What's Coming
It’s time to put together information I’ve been seeing and think about getting through this winter in the northern hemisphere, at least in terms of health. Please stick with me through the bad part so we can get to the better part.
The Bad News
We aren’t post-pandemic. At best we’re mid-pandemic and its effects are much broader than anyone imagined.
Clues? Here in the UK, in the summer that just ended we had about twice as many deaths involving COVID as we did the previous summer.
Deeper data? Hard to find and patchy where it can be found if all you look for is COVID.
People who take the health situation most seriously now in both of my countries, especially in the UK, are often financial people: insurers, bankers, and especially economists. They look at business performance, the flow of money and the workforce. Digging into why all of that looks weak led them to realize how many people are sick. I didn’t say sick with COVID. Just sick. I didn’t say they are taking the pandemic seriously. I said they’re taking the health situation seriously.
Politicians can declare we’re back to normal, but money talks. Money has noticed we aren’t in the clear.
What Data Are They Seeing?
I mentioned reliable data is hard to get when you only look for COVID. Case rate data is more hole than fabric, not very meaningful any more.
Most epidemiological surveillance has been dismantled, not just in my two countries but in much of the world. The UK still has the COVID Prevalence Survey, a golden piece of retrospective weekly data from the Office for National Statistics based on random-sample COVID PCR testing of the population and expert statistical analysis. Few countries still have any COVID prevalence data that is nearly as solid. In what is regarded as a lull, the most recent ONS release said about 1 person in every 35 in England had COVID. We used to regard that rate of incidence as high. These days, people shrug about it.
Even the ONS survey will become mushy if PCR tests aren’t updated soon. Rapid tests that people can do at home now have a high false negative rate. The latest figure I’ve seen for it is 47%. Social media has a gradually escalating drumbeat about being sick for 4 or 5 days before rapid tests turn positive, or a whole family getting sick but some of them never testing positive… sometimes even on PCR tests.
If COVID data is too patchy to rely on, what is worrying the financial people?
They’re looking at so much other data, I doubt I could make a complete list. Worker productivity. Long term or permanent departures from the workforce. Health insurance claims. Use of sick leave. The pace of disability claims and other welfare benefit claims. Absence rates in schools for both teaching staff and students. (When a child has to miss school because of being ill, often a parent has to take time away from work to take care of the child.)
The reliability of those other data sources has not changed appreciably. Each country has its own version of such data. It’s about as good as it was a few years ago. It is painting an ugly picture. Drilling into doesn’t find all this trouble is from active COVID cases.
If it has seemed like outbreaks of other infectious diseases are flaring up, that isn’t only a matter of noticing outbreaks because you’re primed to pay more attention to them. Katelyn Jetelina, one of the epidemiologists I follow, recently posted about the current “tsunami” of respiratory illnesses putting people in hospitals in the USA. It’s driven mainly by respiratory syncytial virus (RSV), with flu starting to kick in. Another COVID wave is expected on top of all that.
Notice what’s already happening and what is not a big factor yet.
Similar reports are coming from other countries. Look at the news over the past six months. RSV, flu, common colds, diabetes, heart disease, strokes, kidney disease, outbreaks of things nobody expects…
What’s going on?
Aftereffects
News media unthinkingly parrot the new term immunity debt as the explanation. Supposedly lockdowns, face masks, ventilation, air filtration, social distancing and avoiding crowds deprive the immune system of getting enough practice at fending off diseases. Supposedly we set ourselves up to get sick so much by not getting sick often enough. Supposedly we need regular exposure to viruses in order to remember how to fight them.
This is a new twist on an old idea called the hygiene hypothesis. It has merit with bacterial exposures, but no merit for exposure to viruses.
Bacteria come in beneficial varieties as well as harmful varieties. We need to pick up some of the beneficial bacteria to have a healthy biome in our digestive tract and reduce the incidence of allergies. We don’t need to mix with crowds of people to get this. Normally we pick up good bacteria from such sources as birth, breastfeeding, living with our families, childhood play with a few friends, and being grubbly little children who dig in the garden and put toys in our mouths and so on.
But catching viral infections doesn’t convey a benefit and often causes harm. Using a new term to spread the idea that we need regular exposure to viruses to keep our immune systems strong is completely false. The term immunity debt currently making the rounds is misinformation.
Dr. Marsha Wills-Karp, chair of the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health, recently gave an interview about this. It’s a clear, understandable explanation of the hygiene hypothesis that doesn’t take long to read.
Hybrid immunity is another term circulating in pandemic-related disinformation. The original strain of SARS-CoV-2 left people with a few weeks of heightened resistance to reinfection. Some people got a notion that if they were vaccinated and then got infected, the vaccine would increase their odds of getting through it without needing hospitalization (true), and they were protected from any significant negative aftereffects (not much). Hybrid immunity would be a stronger two-layer immune system shield than vaccines could provide (false).
It never worked that way, for reasons I’ll get to in a moment. Vaccines reduce the risk of Long COVID, but not by nearly as much as most people believe. There is no longer the faintest hint of emerging from active COVID better protected against reinfection for very long. When Omicron emerged, it could reinfect people after as little as 23 days. Some of the current subvariants have cut that to 8 days. Hybrid immunity against COVID is a myth.
We’re looking for an explanation for why we have so many outbreaks of so many types of illness at the same time. We could postulate immunity debts for the infectious diseases, a sudden surge in obesity for diabetes, a sudden surge in alcoholism for liver disease, a sudden surge of something else for kidney failure, a sudden surge in fatty diets for heart attacks and strokes, etc. How likely is it that we have so many sudden increases in separate causes for so many non-infectious health problems?
A simple single cause is right in front of us. People do emerge from COVID changed, but for the worse, not the better. Because the receptor it uses to infect cells is widely used in our bodies, it can attack a wide range of organs and systems. Brain, pancreas, liver, kidneys, lungs, cardiovascular system… We have many scientific studies documenting this.
That also explains the increase in people getting sick from a variety of infectious diseases. The immune system is left damaged by COVID. Not strengthened. Damaged.
We have seen other viruses do this. Measles does it, reducing immunity to other infections. Famously, HIV does it. In fact, COVID especially targets T-cells, which are the very portion of the immune system that HIV demolishes. It does this even in people whose COVID is so stealthy that they didn’t realize they had it. We have many scientific studies documenting this too, as well as other harm to the immune system. AIDS taught us what happens when we don’t have enough fully functional T-cells, so I’ve chosen to focus on that.
What’s Coming
In much of the world, we allowed COVID to rip through us. SARS-CoV-2 is still mutating, still finding new ways to evade our vaccines, medicines and immune systems. But it has already left many people (in some countries, a large majority) more vulnerable to everything else than they were before.
What’s coming is one of two things.
We can step up measures to avoid giving each other germs as readily as we do now, or
We can get sicker than we used to get more often than we used to become ill. It wouldn’t always be with COVID. It would be with everything, more often and worse.
Winter has arrived in the northern hemisphere. We can get through it sick over and over, or not.
The Better News
The better news is that to take the first option, we know what to do. We don’t have as many studies about this, but we have enough.
Over the past few centuries:
We made drinking water cleaner.
We got better about how we manage sewage. I can’t say we nailed it. I live in the UK where we still dump some untreated sewage into rivers that we pull water from downstream for drinking water supplies. This isn’t the only country where sewage dumps happen. But we aren’t dumping buckets of it in the street.
We store food more safely, and generally handle it more safely.
We learned to sanitize surfaces, implements and ourselves better.
Studies have told us that if we breathe cleaner air, we won’t get sick as much as we do now. Studies have even told us what we can do to achieve that.
Avoid crowds.
Have lots of ventilation. If not outside, open windows and doors.
Use high grade filtration (HEPA). Even better, pass the air through ultraviolet light on its way through the filtration machine.
Whenever you may not have all of that, wear a high quality face mask (at least N95 or FFP2, even better N99 or FFP3).
Stay away from other people when you feel unwell. Even if you don’t feel too bad to soldier on, it could be harder on someone else.
To tell us this works, we especially have studies in schools. In Italy, HEPA filters that processed all the air in a classroom 5 times an hour cut COVID transmission by 82%. We’ve got studies where face masks plus HEPA filters resulted in zero transmission. Whatever reduces COVID transmission also reduces cases of other airborne diseases. Colds, flu, RSV, pertussis (whooping cough)… all of them.
Whether we put in the bit of effort or put up with the consequences of not doing it is up to us.