Three endgames for the virus

1. The treatment endgame. We learn to live with the virus. Deaths are prevented using treatments.

2. The suppression endgame. We keep people from coming into contact with the virus.

3. The immunity endgame. Enough people get the virus and/or a vaccine so that it has few people to infect.

It sounds like (2) works in some countries, using ots of testing, tracing, and quarantining. Many people are angry that the U.S. has not executed this strategy. But (a) a lot of other countries also have not been able to execute it and (b) it seems like a fragile strategy, in that at some point you could experience too many cases to deal with using testing and tracing, and then where are you?

Lockdowns were supposed to be part of (1), the idea being to “flatten the curve” and ensure enough treatment resources. I have speculated on a super-strict short-term lockdown to achieve (2), but that is probably a fantasy. Meanwhile, many people seem to have come to believe mistakenly that the lockdowns that we actually have can achieve (2).

I thought that (1) was more likely to work than (3). But events seem to be moving in the other direction. We see have seen deaths rise pretty dramatically in recent weeks. Not to NY/NJ nursing home levels, but still alarming. So the treatments have not yet reached the point where we can just live with the virus as we can with the flu.

To my knowledge, herd immunity has not merged anywhere. That leaves the vaccine.

Vaccine trials seem to show efficacy. As you know, I worry that the results might not be reliable, because even in the placebo sample there were not many cases. But my guess is that since mid-November there have been many more cases, and if the results are still strong then that would be pretty convincing.

I suggested the other day that challenge trials could have been used to more efficiently demonstrate efficacy of the vaccine. But there is an argument that there is no way to evaluate safety quickly. If the vaccine is going to have harmful effects, these may take a while to show up. So perhaps we could not have evaluated a vaccine in a matter of weeks, even with challenge trials.