‘COVID Zero’ is unattainable; acceptable risk is the goal

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Ten years ago, a deadly infectious disease killed more than 36,000 Americans. The next year, it killed another 12,000. Over each of the following eight years, the same disease caused between 22,000 and 62,000 deaths.

That disease is influenza — also known as the flu — and it ranks among the 15 leading causes of death in the United States.

Talking about the effects of a typical flu season is somewhat fraught these days. We are living through the worst pandemic in a century, one that is of a different order of magnitude from the flu. In the early months of COVID-19, some people who were trying to deny its severity, including then-President Donald Trump, claimed that it was barely worse the flu. That’s false.

Soon, however, the flu will become a meaningful point of comparison.

In coming months, COVID will probably recede, as a result of vaccinations and growing natural immunity. But it will not disappear.

“Some people have gotten this idea that we’re going to get to ‘COVID zero,’” Dr. Amesh Adalja of Johns Hopkins University told me. “That’s not realistic. It’s a fantasy.”

COVID is caused by a coronavirus — known as SARS-CoV-2 — and coronaviruses often circulate for years, causing respiratory infections and the common cold. The world is not going to extinguish coronaviruses anytime soon, nor will it extinguish this specific one.

The reasonable goal is to make it manageable, much like the seasonal flu. Fortunately, the vaccines are doing that.

Israel, the country that has vaccinated the largest share of its population, offers a case study. One recent analysis followed 602,000 Israelis who had received a COVID vaccine and found that only 21 later contracted the virus and had to be hospitalized. Twenty-one is obviously not zero.

Vaccines are almost never perfect. But the COVID vaccines are turning it into the sort of risk that people accept every day.

Here’s a useful way to think about Israel’s numbers: Only 3.5 out of every 100,000 vaccinated people there was hospitalized with COVID symptoms. During a typical flu season in the U.S., by comparison, roughly 150 out of every 100,000 people is hospitalized with flu symptoms.

And yet the seasonal flu does not bring life to a halt. It does not keep people from flying on airplanes, eating in restaurants, visiting their friends or going to school and work.

The vaccines will not produce “COVID zero.” But they are on pace — eventually, and perhaps even by summer — to produce something that looks a lot like normalcy. The extremely rare exceptions won’t change that, no matter how much attention they receive.

As Dr. Stefan Baral, a public health researcher and infectious disease expert, put it on Twitter: “Risk assessment? Absolutely! Risk mitigation? Absolutely! Risk management? Absolutely! Risk communication? Absolutely! Risk Elimination? Impossible.”



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