Thanks to slow-but-steady improvement in American habits of masking and distancing, a rising share of naturally-acquired immunity in the population, and now the remarkable efficacy so far of the first wave of vaccines, new COVID case rates in the US dropped sharply from late January to late February, after tragic holiday highs. These levels are not yet low—they are still similar to last spring’s highs, and people are still dying at the rate of several 9/11s a week—but the trend line, increasingly driven by vaccination, is cause for optimism that life in America is going to get substantially better in 2021 and beyond.
This is the hoped-for scenario, and many experts feel it is the most likely one. However, there is still a chance—with odds hard to predict—of another scenario that isn’t just somewhat different, but off-the-charts different. In this other scenario, a new variant emerges that escapes the current generation of vaccines, and runs the global table, including the highly-vaccinated countries, whose hard-won safety would be simply, shockingly, erased. This is the hit-by-an-asteroid scenario: we’d be faced with another emergency requiring lockdowns, testing, tracing and quarantine, and a fresh surge of patients into our hospitals.
It’s likely that a new vaccine could be developed very quickly to respond to such a new variant, but to have broad acceptance from a shocked, weary, and wary public, it would need to be credibly and transparently tested for safety and efficacy. Manufacturing would need to switch over, and we’d all have to line up again for another shot or two. The vaccination cycle could be faster the next time, but it would still take months, vaccine resistance might grow worse, and there would be another round of deaths, long COVID cases, and economic, social, and psychological damage.
An asteroid variant could emerge wherever the case rate remains high, meaning either in the large part of the world that won’t get the vaccine for quite a while longer, or in a highly-vaccinated country that has lowered hospitalizations and deaths, but is still supporting a high rate of new infections. We are seeing this latter scenario playing out right now in Israel (minus the asteroid variant so far), where their rate of deaths and hospitalizations is dropping very fast, but their rate of new infections has plateaued at a high level. This makes sense, because this virus is far more dangerous to older people, and they are getting vaccinated first. Once the vaccination campaign took off, it became almost impossible to keep younger people entirely hunkered down and masked up. So, with most oldsters protected and many younger people back in circulation, the virus is infecting a lot of those younger people but not killing many of those older people.
Hence the data: many cases but few deaths. Here’s the risk built into this scenario: the virus in Israel is now replicating in a world where it is under selection pressure from the vaccines, and there’s still a lot of virus out there. Under this pressure, a vaccine-proof variant will be highly favored if it emerges, and could spread with stunning speed. If Israel succeeds in vaccinating a high proportion of its entire population, helps the Palestinians do likewise, and limits travel from elsewhere, they will get their rate of new cases down and reduce the risk of being the source of the asteroid variant. Until then, they are whistling past the graveyard.
If you multiply the Israel scenario by 37, you have the United States over the next few months. We are a country 37 times larger that Israel that is following it down the path of rapid vaccination, is similarly focused on vaccinating seniors, and has a very antsy younger population ready to get back to work and play. Or, in Boise, ready to burn masks on the steps of the state capitol.
We are already seeing our new case rate appearing to plateau in the range of 60-80,000 new cases/day. This is higher than at any time earlier than late last October. We have all the major known variants from around the world already here, and many home-grown ones as well. So far, none of these has broken free of vaccine control, but we are certainly in a danger zone, and no one can make a confident prediction about what the odds are of an asteroid variant.
The specter of periodic breakthroughs on this scale will hang over us until most of the world is included in the project of suppressing the virus by vaccination, or until we learn that we have somehow discovered the limits of this virus’ ability to mutate to its own advantage, and can vaccinate to block all of its possible escape paths. That’s a lesson usually learned in hindsight.
The only certain way to protect ourselves from a long-hanging Covidian Sword of Damocles is to vaccinate the whole world fast, and be prepared to do it repeatedly. This is a daunting, unprecedented task, yet it may be the only way to escape the open-ended risk of future waves of COVID-19 and its descendants. No country as central to the world’s economy and geopolitical structure as the US is will be able to wall itself off from the swirling currents in the global SARS CoV-2 gene pool.
Any viral mutation able to confer enough advantage to be able to become a growing share of the global pool will find its way to our shores. We’ll get better at playing whack-a-mole, but until COVID is controlled everywhere, we won’t be safe in our beds.
If there’s a ray of hope, it’s that the same small set of mutations which seem to confer reproductive advantage on the virus by making it more transmissible and less controllable seem to happen over and over—almost like there aren’t that many different mutations available to this virus that can create a big advantage. If it turns out that we’re already seeing most of the possible dangerous mutations being mixed and matched ( we can’t know yet), then we’ll almost certainly see the emergence of a “greatest hits” version of the virus which has all the useful mutations discovered to date and becomes the dominant strain globally.
It will be worse than the mixed lineages we’re confronting now, but not beyond the partial reach of today’s vaccines, and soon containable for the long haul by, say, vaccination update cycles every few years. In this scenario, the light at the end of the tunnel might almost be coming into view.
If you are of a more doleful disposition, you can fortify your bleak outlook with the knowledge that this virus is just now beginning to feel selection pressure from the vaccines. By vaccinating into the teeth of a global pandemic, we are giving the virus every opportunity to find a mutating pathway around the vaccines. These vaccine-pressured mutations could be worse than what we’ve seen so far.
We don’t know how capable SARS CoV-2 might be of mutating its way out from under the thumb of the vaccines. If its ability is limited, then we are on the road to recovery, though it might be more of a roller coaster than a freeway. If the virus proves able to execute a full breakthrough against the current generation of vaccines, maybe even more than once, our future ride will be on a much wilder roller coaster, with unpredictable cycles of infection, non-pharmaceutical defensive maneuvers, new vaccine development, new vaccination campaigns, and then shell-shocked return to mostly-normal life, licking fresh wounds. Such cycles could continue until we get nearly the whole world on a regular vaccination schedule.
If it’s a comfort to you, many experts think we’re likely to get away with only a modest surge this April/May, a pleasant summer of low COVID risk, a survivable surge in October/November, and a consistently low-COVID 2022. Expert opinions vary widely on this point, however, and all experts load their predictions with caveats and cautions. This virus has been full of surprises so far; we’d be wise to keep a bridle on our optimism.
What You can Do
Here’s what you can do while you marvel at the complexities of predicting the course of a pandemic. Get vaccinated at your earliest opportunity, and earnestly entreat your hesitant friends and relatives to follow suit. (Nutshell advice: seduce, don’t bully). Pushing vaccine-based immunity levels very high in the US population as quickly as possible reduces the risk that a nightmare variant will emerge here.
Keep up appropriate distancing and masking in risky situations until the large majority have been vaccinated and the virus prevalence (as seen in new case rates) has dropped very low. As long as there’s a high case rate, even if the death rate plummets (it hasn’t yet), we remain at risk of an asteroid scenario.
Retain a core of emotional resiliency against the chance of further rounds of COVID driven by variants that escape the vaccines. This scenario is not under our control. It might happen despite our best efforts. As hard as it is to imagine, we need to be able to behave like Londoners during The Blitz, and carry on in the face of bad luck, should it come.
Support a huge effort to wage a global fight against the virus, for selfish reasons as well as noble ones: knocking it down everywhere is the key to safety here. The temptation to shift our effort as quickly a possible to restoring the economy and helping those already harmed is strong, but this virus war isn’t over yet, and we’re not safe until we have the virus under tight control everywhere.
All that said, 2021 is likely to be a better year. Once you and your loved ones are vaccinated, the isolation will be greatly decreased. Many ordinary activities will be far safer. The economy will pick up—it may even boom. Enjoy it all. Just don’t take it for granted quite yet. Keep your loved ones close, and your mental toughness closer.