I was at a conference with a bunch of business leaders from our region. Near universal vaccination among the attendees, and yet broad opposition to vaccine mandates. They were vaccinated, they supported their employees being vaccinated, they were philosophically opposed to requiring people to be vaccinated. There were different feelings from many about requiring medical staff to be vaccinated.
I share all this to point out that there are many Republicans who are pro-vaccine, but anti-mandate. The problem is that loudly proclaiming that sounds like mixed messaging:
1. Everyone must get vaccinated!
2. I’m vaccinated. Everyone should get vaccinated. But I’m opposed to requiring vaccinations.
3. Vaccines are the spawn of the devil!!!
Two of those are clear and concise positions. #2 requires you to hold what appear to be conflicting thoughts in your head at the same time, and frankly, many people can’t do that.
Let's simply restate #2 as, I believe vaccines work and getting one is a personal choice. Now you're no longer in two camps and instead, making what seems to be a widely held position.
What we are seeing right now is actually the beginning of the transition from pandemia to endemicity.
Looking at endemicity from the point of view of tolerance of a certain amount of death and suffering on the part of the general population leads directly to the perception of the severity of the threat.
With the perception of of severity of the disease decreasing, measures of risk mitigation will meet less and less acceptance. This puts vulnerable people at increasing risk. We are currently at the cusp of having highly active therapeutics generally available and these medications allow us to quickly develop strategies to avert serious infections in the immunocompromised. We will likely be able to protect the immunocompromised from serious disease in the near future, removing this large number of patients from the high risk pool leaving it comprised almost exclusively of the unvaccinated.
Ironically, the general population is about to adopt a view of Covid similar to views common on the Covid denier/no-vax side from the very beginning of the pandemic.
I cannot stress enough that the decreasing perception of illness severity on the part of the general population is in lockstep with the acceptance of bad outcomes in an identifiable subgroup, i.e. Covid deniers and the unvaxxed, effectively marginalizing them in the pursuit of return to normality.
Politically and ethically, an administration cannot simply abandon efforts to reach the vulnerable subgroup, no matter how unsympathetic the members of the group are and how ready the general population is to leave them to their own devices. Of course, extremist and populist goverments would not have a problem with that because such governments are always on the lookout for subgroups to ostracize and hurt.
And that is why I hold two apparently contradictory positions:
1. getting the vaccine is a personal choice but not getting it may require acceptance of some inconveniences in daily life
2. vaccine mandates are necessary while knowing that universal compliance is impossible to achieve.
I am certain that the current administration knows perfectly well that the bogging down of mandates in the legal system was unavoidable and that they were actually to be expected. It is also very clear that the federal mandates are achieving what could reasonably be expected to be achieved by simply starting the debate about "mandates". It is a simple case of advancing your goals just by having a debate without any expectation to win the debate.
The debate about mandates has been going on for many weeks and will keep going and here is an incomplete list of what the "mandates" are accomplishing.
The introduction of federal workforce vaccine requirements and the ongoing debate about vaccine "mandates":
1) is giving cover to employers to introduce their own requirements and inconveniences
2) is giving cover to unvaxxed individuals who may be under social pressures to not getting vaccinated or who have spouted antivaxx sentiments before and now have an excuse to get vaccinated while saving face
3) is leading to vaccinations in countless people who do not have strong opinions about vaccinations, i.e. fence sitters and procrastinators etc, and have not received them for a variety of reasons but needed a nudge
4) will be giving cover to the government against any accusations that they did not do everything in their power to reach high risk populations, and this is independent of the extent to which the courts and state legislatures allow the efforts to proceed.
Now about number 4. The administration is under pressure to demonstrate that it did everything possible to mitigate the pandemic impact on vulnerable and disadvantaged populations and everything possible is, in a liberal democracy, what is allowed under the law and the constitution and the courts are the place where the limits of executive power are established. I would be the first to accuse the government of abandonment if they did not test the limits in the federal court system. Obviously, after all efforts regarding mandates have been exhausted and nothing more can be done, the stage is set for abandonment of the remaining vaccine resistant populations to their own devices and alignment with the general public sentiment which is trending strongly towards perception of Covid as not much worse than the flu; which happens to be close to the truth for fully immunized people.
Luckily, the majority of the unvaxxed appear to ingest anything whatsoever once they feel sick, giving the administration another opening in trying to contain the catastrophe among the unvaxxed with the new antiviral drugs.
Now about the apparently decreased severity of Covid caused by Omicron. This discussion is marked by confusion and it might be time to clarify a few things.
In a certain sense this discussion is about the virulence of the coronavirus as manifested in its different variants. The problem here is that virulence is not a straightforward concept and, without a bit of background knowledge, the public discourse fails to make sense.
First we have to acknowledge that there are different meanings of the term
virulence depending on who uses the term (or a synonymous term) under which circumstances and with which intent. The reason why virulence is not a straightforward concept is because in its original meaning the virulence of a pathogen is simply a measure of the ability of a pathogen to cause disease or death. In a contolled laboratory environment in which virulence ist measured by the effect of a pathogen on a standardized host organism and the change of those effects in response to alterations of pathogen. If a particular feature of a pathogen results in a differential effect on virulence based on the absence or presence of said feature (for example absence or presence of a capsule in some bacteriae renders them either harmless or dangerous), the feature is then called a virulence factor.
In the laboratory with a standardized host organism, virulence thus appears solely determined by the pathogen. This is untrue in the real world where cases of infection are drawn from non-standardized populations and where the definition of virulence, number of cases / number of disease and death, reasserts itself as showing the virulence in the real world is just as dependent on the population from which the cases are drawn as on the pathogen itself.
The closest the public discourse comes to the scientific meaning of virulence is this:
1. the effect of a new variant on severity and frequency of severe disese and death in the unvaccinated population. This is the closest to the lab setting as the unvaxxed population is somewhat standardized because it has never encountered the pathogen. Unfortunately, at this point there is no good way to remove the never infected from the other unvaccinated in the equation, making it very difficult to arrive at an accurate estimate. The presence of some previously infected will cause underestimation of virulence to an unknown degree. This is why there is such a delay in determining if Omicron is less dangerous than other variants - the error lies in the same direction and on top of it, everybodey wants to hear that it is less dangerous.
The second way the term virulence, or equivalent, is used I would call apparent virulence, and this apparent virulence is of great importance for policy decisions:
2. Apparent virulence is simply the number of all cases in a geographic area divided by the number of cases of severe disease and death. Apparent virulence is the most important measure going into health care resource management assessments.
Apparent virulence is a measure of the impact of the pathogen on health care resources in a particular area and depends not only on the actual virulence (1., above) of the pathogen but also on the immune status of the population.
Apparent virulence therefore does not tell us much about the pathogen when the immune status of the population is not well known, but is of immense practical value for medical resource management.
The third meaning in which the term virulence or equivalent is used I would call perceived virulence:
3. Perceived virulence is the most politically charged and arguably the most important sense in which comparative disease severity of the Omicron variant is discussed. Perceived virulence (or threat perception) is what was manipulated from day one of the pandemic by political actors and is still the focus of political activity.
Covid denial, for example, is just the extreme to which downplaying disease severity (virulence) can be pushed. The extent to which the perceived virulence of the coronavirus has been successfully lowered by political actors and their multiplicators (mostly on the right) in susceptible populations can be seen in the surprise many unvaxxed Covid victims show when they get really sick and end up dying from a disease they were convinced to be largely a hoax.
Perceived virulence is now decreasing rapidly among the vaccinated as the conviction that those who are still unvaxxed cannot be reached (which is technically certainly untrue but practically likely true). The administration is actively working on all levels to support that notion and faces no resistance whatsoever as downplaying Covid is what the unvaxxed are doing all day long and the rest of the population is ready to join the unvaxxed in that stance.
Unfortunately, for the unvaxxed, the Omicron variant so far appears to be less virulent than Delta but of similar virulence as the original virus. Two years ago, the world shut down for a virus with that virulence but today we call it a mild form. This cannot be explained by anything but the lowered perceived virulence and actual apparent virulence in the vaccinated population. In other words, the unvaccinated are on their own and we can be assured that everything possibe up to "mandates" was done to help them.
Of course, this is not good news for health care resources stretched to the limit and it is not the end of what the current administration has on their plate.
The fact that majority opinion is aligning with opinions on the unvaxxed side now also means that the issues with downplaying the pandemic on the basis of ones own risk for a bad outcome are now appearing everywhere. And that is because perceived virulence is ultimately an assessment of ones own risk of a bad outcome plus a common good consideration that is now excluding the still unvaxxed.
The readiness of the general public to leave the unvaxxed in the dust and the capability of societies to tolerate mass casualties should not be underestimated. Just think how easily we tolerate tens of thousands of traffic deaths and injuries per year for te sake of transportation. We would never tolerate a death toll like that if microwave ovens were zapping us on a regular basis in exchange for some hot beferage. But a couple of hundred thousand deaths a year from Covid in the hinterlands in exchange for return to normality while not being in much danger oneself would be tolerated quite well - especially as the unvaxxed are willing to collaborate in their own deception. As long as the stakes are appropriate, an enormous number of deaths and much misery will be tolerated.
A decrease of perceived virulence of a pathogen in the general population is also the best marker for te transitioning of a pandemic to the endemic state as it is an attitude adjustment based on a risk benefit assessment. I find it fascinating to observe this in real time.
There are many moving parts but the general direction appears clearer by the day. It is obvious that we are moving toward a situation where a susceptible population that is disadvantaged for social reasons suffers the brunt of a disease transitioning to the endemic phase for the rest of the population. The fact that the behavior of this risk group does not make them sympathetic should not distract from the duty of government and other entities to find ways to mitigate the effects of the disease. Some interventions will also help decompress the health care systems such as large scale programs for preemptive antiviral treatments etc. as well as travelling health care resources to absorb local spikes and need to be vigorously pursued. I personally find it encouraging that the unvaxxed appear to be ready to swallow anything as soon as they get a sore throat - so the antiviral strategies have a chance to work.
All that said, another variant can change things but at this point I consider it likely that Omicron will result in a different immunologic situation on a society level than before, thus heralding a new phase in the coronavirus saga.