Out Sick

Image from PNG All

(Image from PNG All)

Recently a package shipped from one lab to another within one of the projects I’m wrangling got delivered. Our timeline had no room for delay. That’s why we shipped it with a service that “guaranteed” delivery on the next business day. The trouble is that the express delivery service which took it six days earlier promised to deliver it on a Monday, not Thursday.

It languished for days in the delivery depot, sorted and ready to go out for delivery. It didn’t budge from there despite a handful of us trying every way we could to get their attention. At last we found someone who knew someone with clout in the delivery service to exert some leverage. Why did it sit there? Because so many drivers were out on sick leave.

Earlier in the same week, Gatwick airport had to cancel about 70 or so flights. Why? They said the primary reason was staff shortage due to absences. In other words, too many people were out sick to run the airport at normal capacity. Gatwick said ripple effects from disruptions elsewhere in Europe were only a secondary factor.

This is in the northern hemisphere in summer. It’s low season for influenza, norovirus and other seasonal diseases. It’s happening all over.

The Office for National Statistics says more than 8.6 million people in the UK are economically inactive. It’s a shorthand term for people of working age who aren’t working, aren’t looking for work and couldn’t start work in the next couple of weeks if it came to them.

That number means nothing without some context. This is a country of about 68 million people. About 20% (one out of five) people of working age are economically inactive.

Let’s narrow it down to the 3.4 million who are between age 50 and normal retirement age but are economically inactive. Mainstream media stories had been calling their disappearance a Great Resignation, implying that as the pandemic threw everything into disarray, they simply chose to enjoy early retirement. Enjoy is perhaps not the right term for it. The Institute for Fiscal Studies took a closer look and found that 48% of them fell into poverty as a result of not working any more.

If they could work, they probably would work until they could set up for a better retirement. From more medical studies than I can cite here, we know that age bracket tends to be hit harder by COVID than younger generations. We shouldn’t be surprised to lose so much of the high-experience portion of the workforce.

To repeat the obvious, we aren’t merely looking at a big chunk of the workforce calling in sick temporarily, although that’s happening too in each wave. This surge of economically inactive people is driven by those who are out sick for the long haul. The World Health Organization estimates at least 10% (one in ten) people who get COVID develop Long COVID. Each wave passing through a society leaves more of its workforce either impaired or out sick. Some may recover but we know far too many have been sick for a few years now with no end in sight.

What happens if we carry on the way we’re going? What happens when a power plant has too many people out sick? A nuclear plant? The company that distributes electricity from the power plant to homes and businesses? The water company? Anything else essential?

Mother Nature is dishing out some lessons about diseases. We haven’t been listening closely enough, so we’re getting remedial assignments.

Moves to implement those lessons have not been much noticed, but they are beginning to happen. WHO got around to admitting SARS-CoV-2 spreads as an airborne pathogen, so face masks are a good idea. So did the USA’s CDC.

In the UK, doctors in the British Medical Association - Scotland are calling for face masks to be standard practice in health care again. In May, the NHS issued new guidelines calling for better ventilation in health care facilities, and for air filtration where ventilation is not adequate. Nobody is doing anything to comply yet, but in the UK documents and protocols must always be issued before something can be done. At least those are starting to be created.

Parallel moves are starting in other places, but it’s easier for me to go into this level of detail about the UK because this is where I live. If we measure pandemic response effectiveness by excess deaths per capita, the UK is also one of the worst performers. Even Brits are taking baby steps to do better, and we’re not leading lights in this regard.

Is there anything we can do about this besides ventilation, air filtration, masks, working from home where feasible, home schooling and avoiding situations where airborne transfer is too easy?

Not yet, but there are teams working on escape hatches. The ideal solution would be a highly effective sterilizing vaccine—a vaccine that prevents infection instead of only reducing the likelihood of a severe case—keying on a piece of the virus which is not subject to frequent mutation and is common to a range of variants and other coronaviruses. Multiple research teams are working on such a vaccine, each taking a different approach. At least two of those efforts are working on a vaccine delivered as a nasal spray instead of by injection.

I don’t pin all my hopes there. We got the vaccines we have against this pandemic in record time thanks to research toward a vaccine against HIV. Techniques developed for that gave us a phenomenal head start. But there still isn’t a vaccine against HIV. Retroviruses and coronaviruses have important differences. Therapeutics, not vaccines, turned the corner for us with HIV.

So I’m also watching therapeutics. I won’t be surprised if we get a partial escape hatch for this pandemic that way before we get a sterilizing pan-coronavirus vaccine.

We are not where we want to be with therapeutics yet. Treatments we have now aren’t widely available. Nobody in my British circles has gotten Paxlovid, and only one person got monoclonal antibodies when those still worked. Like current vaccines, current treatments don’t promise a good outcome. They reduce the chance of needing hospital treatment and reduce the chance of Long COVID (by about 15%), but that’s all. Fully vaccinated and boosted people still have a greatly increased risk of developing serious health problems or dying after even a mild or asymptomatic case. We need better therapeutic drugs.

An Australian group is working on a pill to treat Long COVID and perhaps block reinfections.

An international research group has identified half a dozen extraordinarily potent antibodies that work against all known variants of SARS-CoV-2 and related coronaviruses. Their findings can be used to develop better treatment and perhaps also better vaccines.

Those are just a couple of specific examples of progress toward the escape hatch we all want. We aren’t there yet. We’ll get there eventually. In the meantime too many people are out sick, and too many of those are out for the long term.

Business journals (of all places) are getting increasingly loud about saying we need to get better at protecting people from getting so sick. We can’t carry on as usual when so many people are sick so much of the time. When business becomes adamant, governments listen, often better than they listen to voters. It’s weird to be depending on business to do this, but let’s run with it… while we still can.