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Covid: Predictions for the Next Ten Years

I am not a medical doctor, only a doctor in statistical science. Yet much of the political crisis has its origin rooted in data and statistical models: people who disagree, on either side, do so mostly because they disagree with the conclusions based on the opponent's data (accused of cherry-picking), or the validity of the data in question. In short, this crisis epitomizes what is called "lying with statistics" by people ranging from laymen to scientific experts. Some of the lies are due to ignorance, innumeracy or lack of analytical acumen, some are made on purpose or because of being pressured by a third party that wants to enforce its agenda.

I won't discuss the data here, but rather, what is missing in the data, and the potential implications. In short, I focus on the absent data (so massive it dwarfs the observed, recorded data). My predictions should be taken as personal opinions only. In fact, they are mostly associated to unanswered questions and unobserved data; I would describe these predictions as an attempt at good judgment, in the absence of solid data. I also explain why an 85% vaccination rate is unachievable in the long-term in the US, and why the outlook, nevertheless, is probably promising. Section 1 discusses my predictions. Section 2 discusses common reasons - not mentioned in the media whether left or right - why some people are not vaccinated. I believe that vaccines work, so by listing the reasons in question, it does not mean that I endorse them.

1. My predictions

A potential way to get some insights about the future is to look at the Spanish flu. Is the common flu a descendant or relative of the Spanish flu, that mutated over time and is constantly mutating and mixing with other related viruses? I don't have an answer. Similarly, one might think that Covid, after killing everyone it could, will have a much harder time being so lethal. Also, a smart virus does not want to kill too many people. In that regard, one could argue that Covid is smarter than Ebola. A smart virus would want to infect a large number of people who will be asymptomatic and will spread the disease unknowingly. The fact that the virus kills many people in the process is probably not a feature in the design of the virus, created for that purpose, but rather a side-effect due to poor design. It does not help the virus as the target population also adapts and will find ways to evade it (vaccines, for instance).

Coming back to the Spanish flu, one could argue that the current Covid will evolve in similar ways and become much less lethal sooner rather than later, like in the next few months. In part, because many people are vaccinated, and among those unvaccinated, many have been infected once if not twice. Among those unvaccinated but previously infected, many will experience only mild episodes in the future and will get an immunity similar to those who are vaccinated. For instance, many people got the flu a few times as a kid, and never caught it again in the next 40 years. Maybe they caught it again, maybe even every year, but were unaware as it produced no symptom. How many people are in that category, I don't know. It would be interesting to do a survey to find out. My guess is that it is more than 50% of the population. Since these people never go to a doctor to get tested for flu, they are not in the statistics. Hospitals never see these people, maybe a reason why some doctors believe that they don't exist. But I believe this is a reason why it is impossible to reach an 85% vaccination rate on a long-term basis.

Also, another important question: how much do these people contribute to the spread of the flu, compared to vaccinated people, and to people who get very sick? Finally, not catching the flu for 40 years in a row does not mean that you are immune for life: as you get older, your immunity system gets weaker, and many really old people eventually die from the flu (technically from old age, but it was the flu that was the last straw for them), even if they were untouched for 70 years. And some seasons are particularly deadly. To summarize, Covid will never disappear entirely, in my opinion. Some years will see a deadly variant. Vaccinated people will probably have to get a shot, or two, every year. It may end up like the flu. Maybe not as bad, or maybe worse on average.

Another type of prediction is about how the governments will react. Will vaccine become mandatory for all? I don't think so. Will you forever have to show proof of vaccination to go to a restaurant? I don't think so, indeed I think it won't be the case anymore within a year. Will vaccinated people get privileges over non-vaccinated, in the long term? Probably. But in order to keep these privileges, they will most likely have to get a booster shot, at least once a year. Now my predictions about government mandates have been overly optimistic in the past (I never imagined governments would enact such tough mandates for so long, and I tend to be a pessimistic person). So you might want to take this with a grain of salt. It is possible that lockdowns and tough mandates will happen again on deadly years, in some locales. It is even possible that an 85% vaccination rate can be achieved in the short-term with very tough mandates, but as people become complacent or forget about it over time, some suffering enough from the vaccine not to want booster shots, some like healthy kids thinking vaccine is worse than Covid for them (from a risk management point of view), and because numerous recovered people will realize they are not getting sick anymore (like people who never get the flu again), the effective vaccination rate will drop sharply in the future (you can't count someone vaccinated 5 years ago as being vaccinated, for a disease like Covid). Nevertheless, Covid will become much less lethal for the reasons previously discussed. Good vaccines, with fewer side-effects, and not involving needles, will probably be developed, and I think it will increase vaccination rates. 

2. Why so many people are still unvaccinated?

One in about 500 people has died from Covid so far, in the US. This is a huge number compared to one in 5,000 who die in a car crash in a 2-year time period, but if your circle of friends consists of 100 people, there is only a 20% chance that you know someone who died from Covid. However, Covid is not a random killer, and trying to put everyone in the same bucket, for policy purposes, creates problems. We are all unequal against Covid, and Covid is an unfair and discriminatory virus. Some people have several relatives who died from it (especially if you have frail people in your circle), and some have none. It is clustered, not random. A bit random, but not that much, and certainly far less random than a lottery. Some people know that their risk is very low (see the numerous people who never get flu 40 years in a row). And some people erroneously think they are stronger than others. This has some indirect impacts on the decision to vaccinate.

I will exclude from this discussion people who believe in conspiracy theories, people who believe God will protect them (or possibly punish them), people who believe in miracle cures, people who believe vaccines are dangerous, people who want to wait longer, people who for no reason believe they are immune, or that Covid is vastly exaggerated. This represents a portion of the unvaccinated. As a scientist, I don't know any of these people. It would be interesting to estimate how much of the unvaccinated they represent. I think it is less than 50%, but I am biased as I don't frequent these circles, and it is quite possible, because they are very vocal, that they are actually far rarer than most people think despite the appearances. But I have the same bias as doctors who think the numerous people who never get the flu 40 years in a row don't exist because they never hear about them complaining about never getting the flu. 

That said, let us focus on the unvaccinated people that are not in one of the above categories. A priori, it excludes all the so-called "idiots", and only includes people who believe that vaccines work and are very safe. It would be important to estimate what proportion of the population (among the unvaccinated) they represent. Below, I am listing some of the arguments that I hear from them, which are never mentioned in media outlets. It does not mean that I endorse these arguments: I am just simply reporting them. I believe that this is the hidden face of the unvaccinated because, despite (in my opinion) representing the majority of the unvaccinated, no one ever mentions them. 

  • People who claim that they experienced serious side effects from the first or the second shot, or from previous vaccines. These side effects might be considered mild by most people who get sick once in a while, but for them, being somewhat sick and at home/unable to work for three days because of the shot, is the worst that they have experienced in a long time. They may not recognize that catching the virus could have been far worse. While technically vaccinated, they will be classified as unvaccinated in three years (or more precisely, not immune) if they start refusing future shots.
  • People who know (with facts backing this evidence) that their risk of serious illness from Covid is very low. Their family members might be vaccinated, they may work from home or are retired, maybe they don't fly, but they know that they are not exposing other people. If they lived with someone frail in their family, they would get vaccinated. If they get Covid, they'd rather die at home than generate potentially very large hospital bills. They want that money to go to their kids, not to a hospital. 
  • Healthy people who believe they need exposure to germs to boost their immune systems. They would not take the risk with smallpox, and would be vaccinated against it, but not Covid which they see as much less dangerous. They may have caught all the preventable diseases that they were not vaccinated against as a kid and recovered on their own, almost never visit a doctor, and indeed it worked for them; they expect that it will continue to work this way until they reach old age, or if something far worse than Covid happens: in that case, they will get vaccinated. 
  • People concerned with the administration protocol. They know that vaccines are safe, but they are concerned that the people providing the shots at their grocery store, may not be competent and prone to mistakes. Some people will avoid medical facilities out of fear of catching various diseases. They think they might indeed catch the virus in a hospital, not because of getting the vaccine shot, but because of being exposed to infected patients. The time spent to get vaccinated (driving to and from a vaccination center) may be enough of a deterrent. Some fear needles but would get the vaccine if it could be taken orally and/or at home. Some are concerned about the paperwork: there are stories of vaccinated people who lost their card and were unable to get a new one; for all matters, these vaccinated people are now treated as if they were unvaccinated. 
  • People who view the vaccine as a product or commodity. If you ask them why they are not vaccinated, they have no reason. It's like asking them why they don't buy oranges at the grocery store despite the fact that they have nothing against oranges and know it is a healthy fruit. These people may have a very long "to-do" list, and vaccination is not at the top in that list. They may even love oranges, but obviously can't buy the myriads of products that they like, if anything due to lack of time or lack of money, even if some of these products (say oranges) are available for free.
  • Some unvaccinated people have been constantly insulted, to the point that the argument "protecting other people" does not work anymore. They don't want to protect those who insulted them and predicted their death (or that of a family member), especially as these predictions were wrong for them. Not only that, but they have realized that the vaccinated people predicting all sort of ailments happening to their family, were wrong. They start asking whether what these vaccinated people say about the vaccine or Covid might be just as wrong.
  • Probably the largest segment, and rapidly growing, are those who were infected once or twice, especially recently. They believe that they are immune for the next 12 months, and expect the next episode to be milder. They don't see themselves as any different from vaccinated people, in terms of risks of infecting others or getting seriously sick themselves. Some may even start questioning masks, as the very mild difficulty breathing they experienced themselves personally due to Covid was same as wearing a mask, but only of shorter duration and only on occasions (like a 2-hour episode every other day before eventually disappearing after full recovery).

Again, this is not an endorsement of these viewpoints. Some of these people will eventually become very sick or die, and infect others. But vaccine itself does not fully protect either against transmitting the virus. It is said that it works better than catching the disease (assuming you don't die from the disease) in terms of building immunity and stopping the spread. But the statistics are biased in the sense that the average recovered patient got her last infection months before the average vaccinated person got her last shot. Over time, we will see if natural immunity is stronger or not than that provided by the vaccine. It seems that volatility associated with recovering is higher, thus predictability more difficult, than from vaccines, in terms of assessing the acquired immunity for a specific individual. My guess is that natural immunity works better than vaccines for some people, and worse for other people. In both cases, you'll probably have to be infected/exposed again, or better, vaccinated again, to keep up with the new variants of Covid. But recovered people are going to be the biggest challenge for government policies, for years to come. Just my 2 cents.

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About the author:  Vincent Granville is a data science pioneer, mathematician, book author (Wiley), patent owner, former post-doc at Cambridge University, former VC-funded executive, with 20+ years of corporate experience including CNET, NBC, Visa, Wells Fargo, Microsoft, eBay. Vincent is also a self-publisher at DataShaping.com, and founded and co-founded a few start-ups, including one with a successful exit (Data Science Central acquired by Tech Target). You can access Vincent's articles and books, here. A selection of the most recent ones can be found on vgranville.com

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Comment by Lance Norskog on November 3, 2021 at 9:06am

A good summary! Other reasons for people to refuse the vax:

1) "It's free." No, they ask for your insurance so they can bill it. Many sites have asked for money even though they're not supposed to- there are some anecdotal reports.

2) "It's free." People don't trust this statement, they don't believe anything is free with the US health system- and rightly so.

3) "The precariat." They hear they'll be sick for a few days. A large minority of people working for a living in the US cannot tolerate a few days out sick. They are at the edge. They drag themselves into work when they have colds, flu, injuries.

As to the future of Covid, we have a (mostly) accepted story that OC43, another coronavirus, was the 1890 "Russian or Asiatic Flu". This was a worldwide pandemic that killed millions. The symptom list for OC43 is really weird for influenza, but roughly matches Covid-19. Some epidemiological historians had a blinding light bulb moment several months ago. OC43 gradually got less virulent and still circulates as one of our standard four "common cold" coronaviruses- I'm sure it kills a few tens of thousand Americans every year, just like "mild" influenza.

On OC43 and the "Russian Flu": https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252012/

Cheers!

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