What might a vaccine mean? It’s the pandemic news from Britain

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Now that we (may) have a vaccine, let’s talk about what it could mean. Because it’s not all Problem Solved. We’ve had a little time to feel good, so now we get to look for monsters under the bed. They may turn out not to be there, but let’s take a look while it’s daytime. Just to be safe.

Potential monster number one: We don’t know yet whether the Pfizer vaccine will keep people who’ve been exposed to the virus from spreading it. It may, but it’s also possible that it–or any other vaccine–will keep people from getting sick but not keep them from being silent spreaders. That would mean we can’t end social distancing and can’t burn our masks.

I can’t tell if those are beady little monster eyes I’m seeing or if it’s the buttons I lost a couple of years back.

I really should clean under there more often.

Potential monster number two: If the Pfizer vaccine is the one we all go with initially, logistical problems are a certainty. It has to be kept at an insanely cold temperature–minus 70 C. That’s minus 94 F. Not even forty years in Minnesota prepared me to understand how cold that is. The worst I saw was minus 40 F., and I think that counted the wind chill. It was cold enough to freeze any thought other than How do I get indoors but wasn’t cold enough to impress this vaccine.

That’s going to be more of a problem in countries without a well-developed infrastructure and without the money for a supply of–um, what do you use to keep a drug at that temperature? Something with more insulation than your average lunch bucket. 

Irrelevant photo: mallow

Potential monster number three: How much of the vaccine can be produced how quickly, and at what cost. And how much of what’s produced will be available to poorer countries? Because until the virus is under control everywhere, it won’t be fully under control anywhere. 

Potential monster number three and a half: Initial supplies will be limited, and the British government’s drawn up a tentative list of what sort of people will be priorities, but no country’s likely to have enough doses for all of its population. So what does that mean?

Say a vaccine protects 70% of the people who get it. (This is based on an article that came out before the preliminary Pfizer announcement of 90% protection, so the numbers will change but the structure of the problem won’t.) If 70% of the population is vaccinated, which is unlikely at first, 49% of the population will be immune.

Why 49%? Why not 49%. It’s a nice number–just off balance enough to be convincing. What it’s not, though, is enough to give us herd immunity. If the priorities for vaccination are the oldest people, the most vulnerable, and (please!) the front-line workers, that will still mean that younger healthy people need to maintain social distancing, wear masks, and generally continue to live the way we’ve been living. And people who’ve been vaccinated probably will as well if the vaccine doesn’t keep them from being contagious. Otherwise they’ll endanger both the 51% of vulnerable people who haven’t been protected. And (I know, I keep saying this) younger people are more vulnerable to this than we tend to think, so they’ll endanger them as well.

But it’s not all monsters and buttons and dust bunnies under the bed. We’ve got some potential monster-slayers too. 

Sorry, I don’t mean to get bloodthirsty about this. If you’re squeamish about killing a virus, take heart: A virus is not actually alive. Or else it is. This is something microbiologists argue about. It all depends on how you define life. Either way, though, it’s them or us. It’s enough to drive even the most dedicated pacifist to sit down and have a good long think.

So, potential monster-slayer one: On a very long-term basis, it’s possible that young kids who catch the virus but don’t get sick will build up a generational semi-immunity and Covid will eventually become just another cold. It’s possible that the four coronaviruses that cause colds started out like Covid. One of the four left cattle and discovered humans around 1890–the same year as what’s been thought of as a flu pandemic but might, in hindsight, have been a cousin of Covid. 

It’s possible. It’s also possible that all that is wrong. And of course most of us have to live long enough and emerge healthy enough for that to matter.

Potential monster-slayer two: More immediately, with the introduction of a vaccine, testing and tracing come into their own. They’re most effective when case numbers are relatively low–much lower than Britain has at the moment– because a country needs to track and quarantine every case. A vaccine could put us in a position to use testing and tracing well. 

Of course, even if you only have three cases, you still need a competent track and trace system. I’m not sure ours is up to the challenge of three cases yet.

Early in the pandemic, South Korea used track and trace well and Joshua Gans of the University of Toronto says, “We need to all become South Korea as quickly as possible.”

That will mean ensuring that quarantine actually works. Estimates of the percentage of people in England who fully self-isolate when they’re supposed to are low (11% according to one study), and the situation isn’t helped by the lack of genuine financial support. Some people can’t afford to stay home. Others, presumably, don’t take it seriously.

One problem with testing has been that the fast tests are less accurate than the slow ones. A test that is 90% sensitive will miss 10% of positives. But don’t despair. Baffling math may save us here. “Two tests five to seven days apart are 99% sensitive in finding you positive–if you actually are,” according to epidemiologist Tim Sly.

No, don’t ask me. They’re numbers. I can’t explain why they do what they do. The main thing is not to let them sense your fear.

The recommendation is to test people frequently–frontline workers, people who fly, people who breathe. Some of the rapid tests can spot people who are actually transmitting the virus, not just people who have symptoms. 

So we’re not ready to have a massive, maskless, indoor party the day after the vaccine arrives. Or maybe even the year after the vaccine arrives. Put away the confetti. Take a bite of the ice cream, then shove it back in the freezer.

But the picture is changing, and even though we have a government that’s elevated incompetence to an art form, I’m hopeful.

69 thoughts on “What might a vaccine mean? It’s the pandemic news from Britain”

  2. Another factor is the possible impact of the outcome of trade negotiations between the newly independent and insignificant UK (huzzah!) and the countries where the vaccine is made – I’ve seen Germany mentioned for this. Maybe I’m being unduly pessimistic, but if Johnson and his cretins have antagonised them so much I fear we may find ourselves way back in the queue. And I doubt that many forms of refrigerated transport would cope for long enough at the customs queues. Warm vaccine, anyone?

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  4. Truly terrifying to contemplate us all becoming South Korea (a country I love by the way); it might make the other superpowers a tad nervous. And as for poor old Tim, epidemiologists are having enough trouble cutting through as it is without carrying the additional burden of being Dr. Sly.

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  6. Of course, there is the math of the other vaccines being developed, the therapeutics and the people who think the whole thing is a hoax. The mind boggles. I’ll leave it in your capable hands to continue figuring this mess out. Or, shove these things back under the bed.

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  10. I totally agree on #3 1/2 – My family won’t see any of that vaccine for a long time … People are acting as if that was the holy grail. Germany is in partial lockdown and I’m pretty sure they just call it that so people don’t go crazy. Just yet.

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  14. MD daughter says that to maintain a “typical” cold chain, 4-5C is already difficult. And she did almost a year in Africa with Doctors w/o borders. So -80C? Even in developed countries it means only certain hospitals can keep the vaccine at that temp. So, huge queues at the hospitals?
    Add to that the fact that a significant number of French (damn Frogs) say they will not vaccinate themselves. How many in the UK and elsewhere?
    😷😷😷

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  15. Great article I like your writing style. I am a US citizen living in Portugal for the past 20 years. The US is in a very bad place but Portugal has it’s problems also. When this pandemic started I told my wife that Europe and the US need to follow the South Korean example of how to stop the covid spread. They did not. The South Korean government immediately set up testing stations around the country. They also did temperature checks for everyone entering a public space. If they had a temperature they were immediately escorted to a testing center and given, first, a seasonal flu test. If positive they were sent on their way. If negative they moved to the next stage which was a scan of their lungs to check forany signs of pneumonia even if they had no symptoms. If positive they were given a covid test and held there in isolation, until the tests results were received. If positive they were sent to a quarantine center immediately and not permitted contact with anyone. The covid positive persons were either held there two weeks and retested then released if negative, or if they were ill, sent to a covid ward of a hospital. Everyone in the population was required to wear masks in public. This is the reason that South Korea got control of the virus and never had to shut down any part of their economy. The west totally dropped the ball and look at the results. Covid positives should never have been permitted to quarantine at home! Now it is too late. i have a solution to this problem and it is very simple. I will explain in my next post on solutions to stop covid so please follow me.

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    • That’s more detail than I’ve seen before on the South Korean approach. Britain’s approach to quarantine has been insane. At one point, it involved taking public transportation to get home, then staying there–probably. Presumably, if public transportation moves fast enough, the germs can’t keep up.

      I’ll be interested to see what your approach is.

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  16. Will we still be allowed ice cream, or will all freezers have been co-opted to Mr Dyson to turn into super freezers for storing the vaccine?

    I do feel the vaccine is a ray of hope, but just a little one. I’ll take it, however small, for we certainly need good news presently. But, yes, many and hurdle to leap yet and hence many risks for a trip up or two.

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    • I think the ice cream’s safe. There’s no way we can add together the temperatures of various freezers in the neighborhood (0 F; – 18 C, in case anyone asks) and get to – 70 C.

      I’m hanging onto the ray of hope myself, and reminding myself that it doesn’t mean we can all relax and do what we want now.

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    • Indeed. Since I wrote this, I’ve heard on the grapevine that the local doctors are planning how to handle the first round of injections. They’ have to plan for a space where people can sit for 15 minutes after the shot (to make sure they don’t explode, presumably), and for enough coordination with other doctors’ practices so they can use 1,000 doses, because that’s the quantity it comes in–and they all have to go to people over 80, as far as we know. Why they’re not going to front-line workers first, I have no idea. Maybe because they have less political clout. They’re a vulnerable group and can’t self-isolate.

      It turns out, though, that it can be kept at higher temperatures for something in the neighborhood of five days.

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