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The epidemiological unsustainability of pre-Covid ways of living

There’s a chilling phrase in this Conversation piece about “pre-Covid ways of living”, pointing out that the Delta variant has a estimated R rate of 5 in the absence of any non-pharmaceutical interventions:

The Delta variant has an R0 (the number of people one infected person on average infects) of about 5.0 under pre-COVID-19 ways of living. This is twice that of the original Wuhan virus which had an R0 about 2.5.

https://theconversation.com/80-vaccination-wont-get-us-herd-immunity-but-it-could-mean-safely-opening-international-borders-162863

If we assume more transmissible variants are likely to emerge given the conditions which generate them are still in place, the picture becomes even bleaker. To accept the seeming consensus that “herd immunity through vaccination alone is no longer a realistic option” means, if I understand correctly, the political choice is between (a) a state defined by a permanent biosecurity regime of border restrictions, social distancing and intensive contract tracing supplemented by a vaccination programme (b) a state which individualises risk through a rolling vaccination programme and tries to cope with social, economic and political shocks of periodic waves of resurgent Covid. The argument for (b) is that once the link between infection and hospitalisation is broken then the impact of these shocks is greatly reduced, with the UK currently representing a real time experiment in this form of laissez-faire pandemic governance.

However what seems certain is that we’re not returning to pre-pandemic life on epidemiological grounds, even if it were somehow magically possible socially, economically or politically. I wonder how much of building a consensus for (b) will be grounded in the mistaken belief this is a return to normality, as well as the cognitive and political interests this creates for ignoring the scale of the suffering (e.g. long covid) that is left in the wake of these periodic waves. This is the fault line of post-pandemic politics: two very different models of governance to respond to a transformed bio-environment, as well as how they will interact with the climate crisis.

We urgently need to find ways to conceptualise the implications of this challenge for social dynamics. For example consider how James Meadway wrote about the ‘virus business cycle’ in this prescient essay from last year sketching out the coming “world of low growth, high costs and permanent government intervention”. Once we shift from seeing interventions as emergency measures responding to unexpected contingencies and instead look for what will be sustained features of our environment, the conceptual challenge becomes a lot more straightforward:

This is the new “virus business cycle” in action: as the virus surges, lockdowns are imposed, tanking the economy; restrictions are then lifted, restarting the economy, but bringing about another surge in infections and so forcing further lockdowns. Until the virus is brought properly under control – which means suppressing it thoroughly, and ensuring tests and contact tracing are used – we will be trapped in this stop-go cycle. There will be no secure economic recovery until the virus is suppressed: the Organisation for Economic Cooperation and Development’s forecasts from June suggested that a second lockdown would severely hinder any recovery from the first. If third or fourth or more rounds of restrictions and lockdowns are needed, long-term economic growth will be pushed towards zero, depending on the scale of the restrictions. Suppression is essential.

But suppressing the virus imposes its own costs. Producing and distributing vaccines on the scale needed will be an enormous resource burden in its own right. Given how infectious the Sars-CoV-2 virus is, around 60 per cent of the population need to be immune for “herd immunity” to be effective. And if we have no long-term immunity to this virus, this is a resource challenge that will never go away, as successive rounds of vaccination and re-vaccination may be required. Ideally this would be internationally coordinated, allowing limited resources to be used effectively and fairly. The World Health Organisation’s Covax programme is supposed to provide that global coordination, but both the US and China have so far refused to sign up.

https://www.newstatesman.com/politics/economy/2020/09/why-covid-19-means-there-will-never-be-return-economic-normality

Alongside the resource costs of vaccination, there are the additional costs of surveillance, testing and measures necessary to support social distancing. These are real costs, in the sense of requiring a diversion of resources to sustain, and (other things being equal) will make economic activity harder and more expensive across the economy. And they are costs that, even in the best-case scenario of a rapidly available, effective vaccine with long-term immunity, will not be removed entirely, since the risk of future epidemics is increasing with climate change and environmental collapse. All these signs point to a reduction in long-term potential for growth, with increased activity and investment in some sectors, such as medical research, unlikely to overcome rising costs across the rest of the economy

https://www.newstatesman.com/politics/economy/2020/09/why-covid-19-means-there-will-never-be-return-economic-normality

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Mark

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