Entering Year Four of the Pandemic
And without changes we're probably on track for year five
We’re now entering the fourth year of the pandemic. Yes, the pandemic is still with us; a pandemic being, per the CDC, an increase, often sudden, in the number of cases of a disease (COVID-19 in this case) above what is normally expected, that has spread over several countries or continents, usually affecting a large number of people. As of this posting, it’s estimated at least 3,380 people are still dying every week in the U.S. from COVID-19. If that rate were to continue (and U.S. C19 death rates have been relatively consistent since May of 2022), 2023 total numbers would be just shy of 176,000 people. That would make it the fourth leading cause of death in the U.S. using 2020 CDC numbers. So, yeah, still with us.
Recently Eric Thomas, the director of the Kansas Scholastic Press Association, provided a retrospective of the pandemic in the Kansas Reflector, looking at what the month of January foretold for each year, starting in 2020. His looking ahead for 2023 was subtitled January 2023: The Hope, but to me the tone of this section suggested more resignation than hope. The medical professionals quoted discussed the chronic nature of the disease at this point, and how it’s going to be a challenge moving forward. I think their tone of resignation is understandable given the lack of collective efforts to control transmission. I tried to lay out some of the underlying reasons for these challenges in a previous post focused on mask wearing.
The start of the new year being as good a time as any, I decided to look at where we are relative to a few aspects of the pandemic. I hope public health officials, government leaders from local to federal levels, our higher education and pk-12 institutions, and businesses will do the same. Because there are implications here for maintaining healthy and productive workforces as well as protecting our most vulnerable over the next few months (and potentially longer than that relative to long COVID). But given the resignation and challenges alluded to above, I’m not overly optimistic this will happen, at least to the level needed.
Currently a new subvariant from the Omicron family - XBB.1.5 – has taken hold of the northeast and is beginning a rapid spread across the U.S. Fairly soon it will most likely be the dominant subvariant in the U.S. Per my understanding of what some experts are saying, the data suggests it’s both inherently more infectious and more immune evasive than previous subvariants (so any recent infection from other subvariants, certainly any infection prior to a few months ago, likely won’t provide you much protection against this subvariant).
There is some indication that it isn’t any more deadly than previous subvariants from the Omicron family, but more data is needed to verify. From a vaccination perspective, you probably need the latest bivalent booster to have any significant vaccine immunity against this subvariant. Here’s a recent twitter thread update from Dr. Ashish K. Jha, White House COVID-19 Response Coordinator:
If you want to dig into more of the details, I recommend Dr. Eric Topol’s recent twitter thread:
and substack post (though by the time you read this, there will likely be more up to date information):
In December, many public health officials (including the CDC), epidemiologists, virologists, medical doctors, aerosol scientists, etc., began more strongly calling for a return to masking indoors in public to address the tripledemic of COVID, flu, and RSV, driven in part to reduce the stress on our healthcare system, and public education system to a lesser degree (though flu and RSV cases are now down). They are still recommending this as the new year starts (particularly with XBB.1.5 spreading).
I’ve seen discussions regarding the potential for COVID infections to reduce the effectiveness of our immune system to fight off other infections, which may be another contributing factor to the institutional stresses (hospitals, schools, workforces, etc.) we’ve seen over the fall and winter. In other words, holding everything else equal, you’re more likely to contract another infection like the flu after recently having COVID (and be more sick as a result) compared to not having contracted COVID to begin with. Some experts, though, think this may only apply to individuals with serious COVID infections.
We still have much to learn about the long- and short-term impacts of COVID on our physiologies, but what keeps coming out continues to reinforce the importance of avoiding it. The more repeat infections you have, the greater your chance of ending up with other long term physiological complications, impacting your quality of life, your healthcare costs, and your productivity. And multiplying these impacts nationally and globally, we start to see very real, very negative impacts to our workforces and economy.
In my previous post on mask wearing, I mentioned an August 2022 article from the Brookings Institute that then estimated as many as 4 million workers were likely out of work as a result of long COVID, translating to $230 billion in lost U.S. earnings or nearly 1.4% of the total U.S. gross domestic product. That number rises to $544 billion when the economic burden associated with the lower productivity of people working while ill, the associated patient healthcare costs, and the lost productivity of caretakers is included. Unless those with long COVID start recovering at faster rates (and/or we do a better job of limiting transmission), these numbers will only grow (as they likely have by now).
I also laid out a modeling example from a specific federal organization of 261 employees, housed in one building, that indicated if employees were brought back to the office without addressing the COVID risks present (relative to BA.5 at the time), they could have an annual loss in productivity of 1.0% to 1.8% of their annual payroll. And that was a really conservative estimate. Regardless of the level - individual, organization, or society - the picture COVID paints isn’t pretty.
Outside of the U.S., China is currently experiencing significant COVID transmission. Its current surge of cases, due in part to its abrupt reopening, less effective vaccines, and low vaccination rates in general, is worrying obviously due to the humanitarian and economic impacts. But its also pretty concerning relative to the increased risk of more infectious, more immune evasive, and/or more deadly variants or subvariants evolving. And this is a risk from ongoing transmission in general. As I’ve written elsewhere, “by not limiting transmission we are in fact leaving things to chance (with the odds decreasingly in our favor the longer high transmission rates continue), potentially letting evolution take us to where we don’t want to go.”
This brief review of where things stand as we start 2023 suggests we should be expending more collective effort to limit transmission instead of primarily relying on individuals taking actions based on personal assessments of their own risk. And the measures available to us are generally still the same. We need to more rapidly improve building ventilation and filtration, increase vaccination levels, monitor waste water and testing at the community level, and continue improving both access to, and use of, individual rapid tests and high efficiency respirators. Masking is needed indoors in public (and likely in some crowded outdoor conditions) when transmission rates are high or rising.
We’re not talking about lock-downs, or closing restaurants, or remote learning, or virtual only conferences (though it’s also important that schools not bear the brunt of controlling transmission). Instead, to limit the negative impacts to our workforces, economies, and our most vulnerable, as well as the likelihood of dealing with worse variants, it would be prudent for us to collectively learn how to accept the flexible, local implementation of mask mandates when community transmission rates warrant them (though that also requires more widespread infrastructure for community monitoring). Otherwise January 2024’s COVID outlook may look much the same (or worse).