by jMyles | 2025-07-22 03:03:35+00:00
> since your profile says you study epidemiology

To be clear: this is totally a hobby for me, although I have made friendly/collaborative inroads with many of the top minds in the field through correspondence going back about 15 years. During the covid19 pandemic, I found myself sitting-in on roundtables and discussions where I was often the only non-MD/MPH on the call.

> I was of course going off the stuff that was going around during Covid's height when people would refer to theories that faster and increased international travel would lead to more pandemics

This has been a topic of scholarly debate and discussion for sometime before covid19; it is a frequent concern regarding several types of pandemic, but especially respiratory pandemics and even more especially hemorrhagic fevers. Food-borne, fomite-borne, and sexually transmitted diseases less so. I think it's fair to say that arboviruses remain an unknown in this regard.

In the case of respiratory pandemics, as best I can tell, the science is very much settling to the conclusion that acute spread through low-risk tiers - which of course is bolstered by international travel - offers some protection against the kinds of pandemics we saw from the emergence of now-endemic H3N2, or the 1918 influenza pandemic, or the 1890's "Russian Flu", which I believe (and I believe most scientists who have studied this believe) was likely the emergence of now-endemic hcov-OC43.

My hope is that one of the key lessons of covid19 is that we need to utilize the population who quickly gain immunity as relief pitchers for the high-risk tier. For example, by the time we closed libraries and schools, there were already millions (perhaps 10 million or more) young and healthy people who had gained immunity from infection without even realizing it. These are the people that can run the libraries and cafeterias and shelters, and perform as substitute teachers and childcare providers, so that we're not turning our nation's poorest children to the streets.

A similar phenomenon occurs on college campuses - in the case of pathogens like coronaviruses where college-age people typically seem to be quite low risk, it makes sense to leave residence halls and similar infrastructure in place, to allow this cohort the option of quickly gaining immunity to be available to assist the higher-risk tiers in isolating. Of course this needs to be done with caution and empiricism - the 1918 pandemic reminds us that the age/risk correlation is sometimes inverted, and this can be very confounding to an orderly public health response.

Perhaps most importantly, any plan which delays spread in the low-risk tier, by definition, requires the high-risk tier to isolate commensurate with that delay, and this is a dire situation. Most poor people (who are disproportionately high-risk) simply don't have the means to survive prolonged isolation. Much better is to facilitate spread stratified by risk - ideally a complete spread through the low-risk tier in short order, so that this cohort can safely assist high-risk communities during their isolation.

This basic principle enjoyed what seemed like consensus prior to covid19, and became total hot lava. Hopefully we have returned to sanity and won't make this mistake again.