After the Omicron wave, Vaxxed and Done (V&D) will become the best endemic Covid policy. Let's do it!
I felt lucky on New Year’s Eve and made a prediction the US would enact Vaxxed and Done (call it V&D) as Covid policy by March 2022.
This is really a pair of predictions: a) by March, once the Omicron peak is over, V&D will become the best US Covid policy choice, and b) it’ll be in effect by then. Since Dec 31 my confidence up to ~90% it’ll be the best policy choice by March, but down to ~65% it’ll be enacted by then.
Covid policies have many possible choices, but thematically let’s break them into three broad regimes:
Vax optional, move on. Fitfully drop all covid rules. That’s where red states are drifting. Team Surrender. A perhaps worse variation is hypocritically keeping strict rules in place, but slowly ignoring them. That’s where blue states are headed. Team Hypocritical Surrender.
Vaxxed and Cautious. Push vaccines. But also continue to push existing strict policies such as mask mandates, lockdowns, routine testing of asymptomatic people, travel restrictions, school shutdowns, social distancing, reduced capacity for restaurants and offices. Team Safetyism.
Vaxxed and Done. Push vaccines and boosters, but otherwise back to normal. Stop all strict policies in #2 above. So stop routine testing of asymptomatic people, travel restrictions, school shutdowns, lockdowns, social distancing, reduced capacity rules. That still allows for increased spending for rapid at home test kits, and increased spending on updated boosters against new variants. Masks are voluntary but encouraged when sick or at risk. Vaccine mandates can backfire, so are trickiest. Let’s go with vaccines strongly incentivised, but only mandated in some cases (eg healthcare workers). Team V&D.
As a meme:
Today in January 2022 we’re officially in regime #2 Vaxxed and Cautious. Team Safetyism. During Omicron this makes sense. But two years into the pandemic we know that’s unsustainable. Once the Omicron wave has passed we’ll drift towards some form of #1: Team Surrender or Team Hypocritical Surrender. And in case you hadn’t noticed, many parts of the country are there already. My argument is we should actively choose #3 Vaxxed and Done as our long term, national endemic covid policy, as soon as the current Omicron peak is over. So by March.
V&D isn’t original to me of course. I copied it from the excellent Zvi Mowshowitz, who has been arguing since December that “Omicron will blow through the US by 3/1/2022, leading to herd immunity and something like the ‘end’ of the COVID-19 pandemic.” So yes. My prediction is me repeating Mowshowitz. But the prediction doesn’t matter. What matters is rallying people to Team V&D. Right now the most prominent person I’m aware of advocating V&D is Derek Thompson: “If we’re lucky, on the other side of this Omicron wave, ‘vaccinated and done’ won’t be one of many viewpoints in an unfolding COVID Rashomon. It will be something like reality.” The good news is Thompson got positive feedback on his V&D article. Because V&D (post Omicron) is really just plain common sense.
Here’s the V&D argument in bullet points, with supporting links:
Yes flu isn’t covid. But policy for endemic flu is our closest model for thinking about endemic covid. Flu policy is simple: avoid it if you can, don’t spread it, get vaccinated routinely against new variants. That’s matches #3 Team V&D far better than #1 Team Surrender or #2 Team Safeytism.
“Most people are going to get Covid”, Janet Woodcock, acting head of FDA.
“COVID is here to stay: countries must decide how to adapt. The Omicron variant has laid bare the need to live with a disease that throws up an ever-changing set of challenges.” Nature editorial.
Omicron is so contagious it’s hitting people who avoided direct impact earlier. This is very bad. But also means by March nearly everyone will get covid directly, or indirectly as vaccine. And know people who got it. That direct experience will motivate people to end overzealous covid policies. The fast spike up also means a fast drop down. So rolling out a sustainable, endemic covid policy immediately after that drop is the most opportune timing. Let’s flip the switch to a long term sustainable covid policy while our Omicron experience is still painfully fresh.
Zvi Mowshowitz predictions as of Jan 13: Cases peak in northeast now, rest of country within two weeks, mode peak cases estimate is Jan 17. Chance daily cases already peaked by Feb 1, 93%. Chance we are broadly looking at a future crisis situation with widely overwhelmed American hospitals, new large American lockdowns and things like that: 2%.
Estimated case fatality rate for SARS-CoV is 10%, MERS-CoV 34%, Seasonal flu 0.1 to 2%. From Our World in Data.
Below is a Financial Times chart of the risk of catching and dying from Covid. The x axis is age. The y axis is mortality risk, using a log scale. As expected it’s highly skewed by age. Vaccines provide ~10x risk reduction. These are pre-Omicron stats. Omicron is more contagious but somewhat lower risk than Delta. That said, the overall relationship between age, vaccines, risk remains.
Derek Thompson put it this way: “The risk of death from Omicron for boosted, healthy adults under 50 seems to be somewhere between that of riding a bike and going on an airplane.” And in recent podcast interview on Omicron, John Burn-Murdoch said the vaxxed and boosted have ~25x less likelihood of going to the ICU than the unvaxxed.
Zeynep Tefekci cites a new paper using January (Omicron) data: “The hospitalization rate among 3x-vaccinated 80+ year olds is lower than the hospitalization rate among unvaccinated 12-29-year-olds.” These vaccines are a miracle. We just need to accept that miracle into our bodies, and we magically get our lives back.
Covid policy is now about avoiding it for the unvaccinated who are also old. Everyone else is already (statistically) fine. And let’s face it, there are very few remaining old and unvaccinated who might still be convinced to get vaxxed.
On to school closings. “America has failed to learn from the safe opening of classrooms abroad. Its children have lost more school days than peers in most rich countries.” Economist.
“Now that vaccines are widely available, however, the risk calculus has changed. If doctors, dental hygienists, bartenders, retail clerks and housekeepers can keep working without extraordinary measures, then so can teachers.” And “The evidence is now clear that school closures caused massive learning loss.” from Matthew Yglesias.
In Spotted Toad’s fine pre-pandemic book on teaching unprivileged kids in middle school, he noted “The talent show didn’t make anybody learn much more, of course, or learn more at all, but the point of school is hardly learning, but to figure out a way to be in the same building with a bunch of other people day after day after day, to clap when the lights come on and laugh even when a joke doesn’t quite go right, to do your piece and then let somebody else go onstage and do theirs.” For the less fortunate, school is one of the few places kids are safe and socialized.
Freddie deBoer is blunt. For the less fortunate “the educational function of public schools, while certainly of prime importance, is the secondary function of public schools. The first function is giving children warm, safe places where they can be stimulated and looked after, and where they can access cheap or free meals if they need them. The humanitarian good of this function dwarfs that of the education function.” And “If you’re one of these lucky liberal elites who blithely insists that there’s no problem holding kids out of school (in winter!), good for fucking you. Keep your kids at home then. But don’t rob parents and children of the only place where those children can go and be in the kind of environment every child deserves. Despite my reputation I very rarely write angry. But I am angry about this, and you should be, too.”
Regarding masks, yes they work but come on, let’s pick our battles. Post Omicron seems simple. Masks voluntary but strongly encouraged for the sick or at risk. Don’t let the perfect be the enemy of the good.
Now vaccine mandates. US school vaccination requirements started in the 1850s(!) to prevent smallpox. And: “All fifty states in the U.S. mandate immunizations for children in order to enroll in public school, but the specific vaccines required differ from state to state, and various exemptions are available depending on state law.” While the details change, there’s historical precedent for strong pressure for vaccines, up to and including mandates to participate in some activities. Though all those historical mandates allow a path to exemption.
Matt Yglesias on antivax only recently becoming politically polarized. In 2015, antivax factions existed on both the left (eg, RFK and measles) and on the right (eg HPV). The common element was the antivax of both parties tended to be conspiracy theorists. As the Republican party became friendly to conspiracies, the antivax movement aligned with it. Trump and Covid accelerated this trend, but it predates them. That is, the antivax movement won’t magically go away.
How bad is antivax sentiment? Chris Arnade has been walking around the country, a self described front row person (college degree) talking to people from the back row (non-college). From a recent Razib Khan podcast, edited for clarity: “Almost everybody around me, comes up to me and tells me their vaccine status. Many are unvaccinated. It’s a source of identity for them which is really depressing. Because they feel like that’s all they have to hang their hat on, because all their other forms of identity have been taken away. People make fun of them for being religious, or people make fun of them for being this. A lot of people I deal with have been burned by the professional managerial class, the school teachers who scold them, you get involved with them and it always ends up hurting you. You get made fun of or you end up in jail, or you get you get sued, or they call the police on you or whatever. It’s just no, why deal with those people.” It’s heartbreaking but true, antivax is a hill people are willing to die on.
Do mandates work? Yes, but it helps if you punish people. The Mayo clinic fired 1% of it’s work force (700 people out of 70,000) for not getting vaxxed. Prior to the mandate, 7% were unvaxxed. Houston Methodist Hospital required its workers to get a vaccine. Before the mandate, 15% of its employees were unvaccinated, afterwards 2%. Delta Airlines didn’t mandate but penalized employees $200/month, so 2% quit.
On Jan 13, the Supreme Court blocked Biden’s vaccine broad mandate for business, but allowed it for medical facilities. Omicron would hurt any sitting president. So it’s no surprise it’s helped Trump remain ahead of Biden in 2024 election prediction markets. As Omicron wanes in a few weeks, remember who Team Safetyism is supposed to help. People who are old and unvaxxed, likely prone to conspiracy theories. Old deplorables. Those who cling to their Team Safetyism religion deep into 2022 will be seen by those old deplorables as elite scolds, part of Team Hypocritical Surrender. And that helps Trump more than Biden. Sorry. Perhaps you don’t care if overzealous safeyism helps Trump get re-elected. But I do.
A key advantage of Vaxxed and Done is it dampens the partisan noise from our covid conflicts around masks/school closings/social distancing/mandated testing/travel restrictions. This will help us in the front row pour energy into making vaccines accessible, safe, cheap, easy, and widely adopted. Vaccines are the best way to help the back row. V&D as the new covid policy will also help the credibility of policy makers. Unlike today’s safetyism, it’s simple to understand. Why not gain the full benefits of getting across the covid finish line as soon as we can?
Again, just to avoid misunderstanding, Vaxxed and Done as policy only makes sense after Omicron cases come back down. But that’ll happen in February, only a month away. If you’re on Team Safetism now, consider what’s next. Don’t drift into Team Surrender. Join Team V&D. Spread the word!
What's the difference between V&D and Surrender? I think to differentiate them you either need an extremely strong vaccine mandate (which sounds like you're not quite willing to bite the bullet on) or some sort of vaccine passport system (which, depending what it gates access to, could effectively be a soft mandate).