The Virus is Evolving

and our response isn't

What would it look like if we evolved our COVID response?

Thus far, our government policy-level COVID response has centered on three things: vaccines, testing, and masking. It’s the CDC guidance. It’s the WHO guidance. It makes sense, and it’s based on evidence. It’s cost-effective. And of course, it’s not working. Not in the US, anyway. 

People aren’t getting vaccinated. They’re scared and they don’t trust the public institutions that want them to get the vaccine. The complex, rapidly-evolving data about vaccine effectiveness doesn't translate into an easy sell for someone who’s already vaccine hesitant and afraid. 66% of the US population is considered fully vaccinated, and 33% of the US population is fully vaccinated and has received a booster. Those numbers hide some very ugly regional disparities: 51% of people in Alabama and Mississippi are fully vaccinated, in comparison to 80% in Maine and 82% in Vermont.  

Testing isn’t helping much. US COVID testing is a mess. Free PCR testing for the uninsured ended in March, which means that reported community COVID numbers went way down. (1) People may be using antigen tests at home, but they're not reporting their results anywhere. Antigen tests have some major flaws. They are very prone to false negatives, because they have a very limited time period when they can detect COVID. You can test negative on an antigen test and still be both infected and contagious to others. At the same time, your negative test result may cause you and people around you to relax their COVID precautions. I strongly suspect that the false sense of security that comes from antigen testing has driven a lot of outbreaks in large gatherings of people. 

Masking is rare and getting rarer. Public health authorities screwed up the mask guidance. Just completely and utterly failed. People don’t understand how a mask keeps them safe, and they don’t understand that their mask keeps others safe. At the same time, disinformation sources with an agenda(2) have been working to convince people that masks don't work or are actively harmful. So, masks aren’t working.

These three approaches aren’t working, and we just keep trying to make them work. The virus is evolving, and we aren’t. 

What would it look like if we did evolve? I think we should look at Tuberculosis for guidance. It’s transmitted by air, the vaccine isn’t all that effective, and it can range from deadly to mild. It’s endemic in some places and acutely epidemic in others. It mutates fast. And we are (slowly, mostly) winning our fight against it. The TB prevention approach involves air flow, UV disinfecting lights, and a very muscular approach to case identification and reporting. 

Next week I’ll look at how we could apply that to COVID. 

1. The CDC is now using hospital COVID cases as its major prevalence measure - not community COVID testing. That’s a lagging indicator - it will rise after COVID cases spike. There is a reason when you see in-depth analysis on new COVID variants it’s rarely based on US date. Our data isn’t detailed enough to be all that useful any more.

1. Usually some kind of quack product to sell.