How We Got Here

It was a scary time.  When the first wave of COVID-19 swept through the nation in the spring of 2020, infection rates, hospitalization rates, and death rates climbed rapidly, and we didn’t know how high they would go.  Nursing homes were especially ravaged.  Once infected, more than 40% of people over 75 years old died.  We were focused on keeping people alive, and we were committed to making sure that the sick had the resources for their best chance at survival.  As hospitals filled up, our greatest fear was that people would die waiting for a ventilator.  We determined to decrease the height of the wave by stretching out the time it would take to pass over us.  Whether you agreed with the policy then, whether you agree with it now, that’s why we locked down, masked, and social distanced.  We thought it was the best way to accomplish our objective of keeping people alive.

As the first wave passed, we relaxed a bit and found ways to feel normal again.  We all stocked up on toilet paper.  We tested small gatherings on Memorial Day and Independence Day.  Those of us who survived (regrettably not all of us did) became convinced we could survive again.  As the second wave of COVID-19 swept over us in the summer, we had new tools—tests, convalescent plasma, and drugs.  And we had the promise of vaccines.  If we could just hold on until the vaccines arrived, we would have a lifeboat that would save us from the virus and make things normal again.  We all wished it would be so; it was not to be.

The second wave was devastating, infecting more people, and lasting longer than the first.  Again, the elderly, the obese, and the diabetics were hardest hit, but more people survived infection this time.  Mortality rates for those over 75 years old were cut in half—still too high, but better than before.  

As the second wave passed and we entered the calm of fall, we began to see our vaccine saviors on the horizon.  Applications were submitted to the FDA.  But by now, the virus had mutated, and the more infectious alpha variant headed our way.  This third wave, the largest and broadest of the three, proved that we had learned how to handle the virus.  Death rates for infected individuals older than 75 dropped to 15%, about the same as Russian roulette.  Still, more Americans died in the third wave than in the previous two combined.  

As the alpha wave headed towards its crest, Pfizer-BioNTech received an EUA for its vaccine.  People clambered for vaccination, especially the elderly and front-line health care workers.  Moderna was authorized, then Janssen.  Local health departments organized waiting lists, and people skipped work when they got the call for their turn.  Operation Warp Speed put vaccines into arms in record time.  And the alpha wave began to subside.  There seemed to be an inverse correlation between vaccination rates and infection rates.  

It was about this time, as lifeboats appeared on the horizon, that we lost our way.  We stopped focusing on helping people survive, and we put our energy into pulling people into the lifeboats.  We didn’t recognize that the boats were leaky, and that some people were better off where they were.  We believed that vaccination would lead to eradication which would lead to freedom and our pre-pandemic lives again, but it wasn’t true.  Even as the alpha wave receded, it became clear that the virus would be here to stay.  

Yet we clung to the fantasy.  We abandoned our initial objective of helping people live.  Instead, we believed in the make-believe of universal vaccination—if we could just vaccinate everybody, the virus would leave earth.  Nevermind that the vaccinated can pass the virus to others; at least they won’t be infectious for as long.  Nevermind that the vaccinated get sick; at least they won’t die.  Nevermind that some vaccinated died; their deaths are clearly the fault of the unvaccinated.  Nevermind that vaccination doesn’t last very long, doesn’t prevent severe disease, and isn’t as good as natural immunity.  Vaccinate!  Vaccinate!  And vaccinate again, with unauthorized boosters!  Afterall, it’s a pandemic of the unvaccinated.

As the delta wave washes over us now, we must have the courage to believe what we see.  Our vaccines are leaky, and they will not eradicate the virus.  We cannot vaccinate our way back to our pre-pandemic lives.  It’s time to change the paradigm.

We must return to our original objective of keeping people alive, and we must measure our actions, our public health policies, and our pandemic response against this objective.  When we stop following the fairytale of universal vaccination, we can use vaccination as a tool to further our true objective of survival.  We must develop other tools, prophylactics, and early treatments, and we must see whether any old tools can be repurposed to accomplish our objective.

We can defeat this pandemic if we change course, but the window of opportunity is closing.  We must change course now.