Last week the US passed what many are calling a “grim milestone” – over one million deaths related to the COVID-19 pandemic. While this was dutifully reported in mainstream media, there was little fanfare or handwringing, a testament to the level of pandemic fatigue we are also experiencing. As has also been widely reported, people may be done with the pandemic, but the pandemic is not done with us. Many people I speak to, including some fellow healthcare providers, have the attitude – I’ve already caught COVID, I’m fully vaccinated, I’m just going to live my life and not worry about it anymore. This is understandable, but we have to be realistic about what this will mean.
What we are experiencing is what a world-wide pandemic looks like. The 1918 flu pandemic lasted two years and killed an estimated 50 million people worldwide. Improved medical care is mitigating the death toll of this pandemic, but perhaps it is also extending its duration. We have passed the two year mark, and experts are warning of a potential new wave this Fall. The problem, of course, is the new variants of SARS-Cov-2, with the Omicron subvariant BA.2 being of special concern.
Pandemic fatigue is everywhere as restrictions are being lifted, and Congress is stalled on passing new funding for pandemic relief. The sense of urgency is apparently gone. People want life to get back to normal, and are willing to live with COVID. At some point we do need to make this transition, just like we live with the flu every year. But timing is important, and we simply may not be ready for the consequences of what living with COVID will mean at this time.
The WHO recently estimated that the actual death toll from COVID may be about three times the officially reported number. They estimate there were 14.9 million excess deaths in 2020 and 2021 (not even including 2022 so far). These are numbers that are starting to look like the 1918 pandemic. Some countries like India are still facing high numbers. While China may have been successful early in shutting down to prevent spread of the virus, they are facing a vulnerable population and are increasing their restrictions again.
Also, using death as the only marker for the health toll of this pandemic is misleading. Those who survive may experience significant morbidity, chronic symptoms collectively referred to as long COVID. A recent study, for example, found that having severe COVID correlates with brain shrinkage and cognitive deficits equivalent to normal aging between ages 50 and 70 – 20 years of brain aging. This was correlation only, but it is extremely likely that most or all of the correlation was caused by the infection. As a neurologist I am seeing many patients referred for cognitive, fatigue, and other neurological symptoms following COVID. People generally recover to some extent, but not always or completely.
Generally pandemics burn themselves out when enough people get infected, and therefore have some level of immunity, so that the infectious agent cannot easily spread. Also there is selective pressure toward new variants that are more contagious, but not necessarily more deadly, so by chance alone we may see highly competitive variants that are not as deadly. So far we have seen increasingly infectious variants, like Omicron, but they have not really waned in severity.
There is, of course, another way to gain resistance to infection without getting infected – vaccines. Vaccines remain our best weapon against the virus and the single most effective way to bring this pandemic to a close. In the US about 78% of the population has received at least one dose of a COVID vaccine, while about two thirds are considered fully vaccinated. While these numbers are high enough to reduce the severity of the pandemic, and have certainly helped reduce hospital admissions, they are not high enough to provide a solid herd immunity effect that would prevent waves of spreading virus. These relatively low vaccination numbers are nothing short of a self-inflicted tragedy.
Let me be the one billionth person to point out the ironic disconnect here – we are lucky to have the benefit of advanced mRNA and other vaccine technology, able to bang out multiple highly effective vaccines within a year of the pandemic emerging. And yet, a third of our population is not fully vaccinated. Around the world the numbers are more variable. Many industrialized nations have rates in the 90s. Africa lagging the most, with extremely low vaccination rates due to poor availability of the vaccine.
There is absolutely no logistical reason why the US and every industrialized nation cannot have vaccination rates higher than 95%, enough to effectively shut down this pandemic. We are experiencing a societal failure that we need to examine and remedy. This pandemic is not over, and it may not be over for a long time. Further, this will not be the last pandemic, and it likely won’t be a century until the next one.