Thread by @AstorAaron

This might be the most important piece you'll read on covid now. We need explicit answers to:
1) What is the goal at this point?
2) Are the goals different regionally? If so, because of different risk tolerance or other reasons?
3) What are the off ramps?
nytimes.com/2021/08/30/opi…

This entire pandemic we've seen both under-reaction and over-reaction. In both situations, we have no discernible goal in mind. I've long argued that the goal should be endemicity, not Zero Covid. That means the virus will circulate, but few will get badly sick.

If Yale is going to push more NPIs with a 99% vaxxed campus, what is the goal there? Where is the off ramp? Meanwhile, here in Tennessee we have less than 50% vaxxed and still plenty of never-infected & not-vaxxed aka "immunologically naive" adults. Hospitals postpone procedures.

Here is our local hospital. As elsewhere (though not reported in this chart), the vaxxed hospitalized are mostly very old and/or immunocompromised. The unvaxxed are more middle age. Note the lower age median (51) than age average (60).

But what is our goal here in Tennessee, not to mention at Yale? We generally reject the Zero Covid goal, so we are more realistic IMHO. But we are not in an endemic state yet with hospital use at this level. We continue to under-react while Yale continues to over-react.

And yet, I would venture a majority of people here don't think we are under-reacting and a majority of people on the Yale campus don't think they are over-reacting. Lots of yelling, mocking and pointing fingers, but who is even setting these goals regionally?

It may very well be that different places will have different end games in mind, and varying policies and community habits will reflect them. But then local leaders need to be explicit about those different end games. And it should be more than just saying "safety" or "freedom."

None of this is easy because the virus itself changes, seasonality creates its own rhythm of waves, natural infection rates differ from place to place (as do vax rates), and some places get more external visitors (or students) than others. Nobody lives in a bubble.

CDC has, of course, been all over the map on messaging too. Not just on specific recommendations like masking but on the ultimate national end game. Surgeon General Vivek Murthy made some helpful comments recently acknowledging endemicity as the end game. We need more on that!

But these are the questions we need to be asking at the national and local level - What is our end game? How will specific policy measures get us toward that end game? And how will we know when we can turn away from these interventions and...be comfortable with it?

With boosters available now or very soon for elderly and immunocompromised, and child vax for under 12s, there will be no justification by Dec. for any restrictions at all in blue cities/states with high immunity levels. Even among the very cautious. Take the W!

Lower immunity areas - or high immunity pockets surrounded by low immunity areas - will probably cycle through a few more nasty waves with high hospitalization numbers. Still, they need to talk about the regionally acceptable end game, even if most have personally "moved on."