COVID topic vol 2

[Ego]

I think a more conventional understanding is that our bodies' inflammatory response is what makes us feel sick.

Well, sure. I oversimplified. I think we are saying the same thing.

I feel an argument could be made the other way: if certain symptoms cause someone to be isolated from others (via self isolation or govt. policy), you could say the selection pressure on a virus is to become less dangerous/less symptomatic, so the virus may spread and not end up in an isolated host.
I don't know if COVID-19 and its variants tend one way or the other, but I would be cautious in linking social isolation to more virulent strains.

This from last October
https://www.sciencedirect.com/science/a ... 7920318649

...the virus hasn't needed to evolve in order to be successful. Not yet, anyway. This is what makes some virologists nervous as we move into the next phase of the pandemic.

As a rule, evolutionary adaptation happens due to “selection pressure”, which is when an organism's environment changes to favour certain variants over others.

Right now, SARS-CoV-2 is under very weak selection pressure. There are still plenty of humans to infect who have no “immune memory” to fight the virus; there are very few drugs to evade; and there is no vaccine. But as these benign conditions become harsher for the virus, selection pressure will ramp up and we can expect to see it evolve in response, perhaps in ways that make it even more dangerous.

And this from early February in Nature.
https://www.nature.com/articles/d41586- ... c-42375251

On 3 February, researchers at the London School of Hygiene & Tropical Medicine (LSHTM) released an analysis1 of some of those data, which suggests that the risk of dying is around 35% higher for people who are confirmed to be infected with the new variant.

and

The team found that B.1.1.7 is more deadly than previous variants for all age groups, genders and ethnicities. “This provides strong evidence that there indeed exists increased mortality from the new strain,” says Henrik Salje, an infectious-disease epidemiologist at the University of Cambridge, UK.

ETA, a few weeks ago I read a paper that explained why the conventional wisdom holds that viruses mutate to become less deadly. In it the authors argued that the viruses we encounter are either stopped right away or they run wild and never encounter significant selection pressure. So, they are either stopped before evolving or they spread so well that they don't need to evolve increased virulence.

Our half-measure response to Covid may have given the virus just the right amount of selection pressure.

[Qazwer]

@Ego I am having trouble with the math in my head. My limited understanding: The virus only ‘cares’ about the number of times it can replicate. A more deadly version gives it less chance to do so. It could happen and often does that the change with making it reproduce more just happens to also make it deadlier though although not related or optimal in terms of the virus.
Basically I am asking if you have more information or the reference on that article you mention you came across a couple of weeks ago. I really would like to read it.

[trfie]

A dead virus does not mutate. So it is a societal underreaction that has resulted in the new strains (one of which is much more transmissible with the same mortality rate). If covid-19 was eradicated by May 2020 like it should have been, all these recent strains would not exist.

[Ego]

@Qazwer, I generally try to post links when making a claim like that but I was unable to find the study. I believe I found it by way of Scientific American but I cannot remember for sure.

Here is another good OpEd in SA regarding increased virulence.
https://www.scientificamerican.com/arti ... us-evolve/

To @trfie's point, right now the virus is not particularly deadly. So if the result of an increased contagiousness is that it becomes a little more deadly, then from the virus perspective it is a small price to pay for circumventing social distancing and continuing to spread.

The larger point I am trying to make is the same point I've made for about a year. This is an unstoppable virus. Rather than say it over and over, I encourage people to read the Scientific American article above.

With declining rates of new infections and the rollout of vaccines, some are beginning to speak of an end to COVID-19. But that rhetoric, in my opinion, is ill-considered and premature. Based on what we know now of SARS-CoV-2, it may no longer be a question of months before an end to the pandemic but a question of years, if not decades. We should plan for it.

[Green Pimble]

...snip

Thanks for linking those! Interesting and scary. I don't suppose a 'world wide lockdown' until transmission is under control is ever going to be a possibility.

[Qazwer]

@Ego thank you for looking
The article you linked I think has one logical flaw. The same one I have seen in most writing on this topic. In the history of viruses, infections etc, one year is a short time frame. We have no idea what will happen.
The article correctly points out the huge reservoir human and animal that are the raw materials for mutated strains. It also correctly points out the stresses produced by medications. I think it minimizes the extra risk that there are no serious plans currently to immunize most human beings except for specific nations. The virus is going to be here. It has the pressures to change. But then the article predicts that it will create a more dangerous outcome in the final paragraphs. I am not sure what the next decade will be. It might be better. It might be worse. It is still too early to tell.

[Ego]

I am not sure what the next decade will be. It might be better. It might be worse. It is still too early to tell.

Oh, I agree. I *believe* it will be better once we wrap our minds around the fact that it is here to stay and cope psychologically with the consequences.

I just listened to the first 20 minutes of the latest TWiV podcast. They were discussing the confusing studies from Manaus, Brazil where in December 76% of the population were seropositive for covid antibodies which would indicate they reached herd immunity and yet in January they had a very serious outbreak (that should have been impossible) where the hospitals filled.

https://www.thelancet.com/journals/lanc ... 5/fulltext

[jennypenny]

Discussion on econtalk today about covid vaccines and distribution. The qualitative vs. quantitative issue re vaccine distribution is interesting.

[ducknald_don]

I just listened to the first 20 minutes of the latest TWiV podcast. They were discussing the confusing studies from Manaus, Brazil where in December 76% of the population were seropositive for covid antibodies which would indicate they reached herd immunity and yet in January they had a very serious outbreak (that should have been impossible) where the hospitals filled.

It turns out that 76% was inflated four fold for some reason, I think we can take the whole thing with a pinch of salt.

[Riggerjack]

Oh, I agree. I *believe* it will be better once we wrap our minds around the fact that it is here to stay and cope psychologically with the consequences.

You have been adamant about C19 being here to stay, for quite a while, now.

I don't agree. Or rather, I think we have different ideas about the future dangers of C19.

Whooping cough is a respiratory virus, it's been with us for ages. But it's not much of a danger. Get your shot, and never think about it again.

Why do you think C19 will be different? Once enough people get herd immunity through antibodies or vaccination, outbreaks are relatively simple to contain.

In 2019, nobody got worked up about a whooping cough outbreak. Nobody got worked up about the outbreaks of tuberculosis. Because these can be contained and/or wiped out with typical public health efforts.

Why would C19 be any different? The vaccines are far more effective (if the data holds up).

I'm sure C19 outbreaks will be problematic in the future, but I don't see how they will be any more problematic than any other airborne virus.

[Ego]

Why do you think C19 will be different? Once enough people get herd immunity through antibodies or vaccination, outbreaks are relatively simple to contain.

Off the top of my head, for that to happen...

- The vaccine must provoke immune response in even the most vulnerable or they will continue to be vulnerable*
- The vaccine must provoke sterilizing immunity in nearly everyone or herd immunity will not be accomplished*
- Antibodies from infection or vaccination must provide durable long-term immunity.
- The virus must not mutate significantly (it already has)
- The powers that be must willingly relinquish the ability to exercise extreme controls over the population
- The media must willingly allow the most terrifying story of a generation (if it bleeds it leads) to fade away.

*Depending on who you believe, 40-60% of the population is refusing the vaccination.

[ducknald_don]

@Ego all that applies to the Flu but we manage to live with it. People say they will refuse the jab but the intention-behaviour gap is quite large. Things will get back to normal.

[Bankai]

Yeah, I don't see covid being a bit threat going forward:

Rollout of the Pfizer BioNTech and Oxford AstraZeneca vaccines has led to a substantial fall in severe covid-19 cases requiring hospital admission in Scotland, suggest the results of the first study to report on the impact of the UK’s vaccination strategy.1

The results, available as a preprint, showed that four weeks after the first doses of the Pfizer BioNTech and Oxford AstraZeneca vaccines were administered the risk of hospitalisation from covid-19 fell by up to 85% (95% confidence interval 76 to 91) and 94% (95% CI 73 to 99), respectively

https://www.bmj.com/content/372/bmj.n523

If 94% reduction in hospitalisation after a single doze translates to the same reduction in mortality, we're talking <0.05%.

[chenda]

Yes I think this summer (or winter depending on your hemisphere) is likely to be pretty much normal. People are already booking holidays and will probably go on celebratory spending sprees, well probably not forum members but normals will.

[Riggerjack]

- The vaccine must provoke immune response in even the most vulnerable or they will continue to be vulnerable*

We can live with people being vulnerable. No Supermen before 2020. Don't need to be invulnerable now, either. If a disease is not in common, how vulnerable are you? Herd immunity is, and has always been the protection of the vulnerable.

- The vaccine must provoke sterilizing immunity in nearly everyone or herd immunity will not be accomplished*

Um, no. Historically, vaccines have been effective at much lower rates. IIRC it was something like 40% minimum efficacy for the FDA to approve of a vaccine. And 60% was considered a good target for efficacy in a new vaccine, before numbers came out.

*Depending on who you believe, 40-60% of the population is refusing the vaccination.

It's 2021, and you are worried about polling numbers?

If there is something we should all know by now, it's that people who respond to polls are... Let's call it, Atypical. Then add in preference falsification, and it turns out that people say they will do something, but then don't. In other words, people lie, and lie especially to polsters.

So as the vaccine rollout proceeds, and the threat of C19 dies down, and with few vaccine horror stories, people who are on the fence will take the plunge. And then immediately begin the shaming of the unvaccinated.

In this way, the barriers between vulnerable pockets continues to grow. Until coronavirus outbreaks are newsworthy, rare events. As they always should have been.

[Hristo Botev]

Just anecdotally, DW's life has improved drastically over the past couple weeks, as her hospital's numbers have gone WAY down, to the extent that they've turned several units back over from COVID to their original purposes. That's of course happened before, during prior valleys following peaks, but not to this extent. Hoping this isn't just a temporary lull.

And also anecdotally, on my walks to/from work I'm seeing a whole lot more people running or walking in pairs/groups without masks, than had been the case. And I live in one of those gentrified in-town neighborhoods where wearing a mask and giving people 10'+ of space on a sidewalk had taken on a virtue signalling status equivalent to driving a Prius or sticking the right yard sign in front of your house. So, if folks are feeling comfortable to ease up the restrictions a bit here, I can only imagine what's going on outside of the metro area.

[Ego]

So as the vaccine rollout proceeds, and the threat of C19 dies down, and with few vaccine horror stories, people who are on the fence will take the plunge. And then immediately begin the shaming of the unvaccinated.

In this way, the barriers between vulnerable pockets continues to grow. Until coronavirus outbreaks are newsworthy, rare events. As they always should have been.

Perhaps we should revisit this on January 9, 2022.

@all, I agree that things will go back to quasi-normal in the summer. I believe it will go back to not-normal in the fall. We will be faced with similar choices as this/last year. We may see vaccine boosters for new variants with all the rollout chaos and the unboostered not wanting to work. I'm betting school closures will be off the table. I imagine a slightly dampened sine wave for the next decade. I may be wrong. We shall see.

[Qazwer]

COVID may be another distinguisher between rich and poor countries for a potentially very long time. Malaria kills a lot of people a year. I know no one who died of malaria last year. No matter how this plays out for people in rich nations; this will continue to be a massive tragedy. It will stress already weak health systems for years. It will harm productivity given whatever this Long COVID is. It may or may not be any bigger than a flu which will spike every 20-30 years or so killing a bunch of people in the US. But it is likely to be a truly awful thing worldwide.
How awful it will be in rich countries is one of those existential type risks with a long tail. Another one to keep an eye on but this time with a larger reservoir just do not have enough data to estimate yet.

[Bankai]

Not sure about that, I think the whole world will be vaccinated in a year or two. Vaccinating whole Africa (1.2b pop) with AstraZeneca vaccine ($2-$3 per dose) will "only" cost $5-$7B which is nothing compared to $trillions already spent fighting the pandemic and rich countries will be happy to donate excess vaccines or outright pay for it. It might be a bit tricky with booster shots if they're required every autumn/winter.

[Ego]

It turns out that 76% was inflated four fold for some reason, I think we can take the whole thing with a pinch of salt.

I searched and was unable to find news about how the rate of those with antibodies was inflated four fold. Where did you see that?

@Bankai, the reason for concern in Manaus is that they had (supposedly?) reached herd immunity and yet the new variant still spread.

https://www.rte.ie/news/coronavirus/202 ... l-variant/

The Brazilain variant also contains the E484K mutation detected in the B1351 variant from South Africa. This is sometimes referred to as an "escape" mutation because it can help the virus to evade the antibodies created by the immune system during earlier infections.

There is a fear that this mutation might increase the risk that a person could become infected with Covid-19 for a second time.

Dr Glynn underscored last night that further studies are required to determine whether this new variant is likely to have an impact on vaccine effectiveness or infection severity.

The COVID-19 vaccine, like other vaccines, works by training our bodies to develop antibodies to fight against the virus. As I understand it, if the infection-induced antibodies did not protect those in Manaus from the new variant then there is little hope that the vaccine-induced antibodies will do so. I may be wrong. Anyone?