COVID vaccinations are moving along at an increasingly rapid clip. Deaths, hospitalizations, and cases are down. Still lurking in the background, though, are mutations of the virus that some experts maintain will cause yet another surge of virus, just as Americans start to exhale. I spoke with New York editor-at-large David Wallace-Wells about the current state of the pandemic in America.
Ben: For months now, we’ve been hearing that it’s “vaccines versus variants.” That is, it’s a race between getting Americans inoculated and what some deemed an inevitable surge of new cases resulting from mutations of the virus first discovered in the U.K., Brazil, and South Africa, and elsewhere. Lackluster genetic testing makes it difficult to know how many such cases the country has seen, but we know there’s been a rise of variant prevalence in some places, New York City included. However, the overall case rate is at its lowest level since October, with hospitals and deaths continuing to fall from their January peak. And vaccinations are galloping along — well over 2 million per day, with about 19 percent of Americans having received at least a single shot, and President Biden pledging that everyone can get one by May. Optimism is definitely in the air; what’s your view-from-30,000-feet take on where we are?
David: I think things are definitely looking up. The vaccine rollout is moving more quickly than seemed likely six or eight weeks ago, and as for the variants … I think it’s wise to be cautious, and to keep a close eye on things, but I also think there are some meaningful signs that even these quite scary-seeming versions of the disease may not prove all that scary in the end. I’m very worried about the Brazilian variant, since there is some evidence that it has achieved “immune escape” and produced a wave of reinfections. But the course of the others contains some real contradictions which I don’t yet know how to resolve. They appear to be considerably more infectious, and perhaps more lethal, than the “classic” strains. And yet they are growing in prevalence precisely as cases are falling nearly everywhere in the world. How can that be? Seasonality is surely playing a role in that decline, but if a new variant is 50 percent more transmissible than the old, you would expect it would require quite dramatic new restrictions to produce a decline in cases. In other words, it would be really hard, and pretty rare, to engineer a decline in the presence of those variants. Instead, it seems to be happening everywhere.
Ben: Even happening in places that aren’t vaccinating as fast as the U.S. — which is to say almost everywhere, right? So that can’t be the whole story.
David: Right. In many of these places, there has been little to no vaccination to speak of at all. Several scientists I’ve spoken with have suggested that we may be misinterpreting research into the relative transmissibility of the strains, which may have a comparative advantage over the classic strains not because they are any more transmissible but because the old strains are losing some of their transmissibility through mutation — in other words, the new variants are doing better in their competition with the old ones, but not any better in absolute terms. On the other hand, other scientists I’ve spoken to find that hypothesis preposterous. We’ll have to see, but whatever the explanation, the combination of seasonal effects, some amount of population-level immunity and existing pandemic restrictions does seem to be producing really good news almost everywhere, though of course the absolute level of cases remains tragically high.
Ben: Several governors — and not just in the predictable places — have taken pretty dramatic steps rolling back regulations. For instance, Massachusetts restaurants don’t have a capacity limit anymore. And places like Texas are going much further, nixing the mask mandate and pretty much returning to “normal,” or at least trying to. How much does acting like the pandemic is over, or almost over, concern you?
David: I’m reluctant to be too much of a contrarian about these things, because I do think the policy changes are likely to produce some additional number of cases, and therefore deaths. But I think the scale of the effect is much smaller than most people appreciate. Almost every survey of behavioral changes over the course of the pandemic suggests that public policy — mask mandates, dining restrictions, etc. — follows changes in behavior rather than causing it. And while a big CDC study was hailed this week as demonstrating the value of mask wearing and mask mandates, the effect it showed was, to me, strikingly small: Mask mandates reduced the rate of growth of the disease between 0.5 and 2 percentage points. Over time, those differences add up. But they aren’t enormous.
Ben: What about the risk of some previously unknown variant causing havoc at the last minute, so to speak? From what I’ve read, given that vaccines seem very effective against all the other ones, this doesn’t seem too likely, but …
David: I certainly don’t think you can rule that out, and the longer the world goes unvaccinated, the more mutations are likely to pop up. But looking at the global trajectories, I personally suspect the role of variants has been somewhat overstated to this point, and there may not be all that much risk going forward of a truly game-changing mutation. There’s even been some speculation that the virus is “running out of room” to mutate, at least on the critical spike protein. Knock on wood.
Ben: While the pace of vaccinations is looking good in the U.S. and U.K — and could plausibly start looking good soon in the E.U., Russia, China, and some other places — there’s still a large part of the world that isn’t even close to having the infrastructure in place to vaccinate its population quickly. It’s also true that some such places — in Africa and Asia, for instance — weren’t hit that hard by COVID in the first place. So what’s your thinking on how much this could be a looming problem going forward?
David: It depends what you mean by “hit hard.” In a lot of these places there have been widespread infections, but they’ve been sort of “hidden” by the age structure of populations there — the age skew of the disease is so dramatic that in younger countries you can often barely see the death toll.
It’s risky to generalize, since the experiences of different populations are really divergent, and it is of course a moral imperative to protect as much of the world as we can as quickly as we can. But I suspect there is more naturally acquired immunity in the developing world and Global South than is often acknowledged, which could be a buffer (if only a buffer) against dramatic waves in the medium term. That said, any unprotected pocket provides a risk for mutations, on top of the risk for severe illness and death. Which is all to say, it would be nice if the global vaccine rollout was going as well as the American one, and it’s something of an outrage that it isn’t.