This Disease is Complicated and There are No Simple Answers.

Lockdowns – No Lockdowns

Masks – No Masks

Vaccinations – No Vaccinations

Many people take the stance that: _____ (fill in the blank) “works” or doesn’t “work.”

The COVID pandemic has tested all societies. It has been over 100 years since the Spanish Flu and we seem not to have the institutional memory necessary to deal sensibly with a pandemic. Austria, for example, has just gone back into lockdown, despite having 64% of its population fully vaccinated.

Make no mistake – COVID is a big deal, even for low-risk populations. With a mortality rate of approximately 1%, if we took no precautionary measures, the death toll in America would reach about 3.3 million and total of nearly 80 million worldwide. And it isn’t just deaths that we should concern us. Here is an excerpt from an email I recently received from a seemingly health colleague in his 40s.

Just wanted to drop in and catch you up on my status.  I was in the hospital for 2 weeks and have been home now for 3 weeks.  I’m fully recovered as far as being sick, but have some damage to my lungs that is inhibiting my breathing.  I’m weaning off oxygen and starting to move around, trying to build back some stamina, but by most accounts it’s going to take several weeks or even months to get back to normal.  I’m able to work mostly full time now. 

Virtually all countries have been underserved by their public health departments. The basic problem seems to be that we are trapped in a political vortex of either/or thinking.

In the US, a most unfortunate example occurred right at the outset of the pandemic when Dr. Fauci lied, saying masks were unnecessary, when he was really trying to ensure there were enough masks for healthcare workers by misleading the public. He then flip-flopped to say that mask requirements were mandatory. To this day he defends misleading the public presumably because he believes he knows better than the citizens and that we should just do what he says no matter what. Had he simply been honest, people may have listened to him more carefully, instead, we have a culture war over his pronouncements.

As more data emerged over masks, Fauci massively oversimplified (there are different types of masks with vastly differing efficacy) to imply a duality – masks work/don’t work. The reality is that different types of masks provide different levels of protection. However – no mask provides 100% protection. This left the mask mandates open to debunking rather than informing the public of the varying levels of protection that different masks could provide.

More recently, our government has resorted to Big Bird propaganda rather than giving our citizens a full factual picture of the data, including likelihood of transmission by children, broken down by age, and the risk of myocarditis in children. Perhaps the “experts” in our government believe that the citizenry has the intelligence of toddlers.

The debate over vaccines follows the same pattern – do they work, yes or no? Ever since the breakthrough outbreak on Cape Cod this summer, it has been obvious that the vaccines do not provide 100% protection. We need to have an honest discussion of the vaccines’ waning efficacy over time. This is a biological fact, proven by studies in Israel, the UK and by the Veterans Administration. England is wrestling with breakthrough cases among fully vaccinated adults in their 40s, where 2.1% have tested positive, largely with unvaccinated high school age children in their homes. New data shows that there have been 1.89 million breakthrough cases in the US, out of the 195 million fully vaccinated (just under 1%), with 72,000 hospitalizations and 20,000 deaths, mostly among people with co-morbidities.

The public dialog on vaccines became – why get vaccinated if they don’t work – versus you need a booster every six months or you can’t go grocery shopping. Instead, we should be focusing on the degree of protection provided by vaccines, not only from infection, but from serious illness/hospitalization, how that protection changes over time, and informing the public about the risks and benefits of booster shots. 

One also might wonder why the CDC chose to call it a COVID vaccine rather than a shot. Flu shots are technically vaccines, but we call them shots as distinct from other vaccines, such as measles or smallpox, because we need a new one every year. This choice of words has contributed to public confusion.

Health officials have also taken the seemingly absurd position that COVID survivors, who have developed natural immunity, must be vaccinated – despite evidence that natural immunity is 13 times stronger than vaccinations. Where is the open and honest public debate based on evidence?

Remember all of the discussions about the Sweden avoiding lockdowns? If we revisit the data, we find that Sweden did suffer far more excess deaths than Denmark (which had strict lockdowns) early in the pandemic, but since May 2021, Denmark has had more excess deaths than Sweden. 

It will be interesting to see how this plays out by the time the pandemic is over. Since COVID is now endemic, it seems likely that everyone will be exposed at some point in time. How will Australia and New Zealand fare with their strategy of shutting off the world? Will China be able to contain the pandemic with rolling lockdowns? Time will tell.

The pandemic is not over, but at last we have hope on the treatment side with Pfizer’s COVID pill shown to reduce hospitalizations and deaths among symptomatic patients by 89% and Regeneron’s Antibody drug, which cuts the risk of covid by 82% for the immunocompromised.

The bottom line is that we have multiple lines of defense against COVID and some work better than others depending on the circumstances. New technologies continue to emerge that change the risk calculus. Unscientific, one-size-fits-all mandates that view the cost of a single death as infinite, while ignoring all of their other externalities (including other adverse health effects, mental health, and economic costs) is a poor way to make our way through the pandemic. We all have an interest in minimizing the damage from COVID, but we do not all have identical circumstances. Public health officials should work harder to deliver and explain the facts, and less on propagandizing oversimplified solutions. In addition, the public would be well served to admit that this disease is complicated and there are no simple answers.

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