Diverging Views on Covid-19 Risks

LATELY, views about Covid-19 are diverging generally into three camps: In the first, the future looks rosy and bright; for the second, emerging Covid variants threaten to pose serious risks; and the third camp believes there is too little information, though they have lingering concerns.

Many who are fully vaccinated consider the most worrisome risk, even if very unlikely, is Covid’s “long-haul symptoms” —most often intense fatigue, which can last more than six months and affect all ages, including the youngest and healthiest.

Meanwhile, officials continue to advocate caution: the CDC discourages long-distance travel and large gatherings; and President Biden said Americans need to continue wearing masks until “the vast majority” of Americans have been vaccinated—which by the end of last week was 12% of the population.

First, the yay-sayers—with conservatives leading the pack. “Republicans consistently underestimate risks, while Democrats consistently overestimate them,” according to a Gallup/Franklin Templeton survey of 35,000 Americans. More than one-third of Republican voters incorrectly stated that people without Covid symptoms could not spread the virus and that Covid killed fewer people than seasonal flu; while a large share of Democratic voters put the hospitalization rate due to Covid, which is close to 1%, at around 20%.

“Once most adults are immune—following natural infection or vaccination —the virus will be no more of a threat than the common cold,” writes Apoorva Mandavilli, quoting a study in the journal Science. It will become endemic—a pathogen circulating at low levels “that only rarely causes serious illness”—like the four endemic common cold coronaviruses circulating currently.

“Ending the Covid crisis should take only a few months,” writes Eric Levitz in New York magazine. Levitz makes the important distinction between the goals of herd immunity and “eradicating” the novel coronavirus versus Covid following the path of earlier coronaviruses and becoming “an endemic common cold.”

The possibility that emergent “hypervirulent” Covid variants might prove resistant to existing vaccines appears “far-fetched,” according to Levitz. Against both the British and South African variants, the full two-dose regimen of the Pfizer vaccine produced neutralizing antibodies in 90% of participants in an Oxford University study—and “insulated subjects from the threat of even mild illness, no matter the strain.”

The vaccine “dramatically reduced viral load in those infected with the virus”—reducing both its rate of transmission and its lethality—in studies in England and Israel. This coronavirus should become endemic, writes Levitz, even if the ongoing emergence of new variants makes it impossible to achieve herd immunity—“the point at which such a high percentage of the population is incapable of transmitting the virus, it gradually dies away.”

Levitz concedes, however, that “It is possible that the darkest days of America’s winter are still to come…The ongoing spread of hypercontagious variants, pervasive flouting of public-health guidelines and logistical headaches afflicting the vaccine rollout could coalesce into a perfect epidemiological storm.”

It is exactly those “hypercontagious variants”—with higher rates of both transmission and lethality—that are causing new spikes in Covid cases and hospitalizations in Michigan, and rising case numbers in Maryland, Minnesota and New Jersey.

The main culprit in these states, the B.1.1.7. variant, carries a 61% higher risk of death than earlier strains, according to a London School of Hygiene and Tropical Medicine study. University of Minnesota public health specialist Michael Osterholm warns that the spread of B.1.1.7. in Britain began with small outbreaks “that snowballed even though most of the country was shut down.”

“European countries hit hard by the variant did not experience rising case numbers until the variant accounted for more than half of all circulating strains—a milestone the United States could hit in the coming week,” Osterholm noted.

Alongside the threat from variants, “breakthrough infections with lesser amounts of virus” can occur even in those who are fully vaccinated —as long as a high percentage of the population remains unvaccinated and levels of virus are high, according to CDC Director Rochelle Walensky. Fully vaccinated people who are exposed to the virus in crowded settings like group homes still need to quarantine for 14 days and get tested.

High on the watch list for the too-little-information group is the comparison of Covid’s future to that of seasonal flu or the common cold. Said Harvard Public Health epidemiologist Marc Lipsitch, “I don’t think it’s absolutely guaranteed.”

This third group is also paying attention to the variants. “Let’s wait and see what we know about the variants. Fingers crossed,” a woman recently responded to her 80-year old mother, who had been eager to make travel plans.

Exacerbating the unknowns, different states have different rules about quarantines, while different doctors have different opinions about what is safe. Driving the CDC’s advice March 8 against long-distance travel is that, according to Walensky, “Every time there is a surge in travel, we have a surge in cases in this country.”

In D.C. and most surrounding counties, Covid numbers remain “very high”—the second highest category in the New York Times ranking, meaning more than 10 new cases/100,000 population/day. For those in the “very high” category, indoor activities are “very dangerous”—with the accompanying advice to avoid nonessential travel and events with more than a handful of people.

Meanwhile, “long-haul” symptoms continue to make front-page news—afflicting as many as 30% of Covid patients, of all ages, among cases ranging from serious to asymptomatic. The 177 Seattle-based patients followed in a University of Washington study were “relatively young and healthy,” said infectious disease specialist Kristin Englund at the Cleveland Clinic.

In studies from England, Canada, China and the U.S., Covid “long-haul” symptoms have included debilitating brain fog and fatigue, often relapsing and remitting over three months and longer, as well as loss of smell and taste, heart problems and the potential for new cases of diabetes.

After a bout of Lyme disease, I was exhausted for months—with little energy for more than a minimal amount of work and low-level family caretaking—followed by years of difficulties with sleep and peripheral neuropathy. As a result, I waver between groups two and three—slightly worried but lacking sufficient information— trying to take precautions when possible.

For meals inside restaurants, I’m not sure when I will be enthusiastic. Even indoor dining at friends’ houses now sounds slightly claustrophobic after so many months of outdoor get-togethers. Because we did these in very cold weather, the prospect now of spending time in the warmth of sunshine or on balmy summer nights seems almost irresistible.

—Mary Carpenter

Mary Carpenter has been closely following Covid-19 developments.