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> The best case scenario is a new less deadly highly contagious strain that become the most dominant and spreads worldwide. No, this scenario wouldn't be good

> The best case scenario is a new less deadly highly contagious strain that become the most dominant and spreads worldwide. No, this scenario wouldn't be good news at all. Firstly, a marginally lower case fatality rate is a linear improvement, whereas much higher transmissibility is an exponential worsening. In other words, the reduced risk of an infected person getting into hospital is dwarfed by the exponential increase in the number of sick people, and the net result is way more hospital admissions. This could easily overwhelm healthcare systems in the coming weeks and make them unavailable for anyone who needs them, not just Covid patients (unfortunately, these indirect casualties of Covid are undercounted) Secondly, each new infection is an additional ticket in the great variant evolution lottery. The more infections, the higher the risk of a vaccine-escaping, serious disease-causing new variant being selected. Low vaccinations rates in South Africa, plus the high number of untreated HIV+ patients there (who struggle to get rid of Covid and are a perfect breeding ground for variants) are thought to have contributed to Omicron's emergence. That's why "let it rip through so we get natural immunity" is such a short sighted stance.

jgalt212 5y ago
> Firstly, a marginally lower case fatality rate is a linear improvement, whereas much higher transmissibility is an exponential worsening. With the current data available from SA, EU, and UK, the CFR has not been shown to be marginally lower, but dramatically lower. Things could change, of course, but right now the first part of your statement is really the case (as observed).
oceanplexian 5y ago
The thing is, vaccines were never advertised as tools to prevent infection. The story has always been that it reduces symptoms and hospitalization, so there are plenty of opportunities for the disease to get “tickets” in the evolution lottery. Between that, the animal reservoirs (COVID can spread to different species), and the millions of people in undeveloped countries who will never get a vax, COVID was guaranteed to mutate no matter what the public policy. Letting it rip is less a strategy and more an acknowledgement of reality.
- jimmyearlcarter 5y ago
  The vaccine was initially sold as the tool to end the pandemic and get life back to 'normal'. The narrative has evolved to suit the deficiencies of the vaccine and keep profits from sinking.
  - NicoJuicy 5y ago
    Or if the virus gets irrelevant. One doesn't exclude the other. People don't see an end with natural evolution, so the vaccine was/is the main focus for a long time.
  - yread 5y ago
    They could have ended the wildtype pandemic. As soon as delta appeared it was impossible. They have 90% efficiency at best and you need 84% of all people protected to stop delta (1-1/R0 for R0=6). It's impossible to get such high vax rate.
    - Ar-Curunir 5y ago
      Not necessarily. Eg the Netherlands has ~77% vaccination rate, which is pretty close to the quoted 84%.
      - sharken 5y ago
        I'd go so far as to say 77% is "good enough", ie. it's time to live with the virus and not change our ways because of it.
    - arcturus17 5y ago
      We’re at 80% vaccination in Spain… I think we can surpass 84%.
      - jefftk 5y ago
        37.7M fully vaccinated, 47.35M population -- impressive! I was initially assuming you were excluding kids or other people ineligible to get vaccinated.
smaryjerry 5y ago
That would make sense but been the originally strains did not overwhelm hospitals. New York has the highest and craziest number of cases and deaths at the beginning and didn’t put one person onto the ship that was provided for temporary beds. Hospitals did not run out of beds and now the biggest problem is running out of staff, the same as every industry. At our local hospital all of the nurses quit for better, higher paying jobs. We’re running at less hospital labor than even pre pandemic, aren’t building new hospitals, and the highest peaks in cases and deaths were while the strictest lockdowns and mask mandates were already in place. There is complete fear overload and yet all attempts at preventing spread, even vaccines, have failed. They reduce symptoms but do not stop the spread. That’s how contagious this virus is, without any symptoms whatsoever people are spreading the virus, even with masks on, and limits on how close they can be to people. We now have vaccines, we have even pills that have been approved, we also know healthy lifestyle fights against it, yet we are still in a 2 year long “state of emergency.” Letting it rip through is not an option we can choose, it will happen regardless of what we do.
- ceejayoz 5y ago
  > didn’t put one person onto the ship that was provided for temporary beds It wasn't for lack of need. https://www.nytimes.com/2020/04/02/nyregion/ny-coronavirus-usns-comfort.html https://www.nytimes.com/2020/04/02/nyregion/ny-coronavirus-u... > But the reality has been different. A tangle of military protocols and bureaucratic hurdles has prevented the Comfort from accepting many patients at all. > On top of its strict rules preventing people infected with the virus from coming on board, the Navy is also refusing to treat a host of other conditions. Guidelines disseminated to hospitals included a list of 49 medical conditions that would exclude a patient from admittance to the ship. > Ambulances cannot take patients directly to the Comfort; they must first deliver patients to a city hospital for a lengthy evaluation — including a test for the virus — and then pick them up again for transport to the ship.
  - smaryjerry 5y ago
    If the emergency and need was that bad they would have absolutely figured out simple logistics to get people on a ship. The fact is most people were told go home and wait it out and are still told that and that is the treatment most people receive. There is no point in continuing our state of emergency when our emergency services are not and never were at risk. Every single lockdown and mask measure put in place has had no significant impact on the spread of the virus. It is that contagious.
circlefavshape 5y ago
> That's why "let it rip through so we get natural immunity" is such a short sighted stance. That is absolutely not what the OP said, fwiw
peakaboo 5y ago
Natural immunity is the ONLY way back to a sane planet. It's time you take a step back, look at what happened for two years now, and realize we don't need this insanity anymore.
- kelnos 5y ago
  Given how quickly the virus can infect people and put them in the hospital if unchecked by masking/social distancing/etc. and vaccines, just letting everyone get infected would rapidly overwhelm our health care system and cause a lot of deaths that could have been prevented. If the world had collectively done nothing about COVID over the past two years, sure, the pandemic might be "over" by now, but the total death toll would likely be much higher than what we'll probably end up with when all this is actually over, given our current path. I'm not thrilled with how the past two years have gone, but it could have been much, much worse. It could also have been much better, if it weren't for people using the virus to score political points. Even with a mix of vaccines and natural immunity, I don't think we can rely on natural immunity to solve this. That just doesn't pass the smell test.
  - spookthesunset 5y ago
    The world “experts” clearly didn’t do anything at all these last two years if they are still freaking out about “healthcare collapse”. There is zero excuse to push lockdowns, masks or any of that nonsense at this point to “protect healthcare”. Healthcare should have been “protected” by now if this is supposed to be a normal thing
- Nursie 5y ago
  > Natural immunity Gaining herd natural immunity implies a lot more death. Also natural immunity wanes after a while, and variants can work around it. So no, it's not the only way, nor is it even a certain way at all.
bagacrap 5y ago
there really can't be an "exponential" increase in the number of cases, whatever that means, given that there's a hard upper bound which is the number of hosts.
- stnmtn 5y ago
  While technically correct, you and I both know what they meant by exponential. Sure, there's a limit, but if we're looking at function that is exponential until it reaches an inflection point where there's simply less hosts to infect than possible...
  - rolph 5y ago
    a rate of change in the rate of change, to wit a second order derivative
  - oneoff786 5y ago
    By exponential, you mean there’s a steep part but you don’t really know the difference between exponential and logarithmic. The rapid slowdown of infections is FAR below 100% of people.
    - stnmtn 5y ago
      > Sure, there's a limit, but if we're looking at function that is exponential until it reaches an inflection point where there's simply less hosts to infect than possible... What do you think I meant by this? Do you think I believe that the rate of infection will keep going up literally exponentially until it hits 7 billion then turn flat, or do you think that by my usage of 'inflection point' maybe I had more nuance than that?
      - oneoff786 5y ago
        I took it to mean you’re claiming growth is exponential or nearly exponential until it nears 100% like a sigmoid function. But that’s wrong. Growth stalls out much much earlier. It’s just not right to call disease spread exponential.
drexlspivey 5y ago
> Firstly, a marginally lower case fatality rate is a linear improvement, whereas much higher transmissibility is an exponential worsening. No it's not, if delta infected say 1b humans and omicron infects 4b humans deaths can easily be offset by a lower fatality rate
- inciampati 5y ago
  The problem is that (higher) exponential growth will cause many more hospitalizations to happen in a much shorter time interval. That can make the wave more deadly even if the virus is somewhat milder.
- ceejayoz 5y ago
  You're missing the point. If Delta kills, say, a million people, and Omicron only kills half a million people, but Omicron kills that halved amount in, say, 1/10th the time, Omicron is more likely to lead to overwhelmed hospitals.
  - jimmaswell 5y ago
    I wish they would just triage unvaccinated people below everyone else so hospital capacity would stop being a problem.
singingfish 5y ago
Yep, the result of a large number multiplied by a small number is still a large number. It's definitely a worry.
aqme28 5y ago
Or more simply, 5x as contagious but 1/2 as deadly? That's still a lot more deaths.
- kbelder 5y ago
  Good chance it means more deaths sooner, but fewer total deaths.
- oneoff786 5y ago
  No it’s not. Contagion spread is logarithmic, and has obvious upper bounds. E.g. about a third of the us has gotten Covid. 5x contagious does not give you 166% of the population infected. Nor does it give you 100%. Probably not even 90%. I would bet no more than 50% over the next year. Half as deadly on the other hand is a big deal. It’s not just deaths, it’s also hospitalizations. If you imagine the bell curve of outcomes, the deaths are the small tail on the right and the hospitalizations are the fatter bit on the right. If you get to move everything to the left a bit, you remove the biggest chunk of the population from getting hospitalized in the first place.
  - renaudg 5y ago
    It sounds like you don't know the first thing about epidemiology modelling : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962332/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962332/
    - oneoff786 5y ago
      Read your own damn paper. The exponential phase of a disease spread is at the very beginning when the total number of cases is small. The rate rapidly decays to a point of being mostly linear and continuing to drop off. People think exponential is an accelerating rocket ship to 100% infected. It is not. It’s a decelerating trend likely to stall out well below 100%. If the R factor increases from 1 to 2, over a LONG period, you would be wrong to expect exponentially more cases. You would probably see fewer than 2x the cases. You would see it expand much, much faster initially. But both would see slow downs at similar inflection points. The very first sentence of your own linked abstract: > The INITIAL exponential growth rate of an epidemic is an important measure of the severeness of the epidemic, and is also closely related to the basic reproduction number. Estimating the growth rate from the epidemic curve can be a challenge, because of its DECAYS with time. the long term model is not exponential. This really should be obvious, but you cannot create an accurate disease model that does not show the impact of population size. Pure exponential models are only relevant on a theoretical infinitely large population that is well and randomly mixed. When you establish that there’s only so many people, the growth rate has to decline, and not at 100% of the population. It stalls out well before that. Look into random graph models.
drited 5y ago
>marginally lower case fatality rate The op didn't state marginally could you please share where you are getting this from? The first publicly confirmed death globally from Omicron was reported just yesterday (source: https://www.reuters.com/world/uk/britain-says-omicron-spreading-phenomenal-rate-2021-12-13/ https://www.reuters.com/world/uk/britain-says-omicron-spread... Given that the South African study discussed in this Washington Post article included 78k people, none of whom died if the above Reuters article is correct, doesn't this suggest that the case fatality rate is a lot lower (not marginally lower)?
- aqme28 5y ago
  It's growing exponentially and deaths are a lagging indicator. The true denominator is far from 78k people.
  - drited 5y ago
    I know deaths lag cases. I mentioned just the cases in the south African study because those are the earliest cases we have. None of the 78,000 cases up to 7th Dec in South Africa resulted in a reported death up to 13th Dec. This can be deduced from yesterday's Reuters article I linked which said the first reported death globally was in the UK (not South Africa) and from the fact that the study looked at 78,000 cases of Omicron from 15 November 2021 to 7 December 2021 (source: https://www.discovery.co.za/corporate/news-room https://www.discovery.co.za/corporate/news-room). At the time the Reuters article was published we were 6 days after even the most recently reported of those South African cases. I wasn't trying to present the global denominator - that is far higher than 78,000 since it includes all countries, not just the 78k reported in the South African country.
    - renaudg 5y ago
      > None of the 78,000 cases up to 7th Dec in South Africa resulted in a reported death up to 13th Dec. Covid takes about 3 weeks to kill. The Omicron epicenter in SA has a much younger demographic than in western countries.
  - 5y ago
renaudg 5y ago
Good explanation of why a milder more contagious variant is bad news : https://twitter.com/AdamJKucharski/status/1343567425107881986 https://twitter.com/AdamJKucharski/status/134356742510788198...

jgalt212 5y ago

> Firstly, a marginally lower case fatality rate is a linear improvement, whereas much higher transmissibility is an exponential worsening. With the current data available from SA, EU, and UK, the CFR has not been shown to be marginally lower, but dramatically lower. Things could change, of course, but right now the first part of your statement is really the case (as observed).

oceanplexian 5y ago

The thing is, vaccines were never advertised as tools to prevent infection. The story has always been that it reduces symptoms and hospitalization, so there are plenty of opportunities for the disease to get “tickets” in the evolution lottery. Between that, the animal reservoirs (COVID can spread to different species), and the millions of people in undeveloped countries who will never get a vax, COVID was guaranteed to mutate no matter what the public policy. Letting it rip is less a strategy and more an acknowledgement of reality.

jimmyearlcarter 5y ago
The vaccine was initially sold as the tool to end the pandemic and get life back to 'normal'. The narrative has evolved to suit the deficiencies of the vaccine and keep profits from sinking.
- NicoJuicy 5y ago
  Or if the virus gets irrelevant. One doesn't exclude the other. People don't see an end with natural evolution, so the vaccine was/is the main focus for a long time.
- yread 5y ago
  They could have ended the wildtype pandemic. As soon as delta appeared it was impossible. They have 90% efficiency at best and you need 84% of all people protected to stop delta (1-1/R0 for R0=6). It's impossible to get such high vax rate.
  - Ar-Curunir 5y ago
    Not necessarily. Eg the Netherlands has ~77% vaccination rate, which is pretty close to the quoted 84%.
    - sharken 5y ago
      I'd go so far as to say 77% is "good enough", ie. it's time to live with the virus and not change our ways because of it.
  - arcturus17 5y ago
    We’re at 80% vaccination in Spain… I think we can surpass 84%.
    - jefftk 5y ago
      37.7M fully vaccinated, 47.35M population -- impressive! I was initially assuming you were excluding kids or other people ineligible to get vaccinated.

smaryjerry 5y ago

That would make sense but been the originally strains did not overwhelm hospitals. New York has the highest and craziest number of cases and deaths at the beginning and didn’t put one person onto the ship that was provided for temporary beds. Hospitals did not run out of beds and now the biggest problem is running out of staff, the same as every industry. At our local hospital all of the nurses quit for better, higher paying jobs. We’re running at less hospital labor than even pre pandemic, aren’t building new hospitals, and the highest peaks in cases and deaths were while the strictest lockdowns and mask mandates were already in place. There is complete fear overload and yet all attempts at preventing spread, even vaccines, have failed. They reduce symptoms but do not stop the spread. That’s how contagious this virus is, without any symptoms whatsoever people are spreading the virus, even with masks on, and limits on how close they can be to people. We now have vaccines, we have even pills that have been approved, we also know healthy lifestyle fights against it, yet we are still in a 2 year long “state of emergency.” Letting it rip through is not an option we can choose, it will happen regardless of what we do.

ceejayoz 5y ago
> didn’t put one person onto the ship that was provided for temporary beds It wasn't for lack of need. https://www.nytimes.com/2020/04/02/nyregion/ny-coronavirus-usns-comfort.html https://www.nytimes.com/2020/04/02/nyregion/ny-coronavirus-u... > But the reality has been different. A tangle of military protocols and bureaucratic hurdles has prevented the Comfort from accepting many patients at all. > On top of its strict rules preventing people infected with the virus from coming on board, the Navy is also refusing to treat a host of other conditions. Guidelines disseminated to hospitals included a list of 49 medical conditions that would exclude a patient from admittance to the ship. > Ambulances cannot take patients directly to the Comfort; they must first deliver patients to a city hospital for a lengthy evaluation — including a test for the virus — and then pick them up again for transport to the ship.
- smaryjerry 5y ago
  If the emergency and need was that bad they would have absolutely figured out simple logistics to get people on a ship. The fact is most people were told go home and wait it out and are still told that and that is the treatment most people receive. There is no point in continuing our state of emergency when our emergency services are not and never were at risk. Every single lockdown and mask measure put in place has had no significant impact on the spread of the virus. It is that contagious.

circlefavshape 5y ago

> That's why "let it rip through so we get natural immunity" is such a short sighted stance. That is absolutely not what the OP said, fwiw

peakaboo 5y ago

Natural immunity is the ONLY way back to a sane planet. It's time you take a step back, look at what happened for two years now, and realize we don't need this insanity anymore.

kelnos 5y ago
Given how quickly the virus can infect people and put them in the hospital if unchecked by masking/social distancing/etc. and vaccines, just letting everyone get infected would rapidly overwhelm our health care system and cause a lot of deaths that could have been prevented. If the world had collectively done nothing about COVID over the past two years, sure, the pandemic might be "over" by now, but the total death toll would likely be much higher than what we'll probably end up with when all this is actually over, given our current path. I'm not thrilled with how the past two years have gone, but it could have been much, much worse. It could also have been much better, if it weren't for people using the virus to score political points. Even with a mix of vaccines and natural immunity, I don't think we can rely on natural immunity to solve this. That just doesn't pass the smell test.
- spookthesunset 5y ago
  The world “experts” clearly didn’t do anything at all these last two years if they are still freaking out about “healthcare collapse”. There is zero excuse to push lockdowns, masks or any of that nonsense at this point to “protect healthcare”. Healthcare should have been “protected” by now if this is supposed to be a normal thing
Nursie 5y ago
> Natural immunity Gaining herd natural immunity implies a lot more death. Also natural immunity wanes after a while, and variants can work around it. So no, it's not the only way, nor is it even a certain way at all.

bagacrap 5y ago

there really can't be an "exponential" increase in the number of cases, whatever that means, given that there's a hard upper bound which is the number of hosts.

stnmtn 5y ago
While technically correct, you and I both know what they meant by exponential. Sure, there's a limit, but if we're looking at function that is exponential until it reaches an inflection point where there's simply less hosts to infect than possible...
- rolph 5y ago
  a rate of change in the rate of change, to wit a second order derivative
- oneoff786 5y ago
  By exponential, you mean there’s a steep part but you don’t really know the difference between exponential and logarithmic. The rapid slowdown of infections is FAR below 100% of people.
  - stnmtn 5y ago
    > Sure, there's a limit, but if we're looking at function that is exponential until it reaches an inflection point where there's simply less hosts to infect than possible... What do you think I meant by this? Do you think I believe that the rate of infection will keep going up literally exponentially until it hits 7 billion then turn flat, or do you think that by my usage of 'inflection point' maybe I had more nuance than that?
    - oneoff786 5y ago
      I took it to mean you’re claiming growth is exponential or nearly exponential until it nears 100% like a sigmoid function. But that’s wrong. Growth stalls out much much earlier. It’s just not right to call disease spread exponential.

drexlspivey 5y ago

> Firstly, a marginally lower case fatality rate is a linear improvement, whereas much higher transmissibility is an exponential worsening. No it's not, if delta infected say 1b humans and omicron infects 4b humans deaths can easily be offset by a lower fatality rate

inciampati 5y ago
The problem is that (higher) exponential growth will cause many more hospitalizations to happen in a much shorter time interval. That can make the wave more deadly even if the virus is somewhat milder.
ceejayoz 5y ago
You're missing the point. If Delta kills, say, a million people, and Omicron only kills half a million people, but Omicron kills that halved amount in, say, 1/10th the time, Omicron is more likely to lead to overwhelmed hospitals.
- jimmaswell 5y ago
  I wish they would just triage unvaccinated people below everyone else so hospital capacity would stop being a problem.

singingfish 5y ago

Yep, the result of a large number multiplied by a small number is still a large number. It's definitely a worry.

aqme28 5y ago

Or more simply, 5x as contagious but 1/2 as deadly? That's still a lot more deaths.

kbelder 5y ago
Good chance it means more deaths sooner, but fewer total deaths.
oneoff786 5y ago
No it’s not. Contagion spread is logarithmic, and has obvious upper bounds. E.g. about a third of the us has gotten Covid. 5x contagious does not give you 166% of the population infected. Nor does it give you 100%. Probably not even 90%. I would bet no more than 50% over the next year. Half as deadly on the other hand is a big deal. It’s not just deaths, it’s also hospitalizations. If you imagine the bell curve of outcomes, the deaths are the small tail on the right and the hospitalizations are the fatter bit on the right. If you get to move everything to the left a bit, you remove the biggest chunk of the population from getting hospitalized in the first place.
- renaudg 5y ago
  It sounds like you don't know the first thing about epidemiology modelling : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962332/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962332/
  - oneoff786 5y ago
    Read your own damn paper. The exponential phase of a disease spread is at the very beginning when the total number of cases is small. The rate rapidly decays to a point of being mostly linear and continuing to drop off. People think exponential is an accelerating rocket ship to 100% infected. It is not. It’s a decelerating trend likely to stall out well below 100%. If the R factor increases from 1 to 2, over a LONG period, you would be wrong to expect exponentially more cases. You would probably see fewer than 2x the cases. You would see it expand much, much faster initially. But both would see slow downs at similar inflection points. The very first sentence of your own linked abstract: > The INITIAL exponential growth rate of an epidemic is an important measure of the severeness of the epidemic, and is also closely related to the basic reproduction number. Estimating the growth rate from the epidemic curve can be a challenge, because of its DECAYS with time. the long term model is not exponential. This really should be obvious, but you cannot create an accurate disease model that does not show the impact of population size. Pure exponential models are only relevant on a theoretical infinitely large population that is well and randomly mixed. When you establish that there’s only so many people, the growth rate has to decline, and not at 100% of the population. It stalls out well before that. Look into random graph models.

drited 5y ago

>marginally lower case fatality rate The op didn't state marginally could you please share where you are getting this from? The first publicly confirmed death globally from Omicron was reported just yesterday (source: https://www.reuters.com/world/uk/britain-says-omicron-spreading-phenomenal-rate-2021-12-13/ https://www.reuters.com/world/uk/britain-says-omicron-spread... Given that the South African study discussed in this Washington Post article included 78k people, none of whom died if the above Reuters article is correct, doesn't this suggest that the case fatality rate is a lot lower (not marginally lower)?

aqme28 5y ago
It's growing exponentially and deaths are a lagging indicator. The true denominator is far from 78k people.
- drited 5y ago
  I know deaths lag cases. I mentioned just the cases in the south African study because those are the earliest cases we have. None of the 78,000 cases up to 7th Dec in South Africa resulted in a reported death up to 13th Dec. This can be deduced from yesterday's Reuters article I linked which said the first reported death globally was in the UK (not South Africa) and from the fact that the study looked at 78,000 cases of Omicron from 15 November 2021 to 7 December 2021 (source: https://www.discovery.co.za/corporate/news-room https://www.discovery.co.za/corporate/news-room). At the time the Reuters article was published we were 6 days after even the most recently reported of those South African cases. I wasn't trying to present the global denominator - that is far higher than 78,000 since it includes all countries, not just the 78k reported in the South African country.
  - renaudg 5y ago
    > None of the 78,000 cases up to 7th Dec in South Africa resulted in a reported death up to 13th Dec. Covid takes about 3 weeks to kill. The Omicron epicenter in SA has a much younger demographic than in western countries.
- 5y ago

renaudg 5y ago

Good explanation of why a milder more contagious variant is bad news : https://twitter.com/AdamJKucharski/status/1343567425107881986 https://twitter.com/AdamJKucharski/status/134356742510788198...