The healthcare system cannot withstand endemic COVID-19
The United States has 2.5 hospital beds and 2.6 physicians per 1,000 residents. That number is far below many other wealthy nations. (In Germany, for example, those numbers would be 6.0 and 4.3.) Anyone who has tried to get a doctor’s appointment and found the next available slot months away understands how small the number of available physicians really is. And news stories of patients being shipped hundreds of miles in search of an open bed show just how little leeway there is in hospital capacity.
Not only does the U.S. have few hospital beds available, the system is not designed to run at 100% capacity for an extended period. Over the last three decades, hospitals have typically been about 66% full. They are designed to be 66% full. They are supplied as if they will be 66% full. They are staffed to operate 66% full.
Over the last 18 months, hospitals across the nation have operated at extraordinary levels. The nighttime applause and (not frequent enough) public praise for health care workers is absolutely deserved, because they have been operating at the ragged edge of exhaustion for a period much, much longer than this system was designed to accommodate. Not only are these workers facing extraordinary hours, they are themselves subject to exposure and illness, which has often required them to be isolated from family and friends. In addition, they have faced record numbers of patients who they simply could not help. Nurses and doctors have had to flip that final switch on forced ventilation at a rate that is incredibly traumatizing.
As The Lancet noted back in February, COVID-19 has lead to an extremely high rate of burnout among health care workers around the globe. It’s also very worth noting that this is having a disproportionate impact on women, including women of color, who make up almost 70% of health care workers.
Health care workers can’t go on in a system where hospitals are operating at near capacity, where ICUs are seeing record numbers of patients, and where death and long-term disability is a daily outcome. It’s not just a matter of the expense—though the expense is towering—the number of trained people to support a health care system for a perpetual pandemic is simply unavailable.
If the health care system hadn’t been stripped down with the closing and consolidation of hundreds of hospitals, especially those in rural areas now seeing surges of COVID-19, or if the nation had gone to a national health care system that could be addressed by emergency federal action, things might be different. But the hospitals closed and the system is a morass of private hospitals and private insurance patched together by federal plans. It will not hold.
endemic COVID-19 comes with unacceptable sacrifices
Right now, the economy—on a Wall Street Journal basis—seems pretty sweet. The stock market is up 14% for the year. Unemployment claims have declined. The unemployment rate is down to about half of its pandemic high. With the help of stimulus payments, including the child support payments that should be made permanent, there appears to be every indication that the economy is not just recovering from the pandemic, but prepared to roar.
But at the same time, industries from automobiles to furniture are struggling with something that all of them had claimed to master just months ago: the supply chain. For decades, industry has been getting ever more “lean” and “six sigma” as it trimmed back workers, reduced stockpiles, and grew absolutely dependent on a system that requires 100% production everywhere, all the time.
That’s meant that disruptions anywhere on the planet, like Chinese microchip factories, can generate shortages at American auto dealers. Or in local grocery stores. It’s also meant that keeping things moving during the pandemic included an executive order forcing a largely immigrant labor force back to work at meatpacking operations even as COVID-19 was decimating their ranks.
Living with endemic COVID-19 means living with the idea that “essential workers” everywhere have to be prepared to put their lives on the line, not just to usher the world through an unprecedented crisis, but perpetually. Those workers are more likely to be people of color, and more likely to be in locations or situations that limit their options.
And those workers are being locked in by the one action that Republicans are taking in one state legislature after another: They are making sure that no one can sue employers for forcing them to show up for work in unsafe conditions. As an example, Missouri, currently the bright red center of the latest COVID-19 surge, passed legislation back in May that prohibits liability lawsuits against businesses.
Accepting a perpetual pandemic means that essential workers have to put their lives on the line day in and day out, and that’s on top of the poor safety records already featured in many of these industries. The people who are casually willing to accept thousands of COVID-19 cases a day as the cost of doing business are not the people cutting chickens or working in warehouses. They’re the people who own those businesses.
Unvaccinated doesn’t mean what you think
Yes, from the very beginning of the pandemic Republicans have moved ever more into the anti-vax camp. Civiqs currently shows Republican vaccine hostility unchanged, with 43% refusing a safe, available, effective vaccine. The temptation to say “if those people want to kill themselves to own the libs, it’s no skin off my nose.”
But the vast pool of unvaccinated Americans goes beyond Republicans. For one thing, right now no vaccine has been approved for children under 12. Both Moderna and Pfizer/BioNTech are expected to produce results of studies on this group by September, and it may be expected that the FDA will issue an emergency use authorization soon after, but making vaccines available to kids may mean different dosages or different treatment instructions. In any case, don’t expect any widespread vaccination of young children this side of Halloween.
That means that kids will be starting back to school, not just in states where Republicans have made it impossible to see that teachers and staff have been vaccinated, but where they themselves will have no chance of vaccination. Not only will many of these schools be operating without masks, some Republican governors have already outlawed the use of masks in schools.
While children may have gotten off relatively lightly early in the pandemic, there has never been any doubt that they can act as vectors of the disease. Worse, the delta variant appears to be much tougher on children. Pediatric cases are up. More children are being hospitalized.
Taking Gov. Ron DeSantis’ Florida as an example, where 90% of the seniors are vaccinated in spite of Republican downplaying of the disease and spreading anti-vax conspiracy theories. But only 30% of kids between 12 and 17 are vaccinated, and 0% of those under 12. In Mississippi, only 12% of children between 12 and 17 are vaccinated. When the numbers show that 99.2% of deaths over the last month came among the unvaccinated, that number includes kids, many of them live in states like Tennessee that have taken action to make sure that vaccines are not available.
In addition to children, there are also those who simply can’t get vaccinated. The number of people who have long-term immunological conditions meaning they can’t accept vaccines is small. However, number of people undergoing treatment at the moment—such as chemotherapy for cancer—that means they may not be able to be vaccinated is not small. Even when they are vaccinated, these patients may be so immunologically compromised that they don’t create the level of response necessary to protect against the virus.
These patients are always in danger of catching diseases like flu. COVID-19 represents a disease where the risk is orders of magnitude greater. And, since cancer patients and others undergoing prolonged treatment must make frequent visits to health care facilities, or even have extended hospital stays, they are more subject to exposure.
Cancer patients and those with immunological conditions have enough on their shoulders. They shouldn’t have to bear the additional constant threat of COVID-19 infection.
Never putting out the fire means it will come roaring back
It’s not as if there isn’t already a threat. NBC News tallied 65,000 breakthrough cases in 27 states—and those are the states that are still bothering to report detailed data. Unlike Florida. Unlike Missouri.
But every person infected brings around 10,000,000,000 new examples of the SARS-CoV-2 virus into existence. Every single one of those is subject to mutations. Those mutations then get winnowed by the one evolutionary pressure that faces viruses: getting that R0 number ever higher.
The idea that viruses always mutate to become less deadly over time is simply not true. Viruses become more contagious. That’s it.
Smallpox infected human beings for at least 3,000 years. Archeological evidence suggests that the virus was killing people for more like 10,000 years. It may be much older. It was just as potent in its last case in 1975 as it was when it swept through Egypt under Pharaoh Ramses the V. The same thing applies for measles.
Right now, vaccines are still highly effective in preventing infection, and even more effective in preventing serious illness against the variants. But COVID-19 is a brand new disease when it comes to people. No one, but no one, has a natural immunity. There is no handy closely related but mild infection (ala cow pox) that might provide some with protection. The newness of COVID-19 makes it almost infinitely more threatening that diseases we’ve been dealing with for ages.
COVID-19 is still engaged in a process in which unguided mutation is searching out the best way to infect human cells. The newness of that process can be seen in the huge gains being made in each generation of variant. Alpha was twice as infectious as the original variant that ravaged Europe and the U.S. Delta is over twice as infectious as Alpha. You do not see that kind of change in well-established, long-term disease.
Allowing COVID-19 to continue burning through a few percent of the population each year is like ignoring embers at the edge of a forest. This is a new, deadly disease that has already demonstrated that a great deal of refinement is possible when it comes to increasing infection or evading vaccine. Will Lambda be the variant that makes the next step on the ladder? Maybe. But if the fire is allowed to burn, it will only get hotter.
The threat from COVID-19 has been underestimate from the beginning. It still is
The official number of COVID-19 dead in the U.S. is 606,818. The best numerical models suggest the real number is over a million. Reports out of India suggest that the 414,000 officially dead there is off by an order of magnitude.
This is an extremely serious disease. It is at least twice as contagious as the flu that caused the 1918-1919 pandemic. The latest variants appear to cause a higher rate of serious illness, including among young people.
The goal has to be to eliminate COVID-19. Not live with it. Because we really can’t.