Coronavirus 60 Two Choices

How do you get to Birmingham? I wouldn't start from here.

We should have stopped the virus spreading in January 2020 before it became a pandemic, but the same argument still applies.
We have choices.

1. End the pandemic.
2. Allow the pandemic to continue.

Let's look at option #2 first. By continuing with the government policies and citizen behaviour adopted so far in many western nations we can look forward to a massive spike in omicron cases. Even if the death rate in a population that is largely vaccinated and/or has some natural immunity because of earlier SARS-CoV-2 infections, is an order of magnitude lower than earlier in the pandemic, it will still result in thousands more deaths.

Importantly, it will do nothing to prevent a new variant. There is an evolutionary advantage for a variant that is more infectious, better at escaping natural immunity within the population or the vaccine. There is no evolutionary advantage to become either more or less pathological. That could go either way. That a new variant is milder is wishful thinking, that it becomes worse is something the precautionary principle demands we prepare for.

Covid so far has shown a case fatality rate of less than 1%. Omicron in a mostly vaccinated population may have a case fatality rate an order of magnitude less, but a future variant could plausibly have a worse outcome. MERS has a case fatality rate at least an order of magnitude greater than the worst outbreaks of SARS-CoV-2. Ebola, albeit a very different virus, has a mortality rate nearer 50%.

There's no easy end in sight to the arms race between variants and our vaccination programme. It would mean learning to live with the deaths and morbidity that the virus causes, a very different world to that we have previously known.

It's a bleak outlook, so let's turn to option #1.

But we can't 'End the pandemic'! Oh yes we can. The pandemic ends in a few weeks if nobody meets anybody outside their own household. That, of course, is impossibly hard to achieve, but with proper planning and support, a very strict lockdown could be acceptable, driving R well below 1 and keeping it there. The pandemic would then inevitably come to an end. It would require people's trust in their governments, earned by sufficient and appropriate support from governments. It involves the rigorous application of what we have long known to be the effective route to infectious disease eradication: a combination of finding cases, isolating with sufficient support, and vaccinating.

The other option really is too bleak to contemplate.

Picture attribution: W. Carter