Toward Functional Immunity

Katherine J. Wu:

Eventually, all discussions about sterilizing immunity [Ability to totally prevent infection] become nerdy quibbles over semantics. Clearly, not every infection is clinically meaningful, or even logistically detectable, given the limits of our technology—nor do they need to be, if there’s no sickness or transmission. (A koan for pandemic times: If a microbe silently and inconsequentially copies itself in a tissue, and the body doesn’t notice, did it actually infect?) There is, for every pathogen, a threshold at which an infection becomes problematic; all the immune system has to do is suppress its rise below this line to keep someone safe.

But that might be exactly the point. Say that sterilizing immunity is impossible, that our immune systems cannot, in fact, be trained to achieve perfection. Then it’s neither a surprise nor a shortcoming that COVID-19 vaccines, or other vaccines, don’t manage it: An inoculation that guards marvelously well against disease—offering as much protection as it can—can still end an outbreak. Life would certainly be easier if vaccines offered invincible armor, with pathogens simply ricocheting off. But they don’t, and assuming or expecting them to manage that can be dangerous. The dubiousness of sterilizing immunity is a reminder that just about any immune response can be overwhelmed, if exposures are heavy and frequent enough, Grad told me. The best we can all hope for is functional immunity, more like a flame retardant than a firewall, that still keeps bad burns at bay.

The Spike

I’ve been having a running debate with a good friend about COVID-19 versus the seasonal flu. My friend basically argues that our government’s reaction to COVID-19 is way overdone. I suspect some of you have friends saying similar things.

My friend makes these two general points: 1) More people in the U.S. die of the seasonal flu each year and we don’t lock down (stay-at-home orders) our society over that, and 2) the current mortality rate of COVID-19 (calculated at around maybe 2%) is wrong (way too high) because the current lack of broad testing means we don’t know how many people actually have (or have had) the virus—and it’s likely to be much higher—to be able to say with any accuracy what the actual mortality rate is among those who’ve contracted the virus. So, as he says, the current “numbers and charts mean nothing.” My friend thinks the mortality rate of COVID-19 will be somewhere around 002% or less when all is said and tested. In other words, he thinks, there is nothing to be alarmed about since seasonal influenza is in the same mortality rate ballpark.

Regardless of the debate over statistical measures, the problem I have with my friend’s arguments is what’s happening on the ground. The simple and stark reality is in hot zones where this virus is running rampant, like New York City, the hospitals began filling with people sick and dying from COVID-19 infections. That doesn’t happen during your typical flu season.

No matter how anyone want’s to debate the lethality of COVID-19 compared to the seasonal flu, the stark reality is we know for a fact that where COVID-19 did spread fast and wide, the hospitals began getting hit hard with COVID-19 patients, many of them sick for weeks and many others dying. So instead of talking statistics let’s just talk in simple math. Take a look at this simple graph from the New Atlantis that tracked reported new deaths, per week, from various causes we have data on, and our current COVID-19 epidemic.

As the data shows, and the New Atlantis piece explains, the spike (in red) of COVID-19 deaths is fast and almost straight up. On the horizontal line you see the weeks into the epidemic. On the vertical line the number of newly reported deaths per million. And let me remind you that during the 2017-18 flu and 1957-58 Asian flu, the nation didn’t lock down or require social distancing. So those numbers happened while our society was open and operating as normal. Notice there is no drastic spike in reported deaths. The drastic COVID-19 spike in reported deaths happened largely while the nation was locked down and people were social distancing. Imagine the numbers and the graph line for COVID-19 deaths if we weren’t social distancing right now and just carrying on business as usual, like we do during a typical seasonal flu?

When your friend tells you “Well, there were about 45,000 deaths last year from the flu and we didn’t do this,” you might want to remind him or her that number is for estimated deaths for seasonal influenza OVER AN ENTIRE SEASON or year. In the chart above the period of measure is about 33 weeks. As of this writing, it’s been about 8 weeks since the first death of COVID-19 was reported in the U.S., and the current reported death toll is at 46,785. Just do the math. And remember our society has no vaccine currently. We have no herd immunity, unlike we do with seasonal influenza.

Left unchecked COVID-19 would continue to spread rapidly and our hospital and healthcare systems would become completely overrun. If we had just let our society carry on as usual, like we do during the seasonal flu, there is little doubt the death toll would reach into the hundreds of thousands, probably millions. As the New Atlantis points out, “In the worst week of the 2017-18 flu season, New York saw 445 deaths from flu and pneumonia and 3,481 total from all causes. Last week, the state saw 4,694 reported Covid-19 deaths alone.”

COVID-19 cannot be compared to a seasonal flu. The simple arithmetic demonstrates it’s much worse. We will beat this virus once we have a vaccine, and let’s pray that’s soon.

These are challenging times, but try to keep it all in perspective

Besides being one of the best liberal arts educations you can get, the study of history is also quite therapeutic. The ancient Stoics had a technique for helping individuals deal with the vicissitudes of life, called negative visualization. Basically it’s about preparing your mind for the worse by imagining, beforehand, that things could be a lot worse. Well socially speaking the study of history pretty much provides the same therapy. We may think the current coronavirus epidemic and all that’s happening are really bad, but as any good student of history would tell you, “True, these are not the best of times, but believe me our societies have faced situations far far worse.”

It’s only in modern times, with the advances of modern medical science, like vaccinations, antibiotics, and antiviral drugs, that societies have been able to save millions of lives ultimately from deadly bacterias and viruses that regularly emerge within populations. I would say the discovery of the vaccine should be rated the greatest life saving discovery in medical science history. Before vaccines any new toxic bacteria or deadly virus disappeared only after it had burned through a population.

For example, when the bubonic plague (known as “the Black Death”) was ravaging Europe during the 14th century some regions, towns, and cities, had well over 50% of the population whipped out. It’s estimated that two-thirds of the approximately 660,000 deaths of soldiers during the American Civil War were caused by uncontrolled infectious diseases. Upwards of 2 million soldiers died of infectious diseases during WWI. During the 1918-1919 Spanish influenza epidemic, the world’s death toll was somewhere between 50 and 100 million dead. In the United States alone we had about 675,000 deaths caused by the Spanish flu.

History provides something needed by individuals and societies during difficult and challenging times, and that’s perspective.

The current coronavirus epidemic is a very challenging situation. No one should downplay the long term damage and disruption to our society. But while we’re lamenting how bad this situation is we should try to remember that many past generations in history experienced far worse and ultimately recovered, rebuilt, and thrived. We will too.

We should have been more prepared but we weren’t.

This current coronavirus pandemic was probably one of the most predicable things that could happen. In 2015, Bill Gates talked about this very concern and that we, as a society, weren’t prepared. Throughout history viruses have emerged and decimated societies with lethal regularity. It has only been with the emergence of modern medical science that we’ve been capable of tamping down or getting some control of these outbreaks. In today’s world we have more tools—science and technology—to fight the spread of a virus, but their are two things that remain the key variables in success. One, maintaining a robust pandemic response structure so it’s in place and ready, and two, this is critical, quickly and decisively acting to slow and contain the spread of the virus.

The United States is now the epicenter of a global pandemic that began in China in mid January. There are a lot of questions that need answering. We knew China had a serious outbreak in mid January…and yet our government wasn’t on war footing. This lack of proactiveness meant we lost a month or more of time preparing for this virus and putting in place measures to slow and contain its spread. This epic failure will extract a massive cost on our country, both economically and socially.

This morning I recommend you read an Atlantic piece entitled How the Coronavirus Became an American Catastrophe.

As the authors explain, there were a number of system failures to be sure. The principal failure was not having adequate testing in place which would have aided us in slowing the spread of the virus once it hit the U.S. But in the larger picture there was a failure of leadership. A leader’s principle task is to look ahead and see potential problems and quickly navigate to a better, more safer, course. That simply didn’t happen in this case. Before and during a crisis a competent leader quickly detects potential threats and problems, leans forward, studies the situation aggressively, and then actively engages his assets and capabilities to ensure everything possible is done to avoid a catastrophe.

In this case our national leadership was negligent in preparing this country for our greatest challenge since probably WWII. We will, eventually, beat this virus and life will slowly return to normalcy. But we cannot forget how important (how critical!) competent government leadership is for the survival of our way of life.

Remember this at the next election.

Hammer down now and get control fast, then slowly open back up

Here is a very interesting and informative piece on the implications of 3 approaches to how governments may choose to handle the coronavirus pandemic. As you can tell, most governments are trying to impose the Hammer.

“What if you were about to face your worst enemy, of which you knew very little, and you had two options: Either you run towards it, or you escape to buy yourself a bit of time to prepare. Which one would you choose?”