Guest post: What’s the COVID endgame?

A guest post from PaulL, a regular commentor:

We’re a bit over 2 years into our COVID journey.  It’s timely to question what our future is.  Our government, our media and our commentariat seem to be looking weeks or months at best into the future, focusing on alert levels, current COVID variants, whether we need another booster shot, who should be wearing masks and where.

It’s time we started discussing what the next 20 years are going to look like.

It feels to me that many are still in a mental model where we are going to eliminate COVID.  We just get enough boosters, or we wear masks often enough, or we develop immunity, and it’s going to go away.

It seems clear to me that COVID is not going to go away with any of our current interventions.  It is endemic, there will continue to be new variants, those new variants will continue to exhibit immune escape (whether your immunity comes from vaccination or prior infection).

Why are we not having a discussion about exactly what the new normal is going to look like?  If you listen to Michael Baker I think the conclusion can only be that we’d expect most NZers to require a booster at least twice per year (forever?), and that we’ll be wearing masks in many settings forever, ideally including all children in schools.  Vaccine mandates and traffic lights will remain, and the government will continue to regulate and intervene in many different ways, in particular reserving the right to move back to lockdowns if a new more infectious variant emerges.

Even in that world, I think we’ll be stuck in a situation where new variants are arising about every 3 months, but vaccines take at least 9 months to develop.  So the latest vaccine will always be two variants behind, and that means that the vaccine doesn’t provide a lot of protection against the latest variant.  BA.5 studies aren’t out yet, but with the previous BA.2.12.1 variant the vaccines had a 40% reduction in protection in the double vaccinated + booster cohort (i.e. that regime was 92% effective against BA1, and 52-69% effective against BA.2.12.1 – where effective means it reduced your chance of hospitalisation).  There’s an expectation it would be significantly less effective still against BA.5.

So what now?  Are we as a population prepared to continue getting booster shots every 6 months, and wearing masks in many situations, in order to slightly slow the timing with which we catch COVID, and somewhat attenuate the severity of our symptoms when we do get COVID? 

Surely the only paths out to an actual normal world are:

1. We develop sufficient natural immunity and/or COVID evolves and weakens enough that COVID becomes just another variant of the flu or the common cold – we catch it a couple of times a year and it’s OK, OR
2. We develop a vaccine that is sufficient to eradicate COVID – a “universal vaccine” that targets a biological pathway that COVID cannot simply evolve away from
3. We develop a treatment for those with COVID that makes it much less likely that you die from it – i.e. we treat the symptoms better even if we can’t stop you getting it
4. People just stop wearing masks and stop getting boosters, and COVID recedes into the background despite it still being a substantial risk and a substantial killer

Path 4 seems to be the default, because it seems to be happening everywhere else in the world.  A few people are still very concerned about COVID and are shouting into the wilderness about masks and vaccines (Michael Baker seems to be in this category).  And most people just seem to be treating it like they treat the risk of dying in a car accident – they know it can happen, but it doesn’t stop them getting in their car.

I don’t see any discussion of this, yet surely this is one of the most important things our government can and should be planning for – how exactly our country will emerge from mandates, traffic lights and mask wearing to be some version of the country we used to be.  If for no other reason than a failure of leadership and a failure of explanation seems by default to be leading us to that same option 4 that every other country seems to be marching down – just more slowly than everywhere else in the world except China.  If that’s OK then let’s have that discussion and agree that it’s OK.

I’d like to see some clear statements about the forward road map – we expect the traffic light rules to go away by a certain date, here are the criteria under which we’re going to stop requiring mask wearing, these are the criteria under which we’re going to remove vaccine mandates.  Is this discussion going on somewhere that I don’t look, or is it as sadly lacking amongst our governing classes as I fear?