Regarding viruses, vaccines, and vexing levels of scientific misinformation

It seems like the world crumbled overnight.

I’m typing from a ghost town. A once-vibrant collegiate community is now eerily silent.

Like many others, I lost my part-time job, and I’m now wondering how I’m going to pay the rent in two weeks. I live in an older, 200-square-foot studio apartment with an antiquated bathroom. The cost? Nine hundred a month.

Following a trend, Notre Dame announced that it was making the switch to online instruction for the remainder of the semester. This has left me in a very puzzling situation. Should I leave town for a while, and then return? Or should I attempt to stay and stick things out in this empty college town? Most likely, I’ll be forced to do the latter.

I’m a figure skater, and I work part-time as a coach for little kids. Or, at least, I used to. Outside of school, skating is my lifeblood. Skipping practice makes me cranky and irritable; moreover, skating isn’t exactly the sort of sport you can take three months off from, and expect to return to with the same level of skill. But with all three local rinks closing their doors, I’m out of work, and I can’t practice. So I’ve been doing a lot of sitting indoors, just hoping that my student loan disbursement will come through in time to make the rent.

I’m not the only one, and my situation is very far from the worst. Nationwide, many students have been kicked out of on-campus housing, and it’s possible that not all of them will get a refund. Some university workers will inevitably have their hours slashed, and they’re already underpaid. With recent school closures, many children will be unable to get free lunches. Some working-class people have already lost their jobs; others are still going to work, knowing that they’ll be fired if they don’t show up. These people get paid once every two weeks, and they can’t afford to stock up for an extended quarantine.

Every single social media channel is a mess. There are videos of people punching each other over toilet paper. Toilet paper. That’s the level of desperation and depravity that humankind has reached, over the course of the past week.

Of course, the better aspects of humanity are likewise on full display. Influencers and public figures are encouraging compassion and patience. A few academically-oriented folks, myself included, are passing around articles and debating the merits of certain models. Everyone is encouraging everyone else to save lives by adopting certain safety precautions. Nevertheless, many are advocating for the adoption of certain prevention strategies that–if not catastrophically detrimental–are, at the very least, of questionable value. In the remainder of this post, I’m going to analyze and evaluate three of these strategies: rapid vaccine development, two-week quarantines, and “flattening the curve.”

Can vaccine development save us?

Just Thursday, Denmark’s parliament passed an emergency coronavirus law. Among other things, the law will allow Denmark to forcibly vaccinate its citizens, once a coronavirus vaccine is developed. Now, on the surface, this may sound like a good idea. If (1) governments have a moral duty to protect the lives of their citizens and (2) the vaccine will save lives, then it appears that (3) governments worldwide should do whatever is necessary to promote widespread vaccination.

But what if (2) were false? Or, at least, not demonstrably true within a reasonable degree of scientific certainty?

Researchers in multiple countries are now working on possible coronavirus vaccines. In the US, the coronavirus vaccine research and development is being done by a certain biotech company, Moderna Therapeutics. While normal vaccine development and testing requires a decade or two, Moderna is fast-tracking the development of this particular vaccine, so that it will be available to the public in less than two years. How is Moderna doing this? By skipping crucial animal testing, and testing the vaccine directly on humans. [1]

The first human test subjects were injected this week.

The researchers claim that they’re developing a proper mouse model and that, once they have, animal and human testing will proceed simultaneously. But is that good enough? Unlike prior vaccines, Moderna’s coronavirus vaccine does not contain all or part of a virus; rather, the vaccine contains a certain sequence of messenger RNA. This mRNA will supposedly instruct human cells to produce a certain protein, normally located on the surface of the coronavirus, and thereby trigger an immune response. This is a completely new type of vaccine technology and one that, until now, has never been tested on animals—or humans. Are we morally justified in skipping animal testing, if this means that the vaccine will be available to the public at an earlier date? Even if some test subjects die, or are otherwise permanently harmed in the process? Are these deaths necessary or justifiable, in order to save lives and secure the greater good? Probably not, and for a couple of reasons.

First of all, the vaccine won’t be available for at least another twelve months. It is likely that, by then, the worst of the pandemic will have passed, and the majority of deaths will already have occurred. Secondly, it is not uncommon for new vaccines, even those that have been properly vetted by a lengthy development process [2], to result in serious side effects; this was observed with a quadrivalent version of the HPV vaccine. Testing isn’t always enough to ensure the safety of a vaccine. Sometimes, it takes a few years of public vaccination to “work out the kinks.” All things considered, it appears that fast-tracking the development of the coronavirus vaccine will do more harm than good, and that Moderna isn’t justified in jumping straight to human testing. Moreover, because use of a new vaccine is generally risky, it appears that government-mandated coronavirus vaccination–in Denmark, or in any other country–would violate our notions of informed consent. [3]

But people worldwide are clamoring for a vaccine, and biotech companies can (legally) exploit that ‘consumer preference’ in order to boost their own profits. The result is that we will get a risky (and possibly faulty) vaccine, months after the peak of the pandemic, and that entire nations of people may be forcibly vaccinated against their will. [4]

Will two-week quarantines work?

Not everyone who gets coronavirus has noticeable symptoms. However, it appears that asymptomatic people can be carriers, and the virus has a rather long incubation period. This is why those who suspect that they have been exposed to coronavirus [5] are asked to undergo a quarantine, in order to avoid spreading the virus to others. The recommended length of the quarantine is fourteen days. Of course, this is based on the assumption that the maximum incubation period is two weeks. We now know that this assumption is incorrect.

While studies have placed the median incubation period between three and five days, and most [6] people incubate the virus for less than two weeks, longer incubation periods have been observed. A certain Chinese study found that the incubation period may be as long as twenty-four days, and one case study involved an incubation period that was even longer (twenty-seven days). What does this mean? A small percentage of exposed people, probably around one percent, may still be contagious following a two-week quarantine. After the two weeks are up, these people believe that they are no longer contagious; they cease their quarantine and resume life as usual, all while infecting other members of the community.

Perhaps one percent of infected people does not sound like a big deal. But nearly all of South Korea’s coronavirus cases resulted from a single individual, known as Patient 31, who refused to stay at home and follow proper precautions. Further complicating the situation is the problem of at-home transmission. When coronavirus swept through China, between seventy-five and eighty percent of transmission occurred at home, between family members. The fact that most US “quarantines” are being carried out in family homes–where other, healthy people are present–increases the likelihood that, once the two weeks are up, at least one member of the household is still contagious.

Because two-week quarantines are insufficiently long, and are being carried out in family homes, it appears that they are a poor means of reducing coronavirus transmission. Four-week quarantines, carried out in isolated medical facilities, could be more effective.

Can we save lives by “flattening the curve”?

If you’ve been on social media recently, you’ve probably heard two catchphrases: “social distancing” and “flatten the curve.” “Social distancing” refers to a collection of practices, the supposed purpose of which is to decrease coronavirus transmission; these practices generally include staying at home, traveling only for essential errands, and avoiding crowds. It is widely believed that social distancing will reduce the number of coronavirus deaths by “flattening the curve,” or reducing the number of patients at any one time. [7] The general understanding is that, while “flattening the curve” will not reduce the overall number of coronavirus cases, it will reduce the number of cases at the peak of the outbreak. The idea is that, if we can reduce the ratio of infected patients to healthcare providers (or, alternatively, hospital beds), then we can save more lives.

On the surface, “flattening the curve” is an appealing strategy. If we could all save lives simply by staying home and binge-watching our favorite TV shows, why shouldn’t we? However, there are a couple of notable problems with this approach.

Even if there are models which show that social distancing is effective at “flattening the curve,” they are just that—models. Like any other models of social or biological phenomena, these models involve several crucial assumptions, and some of these assumptions may not hold true in the real world. In the case of the coronavirus models, these crucial assumptions typically include (1) widespread compliance, i.e., that most everyone will stay indoors and follow the social-distancing guidelines, and (2) a stable economy, so that we can continue to run hospitals and provide emergency equipment to patients and healthcare providers. However, in a capitalistic country like the United States, it is impossible to satisfy both of these assumptions simultaneously. Many workers are willing to violate social-distancing guidelines in order to avoid losing their jobs; moreover, even if the guidelines were forcibly imposed (say, by police/military), the economy would collapse, due to a lack of workers. Because the assumptions of the coronavirus models don’t accurately represent American society, it is difficult to say whether social distancing will have the desired effect.

Furthermore, there are some models which suggest that, in the absence of case isolation and widespread testing, social distancing will not work. While social distancing may temporarily “flatten the curve,” social distancing (by itself) is not a viable long-term strategy, and may not even decrease the number of deaths. This is especially true if social-distancing measures are implemented too early, before any significant amount of immunity has developed in the community. Some models (discussed by reporters for Medium and The Washington Post) yield startling results. [8] When everyone practices social distancing, the overall number of cases remains relatively low. After all, if people aren’t interacting with each other, it’s difficult for the virus to spread. However, once the social-distancing guidelines are lifted, and citizens begin to interact with each other again, the number of cases rapidly increases. [9] Without proper case isolation, this results in a huge peak of cases that overwhelms the medical system; this is, ironically, the very disaster we are attempting to avoid through social distancing. In the absence of widespread testing and case isolation, social distancing does not necessarily decrease the number of coronavirus cases or deaths—it merely delays them, with another outbreak likely during this fall or winter. [10]

If social distancing won’t work, what will?

Social distancing will not work by itself; that is not to say that it does not work at all. Coupled with widespread testing and isolation of infected patients, social distancing is indeed effective at “flattening the curve.” [11] Were the U.S. to implement widespread testing, and isolate coronavirus patients in hospitals (rather than having them self-isolate at home), we could possibly eradicate the virus within a couple of months; community restrictions could then be lifted, as social distancing would no longer be necessary. In the absence of widespread testing, we will likely experience (1) large increases in poverty and (2) a second (possibly larger) outbreak in the fall or winter.

What can we do to prevent these disastrous outcomes? The best things that we, as U.S. citizens and residents, can do are (1) demand immediate, widespread testing, and (2) advocate for some sort of temporary government assistance for the recently unemployed.

Notes

[1] While NIAID has conducted a small amount of animal testing on regular lab mice, these mice cannot contract coronavirus in the same way that humans can; in other words, these mice are the wrong animal model for testing, and any results obtained from this testing would be difficult to extrapolate to humans. When I say that researchers are working on developing a proper mouse model, I mean that they are attempting to create a strain of mice that are susceptible to coronavirus, ensuring more accurate animal testing. TLDR: the small amount of animal testing that they’ve done (to date) hasn’t used the correct model.

[2] Usually 15-20 years.

[3] Even if we think that item (2) is correct–i.e., that the vaccine will save lives–we can disagree with the conclusion (3). Governments may not be justified in violating informed consent, even if herd immunity would save more lives than the vaccine’s side effects would kill.

[4] Like Denmark, the UK has introduced legislation that would allow for this type of forced vaccination, once a coronavirus vaccine has been developed.

[5] Notably, this guideline included certain people arriving in the US from abroad; although international travel to the US has since ceased, it is still recommended that people exposed to the virus self-isolate for the two-week time period.

[6] At least 97.5 percent of infected people.

[7] This strategy is referred to as “flattening the curve” because, on a graph where x = time and y = # of cases, spreading the same # of cases out over a longer time interval leads to a lower # of cases at the peak of the outbreak.

[8] All models discussed assume that social distancing will be adopted, nationwide, for five months. While these analyses specifically looked at U.K. data, the same reasoning may be extended to the situation in the U.S. The U.S. and the U.K. have this in common: that the government failed to take the virus seriously, and has failed to implement widespread testing on the scale necessary to control the virus.

[9] This phenomenon was observed in Denver during the 1918 flu pandemic.

[10] Some say that social distancing will have to be practiced for 12-18 months, until a vaccine has been developed and widely administered. As previously discussed, there may be serious problems with this type of rapid vaccine development.

[11] China implemented social distancing along with testing and hospital isolation of patients, resulting in a rapid reduction in the number of cases. That is to say, they succeeded in “flattening the curve”—but only through the use of widespread testing.