This is about Fauci’s prediction, for spring 2022. In my book, relative to the evolving state of knowledge along the timeline of this epidemic, Fauci’s handling of the epidemic has been unimpeachable. Quoting,
“As we get into the spring, we could start getting back to a degree of normality, namely reassuming the things that we were hoping we could do — restaurants, theaters, that kind of thing,” Fauci told CNN’s Anderson Cooper.
For a steward of public health, this is the right thing to say. If this blog had broad readership, I would not want to undermine Fauci’s hopeful message. Relative obscurity releases this blog from the obligations of a steward. There has to be hope – in a reasonable time frame.
The principal obstacles to the timeline are:
- Current vaccines, while tremendously beneficial to the individual, even with the Delta variant, are inadequate to suppress community presence. See Delta Strain; the Rough Ride Begins.
- Israel experience indicates that a non-Delta specific Pfizer booster is still not sufficiently protective to suppress community presence of Delta.
- The school age population will become a tremendous reservoir of Delta, in constant contact with the more susceptible adult community. (For the math inclined: This is the driving term of an equation for adult infection, so powerful that even for adult R < 1, it can drive infection in the adult community all by itself.)
- The school-age reservoir will not drain until late June ’22.
- Although social distancing suppressed the winter 20-21 flu season, Delta may compromise resistance to secondary infection, to the point that co-infection with Delta is common, bringing lethality up to 2020 levels.
- All of the troublesome COVID variants have come from outside the vaccinated world. All of them have traveled well. While vaccination in the U.S. has a suppressive effect on domestic mutation, this is like rearranging the deck chairs on the Titanic.
- Some 100 -140 million recalcitrant U.S. adults may never vaccinate. This group will be ravaged. Survivors will be slow to change their minds. The rest of us have need for protection from this reservoir.
A sociological argument renormalizes this epidemic:
- People tend to cluster with others of similar attitudes.
- The U..S. is in a state of deep division which accentuates clustering.
- Antivaxers comprise such a group, with social interactions biased to stay within this group.
- This group of perhaps 140 million moves through a vacuum in which groups with other attitudes do not socially exist.
- This is in effect an unvaccinated nation of 140M, as was the U.S. in February 2020, except the virus is much worse.
- Fulmination is possible.
Crash production of a Delta-specific variant could avert some of this, possibly leading to a decent summer ’22. From (CNN) White House frustrated with Irresponsible Delta Variant Coverage…Napkin Calculation #4,
It is possible that a Delta specific booster would both
- Reduce the relative risk, which stands at 20-40%
- Reduce the viral load of breakthroughs.
Time relevant delivery of boosters and strain adjustments requires a policy tweak that is actually baked into seasonal flu vaccines, and was the crux of Operation Warp Speed, production in advance of proof.
A decade ago, there were DARPA programs for rapid vaccine production to defend against biological warfare. The programs were successful in rapid production of vaccines of variable quality, for deployment against dire threat. But the loop was never closed; identification of dire need was never pursued. The process infrastructure for identification of dire need remains vacant.
So we may be in dire need of a Delta-specific booster, with no established process or criteria to establish it. If epidemiology were a mature science, if it could predict with some confidence, that X00,000, or X000,000 people will die this winter, it would be an easy decision. Since epidemiology is not on track for this kind of predictive power, is there another course of action? Yes.
Produce a Delta-specific booster in advance of proofs of need/efficacy. Defer the decision to deploy until more decidable. In the meantime, work at occupying the vacancy of decision infrastructure.
At worst, it’s a waste of money.