Viral Reservoirs and Future Potency

First, what isn’t on our plate as a puzzle to solve today?

Almost two months ago, we were thinking about social bubbles. A month ago we were thinking about airbridges. We foresaw what is just beginning to hit mainsteam media headlines.

Countries that are not managing this pandemic well are not going to be accepted into bubbles or airbridges with countries that are managing it better.

Who’s at the top of the list of countries whose people will not be welcome? The USA, Brazil, UK and Russia.

We saw this coming. The way time warps and twists these days, it feels like we foresaw it forever ago.

When two visitors from the UK reintroduced SARS-CoV-2 to New Zealand, which had eradicated it, we were not surprised. Today’s headline that the EU may ban incoming travelers from the USA is not a surprise.

We did not panic for New Zealand. They know how to quickly clamp down and prevent the virus from getting loose again, having done it before, so they’re doing it again.

We did not panic about yesterday’s headline that Germany’s R-number zoomed to 2.88. We understand mathematics. When a country has taken its COVID-19 case numbers very low, one local outbreak makes a much more dramatic impact on the national statistics than it would if the case numbers were higher. A surge of 1500 cases when your case rate is very low looks huge. A surge of 1500 cases in the USA would be a drop in the bucket. Germany had an outbreak in one meat processing facility. It’s local. They know how to clamp down, contain the outbreak and rapidly get back to a safer national footing.

No, those headlines are not on our minds today.

Viral Prevalence, Quarantine, Travel Bans and Airbridges

Today let’s resume thinking about reservoirs and our future. Re-read a few posts if you need to.

Some pundits are saying this virus may fade away like the first SARS epidemic or the MERS outbreak. A senior doctor near me believes the virus will mutate to be milder and then we won’t need to fret much about it any more. But when we pay attention to the theory of viral evolution, neither idea looks very likely.

The earlier SARS and MERS coronaviruses were not as contagious as this one, and humanity pounced on those outbreaks to contain them so a pandemic didn’t occur. This time we lowered our guard and the virus took full advantage. It flew around the world.

Scientists are arguing about how rapidly it is mutating and in which direction. Until they reach agreement, we need to think for ourselves. HIV gave us real-world evidence that the theory of viral evolution is valid. Where the virus can spread with ease, it will have no reason to become milder and can readily become more lethal. Where the virus has difficulty finding new hosts, it will be under pressure to become milder so it can take longer to jump to the next person.

The USA, Brazil and Russia have made themselves into huge reservoirs in which the virus can propagate unimpeded and become as lethal as it wants. The UK is right behind them.

Much of Europe has done better, wrestling the virus to a lower rate of spread. A few places such as New Zealand, Australia, Denmark, Taiwan, Singapore, Hong Kong and South Korea have done a standout job of limiting the virus. Germany is pretty close to being in that group now too, and should be able to join it after their local outbreak fades.

What does that mean for us? You, me, my family, your family, our friends?

Countries that have essentially eradicated the virus, such as New Zealand, have to rejigger to keep the rest of us out unless we prove we are uninfected. New Zealand’s mandatory 14 day quarantine of incoming travelers worked until they made the mistake of granting an exemption on compassionate grounds to two people. To contain the accidental reintroduction of SARS-CoV-2 they had to contact trace more than 300 people. They won’t make that mistake again.

For New Zealand, making the rest of us undergo quarantine on the way in will require a sweeping restructuring of the economy. They were previously very dependent on tourism. Imposing quarantine will cut that to a fraction of what it used to be. But aside from that, they can live normally. They can safely visit each other, go to public places without worry about the virus, even hug each other without fear.

Countries that have relatively low amounts of the virus in circulation have to be similarly cautious about visitors from countries with higher infection rates. With one foot in the USA and one in the UK, what does that mean for me? Most of the EU cannot afford to allow Americans or the British to visit without going through quarantine on the way in, which requires a lot of resources from both the state and the travelers. Without quarantine upon arrival, the alternative is banning such travelers.

If a country with low prevalence of the virus manages incoming travelers in either of those ways, they may have some local outbreaks and local temporary shutdowns like what Germany is facing now. Aside from those episodes, by maintaining some restrictions on the way people interact, they can restart much of their societies and economies.

Both of my countries are among the ones where SARS-CoV-2 is prevalent. That means my American family and I don’t expect to see each other face to face for a long time. You can evaluate your own situation the same way. How prevalent is the virus where you are? How prevalent is it where you might want to go? If it is close to the same, an airbridge arrangement may be forming. New Zealand and Australia appear to be the first countries to discuss setting that up, allowing visits between the two countries without restrictions. But if prevalence isn’t about the same, chances are that you won’t go where you want to go anytime soon.

Viral Reservoirs, Future Potency and Future Disability

Countries with widespread community infection face either awful infection rates that may overwhelm health care resources or repeated prolonged lockdowns. The USA is providing a living example of what happens when reopening of businesses, schools and public places occurs before prevalence of the virus has been brought down enough. Some states such as Arizona and Texas have done that and are suffering for it. Others have taken a more cautious approach. If you want to see the breadth of the contrast, look at this visual of the case rates in each state. Would you prefer to be in Vermont or Arizona?

But the theory of viral evolution tells us to care about such places, not just shake our heads and mutter that what they are going through is terribly sad. Those places are not merely letting the virus rip through the population and, from the perspective of certain politicians, cull the herd.

They are providing immense playgrounds for the virus, vast opportunities for mutations to occur… and we remember HIV. Where it could find new hosts easily, it became more potent. It made people sick quicker and they went downhill faster. Where people changed their behavior to make it harder for HIV to infect more people, it became milder, taking longer to make people so sick that they could no longer go around spreading it.

Any country that does not wrestle this novel coronavirus down to low prevalence is making its population a viral reservoir. By doing so, each such country endangers the entire world. It may spawn a mutation that is even worse than what we face now, more lethal or more disabling.

And therein lurks a hazard most politicians in such countries are ignoring. Where politicans are mismanaging the pandemic especially badly, they display a tendency toward polarized thinking. They appear to see in terms of black and white, not shades of grey. They see broad outlines but not nuance.

They think when a person comes down with COVID-19, the patient either dies or recovers. Letting the virus run through everybody can look like a good option if that’s what they believe the virus does, especially if they believe it mostly kills the elderly and those with underlying health problems. Some politicians see such people as burdens on society. In the USA, some politicians (so far, limited to the Republican party) have openly made statements along the lines of feeling it’s acceptable for such people to die. They would look at the next Stephen Hawking and think good riddance.

It isn’t that simple. People who recover from a moderate to severe case of COVID-19 don’t simply get over it after a couple of weeks as though they had the flu. Some survivors haven’t died but aren’t getting well either. Months later, they still spike fevers and have an ever-changing rotation of symptoms of the virus.

In the next post we’ll talk about the implications of that for society.