Quo Vadis, Covid-19?

 I have not posted for several weeks -- life has been extraordinarily busy here but is now at a more even and manageable keel. The Covid-19 pandemic continues its devastation around the globe, with India and Brazil as current global hotspots. The situation in the United States is clearly improving. Understanding the variations in the pandemic provides clues to what works and doesn’t work to contain and mitigate it. 

India’s situation is indicative of what can happen when control measures (masks, social distancing, ventilation, avoidance of crowds) lapse. India’s curve from Johns Hopkins statistics is here:

After a surge last fall, cases dropped precipitously until mid-March 2021 -- then literally exploded. What happened? A good analysis was made in Time magazine. After major efforts in 2020, including massive lockdowns, blunted the epidemic in India, a narrative emerged that India’s self-reliance had overcome Covid-19. Political leadership trumpeted this. On 21 February, the ruling Bharatiya Party (a right-wing Hindu nationalist party) issued a resolution hailing the “visionary leadership of Prime Minister Modi” in showing to the world India’s successful approach to the pandemic. Massive political rallies and religious festivals occurred; masks and social distancing were dropped; complacency ruled. This incompetent leadership collided with an untamed pandemic with the added problem of viral mutants of SARS-CoV-2 which were more transmissible and pathogenic. The epidemic curve above tells the story in part. It does not tell the story of a massive failure of the healthcare system, black market oxygen at outrageous prices, and the accompanying misery and deaths that are being seen. Leadership matters. Modi and his political party failed on a colossal scale. One spillover result was cremations in public parks and parking lots because crematoria were overrun. Another is bodies dumped into the Ganges River because families cannot afford the increasing price of cremation. India’s ability to provide vaccines, even for its own populace, is gone for now. As Kurt Vonnegut said in Slaughterhouse-Five, “And so it goes…”.

At least the epi curve for India shows a hopeful downturn in new cases over the past two weeks. Here is Brazil’s epi curve:

Brazil is led by Jair Bolsonaro, a right-wing populist. The government under Bolsonaro has pursued a strategy of attaining herd immunity to Covid-19. The approach included laws designed to limit the use of masks and social distancing; the obstruction of states and municipalities to independently respond to the pandemic: and governmental propaganda directed against public health authorities, including a massive disinformation campaign. As the epi curve clearly shows, this approach is a gross failure. If you are comparing the curves, please remember the difference in population between India and Brazil. Brazil’s failure is every bit as terrible as India’s.

In the United States as noted above, we are seeing an emergence from the worst of the pandemic. Here is the epi curve for the United States as of today, for comparison:

Beginning in December 2020 and ramping up in January 2021, the United States committed to getting vaccines for Covid-19 into the arms of all people in the United States. As a nation with resources and infrastructure, we are fortunate that this was available to us. We have also seen the spread of virus variants that are more transmissible and more pathogenic. Thus far, they have not been as much of a problem as elsewhere. My guess is that is in part due to continued use of masks, attention to ventilation, increasing numbers of vaccinated people -- and luck. As noted in the New York Times article, we are not out of the woods. This is a race between variants and vaccination. As Eric Topol put it today, “Even formidable (viral) variants have not been able to override protection by vaccination. What are the top 5 ways to maintain that? Vaccination, Vaccination, Vaccination, Vaccination, Vaccination.” 

Vaccine hesitancy remains a barrier we continue to deal with in the United States. The reasons for this are many. The reasons, sadly, include the element of disinformation spread among supporters of the former president and his Republican followers, who have an unhealthy case of Covid-19 denialism. This graph shows doses of vaccine administered in the United States as of 22 May:

The trend is downward. The New York Times article from which I took this curve has a map that shows the wide variation across the nation; some areas have high vaccination rates, others have lower. What we see globally are real Covid-19 hot spots (India and Brazil) as well as the nations that have clearly done better (e.g., Israel). The unevenness of vaccination across the United States worries experts, because we are seeing hot spots across our nation, a miniature of the planet itself. The science shows the vaccines work, but they work only when they are delivered into the arms of the susceptible.

My major takeaways from all of this? First, the pandemic is not over; so long as there are hot spots, the potential for flares of transmission in susceptible humans remains. Second, vaccines are astoundingly effective if they can be administered into humans. Third, vaccine hesitancy remains a large obstacle, along with disinformation regarding vaccines. Fourth, the United States will probably be back to a good semblance of normal in the next month or so. Fifth, the wealthy nations of the world must dedicate resources to ensuring that the less-wealthy nations of the world get vaccinated. And finally, good leadership matters. India and Brazil illustrate the overt failures of right-wing populism in dealing with Covid-19. The leadership that we replaced in November 2020 here in the U.S. was of the same caliber as Modi and Bolsonaro. Dismal. That should be a major lesson going forward for the U.S. Leadership matters.