Is the US done with COVID-19?

Famously, our administration has said that “the COVID pandemic is over” but that COVID is still a problem. Part of this opinion is likely due to the current Omicron variants being more benign than previous flavors of the disease and a desire to allow infections of this milder version to give the population some level of herd immunity (a difficult statement to make from a political standpoint).

I just ran across this:

“Generally, what happens in the UK is reflected about a month later in the US. I think this is what I’ve sort of been seeing,” said Dr. Tim Spector, professor of genetic epidemiology at Kings College London.

The “Zoe Study”, which has been running since the days of the first lockdown in England in 2020, has accurately captured the start of each wave, and its numbers run about one to two weeks ahead of official government statistics.

After seeing a downward trend for the past few weeks, the Zoe study saw a 30% increase in reported Covid-19 cases within the past week. “Our current data is definitely showing this is the beginning of the next wave,” Spector said.

In the US, some models have predicted that Covid-19 cases will begin to rise again in October and continue to increase into the winter. Experts are hopeful that because most of the population now has some underlying immunity to the coronavirus, this wave would be less deadly than we’ve seen in previous winters.

Immunity also waning in the United States, and Americans have also been slow to get boosted. Just 35% of those for whom a booster is recommended have had one (and presumably even fewer have had their Omicron-specific booster), according to CDC data.

So, here’s my personal take after recently spending six months traveling to over 40 countries and comparing how they were handling COVID. While there was some masking still going on in Central America, most of Europe had completely abandoned masking and any semblance of observing “social distancing”.

So, from a global (excluding Asia) standpoint, there is little stomach for more constraints and my guess is that it would take a super-dangerous variant to change things at this point. The same is likely true for most of Africa. Asia is beginning to open up, with Thailand doing away with vaccination and testing requirements and both Hong Kong and Japan greatly loosening up their laws to allow tourism back in. China (home to a quarter of the earth’s population) seems to be the major country still taking the war against COVID seriously at the population level. I am beginning to think that a large part of that is now political theatre.

On a personal level, both my wife and I have had a total of five COVID vaccinations in the past two years (the two original ones plus three boosters). All were Moderna and only the last one caused any significant side effects (like bad colds, but not as bad as, say the flu). We timed our last shot to “leave room” for an additional booster should it seem necessary before we leave again in mid-January.

Yeah - that leaving thing. We spent the six months on a ship. Everyone, passengers and crew, had been fully vaccinated, tested before boarding (and at 1-2 week intervals) and most had a booster (we picked up a second booster along the way which may have given us extra protection). A fair amount of social distancing and total masking was practiced at the beginning of the cruise, but once the ship got to Europe, many sort of abandoned the practices and the cruise line stopped attempting to enforce the practices. We continued to mask and practice a reasonable level of social distancing and we were among the exceptions as (by my estimation) roughly 75% of both the passengers and the crew were infected by COVID during the trip - almost all after the mitigation techniques were discontinued. It was a sort of COVID lab where I could predict who would show up with COVID in a week by observing how they were acting.

In any case, today, few cruise lines demand vaccinations, masking, distancing or even do testing. IMHO, anyone who takes a cruise of any length under today’s conditions (who hasn’t had COVID in the preceding couple of months) is very likely to come home with a COVID infection. How they fare after being infected will depend on whether their booster shots are up to date. Unmasked airplane trips are likely providing greater than average exposure as well. Despite our vaccination status, we continue to wear KN95 masks (along with all of the Asians, but few else, in our neighborhood). After a few years of this, it’s no different than putting on a belt or a hat (and seems to be as pragmatic as it seems useful in keeping us from catching the disease).

Anyhow, they say forewarned is forearmed, so don’t take COVID for granted this winter - while its symptoms may be milder than iin the past, “long COVID” is still a concern.

Jeff

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Before I start. About cruise ships. I was following your description of the cruise earlier in the year, Jeff. Thanks for sharing. Around 2020, I was contemplating moving to a beautiful small town which is very popular on the Med cruise ship routes, near Venice, but it occurred to me it’s probably going to be covid central for years to come. 100% agree - mask up and take covid seriously, folks, or covid will be taking you. Seriously.


FWIW covid chitchat. Apologies for using ‘general interest’ articles below rather than direct links to scientific papers, but anyone curious in that direction can follow it up easily enough I’m sure.

(1) Multiple new variants experiencing growth in cases: BF.7, BA.2.75, and BA.4.6. General interest summary here:

https://www.cbsnews.com/news/bf-7-ba-2-75-covid-variants-rise-cdc-tracking/

(2) Next wave building in October, to peak around Christmas/New Year.

" …University of Washington and other experts, including Dr. Anthony Fauci, the nation’s top infectious disease expert, foresee a wave beginning to swell in late October, and peaking in late December or January."

https://fortune.com/well/2022/09/24/new-covid-omicron-variants-subvariants-evade-monoclonal-antibodies-bebtelovimab-recombinants-convergent-evolution-sars-immune-evasion/

(3) Antibody escape (vaccine/past infections), broad autoclonal (artificial) antibody escape being seen, in addition to resistance to Evusheld (antiviral combination). Put simply: doctors already have very few fancy medicines to treat the new strains with if you get seriously ill.

https://fortune.com/well/2022/09/22/new-covid-variants-subvariants-may-evade-treatments-eliminate-bebtelovimab-paxlovid-omicron-monoclonal-antibodies-vaccine-immune-evasion/

https://time.com/6216760/ba-2-75-2-centaurus-omicron-variant-vaccine/

(4) Couple of recent general interest articles relating to long covid & reinfection.


(ADHD people: “welcome to the nightmare realm of executive function disorder!”)

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My wife and I are still taking some precautions, but have lowered our guard in the last month after getting our 4th booster. We are in our mid-50s and mostly healthy/active, so we think that we’d be pretty unlikely to get a severe infection or long covid if we were to pick it up now. We plan on getting the 5th booster in a couple months.

It will be interesting to see how the long covid situation plays out for people who get Covid after being repeatedly vaccinated. I’ve not seen any assessment of that, but I assume the incidence will be much lessened.

I don’t think the China lockdowns are political theater. I think it’s a fairly rational response to a population which is still highly vulnerable, due to inferior vaccines, lack of vaccination by a large segment of the population, and the rarity of natural infection.

If they abruptly let down their guard, there would be a massive wave of illness and death. They need to open the doors to foreign vaccine and have a massive campaign to vaccinate the population, especially older folks, then they can relax their approach.

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Biden’s statement is pretty accurate from the perspective influenza. The most famous flu pandemic is of course the notorious 1918 “Spanish flu” that occurred when a bird virus called H1n1 jumped to humans. Most would agree that this pandemic is over, yet people still get sick from H1n1 variants and we still get periodically vaccinated against it, most recently in 2009. COVID is following a pretty similar pattern.

COVID ain’t going away even if all humans get vaccinated tomorrow. It is pervasive in the American deer population, which potentially provides a massive reservoir for the virus to mutate regardless of how many people get shots. Scientists are being conservative in their pronouncements on this issue but it seems prudent to assume that COVID variants are here to stay.

The good news is that judicious use of masks and just common sense turns out to be very effective for two reasons. The first is the obvious reduction in infection risk. The second is the more controversial but (IMO) likely possibility that masks reduce that the severity of the illness. This is based on evidence that COVID severity is strongly influenced by the number of virus initially transmitted (the inoculum). In other words, even if a mask fails to prevent infection it could reduce the number of viruses that get to you and so reduce the severity of the disease.

Wearing a mask solves a lot of problems when it comes to airborne infectious diseases.

Why the 1918 Flu Pandemic Never Really Ended - HISTORY

COVID is spreading in deer. What does that mean for the pandemic?

Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer | SpringerLink

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Locally, in my smallish city in western NC, Covid has been steadily spreading through the population at a fast clip since May of this year. I track it by the wastewater numbers now instead of cases, since there is so much less testing than there used to be.

For comparison, the Delta peak, which was pretty brutal back in fall 2021, had wastewater numbers locally of about 15 million viral gene copies per person. It’s been that high or higher steadily since May. It briefly dipped lower a few weeks ago, but has bounced right back up there the last 3 measurements reported, from 9/14-9/21.

Nowadays virtually everyone has some immunity, and the Omicron variants may not be quite as prone to cause the viral pneumonia that the earlier variants did, so the amount of serious sickness is way below the Delta days. But, the virus is out there copying, mutating, spreading like wildfire.

We can only hope that the next dominant variants go even further down the path of reduced virulence, because a large percentage of the population will be getting it (again) in the next 6 months, given that virtually no one takes serious precautions anymore.

Moderna has been dropping more recently, hit a low for the year yesterday at ~115, and currently is ~120, with trailing PE of 3.7.

“Moderna has been dropping more recently, hit a low for the year yesterday at ~115, and currently is ~120, with trailing PE of 3.7.“

So the question is whether Moderna is a one-shot wonder or whether they can do one or more of the following:

  1. Sign up China as a new customer
  2. Make a reasonable amount of money by a continuing steam of annual (or bii-annual) COVID boosters, similar to what happens with the flu shot.
  3. Use the technology which brought us the COVID-19 vaccine to bring to market additional profitable products

Have they addressed any of these?

Jeff

(10% underwater on a modest Moderna position himself)

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They’ve discussed all of these, though there is not clear visibility on any of them.

The Chinese question only recently made the news, but only with ‘we’re in talks, we’d love to work with them’.

They say they do expect Covid boosters to be an ongoing business for years to come, similar to flu, which seems a reasonable estimate, but there are no guarantees.

Their pipeline of drugs/vaccines in the works has a number of items that could be good money makers. Items in Phase 3 trials are flu, RSV, and CSV vaccines. I guess none have the potential to be the mega-blockbuster that their Covid vaccine was, but they all could be money makers. And they aim to produce a vaccine that combines Covid, Flu, RSV, and common cold Coronavirus, which could be quite popular, though years off.

I like their prospects, but they’re somewhat speculative.

Hello all. I don’t own moderna, but I hope to. That may sadly require your positions to go further underwater, because I’m an absolute cheapskate. I will probably buy it at the prevailing price when the market reaches SP3300ish. Here’s my argument:

  • Moderna proved itself to be, in a very real sense, the most technically capable company & organisation on the planet - despite relatively small scale & funding - at the tasks of designing AND global-scale production AND global logistic low-temperature distribution of a completely novel form of medicine for a completely new disease.

Fastest developed, most effective (of all vaccines for covid to date), and a reasonable price.

I don’t expect earnings to hold up at all, but that’s OK, because they’re cash rich, no debts now, and clearly good at solving species-survival-grade problems. Worth having a little bit. I have faith they will do other extremely clever, competent things later on. It’s a bit like having faith in Berkshire, in a sense.

I also intend to pick up biontech & pfizer if they get cheap enough because they did extremely well too, on multiple factors. What more can we ask from a company other than being cheapish in a value sense, very good at what they do, and able to sell it en masse? Ideally, with little competition, good profit margins, high level of production output, and a must-have for every person on the planet.

The reason why Moderna ‘won’ in so many ways is they prepared hard. Covid basically plugged straight into a live dry run they were doing against possible viruses that could show up. It took them 1 day to come up with a viable vaccine candidate. I mean… it’s like showing an iphone to a caveman, compared to every vaccine development and production attempt of the last few hundred years.

About ‘infectious dose’ and masks, it’s pretty well established from many diseases that a lower initial infectious dose results in milder disease. One of the ways you can do this is by giving rats etc varying amounts of the pathogen by air or injection then calculating LD10, LD50, etc. However, this does not prove the case for covid & masks. It’s just extremely likely.

This paper (2021) refers to existing studies of the flu & some non-covid coronavirii, with human volunteers. Studies were measuring dose-dependent disease severity i.e. how sick per unit of initial virus exposure. Also refers to studies for measles, TB, HIV, and pneumonia.

Lux

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