COVID lulls aren't being earned by policy; they're being bought with infections and deaths

Celebrating a COVID lull years into the Biden Administration's utter abandonment is woefully out of touch with the science

COVID was low over the past couple months, something we can best observe by looking at wastewater data since the CDC told states to stop reporting COVID cases over a year ago.

States across the US have also closed COVID testing centers and halted distribution of free COVID tests, while the federal government invited the private market to price gouge us for tests that are actually, you know, accurate.

Cases are low right now for one simple reason: most people have recently had COVID. If not during the massive winter JN.1 surge, which infected an estimated 100 million people, then in the previous variant-soup wave of late summer 2023. COVID infections confer a temporary immunity, meaning that after a big surge- when tens of millions of people are infected in a matter of months- the public has a transient “wall” of immunity that lowers transmission in the short-term. Celebrating lulls that were “bought” with a surge is celebrating the successful mass infection of the public, thousands of new Long COVID cases, overall worsened health of the public, and tens of thousands of dead people. That’s the cost of every lull that wasn’t earned with policy.

75,603 people died of COVID in 2023 according to death certificates, which is certainly an undercount. (I would note that death certificate flu was 5,999, also a significant undercount and not the number the CDC uses when reporting flu burden). But let’s take the 75k number at face value and provide some perspective about this level of mortality.

75,603 deaths in one year makes COVID the infectious disease killing the most people in the US by far, and likely to remain so.

Let’s compare this mortality with the deaths caused by dangerous, vaccine preventable diseases that we’ve since eradicated or successfully controlled, and which we rightfully considered to be worth working to eliminate. All data from this JAMA Network study. [The authors picked a range of years prior to vaccination to compare to post-vaccine outcomes; thankfully, the study found “a greater than 92% decline in cases and a 99% or greater decline in deaths due to diseases prevented by vaccines recommended before 1980” for diphtheria, mumps, pertussis, and tetanus.]

In the peak year of diphtheria deaths between 1936-1945, 1936, 3,065 Americans died of diphtheria. Adjusting for today’s population (3065/130 million = x/342 million), that would be 8,070 annual deaths from diphtheria.

In the peak year of measles deaths between 1953-1962, 1958, the US saw 552 measles deaths. Adjusting for today’s population (552/170 million = x/342 million, that would be 1,111 deaths from measles.

In the peak year of mumps deaths between 1963-1968, 1964, 50 people died of mumps, or about 91 deaths when adjusted for today’s US population.

Peak pertussis deaths between 1934-1943 were 7,518 in 1934, or 20,346 adjusted for today’s population.

Looking at the years 1941-1950 and 1951-1954, study authors found peak acute polio deaths in 1949, with 2,720 deaths, and peak paralytic polio deaths in 1952 at 3,145. Let’s be generous, combine them both and adjust for 1949 population, giving us, in today’s numbers, an estimated 13,461 deaths.

So, if we were to eliminate the diphtheria, pertussis, mumps, measles, and polio vaccines, normalize the spread of all these viruses, use a year in which mortality was high for our analysis, and adjust for population, we would expect 43,079 Americans to die each year, of all five combined. 43 thousand deaths from diphtheria, pertussis, mumps, measles, and polio, which we successfully prevent each year, and consider it a great achievement to do so.

Last year over 75,603 Americans died of COVID. An undercount.

This is a very strange achievement to celebrate.

We moved heaven and Earth to eliminate (in today’s numbers), 13,461 annual polio deaths; now we’re being told that accepting 75,000 annual deaths of COVID is simply something to “learn to live with”. Or even that it’s a good thing, simply because over 300,000 Americans died in 2021. Our metric for success should not be the deadliest year for infectious disease deaths in decades. That’s an extremely generous metric, one that would be quite literally impossible to fail at.

Our metric for success should instead be zero unnecessary deaths of a disease we have many 21st century tools to mitigate, almost none of which are in use. The same way HIV elimination is the goal, malaria elimination is the goal, and polio elimination was the goal, COVID elimination should be the goal. The entire mindset that diseases should be reduced and eliminated appears to have been replaced with the public perception that “people gotta die some time,” a concerning dynamic I explored more deeply in this piece about the death of public health itself as an unfortunate outcome of COVID normalization.

When we dismantle the idea that tens of thousands of preventable deaths every year are something we should take action to stop, we dismantle the underlying justification for the very concept of public health.

There are a bunch of modern tools that could easily and quickly reduce infectious disease burden in the US, of both COVID and other airborne viruses (which, it turns out, is many of them). We could upgrade indoor ventilation and filtration standards, introduce Far UVC, provide guaranteed paid sick leave, adopt a new OSHA standard that penalizes employers for failing to mitigate airborne disease in indoor spaces, educate the public about which masks prevent airborne transmission most effectively, provide those masks and tests for free, stop stigmatizing masking and framing it as weird or crazy, help people understand why boosters are critical, stop privatizing tools like the vaccines and tests, push for higher durability vaccines and more accurate RATs, the list goes on.

Instead, we’re doing just one thing: telling people to get vaccinated, with a poor success rate. This year, adults over 65 had the highest booster rate, with 42% receiving a shot by April. Only 22% of adults ages 18-65 received the booster, with even lower coverage of only 14% among children. The one tool the administration is most heavily relying on for pandemic control isn’t being effectively utilized, with 58% of at-risk older people, 78% of adults, and 86% of children unboosted. And I doubt vaccination rates will improve when the Bridge Access program, which provided free vaccines to uninsured people, ends prematurely this August due to lack of funding.

One of the reasons COVID deaths continue to be so high compared to historical diseases is that, although some of the vaccine-preventable viruses I named above are deadlier than COVID, only measles is more contagious, and none of them carry the same rate of reinfection we’re seeing from COVID. Quite simply, too many people are getting COVID, much too often.

We are currently in a “lull”, but “lull” is a relative term, and “low” in 2024 isn’t the same as “low” in 2020-2021. In 2021, shortly after vaccination, our summer low hit 12k cases a day. This year it’s never gone below 160k new cases a day- over 12 times higher than the low of three years ago.

Let’s bear in mind that in November 2021, nearly a year after the debut of the vaccines, when Dr. Fauci was asked when things could fully “go back to normal” and mitigations like masks could be dropped, he projected that when new daily COVID cases were under 10k, we could expect to fully resume normal life. During the surge this winter, we had over one million new cases a day. Not only have we never for one day had under 10k new cases since Fauci made this prediction, we have never had under 100k new cases on any day since then. So, we’ve never had a disease burden, for one single day, under ten times what Fauci deemed an acceptable level of circulation - and his projection was made at a time when more of the country was more recently vaccinated than they are today.

Why does the recency of vaccination matter? Two reasons. One, COVID mutates far faster than we’d hoped during the initial distribution of vaccines. I wrote a deep dive about variants, how they develop from unmitigated transmission, and our pharmaceutical companies’ inability to keep pace with the speed of mutation here. The closer the match between circulating variants and vaccines, the more effective they’ll be. More genetic distance = less efficacy. More unmitigated spread = more genetic distance. Failing to mitigate COVID actually harms the efficacy of the vaccines, which should be the last line of defense against the virus, not the first line.

The second reason is that immunity to COVID fades quite rapidly, both from vaccination and infection. Vaccine efficacy (VE) data shows that staying up to date with boosters is critical, because VE peaks between 4 weeks and 3 months, then continually wanes over time.

This waning of both vaccine and infection-acquired immunity is why neither “herd immunity”, nor the media-invented “hybrid immunity” ever materialized. In fact, you’re likely to continue to get COVID every single year. For context, you’re likely to get flu no more than twice per decade. That would be a massive new illness burden even if COVID didn’t carry myriad long-term health risks including Long COVID, heart attack, stroke, diabetes, and new onset autoimmune disease.

None of this means that vaccines aren’t critical, or that people shouldn’t get vaccinated; it in fact means that people should be getting boosted more frequently. But it’s a bit difficult to build a case for getting new boosters when you continually minimize the impact of COVID, advertise it as basically just a cold or flu, mock the idea of masking, or celebrate over 70,000 deaths a year as being pretty great. The public has repeatedly received the message that COVID is over. Why would you get vaccinated for a disease that’s mild and over?

Vaccines, with low uptake and rapidly waning efficacy, are simply not producing lulls or short periods of low cases and deaths; recent infections are. Vaccines are certainly reducing deaths, particularly during winter peaks, when people are more recently boosted. In fact, a recent VISION analysis found that the most recent boosters were 50% effective at reducing hospitalizations among immunocompetent people at the 7-59 day mark. But by 4-6 months, that efficacy vs hospitalizations was reduced to 16%. The picture was even bleaker for immunocompromised people, who, at the 4-6 month mark after the booster, had only a 7% reduction in hospitalization risk.

Celebrating the period of temporary immunity that follows mass infection is, as Dr. Lucky Tran put it, “like celebrating a low in heat wave deaths during winter.” Cold days don’t mean climate change is over. Low COVID death days doesn’t mean COVID has been handled.

Since vaccines are the only mitigation still being employed by the Biden administration- poorly, I might add- we can’t attribute lulls to policy at all. But objectively, deaths are much lower than they were in 2020-2022. How do you explain that?

Let’s start with the obvious: dead people can’t die twice. When you’ve already killed over a million people, you simply have a smaller pool of vulnerable people to kill. The Swedes notoriously referred to this population as the “dry tinder” COVID would simply burn through. Nearly everyone who could not survive their first contact with the virus is dead, because nearly everyone has been exposed - although that pool of people, the people who couldn’t survive the first exposure, was reduced after vaccination in 2021. Avoiding the eventual exposure of vulnerable people, by the way, was the explicit purpose of lockdowns. Had we actually been able to achieve herd immunity, as we have for measles, mumps, diphtheria, and polio, the most vulnerable would never have been exposed to COVID, just like we’ve never been exposed to measles, mumps, diphtheria, or polio. Instead they’re being exposed each time they leave home.

Vaccines doubtless saved hundreds of thousands of lives. Many people who were able to delay their first exposure to COVID until after vaccination thus did not encounter the virus immunologically naive, and therefore survived. But vaccine coverage and efficacy were objectively higher and better in 2021, so it’s odd to brag about summer 2024 COVID prevention vs summer 2022 as if anything has changed other than more people already being dead, testing being unwound, and resources pushed out of reach for the poor.

No matter how we’d responded to COVID, no matter who was in charge of the response, no matter if we’d had longer or shorter lockdowns or more masking or fewer vaccines, deaths would be drastically lower now than they were in 2020-2022. It’s true for every country on Earth, with every type of response (the one exception being China; an apt comparison would be the end of their Zero COVID policy vs today). That’s not a shot at vaccines; vaccines are and were critical. In fact, their efficacy waning is an argument for more frequent boosting, not fewer vaccines, although overall I would argue for continued development of more durable vaccine protection.

But lower mortality than we saw in the first pandemic years is simply the expected reality of a population that went from being fully immunologically naive to being fully exposed via a series of vaccinations and infections. If we want to celebrate successful policy, we should have evidence of Biden implementing any policy to reduce spread. Instead, supporters of the current “vax and relax” policy are comparing apples to oranges and setting an absurdly easy goal of “fewer people died than when no one had ever been exposed to COVID before.” The goal should be zero deaths. Not 75 thousand new unnecessary deaths, millions of Long COVID cases, tens of millions of new health conditions, and zero infection mitigation.

Our governments are doing less than the bare minimum; that’s clear to see from the never-ending massive surges brought on by new variants every few months. As a few prominent media figures celebrated last week, Hawaii announced it was about to hit peak COVID hospitalizations for the past 12 months, a highly concerning glimpse at how immune-evasive the new KP variants may turn out to be. In San Francisco, wastewater shows the KP variants spiking cases close to all-pandemic highs. Lulls are quite simply what follow surges; they aren’t representative of COVID being well controlled.

If I were to look beyond death certificate deaths, this piece could be three times as long. I could unpack the increased stroke and heart attack rates among young people, discuss Long COVID, and review what factors are being ignored when we use death certificates alone to measure impact. In other pieces I’ve already looked at ongoing, unprecedented student absence rates, the global hospital crisis, and record worker sick days. To not see the impact these absurdly high rates of illness are having on the world around us, you have to actively look away.

I don’t find it inspiring to laud 75,000+ preventable deaths in a single year as a victory. I also don’t find it doomerism to demand better; rather, I find it doomerism to wave the white flag to COVID and accept these deaths or even celebrate them. I find it doomerism to accept notably worsened health outcomes and higher levels of illness than we had just a few years ago; it’s a concerning sign that perhaps, when it comes to modern progress, our best days are now behind us.

We deserve better than a vaccine-only strategy with poor vaccine uptake. We deserve a real strategy to mitigate COVID infections, halt the worsening of collective health, and restore the idea of disease elimination as a treasured achievement of the modern era. Until then, we’re celebrating nothing more than a cold winter day on a sweltering planet.