COVID-19 as a Society-Level Chronic Disease, and the Needless Loss of Hope

No, this is not a post about the word endemic. As I’ve written about this week, Thinky Thought Leaders and the Substack Bois have decided that We Are Done With COVID™, reality notwithstanding. It’s pretty clear Omicron broke their brains (we’ll return to that).

It’s also pretty clear most of these same pundits (#NotAllPundits…) have no experience living with a chronic, high-maintenance health condition–or with someone who has one. Let me give an example.

I had a relative who was a type 1 diabetic (also known as ‘insulin dependent’ or ‘juvenile’ diabetes). In the bad old days (I’m the older half of GenX and they were considerably older than me), that meant sticking to a very strict dietary intake and eating times, peeing on a testing strip to determine what their glucose levels were several hours ago (no at-home glucose monitoring), and, of course, twice per day self-injections of insulin. If they didn’t do all of this, they could wind up in the hospital or die.

Yes, things got better with insulin pumps and at-home glucose monitoring, but even then it wasn’t easy–and maintaining ‘good control’ (steady glucose levels) became harder as they became elderly.

It wasn’t easy, and there were things they wanted to do at times that they simply couldn’t, but they didn’t have the choice to declare they Were Done With Diabetes. That’s what living with a chronic condition means. It’s not a matter of toughing it out or not being scared, you have to do certain things–all of them–to stay healthy and not die.

Compared to that, intermittent masking just isn’t hard. It’s not tyranny. It’s just something we have to do right now until the prevalence declines. It’s the way we protect people–including some fully vaccinated people (and fully vaccinated should mean three doses)–from hospitalization and from long COVID*.

But I think Omicron broke a lot of pundits, especially those who haven’t had to deal personally with a chronic medical condition. With Delta, at both an individual level and a society-wide level, there was an endgame–vaccination. Three doses (TEH BOOSTER!) is effective long-term against Delta, and at a high enough level, such that it likely would have, with widespread vaccination, prevented sustained transmission. There was an end, one that we were taking too long to reach due to stupidity, but there was an end–and if you had three doses, you were pretty safe.

Unfortunately, that’s not the case with Omicron. The third dose does provide significant protection against infection, but probably not enough to prevent sustained transmission by itself. That means, over the short and medium terms, we’ll have to continue with other measures, and do things like monitor the prevalence of COVID (and act accordingly**). Hopefully, either a fourth dose or an Omicron booster (or intranasal administration) will get us to where we were with Delta and three doses (which was a good place akshually!).

A lot of pundits, especially some of the not-old ones, strike me as people who haven’t had to manage a chronic condition. They haven’t developed the resiliency to accept that there are things you have to do, and there’s isn’t an alternative, so they have lost hope. Of course, when people lose hope with a communicable disease, they affect not only themselves, but others.

The good news is that, unlike many medical conditions, there will be an ‘other side’ of the pandemic we can reach. It just might take a while.

*As I’ve written multiple times, my estimate, on the conservative side, is that people with two doses of vaccine (there aren’t good data yet for those with three doses) have about a one percent chance of contracting long COVID. Is that small? Sure, but no one says that polio, which doesn’t result in long-term illness in over 99.5% of those infected, is just a stomach bug.

**Which we haven’t done in many places in the U.S., but a boy can dream, can’t he? Meanwhile, things like masking, improving ventilation, and so on still protect a lot of people, and in combination with vaccination, could crush the curve.

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2 Responses to COVID-19 as a Society-Level Chronic Disease, and the Needless Loss of Hope

  1. GM says:

    Three doses (TEH BOOSTER!) is effective long-term against Delta, and at a high enough level, such that it likely would have, with widespread vaccination, prevented sustained transmission.

    That wasn’t really true though, with Delta (i.e. a kind of WT looking spike) we were looking at boosting every 6-9 months because the boosters waned too. And we were only ever going to stop transmission if we got to 80%+ of the population boosted (not merely double dosed), in a short period of time too (not dragged over a year). Infections were going up even before Omicron in Europe in all the countries that were at 80%+ vaccination.

    There was an end, one that we were taking too long to reach due to stupidity, but there was an end–and if you had three doses, you were pretty safe.

    That’s a misguided way of looking at it. We knew the spike is highly plastic and would escape before the pandemic even started. Omicron is a surprise because it has lots of mutations even in places that are completely conserved in other SARS viruses, i.e. we went into a region of the fitness landscape that we did not even suspect existed. Likely there are many others like it that await exploration. But that it would escape was not a surprise in any way, the question was when, not if.

    That’s what these viruses do.

    In Spring 2021 before Delta we were not on our way out of the pandemic. Lot of people are doing historic revisionism talking about how if only Delta had not appeared, we would have been fine.

    No, we were on our way to Delta all the time (and in case it needs reminding, the Great Unmasking in the US happened **after** they were doing curbside cremations and dumping of bodies in rivers in India; that’s how “unexpected” Delta was).

    Similarly, in early November 2021 we were on our way to Omicron, not on our way out with Delta (we were actually looking at a serious winter Delta wave, the reason it did not happen is that we got a serious Omicron one instead).

    And after Omicron finishes having its way with us, we are once again not on our way out of the pandemic, but on our way to Pi, Rho, etc.

  2. Pingback: Our COVID Response Might Have Been Outsourced to Democratic Pollsters | Mike the Mad Biologist

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