How This Ends. (The Pandemic)
I&#x27;m a little surprised by the author&#x27;s tendency of wondering abstractly and suggesting cataclysmic shoot-from-the-hip solutions.<p>There still hasn&#x27;t passed enough time for us to make confident statements about immunity in patients who recover from acute COVID, not to mention make grandiose plans, either as a state or as a society of individuals.<p>A popular blog post or article circulated earlier, plotting very simple mathematical models of infection numbers based on some assumptions about the durability of immunity. But even without visual aids, mathematical intuition suggests that widespread immunity of short duration would lead to a relatively high constant number of new cases, with relatively frequent small waves. In contrast, widespread immunity of longer duration, on the order of a year or two, would lead to lower background level of infection, punctuated by larger, more severe, less frequent outbreaks, made worse if they are seasonal and coincide with the flu.<p>And these are assumptions, things we don&#x27;t know. Which of these scenarios should we be making grand, nationwide plans for?<p>We saw a definitive report about an asymptomatic case of reinfection. That patient managed to get tested twice, despite being reported as asymptomatic the second time. Both times, the viral genome was sequenced, which is why we now believe this is a case of reinfection.<p>In the US, this patient would likely not have been tested at all. Should we update our expectations about the incidence of reinfection?<p>Are there differences in humoral and mucosal immunity to COVID? I don&#x27;t think we have consensus yet. Do asymptomatic carriers infect others? We have some evidence that they do. Other diseases can be spread by asymptomatic carriers. As an extreme example, Typhoid Mary was a real historical figure who infected hundreds over a lifetime.<p>In this context, suggesting that we ship our most elderly and medically fragile members to some kind of COVID-free zone is... staggeringly whimsical.