Another common sense Twitter thread

https://twitter.com/WilliamBHoenig/status/1425580549595410441?s=20

@WilliamBHoenig
At some point, we need to be prepared to stop using active measures, other than immune systems, to try to prevent transmission of SARS-CoV-2. This will likely happen with a nonzero amount of community transmission. 1/n
I think there’s a decent ethical argument that once all adults have had a chance to be vaccinated is that time. That doesn’t afford universal protection from cases or even bad outcomes compared. 2/n
It does mean that the only people who have a large risk of severe outcomes are those who have opted out of vaccination. But I get it: there’s a still a risk of bad outcomes, even if reduced from last year! 3/n
I understand why people would disagree, bc there are too many unvaccinated people who could have bad outcomes and clog up the hospital system (look at FL!), and bc kids aren’t vaccinated (low but >0 chance of bad outcomes), and bc vaccinated ppl have >0 risk of bad outcome. 4/n
What’s curious is that the predominant policies put forward to limit transmission are ones without great track records of independently reducing cases: masks, testing, etc. These aren’t the heavy hitters of 2020, which largely discourage or ban indoor socializing. 5/n
One may make a case that masks in particular in very public places (e.g., stores) can serve as a protection layer for people more concerned about exposure until cases are lower. 6/n
Or, until more people are convinced to get vaccinated, or until kids are vaccinated, etc. 7/n
Waiting until a goal happens with vaccination is a coherent goal, although you have to weigh the costs of an NPI against the benefits, which will certainly be lower than they were a year ago. 8/n
However, waiting until cases get any stay low on a sustained basis seems like a fool’s errand, unless this hCoV ends up looking very different from every other hCoV in its endemic state. 9/n
For all interventions designed to reduce transmission, I wish we would see more strategic thinking: We will do Z action until Y milestone is achieved. If the milestone is “no community transmission”, be wary! If it’s “community transmission stays low”, still be wary! 10/n
If the goal is sensible - childhood vaccination, for instance - that’s the time for a robust debate (“is a low-but-not-0 risk of bad outcomes in children worth deploying NPIs with low-but-not-0 effectiveness?” is how I’d put a lot of the debate right now). 11/n
But that’s DEFINITELY not the same strategic debate as last year, where pushing adult exposure into the days of vaccine could clearly save a lot of lives. 12/n
A couple notes here: First, unfortunately, enough of the Delta epidemic is unfortunately baked in that a lot of people will end up with some degree of immunity from natural infection irrespective of what we do now. That will play a role in post-this-wave harms from spread. 13/n
Second, hospital capacity is still worth watching. Florida’s numbers seem scary to me. 14/14
Btw, I really appreciate engagement from thoughtful people with differing viewpoints from me over the last few weeks. 15/14

Short summary:

- COVID is here to stay. It will be endemic in the population no matter what we do.

- As time moves on and everyone gets antibodies through one form or another, its outcomes will continue to become less severe.

- Non-pharmaceutical interventions like lockdowns and masking (even if they work, which they may not) just kick the can down the road a little, at best.

- Unless we're intending to engage them forever, the only legitimate reason for NPI's is where they are necessary to avoid overwhelming the hospital system.

@sh76 said
https://twitter.com/WilliamBHoenig/status/1425580549595410441?s=20

[quote]@WilliamBHoenig
At some point, we need to be prepared to stop using active measures, other than immune systems, to try to prevent transmission of SARS-CoV-2. This will likely happen with a nonzero amount of community transmission. 1/n
I think there’s a decent ethical argument that once all adults have ...[text shortened]... y legitimate reason for NPI's is where they are necessary to avoid overwhelming the hospital system.

and the people responsible for unleashing this on the world get a complete pass.

The virus is bad no doubt...but unless we get to the bottom of its CREATION we are fuked no matter how many vaccines are produced.

Republicans want to create an investigation into how this got started, dems shut it down. Just really what is going on? does china own the democrats?

Feinstein, swallwell, biden (both)..how deeply is china engrained in our govt?