The End of COVID-19?
Saturday, March 7th, 2020 is a day I’ll never forget. For those of you that don’t follow Dayton Flyers basketball, it was the day of the Obi Toppin Show. The Flyers wrapped up their regular season with a convincing win against George Washington University and were ranked as the #3 team in the nation poised to make a run to win the national championship. A nationally broadcasted television show called “College Gameday” had come to Dayton for the first time ever to host their show. It was a big deal. In what would be his final game as a Dayton Flyer, Obi Toppin had highlight-reel slam dunk after slam dunk. In the storied history of the Dayton Flyers basketball program - this was the pinnacle. As a diehard fan myself, I was elated with joy for my team.
After the game ended, I distinctly remember a conversation I had with my friends that had attended the game with me. I told them, “Enjoy it tonight because this is the end.” At that time, they were skeptical to say the very least and thought I was crazy to say the most. Unfortunately for all of us, my prediction proved to be true. We all know how the story ended.
Since that time, I’ve posted frequent videos and blog posts to help guide folks through this difficult time. Over the past year, it’s been so tough to know who to trust, why to trust them, and what is true or not true regarding COVID-19. I’ve always done my best to present non-biased, non-partisan information and the following article is no exception. It’s been my pleasure to serve you in this capacity and address that need over the past year. I hope you’ve found the information I provided helpful.
I anticipate that today will be my final guidance regarding COVID-19. Thank God, too.
No one wants to be the first person to declare victory over COVID -19 only to end up with egg all over his/her face once the next resurgence happens. That’s understandable and I’m also not going to go out on that ledge, either. However, I will go out on this ledge: I hold a very optimistic outlook and I think that the possibility exists that COVID-19 is coming to an end very soon.
Now, please read this: I would not be surprised if we see a small resurgence of a less lethal, variant strain in the fall (October/November). Undoubtedly, if and when this happens, it will garner all of the media attention but I really think it will be small beans compared to what we’ve already endured. Please remember that if and when the time comes.
The following is the rationale for my beliefs:
In the United States, we have 328 million people. Of those, 22% or 73 million people are less than age 18. I think we should effectively exclude them from our population for my ensuing discussion. We know that this population is very likely to be asymptomatic. I would also suggest that far more people under 18 have been infected than accounted for by testing and we just never knew because they were asymptomatic and/or were never tested. They are also extremely low risk of having a complication from COVID-19 and thus our focus should be on the other 78% or 255 million people.
So far, we have vaccinated approximately 64 million adults with at least one dose of the COVID-19 vaccine. This equates to approximately 25% of the population above age 18.
So far, we’ve had 28 million known COVID cases. Many have argued that the number is actually much higher. This 28 million doesn’t account for asymptomatic cases that were never tested, minimally symptomatic cases that never bothered to be tested, or cases not tested due to shortages in testing supplies early in the pandemic. Estimates have suggested that the total number of COVID cases is actually 4-5x higher than the known confirmed cases. Conservatively, this would put our number of COVID cases at 112 million which equates to 44% of the population over age 18.
Here is an article from the Washington post where the former CDC chief suggested the number could actually be as much as 10x higher.
Combining the numbers (people that have received at least one dose of vaccine and natural immunity from infection), we get 176 million Americans with some form of immunity. Dividing 176 million into 255 million people over age 18, we get 69% immunity.
The target number for herd immunity is approximately 70%.
I think the potential that we are at or nearing herd immunity best explains the current trend that we are seeing in decreased cases.
Dr. Marty Makary from Johns Hopkins School of Medicine published an op-ed in the Wall Street Journal recently titled, “We’ll Have Herd Immunity by April” that I feel makes some very compelling arguments. Some experts have expressed disagreement, but I think Dr. Makary is largely correct. The April timeline will really be dependent upon our vaccine efforts which are, in turn, dependent upon vaccine supply.
Additionally, we have spring and summer quickly approaching which we know will lead to decreased COVID transmission. People are outdoors more and less in confined spaces. We saw cases decrease last year when weather warmed and we should expect the same this year.
Going forward, our vaccination efforts will only get stronger. Supply in vaccine is about to get a major boost with the Johnson & Johnson vaccine hitting the market. We expect emergency authorization use approval (same approval given to Pfizer and Moderna vaccines) within a week or two. Further vaccination effort should bolster the above numbers even further towards herd immunity.
Yeah, but what about the variant strains?
Early indication is that our current vaccines are effective enough against these variant strains. Additionally, the new mRNA technology in the Pfizer and Moderna vaccines can be very easily modified to provide better coverage against variant strains that may arise in the future.
COVID is probably unfortunately here to stay. We call that endemic. You’ll probably need to get COVID vaccine boosters every so often in the future to be “fully protected.” However, I suspect that COVID is about to get a lot less scary. Let me explain:
Once we all have some form of immunity (whether through natural infection or vaccine), the likelihood of getting a COVID infection that becomes deadly decreases substantially. The reason is that memory antibodies form that typically last years, if not decades, in our immune systems. So even if you get a variant strain, the vaccine or natural infection antibodies from past exposure are likely to confer some degree of protection against future exposure.
The perfect example is influenza virus. Influenza is certainly a deadly virus. Some strains deadlier than others. However, we don’t live our lives in constant fear of influenza. If you get influenza, yes it will probably not be fun. If you get influenza, yes you can still die (happens every year to even young, healthy people and I’ve witnessed this happen more times than I care to remember). But we don’t live in fear of influenza because of the high likelihood that our past exposure has led to helpful memory antibody formation that will protect us from death when exposed to influenza in the future. This is true even if we have “variant strains” of influenza…which we do every year.
That’s where COVID was different. None of us had previous exposure or antibodies to help protect us from death. That’s why we experienced so much death this past year. However, going forward things should be different because our immunity is now different.
COVID will stay with us, but I think it should fear us less in the future.
Semi-related post script:
I feel great 3 weeks out from completing both of my Moderna vaccinations. My wife being in the school system has received dose #1 of the Pfizer vaccine. My mother-in-law is a nurse and is fully vaccinated. My brother and sister-in-law have both been vaccinated because of their involvement in the school systems. My father-in-law living in the nursing home has been vaccinated. Both my mother and father have been vaccinated as they live in Indiana and have had opportunities to get vaccinated earlier than same-aged counterparts living in Ohio.
I tell you all of this because my personal life is finally back to normal. We plan to host a birthday party for my son at the end of March because I feel that we can safely do it without putting anyone at undue risk. Even if you think COVID is a complete joke and refuse to get vaccinated, there is still probably a small part of you that feels a little uncomfortable being around a 90-year old parent or grandparent and potentially exposing them (if not, you probably need to check yourself).
Why should you care? Because the vaccine has returned my personal life back to normal just as your personal life will soon be normal, too. I have been going to restaurants, taking my kids to museums, going to church and shopping in stores again. I’ve probably been more careful than most with my daily activities up until this point which should also speak to you regarding my personal confidence in the vaccine. Yes, I’ve heard about the few people that have gotten COVID after being vaccinated. We are talking about “a few” out of 64 million people. Don’t let the exception be your barometer. Additionally, those that are infected with COVID after vaccination are getting mild to no symptoms further demonstrating my above point about influenza and our fear of COVID in years to come.
Your life is going back to normal very soon.
Charles Opperman, MD, FACP
