Gottlieb’s Assessment

Here’s Scott Gottlieb’s assessment of our struggle in the coming year with SARS-CoV-2 in his op-ed in the Wall Street Journal:

The virus is likely to become endemic, meaning it will continue to circulate but at a much lower level than the epidemic. If we are prudent, next fall could look like an especially virulent flu season in which the vaccines are a poor match. Most of the activities Americans enjoy will resume, though some of them will require precautions.

That starts with changes in the way people go to work. It should be frowned upon to come to work sick and try to “brave out” a cold. Testing for flu and Covid will be widespread with home tests. Many people may still prefer to wear masks in public venues, but they won’t be required. We will be more mindful of ventilation indoors and crowds in confined spaces.

These steps will have benefits that go beyond Covid. They’ll also slow the spread of other respiratory infections—including influenza, which exacts a huge toll each year. The flu caused more than 40 million symptomatic illnesses and 650,000 hospitalizations in the 2018-19 season, according to estimates from the Centers for Disease Control and Prevention. A 2018 study in the journal Vaccine estimates the economic damage, including reduced productivity, at $11.2 billion a year. That figure may be conservative; some models say the burden is up to $87 billion annually.

The priorities for next year will be to pass out vaccines widely, hopefully with all Americans eligible by the spring, while continuing to collect information on safety and benefits. It will also be essential to provide easy access to vaccination—preparing drugstores to offer the Covid vaccine like flu shots. If a high percentage of the most vulnerable populations are vaccinated, that would sharply reduce Covid risk. The benefits will be even greater if, as hoped, vaccines don’t merely reduce the risk of severe symptoms but also reduce the chance of being infected and spreading it around.

The coming year will be an adjustment to a new normal. Society won’t return to its 2019 strategy for handling respiratory pathogens, but that isn’t a bad thing. The pandemic response has been plagued by a vocal minority that dismissed Covid’s risks and fought measures like masks. That posture of defiance will have to change for a semblance of normal to return in 2021. But with sensible measures, medicines and vaccines, Covid can be turned into a manageable risk.

I think that’s a best case scenario. More likely will be that fewer than 10 million people will be inoculated by the end of 2020 (half as many as predicted—I’ve heard that the number inoculated to date may be as few as 2 million) and that both production of vaccines and inoculations will lag behind the predictions made to date. It’s possible that inoculations won’t be available to “all Americans” until July or even later.

Questions that I can’t answer include how long will Pfizer’s and Moderna’s vaccines remain the only vaccines even to receive emergency use authorization in the U. S.? Are Pfizer and Modern really able to produce their vaccines at the rate they’ve promised? And will issues that arise as more people are inoculated impede the deployment of the vaccines?

As I’ve said before, my experience in life has been that when you see the light at the end of the tunnel it is generally an oncoming train.