- I’m not an epidemiologist, but the experts seem to think it’s likely though not inevitable that the more transmissible variants will become dominant soon in the U.S., at least in some U.S. communities. Like the original arrival of the SARS-CoV-2 virus in the U.S., this will be, once again, an exponential change. And once again, the inability of the human psyche to truly understand what “exponential” means will doom us to being unprepared – unprepared psychologically as well as practically.
- The same old precautions – masks, social distancing, etc. – are about to become even more important. Selling that means trying to get through to people how exponential growth works. Maybe we can leverage the old story about grains of rice or wheat on a chessboard. Somehow, we need to become much more cautious, just as imminent vaccination is tempting us to become much less cautious instead.
- It’s worth asking people who have resisted masks and social distancing to reconsider. “These new variants could make this a whole new ballgame,” we can honestly tell them. “And by the time we know it’s a whole new ballgame, it will be too late. The new virus variants will have already won the game. We need to field our team now – and we really, really want you on our team this time!” Or something like that. Messages should ideally be tested before they’re rolled out, just like vaccines. But for sure we need to appeal to the prior holdouts with empathic messaging – not finger-wagging.
- It might be easier to sell new precautions than the same old ones. And maybe that’s why double masks are getting so much attention in recent days. What other technically defensible “new precautions” can we think of? Face shields? This is a question you might ask some of the experts in your Rolodex (if you still had a Rolodex).
- The obvious implication of the threat of more transmissible COVID-19 variants is the need to accelerate vaccine rollouts. This isn’t something ordinary citizens can do – but it is certainly something ordinary citizens can push for. And if enough ordinary citizens push for it, maybe officials won’t be so frightened to do it. I think the “first dose first” gamble is worth considering. Other possibilities include half-doses and faster Emergency Use Authorizations for the Astra-Zeneca, Novavax, and J&J vaccines. Anything that can get more people somewhat immunized more quickly is worth considering.
- It would be incredibly difficult for the Food and Drug Administration to back off its endless assurances that it won’t cut any corners – to assert now that the threat of the variants justifies rethinking some of its prior positions. The risk of the virus, already astronomical, is higher now. That justifies taking more vaccine risks – at least vaccine efficacy risks, if not vaccine safety risks. The FDA understandably prefers disease risk to vaccine risk. There’s no loss of public trust attached to harm from a disease. But harm from a vaccine, even much less harm from a vaccine, is a different story. Even so, at some point a small vaccine risk is worth taking to avert a much larger disease risk – and maybe we have reached that point.
- If the FDA doesn’t think we have reached that point, maybe the FDA is the wrong decision-maker for this moment. Maybe the Biden White House can pressure or overrule the FDA with less collateral damage than the Trump White House would have faced. Maybe some of these decisions – such as first-dose-first – can be taken by state officials even without the feds’ blessing.
Copyright © 2021 by Peter M. Sandman
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