Pioneering physician-journalist Jon Snow wrote in his chronicles, “the disease was a broadcast”, in reference to Cholera, the bacterial disease which ravaged 19th century Victorian London and cities throughout the United States.
While most policy experts focused on the rise in incidence or mortality, Snow noted a commensurate rise in fear that quickly became more influential in how people reacted and in how governments responded.
The government sanitation programs in response to the 19th century epidemic have since relegated Cholera to the history books. But not before influencing the hearts – Love in the Time of Cholera – and the minds – standardized use of intravenous fluid therapy – of the world, demonstrating the power of fear in influencing our collective behavior.
But the fear belies a curious anomaly, that appears most prominently in times of health care crises. The fear appears more severe than the disease itself, and never seems to materialize to the extent we predict. Yet this anomaly persists, crisis after crisis, giving a fascination to our fears. And in modern times, if we replace Cholera with Corona, then we have the setting for a modern romance novel.
When the fear is undefined and the risk unknown, we tend to interpret the problem to be bigger and more extreme than what it really is. With an ensuing response that also tends to be exaggerated. Eventually the exaggerations themselves create new problems.
This is where we find ourselves as we approach the end of Winter 2021 and the anniversary of the first COVID-19 cases. We know the pandemic is getting better, but we are not sure how it will get better.
We see the vaccines are decreasing incidence and mortality, but we are not sure how much they will decrease these metrics.
We see the rise of various variants of the original COVID-19 virus. Some more contagious, some more virulent, all entering our mental lexicon with geographic classifications that will scar our impressions of those countries for years to come. But none of us are quite sure how significant the variants will prove to be.
Some believe the variants will usher new spikes in COVID-19 infections, prompting waves of infections rippling across the world. Others believe the vaccines will curtail most of the worst effects of the variants.
We simply are not sure how the next few months will pan out.
Within this uncertainty we concocted a new narrative for the upcoming phase of the pandemic. Pitting the vaccines against the variants. Assuming the pandemic will be figuratively won or lost depending on how effectively we vaccinate the masses. Alluding to a race between the number of people vaccinated and the amount of mutations allowed to form.
We like narratives that pit us as the heroes against a symbolic villain. Which in this case would be our vaccination efforts against the marauding COVID-19 variants.
The only problem is this might be an oversimplification of how the next few months may really pan out. The key words being the time horizon of months.
As the narrative that pits vaccines against variants conflates the long term precautionary measures we will eventually need to take in order to stave off future pandemics with the more urgent measures we must take in the present.
This is the nature of fear and uncertainty. We assume the problem to be so large that we forget how to address it. So we simplify it.
But in simplifying it, we forget how to truly solve it. Creating ad hoc solutions more out of response to the fear than to the original problem. We welcome the comfortable feeling that the vaccines will magically solve the pandemic, and life will return to normal. We are less welcoming to the reality that the vaccines help against certain aspects of the pandemic only. Help that is much needed, no doubt, but help that is specific to the benefits of herd immunity.
Which are distinct from the COVID-19 mutations – in the short term. We cannot judge the successes of achieving herd immunity through vaccines and compare it to the rate of viral mutations.
The virus will mutate, and we will need additional vaccines in the future. But in the present, we must continue the social distancing protocols to combat the variants. And continue to build herd immunity.
Consider them two distinct, different strategies to fight the pandemic.
In the upcoming months, we must ensure high risk patients continue receiving the vaccine while actively encouraging people to maintain social distancing guidelines. This would include both those vaccinated and those not vaccinated. Emphasizing that the two are mutually exclusive strategies that address two different aspects of the pandemic.
The vaccine ensures there is sufficient immunity in the population, which would reduce mortality and the economic impact of symptomatic COVID-19 complications.
Social distancing ensures we mitigate against the increased infectivity of the variants, which would reduce the symptomatic and asymptomatic spread of the variants.
The vaccines are not designed to address the unique characteristics of the variants and we should stop acting like they should. This diminishes public confidence in the vaccines and gives off false hopes about the true efficacy of the vaccines.
A pandemic is not a single fight.
It is a multi-dimensional battle fought along multiple fronts. One tactic may not be effective against all fights on all fronts.
The vaccines currently available should not be evaluated based upon their success against the variants. They should be compared to the benefits they afford high risk populations who need the vaccine.
Conflating the long term benefits of vaccines with short term risks of the variants simplifies the current issue. Yes, long term we need to develop new vaccines that have broader coverage against more COVID-19 variants. Particularly those that are more evasive to traditional immunological responses. And yes, long term these novel vaccine designs may help against future variants.
But in the moment, in the final days of winter and first days of spring, this comparison is irrelevant. What is relevant is understanding the difference in what the vaccines offer, and how the variants should be addressed.
Over the course of the pandemic we developed robust predictive models to target and localize lockdowns. We know how to target specific locales for social distancing. These are the tools we need to fight the variants – not rushing to give everyone a vaccine.
That is not the battle.
Rushing the pace of vaccinations will divert precious resources away from maintaining lockdowns. And conflates two separate fights into one presumed battle.
One that we will lose.
Instead, we need to reinforce the existing solutions we have, by refocusing the specific solution for the specific aspect of the pandemic we are fighting.
Divide and conquer.
Heatmaps showing opioid sub-epidemics by demography and urbanicity
Total number of deaths in each category from 1999 through 2016 are shown in the upper left corner of each plot. The colors indicate age-adjusted mortality rates per 100,000 people. (Synth Opioids OTM: synthetic opioids other than methadone. This category includes fentanyl and its analogs.)