(Zeynep was a co-moderator of the Marxism list that spawned Marxmail.)
NY Times, June 1, 2021
Covid’s Deadliest Phase May Be Here Soon
By Zeynep Tufekci
Dr. Tufekci is a contributing Opinion writer who has extensively
examined the Covid-19 pandemic.
If world leaders don’t act now, the end of the Covid pandemic may come
with a horrible form of herd immunity, as more transmissible variants
that are taking hold around the world kill millions.
There’s troubling new evidence that the B.1.617.2 variant, first
identified in India, could be far more transmissible than even the
B.1.1.7 variant, first identified in Britain, which contributed to some
of the deadliest surges around the world.
In countries with widespread vaccination, like the United States and
Britain, we can expect that Covid cases, hospitalizations and deaths
will continue to decline or stay low, especially because lab tests and
real world experience show that vaccines appear to defend recipients
well against the severe effects of both variants.
For much of the rest of the world, though, this even more transmissible
new variant could be catastrophic.
The evidence is not yet conclusive because the data is preliminary and
figuring out if a variant is more transmissible isn’t easy. It could be
spreading rapidly in an area because of chance. Maybe it got there
before other variants and found a susceptible population, or got lucky
and seeded a mega-cluster. If a variant is seen more frequently in a
country’s genomic databases it could just be because travelers, who are
often tested more routinely, are bringing it in from another country
where it is already dominant.
One key measure that’s been used in previous outbreaks to figure out if
a variant was more transmissible was to look at “secondary attack rates”
in non-travel settings — how many people who come into close contact
with an infected person get the virus themselves. The greater the number
of these contacts getting the virus, on average, the greater the
likelihood that a variant’s transmissibility is greater.
Data on secondary attack rates released on Saturday by a British public
health agency similar to our own Centers for Disease Control and
Prevention suggests that this variant first seen in India may be
substantially more transmissible among close contacts than even the
already highly transmissible B.1.1.7. A report published by the same
agency on Thursday further supports last week’s findings. It was just
such early data that raised alarms about B.1.1.7, with later information
confirming those early fears.
Adam Kucharski, an epidemiologist with the London School of Hygiene and
Tropical Medicine, also told me that the faster spread in areas of
Britain with higher levels of the variant suggests it has higher
transmissibility. This point seems to be backed up by the terrible
outbreaks in India and neighboring Nepal, where it is also widespread.
Given how limited genetic identification is in those countries, the data
from Britain is particularly useful for assessing the risk.
A variant with higher transmissibility is a huge danger to people
without immunity either from vaccination or prior infection, even if the
variant is no more deadly than previous versions of the virus. Residents
of countries like Taiwan or Vietnam that had almost completely kept out
the pandemic, and countries like India and Nepal that had fared
relatively well until recently, have fairly little immunity, and are
largely unvaccinated. A more transmissible variant can burn through such
an immunologically naïve population very fast.
Increased transmissibility is an exponential threat. If a virus that
could previously infect three people on average can now infect four, it
looks like a small increase. Yet if you start with just two infected
people in both scenarios, in total, after 10 rounds of infection, the
more transmissible variant would cause 2.8 million cases, as opposed to
177,000 for the less transmissible one.
Morally and practically, this emergency demands immediate action:
widespread vaccination of those most vulnerable where the threat is
greatest.
Waiving vaccine patents is fine, but unless it’s tied to a process that
actually increases the supply of vaccines, it’s a little bit more than
expressing thoughts and prayers after a tragedy. Officials from all
nations that produce vaccines need to gather for an emergency meeting
immediately to decide how to commandeer whatever excess capacity they
have to produce more, through whatever means necessary. Because of the
threat of increased transmissibility, and since the evidence at hand
indicates that all of the vaccines, even the Chinese and Russian
versions, appear to be highly effective against severe disease or worse,
the focus should be on manufacturing and distributing the highest number
of doses possible as fast as possible.
If the choice is between no vaccine and any vaccine, the precedence
should go to whatever can be manufactured fastest, regardless of
patents, nation of origin, or countries prioritizing their allies or
wannabe allies.
Vaccine supplies need to be diverted now to where the crisis is the
worst, if necessary away from the wealthy countries that have purchased
most of the supply. It is, of course, understandable that every nation
wants to vaccinate its own first, but a country with high levels of
vaccination, especially among its more vulnerable populations, can hold
things off, especially if they also had big outbreaks before. In
addition, excess stockpiles can go where they are needed without even
slowing down existing vaccination programs.
Right now, Covax, the global alliance for vaccine equity, does not have
enough vaccines to distribute, and what supply it does get is allocated
according to national population, not the seriousness of outbreaks. This
needs to change. Our fire department needs more water, and should direct
it to where the fire is burning, not to every house on the street.
The responses could vary. The elderly and health care workers could be
prioritized wherever a crisis is worst. Dose-sparing strategies could be
applied — delaying boosters has been successful in Britain and Canada
when they faced surges. The details can be decided by the global health
authorities.
If there is a reasonable possibility that the world faces a mounting
threat, it’s best to intervene as early and aggressively as possible,
because even a few weeks of delay could make a huge difference. Waiting
for definitive evidence of transmissibility could allow the variant to
rampage — besides, if fears prove unfounded then the world would still
be better off for being more vaccinated. And any solution, even if
imperfect, is better than waiting for the perfect setup or the most
conclusive evidence.
As Dr. Kucharski told me, it’s now entirely possible that most Covid
deaths could occur after there are enough vaccines to protect those most
at risk globally. Britain had more daily Covid-related deaths during the
surge involving B.1.1.7 than in the first wave, when there was less
understanding of how to treat the disease and far fewer therapeutics
that later helped cut mortality rates. Even after the vaccination
campaign began, B.1.1.7 kept spreading rapidly among the unvaccinated. A
similar pattern was observed in much of Eastern Europe as well.
Even if it is determined the transmissibility of B.1.617.2 isn’t as bad
as feared, the emergency is still there.
The kind of catastrophic outbreak like the one in India can cause many
more needless deaths simply by overwhelming our resources. Already,
there are reports that countries ranging from Nepal to the Philippines
to South Africa to Nigeria may face supplemental oxygen shortages of the
kind seen in India. This pathogen has one fatality rate when oxygen is
available as a therapy and one when it is not, and it would be an
unspeakable tragedy to suffer the latter in the second year of the pandemic.
Like all pandemics, this one will end either with millions — maybe
billions — being infected or being vaccinated. This time, world leaders
have a choice, but little time to make that choice before it is made for
them.
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