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How the pandemic ends

Started by steveh, October 17, 2021, 11:46:37 AM

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steveh

Twitter thread on the Covid endgame and what it will look like in the endemic state: https://twitter.com/trvrb/status/1448297954306150401.

Some key points (also pulling in some bits from other reading):

- Endemic means continual monitoring for the virus and intervening when amount of death and disease goes beyond the acceptable level. As we're seeing, the UK government seems to be happy to have this at a much higher level than other countries.

- There will continue to be flare-ups in particular communities but they will be limited in how much they can spread onwards. Possibly 20-30% of people will get Covid each year and it will be significantly seasonal.

- Likely to see ongoing deaths from the virus of around 40-100,000 per year in the US, which would equate to around 8,000-20,000 in the UK. Flu in the US has around 30,000 deaths per year.

- Still too early to know much about the levels of waning immunity, though protection against serious disease is holding up well and better than against transmission. Reinfection figures have the Delta variant 27% higher than the original strain.

- The variants that are currently winning are still those that offer increased transmissibility - like the AY.4.2 variant I posted about in another thread. However, once we hit a point where most people are vaccinated or have had the disease there will be a flip to variants that favour immune escape.

Also worth a read on what it means for the virus becoming endemic: https://twitter.com/EpiEllie/status/1444088804961304581.

Zetetic

Regarding UK tolerance - I guess it's hard to separate this from tolerance of collapse of both unscheduled and emergency care, which is becoming a lot sharper, a lot faster across the UK now, with or without the 'ViD.

bgmnts

Not with a bang, but with a whimper?

To rapturous applause?


mothman

Quote from: bgmnts on October 17, 2021, 02:31:03 PM
Not with a bang, but with a whimper?

To rapturous applause?
QuoteIn one of the countless billions of galaxies in the universe lies a medium-sized star. And one of its satellites, a green and insignificant planet, is now dead.

olliebean

So "endemic" essentially means the government gets to decide how many of us they want to let die from it each year?

Chedney Honks

Same as with anything though. If they reduced the speed limit to 3mph like I've been petitioning them for years, it would save thousands of deaths.

wooders1978

Quote from: Chedney Honks on October 17, 2021, 04:25:55 PM
Same as with anything though. If they reduced the speed limit to 3mph like I've been petitioning them for years, it would save thousands of deaths.

Exactly - tetanus kills a few hundred thousand a year, as does flu, malaria kills a boatload annually, 2-3 million on average

Alberon

Flu kills 5,000 in a normal year and 25,000 in a bad one. At the current death rate Covid would claim close to 55,000. Maybe it would eat into those who would have died from Flu?

The government seems to think it's a level the public finds acceptable. They're probably right.

olliebean

Johnson has been reported as saying privately that "up to 50,000" annually would be "acceptable," apparently solely on the basis of it having been worked out that the financial cost to the economy of more than 50,000 deaths would exceed that of another lockdown. On that basis, presumably if it turns out that the deaths are weighted more towards pensioners and/or disabled people than expected, that "acceptable" level rises.

evilcommiedictator

We still haven't quite got to grips yet with long COVID, and I imagine that will be quite a big thing, particularly in the US, where tons of people will have it.
I wonder if the drumpf will work this out and promise universal healthcare and get in next time on that, as it's going to be a big, big problem (alongside all the other healthcare problems there)

Cloud

If it's possible to do something to bring it down or treat it we certainly should

But if this is how it is permanently then we need to get on with life, as much as it sucks, the risk of illness and death is part of it.

It's not going away - there's another variant taking over now, AY.4.2, 16% transmission advantage over Delta.  It'll keep doing this.

H-O-W-L

My understanding is that feasibly speaking transmission will go up consistently with variants, but lethality will drop sharply with it until we have variants that are drastically less lethal than the standard variant we saw back in '20, but spread like absolutely fucking billy bollocks wildfire.

This is of course not a dead cert; we're talking about nature here. Anything could happen. Variant that makes your arse fly out could pop up out of the ground right as I click "post" on this message. Someone who knows better will call me a dozy cunt and prove even my bare bones laywoman understanding wrong too, I'm sure.

olliebean

Quote from: evilcommiedictator on October 17, 2021, 10:56:12 PM
We still haven't quite got to grips yet with long COVID, and I imagine that will be quite a big thing, particularly in the US, where tons of people will have it.
I wonder if the drumpf will work this out and promise universal healthcare and get in next time on that, as it's going to be a big, big problem (alongside all the other healthcare problems there)

Yes, the calculation about the cost to the economy of tens of thousands of people dying doesn't seem to have taken into account the cost to the economy of potentially hundreds of thousands of people unable to be as productive as they would like due to long Covid.

Chedney Honks

Or even just regular Covid-19.

Zetetic

Quote from: H-O-W-L on October 18, 2021, 08:09:29 AM
My understanding is that feasibly speaking transmission will go up consistently with variants, but lethality will drop sharply with it until we have variants that are drastically less lethal than the standard variant we saw back in '20, but spread like absolutely fucking billy bollocks wildfire.
Why? What's the selective pressure against lethality here? Being more or less lethal doesn't directly affect disease spread, because of how the disease course plays out for this particular disease.

Zetetic

The only ones I can see are:
- Lethality is somehow bound up with spike protein details, so lethality is tied up with vaccine escape (and we don't bother developing new vaccines for the less lethal variant)
- Less lethal variant takes hold in parts of global south (where vaccination and other broad-spectrum responses are sometimes weaker?) and collectively we don't bother to fight it as much as classic 'ViD.


MojoJojo

Quote from: H-O-W-L on October 18, 2021, 08:09:29 AM
My understanding is that feasibly speaking transmission will go up consistently with variants, but lethality will drop sharply with it until we have variants that are drastically less lethal than the standard variant we saw back in '20, but spread like absolutely fucking billy bollocks wildfire.

This is of course not a dead cert; we're talking about nature here. Anything could happen. Variant that makes your arse fly out could pop up out of the ground right as I click "post" on this message. Someone who knows better will call me a dozy cunt and prove even my bare bones laywoman understanding wrong too, I'm sure.

I don't think there's really good evidence for that. It's what happens in the Andromeda Strain, but it was bollocks there too. While it's true that there is an evolutionary advantage to some diseases in becoming less lethal - syphilis became milder and took longer and longer to produce symptoms, which meant people would spread it to more partners, covid spreads rapidly and often before any symptoms emerge. Whether it eventually kills it's host is pretty much irrelevant to it's evolutionary fitness, since it mostly spread ways before that point.