Rethinking Covid policy

The following are not controversial, I think:

  1. The goal a year ago was to vaccinate everyone, thereby stamping out Covid.
  2. We know this failed:  80% of California is vaccinated;   many or most of the remainder have already had Covid;  yet omicron swept unhindered through the vaxxed population.  Therefore it’s patently obvious, and research confirms, that the vaccine reduces severity, but does not prevent infection or spread. 
  3. Implication:  we need a new Covid policy, designed around an endemic virus — a policy  we can sustain for decades or centuries.
  4. Public health policy for centuries, except for the past 2 years, has been to (1) identify who is at risk;  (2) protect, treat and isolate that risk group;  (3) let everyone else go about their business.
  5. We now know a lot about the risk group:  elderly, obese, diabetic, immunocompromised.  No one else is at material risk.  Children in particular are at almost no risk, with fewer than 1000 deaths to date among 70 million Americans under age 18.
  6. We now know that for those in the high risk group, vaccine + booster is highly effective at managing severity.  So we can’t prevent them from getting it, but can prevent most of the consequences.
  7. Focusing policy on just the high risk group, which is <15% of the general population, would free up time, attention and money for treatment.  Treatment appears have been a bit neglected in the push for prevention, because prevention looked promising a year ago.  Now that prevention is off the table, we need to rethink.

Conclusions:  we learned three things in the past year.  First, we cannot control the circulation of Covid.  Second, we know exactly who is and isn’t at risk.  Third, we know how to manage Covid with minimal social impact:  vaccinate, boost and aggressively treat just the high-risk group, and let everyone else go about their business. 

Therefore, that is what we should do.

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