Friday, August 20, 2021

Should vaccinated people be expected to regularly test themselves to protect others and help prevent variants from evolving, and sharing the sacrifice?


Cambridge, MA 2015-8

Dr. Sanjay Gupta has a sobering essay, with videos, “Simple steps for coexisting with the virus”, link The article has a difficult video on long COVID.  It’s particularly disturbing to hear how the virus enters the brain.  There seem to be some cases of long COVID even in vaccinated people with few symptoms during infection.

I wanted to focus on one particular prospect in his essay:  that vaccinated people may have to be regularly tested just as unvaccinated, at least during large outbreaks, as he looks at recommendations from Harvard's Jeremy Faust. 

Gupta does suggest (or relay the idea of) the use of at-home rapid antigen tests, discussed in these blog before.  He seems to imply that they would be mandatory even for the vaccinated, possibly by employers or for entrances into businesses or even for residents of buildings.  That would suggest a smartphone tracking system of the infected, which might have the possibility of evolving into Australian style quarantines.

This idea has completely flipped the idea of “personal responsibility” as we understand it.  Before COVID19 (or COVID21 now) it was pretty much “survival of the fittest”.  That was the case with the H1N1 pandemic in 2009, which did not become “that bad”.  Then, no one seriously talked of quarantines and shutdowns.  I went to bars and yet lived “at home” with a 96-year-old mother.  That would be unthinkable now.  Neither myself, mother, or any caregivers every got H1N1, but we, being older, may have had residual resistance from historical outbreaks in the past (my mother was born 5 years before the 1918 pandemic).

Now, anyone is morally responsible if gratuitous behavior infects others more vulnerable.  This could lead to new standards for civil liability and litigation, and of course new criminal laws.  Of course, the “libertarian” resistance in red states may push back from things going this far.  And we would have to ramp up to manufacture and deliver the rapid tests, and develop the surveillance systems (which a startup could do).

There is even more to this than the vulnerability of others around you.  Infection carries with it contributing to the possibility of incubating more dangerous mutant strains.

Of course, in theory a rapid-testing regime could drive the R-naught down enough that life returns to normal (after a period of Australian-style military discipline on civilians), but Delta is so contagious that this sounds very difficult without sterilizing vaccines (like proposed nasal vaccines).

Perhaps this is all speculative.  But we have seen this idea before.  Remember the case of Typhoid Mary, who, while clinically well, was kept locked up until she died.   During the 1980s, the “religious right” indulged a theory that gay men were “aimplifying” a bloodborne disease until by chance it became more casually contagious or spread by insects.  Actually, I’ve never heard of a virus suddenly becoming an arbovirus.  Another rumor was that immunocompromised AIDS patients would harbor other infections which would mutate and infect the general population – something similar to what seems to be happening with COVID now.  Yet, I never heard of a single case where that really happened and fired up a secondary epidemic in the general population of something else.

Also:  Yahoo! News (Andrew Romano) reports that unvaccinated Americans tend to blame vaccinated Americans on the rise of the variants, against the science.  There are credible theories that vaccines (especially if non-sterilizing) if not rolled out very quickly to the whole world, will encourage the development of variants trying to escape them.  USA Today (Joel Shannon et al) also discusses breakthrough cases, and warns vaccines don't make you invincible. 

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