Covid19: The case of the dissolving seat belt

A simple ask for a simple task with an easily provable outcome: seat-belts save lives so buckle up! Perhaps difficult to comprehend today, resistance to buckling-up persisted well after their invention including fear of entanglement in a fire.

No complaints of seat belts dissolving mere months after their installation are recorded, however. Thankfully, automobile safety features rarely lose effectiveness mere months after installation.

mRNA vaccine technology, under development for years with little success beyond initial trials, demonstrate mitigation of severe Covid19 symptoms consistent with clinical trials. Observations support their further effectiveness at impeding infection and on-transmission with some notable caveats. The virus is a moving target responding to evolutionary pressures: variants of concern (VoC) continue emerging such as the previous ‘South African’ that evaded current vaccines.

Dominant strains such as Delta are less insidious but nevertheless more infectious and on-transmissive than predecessors, while the recent rapidly spreading omicron adaptation could prove even worse yet appears less virulent. Unsettling reports roll in of breakthrough infections, comparable viral loads and rough equivalence for on-transmission despite vaccination status. Confounding these reports, however, is a lack of clarity as to cause: viral evolution, vaccine failure or both.

Vaccine effectiveness generally diminishes over time and intervals for booster shots range from ten years for tetanus to twelve months for influenza. Canadian mathematicians modeled this effect and predicted optimal intervals of 28 days for the Covid19 mRNA vaccines.

The ideal is certainly not always practical.

Recent observations highlight effectiveness persists rather longer but with substantial drops to 50% against infection with the Delta strain some sixteen weeks after the full two-dose inoculation — teetering just above thresholds for vaccine approvals. Recent New Zealand models rely on fixed estimates of effectiveness, largely derived from previous strains such as Alpha.

Celebrated targets of 90% inoculation in New Zealand and fixed infection impedance of around 70% enable a quick, but by no means definite, calculation. Exposure of the 5 million people of New Zealand implies only 30% will be infected out of the 90% inoculated, or around 1.35 million. With severe disease mitigation fixed at 80%, then some 270,000 suffer severe symptoms. These cases will not happen simultaneously, fortunately. Let’s say 1% do. Then some 2,700 people will require critical attention such as beds in intensive care. New Zealand currently has around 280 ICU beds in the entire country, potentially twice as many if mixed with paediatric wards. Limitations of this estimate include fixed rates based on the Alpha strain, ignoring waning and impacts on an unvaccinated 10%.

Twenty eight days or sixteen weeks. New Zealanders inoculated some four months ago now enjoy substantially less protection against Covid19. Boosters are available for those inoculated six months ago. Meanwhile, opportunities for infection are rising in lockdown-exhausted communities with diminishing compliance. The current New Zealand ‘traffic light’ policy unleashes the vaccinated with greater freedoms in a ‘super connected’ society.

What will happen to Kiwis that fall ill with Covid19 — vaccinated or not?

Unlike polio or other diseases, Covid19 is not exclusively prevented by vaccination. The world now has considerable experience with the disease progression, and early testing and interventions can prevent the viral progression to severe damage. Guidance in New Zealand doesn’t stray far from simply isolation, observation and a ventilator despite calls for more nuanced and less exacerabating approaches. Recent announcements reinforce these guidelines while adding customised ‘health-packs’ (of mysterious content?) for the isolated at home. New Zealand is only now in a hopeful queue with $300 million in hand for new treatments of debatable effectiveness in the pharmaceutical pipeline, while the handwriting describing breakthrough infections for highly vaccinated countries and burdened hospitals was written on the wall months ago.

Meanwhile, in the desert mountains of my tierra natal New Mexico, more renowned for its cuisine than its health care, treatments were used in-house a year ago reducing hospitalisations by 75% that are now freely and equitably available for all. Numerous vulnerable and vaccinated Americans benefited greatly from this program, while other countries acted similarly. There is no such treatment available for Kiwis from the otherwise renowned New Zealand health care, despite calls to do so months ago.

Consider: a population, largely isolated from a novel pathogen rapidly evolving and circulating the world, enjoys minimal if any natural immunity demonstrably superior to inoculation. Efforts to seal the border failed and cannot continue indefinitely. A one-dimensional — nearly fetishistic — focus on a single solution, vaccination, is deployed across the population that rapidly diminishes to insufficient protection over a few months. Gaps between sufficient and boosted protection of at least two months are bureaucratically imposed. Treatment options for breakthrough infections are minimal, relying on techniques deployed at the outset of the pandemic, while overlooking experience of other nations demonstrating successful prevention of severe disease progression. Ill-prepared for these looming outcomes — as demonstrated by highly vaccinated scenarios experiencing resurgent case numbers — government health policy grudgingly acknowledges the vaccination failures with ‘health packs’ and hope for unproven pharmaceuticals — only now that society is opening up with a confusing and complex ‘road code’.

Imposed by government policy, a two-caste society blesses the vaccinated with greater freedoms encouraging cavalier attitudes with quite permeable protection. This is tacitly acknowledged by medical treatment guidelines for handling patients regardless of vaccination status. Those with natural immunity after contracting Covid19 are nevertheless treated as second-class citizens whose movements are restricted in the country: only the vaccinated and tested-negative may, for instance, escape Auckland. Meanwhile, medical exemptions are systematically rejected through centralised authorities disregarding individual medical advice regardless of adverse reactions or risk. Evidently, all people are medically identical and all can be treated identically regardless of ethnicity, gender, age, or pre-existing condition.

Lack of preparation for inevitable surges in case counts and disease regardless of vaccination combined with imposition of inferior social status contingent on vaccination suggest the New Zealand scenario orchestrated by the government is motivated not by concern over public health, but something else.

Seat belts save lives, but so do bumpers, brakes and simply putting the phone down. Certainly, accidents will end if drivers are locked down inside their driveways — at a price society can ill afford, repeatedly. Neither should society encourage public roads full of drivers snugly buckled up in vehicles without bumpers, brakes, windows or doors. Note, bumpers and brakes are in the purchasing queue, but international shipping is suffering some delay. Drivers secured only with seat belts nevertheless be advised: your safety feature — over the course of around sixteen weeks — simply dissolves.