Is Europe a Leading Indicator for COVID-19?
Data is many things. But above all, it is counterintuitive.
The more we add to it, the more complex it becomes. The more complex it becomes, the greater the probability of error.
Yet we cannot curb this tendency of adding more variables to data – almost like we are compelled to believe the more variables we study in a given data set, the more accurate it becomes.
Like most counterintuitive concepts in healthcare, our intuition fails us, leading down a road of false equivalencies and misplaced attributions.
This seems to be where we are at currently, heading into the second pandemic winter and anticipating another COVID-19 surge in cases. After all, we see cases rising all across Europe and a new variant, Omicron, seems to have captured the media’s attention for the moment.
Germany, with 68% percent of the population fully vaccinated and known for adhering steadfastly to mask mandates and social distancing protocols, is experiencing its highest peak in COVID-19 cases since the pandemic started.
Norway, with 86% percent of the population 18 and older vaccinated, is also bracing for an uptick in COVID-19 cases. “Based on an overall assessment, we believe it is likely that we will get a wave [of COVID-19 infections] during the winter,” said Miss Camilla Stoltenberg, head of the Norwegian Institute of Public Health.
Throughout Europe, from the United Kingdom to Germany, COVID-19 cases are rising, and policy experts across the world are bracing for the worst – particularly in the United States.
Growing outbreaks in the Midwest and Northeast are responsible for the recent increase in COVID-19 cases in the United States, which is coming after weeks of regional surges in the Mountain West where some hospitals are still grappling with hospital capacity constraints.
And of course, whenever COVID-19 cases surge, people look for things to blame. Some believe the rising cases in highly vaccinated countries are proof the vaccines are ineffective. Some are even blaming the type of vaccine.
The CEO of AstraZeneca, Pascal Soriot, blames the recent surge on the mRNA vaccines produced by Moderna and Pfizer-BioNTech. Soriot said, “it’s really interesting when you look at the UK. There was a big peak of infections but not so many hospitalizations relative to Europe. In the UK [the Oxford/AstraZeneca] vaccine was used to vaccinate older people whereas in [other parts of] Europe people thought initially [our] vaccine doesn’t work in older people.”
But blaming any one attribute or cause is nothing more than a logical failure, known among behavioral economists as attribution error. At the end of the day, we do not have a simple explanation for why COVID-19 cases are rising, as scary as that may appear. To blame any one thing – whether it is vaccines, mask mandates, or economic restrictions – overlooks the massive uncertainty in the data that we have yet to fully grasp.
There is more we do not know than know – even this late into the pandemic. But we continue to reach for convenient solutions.
In the United States, these solutions usually come in the form of political grandstanding over hot-button cultural issues. Those who support vaccinations will blame parts of the country with low vaccination rates, just like those who are against vaccinations will claim that vaccines are not effective.
The arguments are circular because the data remains inconclusive – so we apply value judgments to parts of the data that corroborate with what we already believe.
Ultimately, the rise in COVID-19 may be nothing more than broad endemic trend, like seasonal influenza. We may just have to learn to live with COVID-19. And cases along with new variants will appear with certain seasonality like influenza, or any other viral upper respiratory tract infection.
Vaccines will help those who are at risk and reduce the burden of treatment in hospital systems. But they will not stop people from getting infected.
Mask mandates and economic restrictions will reduce the transmission of viruses and prevent massive surges in COVID-19 that have overwhelmed hospitals in the past. But they will not stop the spread of the virus completely.
It is impossible to say how effective any one of these measures can be in isolation because their overall effect in curbing COVID-19 is fundamentally interdependent. Just like the rise in COVID-19 cases has no one cause or attributable factor.
Both the rise in cases and the mitigating treatment options operate within a broader system, influencing and impacting each other in a complex, coordinated dance that we do not yet understood.
As far as we know, the COVID-19 pandemic might have already transitioned into seasonal endemic infections, producing corona virus variants the same way other airborne viruses mutate. And we may not recognize this transition until months or years later.
We might not ever recognize it. We still do not have a full understanding of influenza after living with it for a century since the Spanish Flu. The only difference between influenza and COVID-19 is how we conceptualize it.
We accept seasonal rises in influenza and prepare for it accordingly. But when it comes to COVID-19, we cannot curb this tendency to analyze it ad nauseam, looking for something – really anything – to blame.
Europe may be a leading indicator, but the innumerable variables differentiating the United States from European countries begs the question of whether any perceived similarity is a real trend or just a convenient aberration in the numbers.
Instead of trying to predict it, to find blame out of it, we should learn to accept it. Accept that COVID-19 will be a seasonal endemic infection more severe than traditional influenza infections for at least another four to five years, at which time global herd immunity will have acclimated to the various COVID-19 variants.
And then we will live with endemic COVID variants like we live with annual influenza variants. We will try to predict the likely variants and formulate annual vaccines to maximize effectiveness – and over time we will be more right than wrong, just like we are with influenza vaccines.
Time, more than anything else, is the best indicator of how the pandemic will play out.
And eventually, we will learn to live with COVID-19 and accept it as part of our everyday lives, like we do all other airborne viruses swirling about.
Antibiotic Prescriptions Associated With COVID-19 Outpatient Visits Among Medicare Beneficiaries, April 2020 to April 2021
Outpatient Visits for COVID-19 and Associated Antibiotic Prescriptions Among Medicare Beneficiaries Aged 65 Years or Older, by Setting, US, April 2020 to April 2021. The volume of COVID-19 visits differed by setting: emergency department, 525 608 (45.8% of all visits); office, 295 983 (25.3%); telehealth, 260 261 (22.3%); and urgent care, 77 268 (6.6%).
Source: Journal of American Medical Association Network