Vaccines And Their Impact

I haven't posted for a while because I've been quite busy. Among other things, I wrote and published a new book. The book isn't about coronavirus itself. At least not directly. Instead, it is a thriller about the nature of blessing and curse in a world that can seem tremendously arbitrary. If you have religious leanings, you might enjoy it. It is available at josephcox.com/agent.

Here is a rundown of my thoughts at the present time:

1. The vaccine's success raises the value of lockdowns and other measures. With a knowable closing date, these strategies can have their costs defined and allow planning. I would recommend more shutdowns and controls while the most vulnerable get protected.
2. Sweden's pop-up in death rates (after a long hiatus) suggests that the bar for long-term protection is higher. How much higher is unclear. The pop could be due to expiring immunity, movement into communities that hadn't previously been exposed, or.... either way they didn't stay at near zero. I was wrong about this area of developing immunity. Promisingly, deaths per case have fallen.
3. I'm not going to take the mRNA vaccines at this time. I trust the people involved (my sister runs a statistical analysis team working on the vaccine for one of the companies). It is just that the long-term data is unknown. I would, however, recommend it for older people. Long-term effects (or potential effects on the next generation) are less relevant and the risks are greater. For myself, I'm going to wait on either more data or the conventional vaccines. My kids won't be getting it for quite some time (I know it isn't approved for them).
4. The vaccines will help *tremendously*. By protecting the old and most vulnerable they will cut death rates massively. Interestingly, we don't know if they prevent *infection.* We just know they cut symptomatic disease. So they may have little impact on herd immunity. They will, however, cut deaths. The average age of death in Israel is still hovering around 80 - getting to asymptomatic cases for >60s would be a wonderful thing.
5. The big and very very hard question is: when is it enough? When is it enough to open society again? This is a question I have no answer for. It is one we constantly struggle with, and not just with corona. Motorcycles are legal. You can leave the home with the flu. Sugary drinks are legal. Smoking is highly limited. We're allowed to drive cars. In each of these cases, we've come to some sort of understanding of risks vs. freedoms. Corona will never totally go away. At least I don't think so. That's why the answer isn't: "we can stop when deaths are zero." The world doesn't tend to work that way. Zero-tolerance doesn't actually work. So we have to grapple with this question and it is a very very hard one.
6. The questions surrounding China's role have to be examined. This is on two levels. One: was this very unusual virus engineered? Two: why did Asian countries seem to be so much less impacted? Yes, some are very efficient and organized. But others... well, they aren't known for their highly functional administrations. There are people looking at the possibility of earlier related viruses in the region - but why they didn't get to the rest of the world dents that theory. The fact is there are some questions we could use answers for.
7. The third-world impacts remain terrible. Estimates are that more than a million have died of hunger. I'd imagine many more are stunted. This will have a terrible long-term cost. The good thing is we didn't just shut down. We flexed and bent and kept things somewhat on track. Yes, many lives were lost. But many more would have been lost without relieving the pressure of the most stringent measures.
8. We got a taste of a new way of doing medicine. Fast, throw things at problem approaches. One might say 'agile medicine.' This way has obvious drawbacks and obvious benefits. With our old approach, we wouldn't have a solution for the elderly. Now we do. With our old approach, we wouldn't have dramatically improved treatment, but we have. I'd love us to learn lessons from this experience and apply them to more conventional issues like cancer, heart disease, and dementia. 

At this point, the world has shifted. China has grown tremendously in power and influence. The West is weaker. Nobody's political beliefs or faith (or lack thereof) in experts has been impacted. If anything, battle lines have been hardened - which is truly unfortunate. As my brother pointed out, recent air travelers have been overwhelmingly Republican. Who could have predicted that something as basic as getting on a plane (or voting in person) would come down to political battle lines.

As I see it, even once the deaths are minimized, the impacts of this virus - from global poverty to social tensions to geopolitics - will take years to unfold.