The Future Disease Burden of Pandemic Covid-19 for Individuals, Communities, and Society

Abstract

Abstract Pandemic Covid-19 has exposed tension between personal choice and public health policy. Vaccination has damped pandemic inertia in the U.S., but emergence of highly infectious variants such as delta and omicron has increased infection of fully vaccinated people. This worrisome trend justifies vaccine booster eligibility and access for all vaccinated people in a timeframe responding to waning protection. In restricting booster eligibility, US FDA and CDC statements indicate failure to consider that SARS-CoV-2 might be persistent, meaning that it might remain dormant in immune-privileged “refugia” such as the central nervous system of previously infected people, even if their Covid-19 symptoms had been mild or non-existent. Opportunistic re-activation of dormant viruses can cause severe illness, as in childhood chickenpox producing adult shingles decades later. External re-infection is unnecessary. Consistent with the “precautionary principle,” the overriding FDA and CDC public health priority should be to prevent as many SARS-CoV-2 infections as possible, not tolerate them, assuming optimistically that they will not impose major public health and associated economic burdens in the future. We naturally have focused upon our tragic past losses. We also must focus upon the future, learning from Covid-19 to manage pro-actively the inevitable next pandemic.