5 ms·

The end of the pandemic will not be televised

17 points by miles 5y ago

leoedin 5y ago
We were almost there in the UK, and then Omicron struck! Ultimately I think it's pretty clear the pandemic will be "over" when people accept that covid is now one of the big pile of common respiratory viruses. That means you don't have regular testing or mandatory quarantine, you just go about your life. It may even be that Omicron, being less severe, is the virus that will bring that. The problem of course is that people who haven't been vaccinated or exposed at a relatively young age are still at quite a high risk of hospitalisation - which means that there's a health service risk to "ending" the pandemic. It's not clear what the solution for that is.
- nyokodo 5y ago
  > people who haven't been vaccinated or exposed at a relatively young age I don’t have the link but there was a report recently that the “immunonaive” in the UK is a vanishingly small percentage. Pretty much everyone kicking around now are either convalescent, vaccinated, or both. T-Cell mediated immunity against Omicron is pretty good even for those with waning antibody levels. So, the impact of Omicron is likely to be significantly reduced compared to previous waves.
- pjc50 5y ago
  From the beginning there have been three options: - containment/eradication (e.g. smallpox) - infection until everyone gets it (kills a lot of people, and the natural immunity is not perfect especially against variants), has no defined "end" - permanent management by individual measures / prophylaxis (e.g. AIDS) If we're going for (2) then we should have started the health care worker training programme two years ago, because we're going to need a lot more both to cover burnout and the ongoing permanent increase in hospitalizations.
  - leoedin 5y ago
    I'm not sure if the increase in hospitalisations will necessarily be permanent. We know that a lot of the common cold viruses are basically harmless in children, but can cause quite serious illness in previously unexposed adults. Because everyone catches them as children (when the immune system is particularly primed for dealing with new viruses), they're not a big deal. It seems likely (based on the fact that we're living with hundreds of "cold" viruses, all of which are relatively benign) that covid will take the same path - eventually. The problem is the bit before that, where everyone gets exposed to a never-before-seen pathogen. I agree though - until we get to a point where everyone has been exposed or vaccinated, there's going to be a continuous stream of bad covid cases.
    - headsoup 5y ago
      The immune system in children isn't primed 'particularly' for dealing with new viruses. It's that it hasn't trained itself on previous viruses and therefore attacking the new ones expecting something else. Their immune system is more 'vanilla' so will create a better general response. Vaccination will not solve this, as we're already seeing, it actually enhances the problem of the immune system attacking new strains expecting the old one and missing somewhat. Look into Original Antigenic Sin
- SideburnsOfDoom 5y ago
  > We were almost there in the UK, and then Omicron struck The end of the pandemic will not be linear. Expect periodic setbacks. Even during a time of general decline, there will be flare-ups. Even during a time of general increase, there will be lulls.
- headsoup 5y ago
  Actually, if a majority of Omicron cases are indeed mild, the only thing keeping the pandemic going is the reporting of 'case numbers' for the sake of maintaining attention. Which we could do for the common cold and cause panic with all the 'cases' spreading like wildfire... Otherwise, please show this evidence for retained high hospitalisation in young people from a mild strain
  - SideburnsOfDoom 5y ago
    > a majority of Omicron cases are indeed mild ... all the 'cases' spreading like wildfire The assumption is that "milder cases, less hospitalisation" cancels out "spreading like wildfire, more transmissible" But that's not the mathematics of it. Less hospitalisation per case means e.g., halve the hospitalisation rate. "more transmissible" means faster exponential growth. So one extra doubling cancels out the halving, and then keeps going. Similarly: y = 1/2 x ^ 3 will rapidly get much larger than y = 2 x ^ 2 as x increases.
    - headsoup 5y ago
      Except what is your assumption for hospitalisation % in the more transmissible variant based on? If it's for example 0.1% (remembering hospitalisation is already only something like 2-5% with Delta - as a 'with covid' ), that's an immense increase in transmission required considering for population density allowing such numbers, previous infections in the at-risk population and seasonal impact etc. And you didn't answer the second bit.
      - SideburnsOfDoom 5y ago
        > Except what is your assumption for hospitalisation % in the more transmissible variant based on? "half" is not an assumption at all, it's an illustrative example. By the way, "e.g." is short for "example". Now, 50% is a plausible figure, but no-one really knows yet. There is no real figure yet. 0.1% (assuming you start at 2%, that's a 20-fold reduction) ... I find that closer to the outer limits of plausibility, but YMMV on what you find plausible. IMHO we'd be lucky, very lucky to have anything like that. You can hope, but as they say "hope is not a plan". What's _also_ plausible is that Omicron is not less virulent _at all_ in itself, but that South Africa's better experience this time around is due to protection due to prior infection (very common there) and vaccination (less common, but still over 25%, and more likely among the more vulnerable), and improved treatments. Reported here: https://www.bloomberg.com/news/articles/2021-12-17/omicron-gets-around-previous-covid-infection-u-k-study-warns https://www.bloomberg.com/news/articles/2021-12-17/omicron-g... https://www.reuters.com/world/africa/south-africa-seeing-slight-increase-covid-19-deaths-off-low-base-2021-12-17/ https://www.reuters.com/world/africa/south-africa-seeing-sli... https://www.washingtonpost.com/world/2021/12/17/covid-omicron-south-africa-vaccinations/ https://www.washingtonpost.com/world/2021/12/17/covid-omicro... https://nyheder.tv2.dk/samfund/2021-12-17-forste-omikron-erfaringer-far-laeger-til-at-frygte-mange-indlagte https://nyheder.tv2.dk/samfund/2021-12-17-forste-omikron-erf... > And you didn't answer the second bit. My apologies, I thought that this was more like a conversation and less like an exam. The mechanism is the maths described, the evidence one way or the other will come about in a few weeks.

17 points by miles 5y ago

We were almost there in the UK, and then Omicron struck! Ultimately I think it's pretty clear the pandemic will be "over" when people accept that covid is now one of the big pile of common respiratory viruses. That means you don't have regular testing or mandatory quarantine, you just go about your life. It may even be that Omicron, being less severe, is the virus that will bring that. The problem of course is that people who haven't been vaccinated or exposed at a relatively young age are still at quite a high risk of hospitalisation - which means that there's a health service risk to "ending" the pandemic. It's not clear what the solution for that is.

nyokodo 5y ago
> people who haven't been vaccinated or exposed at a relatively young age I don’t have the link but there was a report recently that the “immunonaive” in the UK is a vanishingly small percentage. Pretty much everyone kicking around now are either convalescent, vaccinated, or both. T-Cell mediated immunity against Omicron is pretty good even for those with waning antibody levels. So, the impact of Omicron is likely to be significantly reduced compared to previous waves.
pjc50 5y ago
From the beginning there have been three options: - containment/eradication (e.g. smallpox) - infection until everyone gets it (kills a lot of people, and the natural immunity is not perfect especially against variants), has no defined "end" - permanent management by individual measures / prophylaxis (e.g. AIDS) If we're going for (2) then we should have started the health care worker training programme two years ago, because we're going to need a lot more both to cover burnout and the ongoing permanent increase in hospitalizations.
- leoedin 5y ago
  I'm not sure if the increase in hospitalisations will necessarily be permanent. We know that a lot of the common cold viruses are basically harmless in children, but can cause quite serious illness in previously unexposed adults. Because everyone catches them as children (when the immune system is particularly primed for dealing with new viruses), they're not a big deal. It seems likely (based on the fact that we're living with hundreds of "cold" viruses, all of which are relatively benign) that covid will take the same path - eventually. The problem is the bit before that, where everyone gets exposed to a never-before-seen pathogen. I agree though - until we get to a point where everyone has been exposed or vaccinated, there's going to be a continuous stream of bad covid cases.
  - headsoup 5y ago
    The immune system in children isn't primed 'particularly' for dealing with new viruses. It's that it hasn't trained itself on previous viruses and therefore attacking the new ones expecting something else. Their immune system is more 'vanilla' so will create a better general response. Vaccination will not solve this, as we're already seeing, it actually enhances the problem of the immune system attacking new strains expecting the old one and missing somewhat. Look into Original Antigenic Sin
SideburnsOfDoom 5y ago
> We were almost there in the UK, and then Omicron struck The end of the pandemic will not be linear. Expect periodic setbacks. Even during a time of general decline, there will be flare-ups. Even during a time of general increase, there will be lulls.
headsoup 5y ago
Actually, if a majority of Omicron cases are indeed mild, the only thing keeping the pandemic going is the reporting of 'case numbers' for the sake of maintaining attention. Which we could do for the common cold and cause panic with all the 'cases' spreading like wildfire... Otherwise, please show this evidence for retained high hospitalisation in young people from a mild strain
- SideburnsOfDoom 5y ago
  > a majority of Omicron cases are indeed mild ... all the 'cases' spreading like wildfire The assumption is that "milder cases, less hospitalisation" cancels out "spreading like wildfire, more transmissible" But that's not the mathematics of it. Less hospitalisation per case means e.g., halve the hospitalisation rate. "more transmissible" means faster exponential growth. So one extra doubling cancels out the halving, and then keeps going. Similarly: y = 1/2 x ^ 3 will rapidly get much larger than y = 2 x ^ 2 as x increases.
  - headsoup 5y ago
    Except what is your assumption for hospitalisation % in the more transmissible variant based on? If it's for example 0.1% (remembering hospitalisation is already only something like 2-5% with Delta - as a 'with covid' ), that's an immense increase in transmission required considering for population density allowing such numbers, previous infections in the at-risk population and seasonal impact etc. And you didn't answer the second bit.
    - SideburnsOfDoom 5y ago
      > Except what is your assumption for hospitalisation % in the more transmissible variant based on? "half" is not an assumption at all, it's an illustrative example. By the way, "e.g." is short for "example". Now, 50% is a plausible figure, but no-one really knows yet. There is no real figure yet. 0.1% (assuming you start at 2%, that's a 20-fold reduction) ... I find that closer to the outer limits of plausibility, but YMMV on what you find plausible. IMHO we'd be lucky, very lucky to have anything like that. You can hope, but as they say "hope is not a plan". What's _also_ plausible is that Omicron is not less virulent _at all_ in itself, but that South Africa's better experience this time around is due to protection due to prior infection (very common there) and vaccination (less common, but still over 25%, and more likely among the more vulnerable), and improved treatments. Reported here: https://www.bloomberg.com/news/articles/2021-12-17/omicron-gets-around-previous-covid-infection-u-k-study-warns https://www.bloomberg.com/news/articles/2021-12-17/omicron-g... https://www.reuters.com/world/africa/south-africa-seeing-slight-increase-covid-19-deaths-off-low-base-2021-12-17/ https://www.reuters.com/world/africa/south-africa-seeing-sli... https://www.washingtonpost.com/world/2021/12/17/covid-omicron-south-africa-vaccinations/ https://www.washingtonpost.com/world/2021/12/17/covid-omicro... https://nyheder.tv2.dk/samfund/2021-12-17-forste-omikron-erfaringer-far-laeger-til-at-frygte-mange-indlagte https://nyheder.tv2.dk/samfund/2021-12-17-forste-omikron-erf... > And you didn't answer the second bit. My apologies, I thought that this was more like a conversation and less like an exam. The mechanism is the maths described, the evidence one way or the other will come about in a few weeks.