impossible for us to bring what we know about public health to bear.  Good luck with that, new world.

Secondly, the new world will contain long COVID.  A certain proportion of those who have contracted the virus - even those who showed no symptoms - will suffer a wide variety of physical and neurological conditions that do not sound like a lot of fun.  We're still learning about long-COVID, but the CDC is in no doubt that it is real.  Here's their list of known effects: 

• Difficulty breathing or shortness of breath
• Tiredness or fatigue
• Symptoms that get worse after physical or mental activities (also known as post-exertional malaise)
• Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
• Cough
• Chest or stomach pain
• Headache
• Fast-beating or pounding heart (also known as heart palpitations)
• Joint or muscle pain
• Pins-and-needles feeling
• Diarrhea
• Sleep problems
• Fever
• Dizziness on standing (lightheadedness)
• Rash
• Mood changes
• Change in smell or taste
• Changes in menstrual period cycles

No one gets all of them, but no one gets just one or two, it seems.  And there are those who begin to experience organ damage due to an inappropriate auto-immune response - the autoimmune system begins to attack healthy cells in healthy organs, causing inflammation or tissue damage; affected are "heart, lung, kidney, skin, and brain functions."

And that's not to mention - if your COVID journey has led you to the ICU - the PTSD.

I feel like I've done this math before, but here goes.  Long COVID affects between one third and one half of all COVID patients, both symptomatic and asyptomatic.  So - let's say 40%.  If you don't like that number, you can do your own math.

As of this writing, according to Worldometer, 245,567,943 people worldwide have had COVID-19.  Forty percent of that is just under a hundred million.  In the US, those numbers are 46,502,517 and about eighteen and a half million.  Only four states have a population of more than eighteen and a half million.

So the fifth largest state in the US will be completely populated by people who will probably qualify as disabled and will have trouble getting and keeping a job, because of neurological and physical issues resulting from their - possibly asymptomatic - cases of COVID-19.

The only good news is that we don't know how long a case of long COVID lasts.  It hasn't been long enough to do the necessary research.  If everyone gets over it in a year, I guess that's a consolation.

So: the new world.  Endemic COVID and long COVID.  Long-term victims of a virus that will continue to produce long-term victims.  No wonder no one wants to write about the "end" of the pandemic.  

Watching Africa

It turns out that one thing the new world will contain, to my surprise and everyone's delight, is a vaccine for malaria.  “The World Health Organization has recommended the widespread rollout of the first malaria vaccine, in a move experts hope could save tens of thousands of children’s lives each year across Africa.”

Most of us are not familiar with the cost of malaria, almost exclusively paid by the children of Africa.  After a very long life of reading non-fiction, I know only that it is a subtle horror, transmitted by mosquitoes, that sucks the vitality and promise out of generation after generation of Africans.

Wikipedia tells us:

When properly treated, people with malaria can usually expect a complete recovery. However, severe malaria can progress extremely rapidly and cause death within hours or days. In the most severe cases of the disease, fatality rates can reach 20%, even with intensive care and treatment.  Over the longer term, developmental impairments have been documented in children who have suffered episodes of severe malaria. Chronic infection without severe disease can occur in an immune-deficiency syndrome associated with a decreased responsiveness to Salmonella bacteria and the Epstein–Barr virus.

During childhood, malaria causes anaemia during a period of rapid brain development, and also direct brain damage resulting from cerebral malaria. Some survivors of cerebral malaria have an increased risk of neurological and cognitive deficits, behavioural disorders, and epilepsy. Malaria prophylaxis was shown to improve cognitive function and school performance in clinical trials when compared to placebo groups.

Over 400,000 people died of malaria in 2019, the vast majority of them in Africa.  And over 270,000 of them were children under five years old.  Children can become re-infected quickly - often as many as four times in a season - and many of those who survive are likely to suffer neurologic damage and cognitive difficulties for the rest of their lives.

So that's what's at stake.  Give a precise regimen of anti-malarial medications plus the vaccine, "there was a 70% reduction in hospitalisation or death."  What could a few generations of genuinely healthy Africans achieve in the new world?

And isn't it ironic that a vaccine for this one-continent, parasitic disease, that has been 30 years in the making, may change the landscape of the new world in a more significant way than our miracle COVID vaccines that will eventually overcome the pandemic?

I can't wait to watch Africa for the next decade.

And Some Good News

And now, perhaps some unalloyed good news.  It looks like, in the new world, if you can't make antibodies, then antibodies will come to you.

As we all (should) know by now, vaccines have worked by introducing a safe measure of the disease into our bloodstreams, and our immune system has produced antibodies to fight it.  The antibodies stick around for however long they stick around, and then we get another vaccination.  When the real disease invades us, as my doctor said today, "Surprise!  We're ready for you!"  

It seems that there are a group of people who are immunocompromised enough that their immune system is not strong enough to produce a therapeutic level of antibodies.  But today, AstraZenaca has requested emergency use authorization (EUA) from US regulatory bodies for a new drug - AZD7442 - that has been shown in studies to prevent COVID in folks who can't make their own antibodies from a vaccine.

While vaccines rely on an intact immune system to develop targeted antibodies and infection-fighting cells, AZD7442 contains lab-made antibodies designed to linger in the body for months to contain the virus in case of an infection.

AZD7442 has been shown to be 77% effective (which isn't bad overall; we've been spoiled by the 90%+ effectiveness of COVID vaccines) in "reducing the risk of people developing any COVID-19 symptoms."

Pretty good.  If your immune system isn't strong enough for vaccines to do any good, we've got a pill for you!  It can also be used as a booster in certain situations.  

The vision of COVID as endemic in the new world continues to develop.  There may be reason for cautious optimism regarding the impact it will have on our lives in the future.

Good News/Bad News

The good news is that there's good news.  The bad news is that I don't believe it.  Or, more accurately, I don't believe that it will last.

Two articles I've read recently have great news about the new world.  One focuses on the economy.  It features the most naively hyperbolic headline I've seen in a long time:  "America Fought the Pandemic Economy - And Won."  No exclamation point, so that's a blessing.  And it's in Axios, so - a pinch of salt.

We're told that there have been great gains made in employment, wages and household wealth.  "Stimulus checks lifted nearly 12 million Americans out of poverty, according to new census data this week. Government programs also saved millions of people from losing their health insurance, even as millions lost their jobs." 

All great stuff.  But this was predictable and predicted.  A quick and unsurprising recovery from a very unusual recession (I always wondered if we should have another name for it) brought about by a return to consuming and an array of Federal and state stimuli and other financial assistance achieved their goal:  to get through the pandemic without completely wrecking the economy.

Axios' assumption (in the construction of the headline) that the pandemic is over notwithstanding, this is an incomplete picture, at least as regards the definition of the new world.  There is no evidence that any of these economic markers will continue in the positive direction they've taken so far.  Every one of them is artificially supported, and as soon as the stimulus checks stop coming, the rent moratoria all expire, as well as the temporary healthcare supports, and the labor market settles down (thus allowing corporations to once again easily fill positions paying less than a living wage), it'll look a lot like 2019.  So - let's wait a year or two to see where we actually are.

The second piece lets us know that "a new UCLA-led study decisively confirms findings of research published earlier this year, which found that American values, attitudes and activities had changed dramatically during the COVID-19 pandemic."  Those changes have apparently affected a wide variety of our social functioning:

For example, according to the survey, people said that compared with pre-pandemic times, they are now more likely to be growing and preparing their own food, conserving resources, demonstrating less interest in financial wealth and showing greater appreciation for their elders. The researchers found all of those shifts are a function of Americans' increased focus on survival and their isolation during the pandemic.*

The study also found that during the pandemic parents expected their children to help out around the home—for example, by cooking for the family—more than they did before the pandemic.

Wow.  Without knowing it, out of nowhere, we're becoming good people!  Who knew?  Time to check the research methodology.

The earlier research (Februrary of 2021) relied on "Google searches and phrases posted on Twitter, blogs and internet forums." Dr. Greenfield's current research "is based on a survey of 2,092 Americans—about half in California and half in Rhode Island."

Ah.  Social media and a survey. No direct observation of behavior, or analysis of outcomes or nationwide trends.  Research done without having to leave your office.  

To be fair, the authors note that these characteristics will "shift back to pre-2020 norms once the pandemic is more fully under control. But they note that might not be true for people in their 20s and younger, whose values are likely to be more permanently shaped by the events of the past two years."  So maybe there's some hope after all.

 Unfortunately, neither of these findings are likely to tell us much about the new world, as great as they sound.  We've still got a long way to go.

 * - The author, Dr. Patricia Greenfield of UCLA, senior author of both studies, compares these qualities to "those found in small, isolated villages with low life expectancy—such as an isolated Mayan village in Chiapas, Mexico, that she has studied since 1969."  The common factor?  The aforementioned "increased focus on survival," and isolation.