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March 16, 2023

Why We Can’t Wipe Out COVID and Flu

And why that shouldn’t have been a surprise.

The facts (as known today)

The speedy development of the mRNA vaccines for COVID was a great accomplishment; the vaccines saved many lives and even more hospitalizations. What they did not do is provide herd immunity; they did not drive COVID out of the general population the way that vaccines for polio and smallpox have done for those diseases. Even if every human had been vaccinated as soon as the vaccines were developed, COVID would still be with us. Similarly, even if we all had contracted COVID last year, we’d still be at risk this year.  Here’s why:

  1. Viruses like flu and COVID evolve very rapidly and their effectiveness survives many mutations. The polio virus mutates more slowly (1986 study) and almost all its mutations destroy its ability to penetrate human cells. An article published in 2015 reporting a Mount Sinai study says: “The field has long understood that key parts of the gene code for the measles virus remain unchanged over time, while similar genes in flu viruses constantly change, despite the two both being RNA viruses that infect the lungs. Specifically, the new study found that measles is much less able than the flu to survive genetic changes to the viral surface…”.
  1. We are not the only animals to get flu-like diseases; they go back and forth between human and non-human populations. Even if every human were immune, there would still be a reservoir of the virus in birds, bats, or other animals ready to infect humans again as soon as It mutated sufficiently to evade prior immunities. Neither smallpox nor polio are found in other animals.
  1. Nasal COVID can be infectious without making the nose’s owner “sick”. All viruses need to enter a living cell to replicate. The nose is a “frontier”; all sorts of stuff gets in there. Our immune systems are fairly tolerant of strange particles in the nose because they can’t afford to overreact on the frontier. The immune system goes all guns out for invaders in organs which are supposed to be sterile or nearly so. COVID can reproduce in our noses and quickly get back out to infect other people without making us sick. Since vaccines work by enhancing the immune system, they are less effective in the nose than in other organs because that’s the way the immune system has set its priorities. Even if we’re vaccinated or have been infected previously, we can be spreaders through nasal infection without feeling sick ourselves. Whatever immunity we have helps prevent a nasal infection from spreading to other organs. Diseases like polio, smallpox, and measles don’t replicate in the noise so they must defeat the internal defenses of our immune systems before we become infectious.

What happened

I was as close to first in line as I could get for every available COVID shot and booster. I don’t regret that for a minute. At close to eighty I’m at high risk if I get a bad case but have little reason to worry about as-yet undetected long-term risks of the novel vaccines with which we’ve had only a few years’ experience. However, I also wrote that COVID vaccination should be required for most workers. I was wrong about requiring COVID vaccinations even though the requirement for vaccinations against polio, smallpox, measles and other disease have saved many lives and should, in my opinion, stay in place.

All vaccinations protect the vaccinated person to some degree. Vaccinations against diseases like polio and smallpox, which have not been able to evolve to evade vaccination and acquired immunity, protect not only the person who gets the shot but also those in the population who cannot safely be immunized and those very few for whom immunization doesn’t work. Even a democratic society which values individual liberty has the right and responsibility to require vaccination when that requirement can lead to herd immunity and protect the vulnerable.

When I heard that COVID vaccinations were 95% effective, I thought that we could quickly wipe COVID out as a threat. Wrong! I should’ve known from the flu example that the virus would quickly mutate and remain a population threat. There is risk in every vaccination and especially in a very new vaccine developed in haste and using a new technique (mRNA). It was and is clear that COVID is a major threat only to us geezers and some other people with co-morbidities. That’s why we were given priority access to the vaccine. People should have been allowed – as many people were – to make their own risk/reward decisions given that there was no chance of totally eliminating COVID. There should not have been mandates.

There were a couple of blissful months after my first shot and booster where I thought I was immune. Mary and I took a seven-week nearly maskless trip around the country. We were lucky and did not get breakthrough cases. We probably would have taken the trip even if we had understood that the vaccinations would not remain completely effective. We probably were protected by our vaccinations (or we may have had COVID and never knew it). Nevertheless, we were made over-confident by over-hyping of the vaccine by most of the public health establishment.

From Dr. Fauci down, the reasons why COVID shots would not confer herd-immunity must have been well-known. The results of the studies cited at the beginning of this post had been available for years. He and much of the public health establishment chose not to make that clear because they wanted everyone to get inoculated. Well-meaning people like me jumped on the requirements bandwagon because we knew how effective mandatory vaccination for polio and other diseases has been.

The problem isn’t that some of the first recommendations and prognostications on COVID were wrong; that was bound to happen in the face of a novel disease. Credibility was lost because public leaders didn’t acknowledge their uncertainty even as they changed their advice and they claimed there was a “science” which had all the answers even though those answers changed from one news conference to the next. When debate was most needed, we see from the twitter files that the government was trying to assure that dissent – even from highly qualified sources – was never seen.

Misinforming the public (to be polite) is not an acceptable way to accomplish public policy objectives. It is not acceptable for experts to exaggerate because they are afraid they are not being listened to; government policy built on induced panic or misinformation is not good policy; and the press does NOT have a responsibility to either amplify exaggerated claims nor to suppress contrary voices.

Now what?

The sad result is that anti-vaxxers like those who have helped keep measles and polio alive have been given new credibility. The Centers for Disease Control in particular and the medical establishment in general have lost credibility. The great accomplishment of developing the COVID vaccine at warp speed has been sullied just because the vaccine was oversold. Government has lost trust it will need for the next pandemic or other emergency.

The first step in preparing for the next possible pandemic is understanding both the origins of this one and what we did right and wrong in responding. If that search for understanding is partisan – as it is so far, we will learn little and further damage the credibility the CDC et al will need next time.  If the press picks sides, the credibility of the press will sink even further. On the other hand, if we realize that science requires rigorous review and revision and if the public is informed both of new learnings and continuing uncertainty and if the press can keep editorial out of news reporting and concentrate on the medical rather than political implications of new discoveries, then we can begin to repair the credibility which has been squandered.

Meanwhile I will get the next booster available and am happy to get a COVID shot every year even if it’ll only be 70% effective.

See also:

Pandemic Lesson #1: “The Science” Must Always be Challenged

Pandemic Lesson #2 – Experts Are Too Narrow to Make Policy

We Should’ve Said “Requirement” Rather Than “Mandate”

Most Workers Should be Required to Get Vaccinations (I was wrong)

Essential Workers Should be Vaccinated

Public Health Agencies Are Retooling as COVID-19 Response Winds Down. A Slim Majority of Adults Trusts Them to Manage Another Pandemic (Morning Consult)

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