Is it time to step down?

This is Joseph.

So one piece of the covid-19 pandemic that has really surprised me is that it did not spur a reinvestment in emergency medicine. Like there is still dire strain on hospitals, but how is this unforeseen two years into the pandemic? One typically expects a long tail of an epidemic and the way to handle burnout is to expand capacity for a while so that everyone can recover. One month into a pandemic is an unforeseen disaster but weak hospital capacity two years in is a choice. 

The polio vaccine had about 40% of the rate of events of the placebo and even lower levels of paralytic polio. it did exactly what covid-19 vaccination was doing -- reduced the rate of disease and was even more effective against severe disease. But there was a long tail (15,000 paralytic events in the 1950's, 100 in the 1960's, and 10 in the 1970's). So it isn't unexpected that there will be a long lag.

The question is how long do we keep up vigorous public health measures. Now, I do want to make one important distinction. There are some measures, like better ventilation, that have positive externalities (e.g., student learning) that probably make them worthwhile whether or not covid-19 is freely circulating. I would not be adverse to better air in classrooms, both for the sake of learning and because all respiratory diseases are unpleasant. 

But what about the restrictions on travel? The need to constantly provide tests at the border and quarantine after air travel, despite the presence of large reservoirs? Or the smaller class sizes? Limited indoor events for children? Social isolation? it has been more than a decade since somebody failed to light a shoe on fire and we still take shoes off in the airport. Will we add mandatory testing for an extinct disease to what we do when we cross borders in 2050?

That said, I think we need to expect to live with the disease for the immediate future. It not only has the original reservoir (back in China) from which it might return from, but it has been highly successful at jumping to other animal species.  We are not going to be able to prevent it jumping back from (for example) deer, even if the absolute risk is low for any given infection. 

Consider these tweets from Akiva Cohen:

Now Akiva is a lawyer and not an epidemiologist, but there is a reasonable point here. At some point we accept risk as a part of living. For motor vehicle crashes that is 38,000 per year. Covid-19, averaged over the 21 months of the epidemic, is currently running at about 10 times that rate  but at some point we'd expect the death rate to drop to car crash levels and it might be time to start thinking about how we get there as soon as plausible.