But it will be a very small problem, once everyone is vaccinated.
It should be obvious by now that Covid-19 is endemic and will be with us forever. At a fatality rate of roughly 2% for the unvaccinated, it is better than the bubonic plague (50%) and smallpox (30%), but far worse than influenza (0.1%), not to mention colds and other minor respiratory infections. With vaccination, the fatality rate is reduced to, in very rough terms, 0.05%. Thus, with vaccination, Covid-19 is a much less significant public health problem, superceded by influenza, whose vaccine is much less effective.
(This calculation, of the death rate, in vaccinated people, is rather fraught, because the infection rate is hard to gauge. But assuming that over the four months when roughly one third to one half the population has become vaccinated, and exposure rates of this population similar to that of the unvaccinated and productively infected population, the overall death toll was roughly 50,000 people, of which 1,263 were vaccinated, for a ratio of 40:1)
While breakthrough infections and consequences like hospitalization and death (and possibly long covid, though that is unclear) are not impossible for vaccinated people, they are rare enough that we can resume normal activities. Current policies to limit the spread of the virus, even by vaccinated people who can carry and transmit it via light infections, is mostly aimed at the remaining unvaccinated population, who will be ending up in the hospital at much higher rates, and creating the public health burden. So no wonder patience is wearing thin with the unvaccinated, who will eventually just be cut loose to take their chances while the rest of society moves on in a new world where covid is as or even more manageable than influenza.
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| Why is Covid less severe in children? ACE2, the key receptor for the virus seems to have lower expression naturally, and is driven even lower by incidental conditions like asthma and allergies. Other cold viruses, to which children are widely exposed, may have "pre-vaccinated" them to the new coronavirus. And children seem to produce fewer inflammatory cytokines, producing a less exaggerated immune response, which is the main factor in later Covid pathology. |
Why all the breakthrough infections? One issue is that vaccination primes the immune system, which does not prevent infection, actually. What it does is to shorten the time that the body needs to fight an infection that has already occurred, by pre-educating the immune system about the target it is facing. So vaccinated people are going to be infected at normal rates, but they just won't show symptoms nearly as frequently. And second, as widely discussed, the vaccines have great, but not perfect effectiveness. It stands to reason, as has been widely reported, that more vaccines are better than fewer, and as the virus mutates to meet our weapons of social distancing and vaccination, new editions of covid vaccines will be needed. There can never be enough education of our immune systems against these evolving threats. With the advent of successful mRNA vaccines that can be rapidly programmed with new immunogens, we have the opportunity to increase our protection against both new threats, in form of yearly (or more) covid boosters, and against old threats, like influenza, whose vaccines are stuck in a time warp of antiquated technology and poor effectiveness.
This all implies that we (the vaccinated population) will be spreading around covid on an ongoing basis. It will be endemic, and our protection will be by vaccination rather than isolation. The virus has little interest in killing us, so it will likely evolve to be more benign, as our countless cold viruses have done, thereby spreading more effectively in a well-mixed population.
The extremely urgent need for universal vaccination raises the question of why the FDA has not been faster in its authorizations. All children should have already been cleared for vaccination, and full authorization should already have been granted for adults. The safety and efficacy data is present in overwhelming amounts, and if not, (in the case of children), the studies should have been started much sooner, and run on compressed schedules. One gets the impression that this is a bureaucracy that is overly wedded to process, rather than data- particularly the critical interpretation of data that comes from actual use in the field, rather from corporate reports. And this slowness has implications for future vaccines, such as ones against influenza, as well. We deserve better from our public institutions.
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