Weekend Long Reads: COVID-19 and the Flu
by Kevin Schofield
This weekend's "long read" is a column from Dr. Arnold S. Monto, an epidemiologist at the University of Michigan School of Public Health. Our hopes that COVID-19 could be eradicated, he says, were based on faulty assumptions, and we now need to shift to planning for how we will deal with the virus for the foreseeable future — much the same way that we manage influenza.
The notion that we can eliminate COVID-19 has been rooted in the concept of "herd immunity": Once enough people gain immunity through exposure or vaccination, further transmission paths become increasingly scarce and the virus simply dies out. But herd immunity depends on two factors: low transmission and eliminating pockets of susceptible people. The delta variant has blown both of those away; it's highly transmissible, and some number of vaccinated individuals have still contracted it (though, for the most part, they either remain asymptomatic or develop only mild cases).
If COVID-19 isn't going away, that means we need to adjust to living with it — and influenza is one model for how we might do that. Vaccinations will still be important, but, as with flu shots, the model will focus on re-vaccinations at regular intervals instead of "one and done." Doctors recommend an annual flu shot for two reasons: first, because our immunity wanes over time; and second, because of "antigenic drift," ongoing mutations in the virus such as we have seen with the delta variant. Twice a year, the World Health Organization updates its recommendations for which influenza strains should be targeted by flu shots, and we can expect that a similar process will emerge for COVID-19 vaccination development.
At the moment, the best COVID-19 vaccines are over 90% effective in preventing symptomatic infection; that is far better than the 50—60% effectiveness on average for flu shots, and will help keep COVID-19 at bay for as long as we can sustain it. We still don't have good data on how fast vaccine-based immunity wanes, though, and we are only just beginning to understand the patterns of antigenic drift in COVID-19, so it's too early to predict how often we will need COVID-19 shots.
There is one other piece of good news, though: Effective therapeutics and antiviral medicines are coming onto the market now. If vaccines can continue to substantially reduce the number of severe COVID-19 cases, and medicines exist to treat the cases that do occur, we may quickly learn to live with this.
Kevin Schofield is a freelance writer and publishes Seattle Paper Trail. Previously he worked for Microsoft, published Seattle City Council Insight, co-hosted the "Seattle News, Views and Brews" podcast, and raised two daughters as a single dad. He serves on the Board of Directors of Woodland Park Zoo, where he also volunteers.
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