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> Good vaccines + mild severity illness are basically the best case. If it was a common cold or a flu ? Maybe. > “Although COVID-19 has been described as a re

> Good vaccines + mild severity illness are basically the best case. If it was a common cold or a flu ? Maybe. > “Although COVID-19 has been described as a respiratory syndrome, evidence supports the involvement of multiple organ systems, with fibrosis, and inflammation in the lung, heart, kidneys, central nervous system (CNS), liver, adrenal glands, bone marrow, lymph nodes, and gastrointestinal tract. SARS-CoV-2 infection has also been associated with serious thrombotic complications, including strokes, pulmonary embolism, and cardiac injury.” https://www.wsws.org/en/articles/2021/11/10/leon-n10.htm https://www.wsws.org/en/articles/2021/11/10/leon-n10.htm Endemic we want ? Then we want yearly (or 6months it seems) vaccines. And masks. And ventilation. Reinfections will get more severe with age once vaccine or infection elicited sera wanes. > What a stroke of luck that we are here vs a more infectious strain of Delta or some other nightmare that would keep this rolling. Omicron being the new kid on the block doesn't mean another more dangerous variant isn't building itself up in a body somewhere. Maybe two years into the pandemic is not enough to let the reality sink in that we will never come back to before. Maybe we need ten years but by then we'll all be used to the new normal anyway. “Learn to live with the virus”, they said. Indeed.

iamdamian 5y ago
I'm not sure why we wouldn't be able to go back to normal, and taking a stance that we never will strikes me as somewhat defeatist. I'm more of an optimist. Having a small percentage of the population that's at greater risk of serious implications from infection (respiratory or otherwise) is something we've learned to live with before (see: the flu) without masks, mandates, or dramatically rearranging the way we live.
- johnchristopher 5y ago
  > I'm not sure why we wouldn't be able to go back to normal, There are no path back to normal unless the virus disappears. We have vaccines that work for a limited time, we'll soon have pills@home. It will still not be `back to normal`. > and taking a stance that we never will strikes me as somewhat defeatist. We'll also never have FTL spaceships or teleportation star trek style. > I'm more of an optimist. Having a small percentage of the population that's at greater risk of serious implications from infection (respiratory or otherwise) is something we've learned to live with before (see: the flu) without masks, mandates, or dramatically rearranging the way we live. Covid is not the flu. Hoping it'll magically turn into a flu or that we can manage it like a flu is ignoring the reality currently unfolding. 40 years later and we still need condoms. We are not back to sex as it was in the 70's. Generations of teenagers have had their first time with a condom. This is what is normal now.
  - lamontcg 5y ago
    > We have vaccines that work for a limited time This is flat out FALSE. There are two different possible endpoints for vaccine efficacy. One is efficacy against infection, one is efficacy against severe disease and death. Efficacy against infection is very difficult because it is mediated by circulating neutralizing antibodies. It is just difficult to get sterilizing immunity against a muscosally invading respiratory virus in the first place. And then neutralizing antibodies wane over time. Efficacy against severe disease is almost certainly going to be more durable because it is mediated by memory T-cell and B-cells having been already formed due to prior exposure to a related antigen. Unfortunately the result of the phase 3 trails on the mRNA vaccines were way too good on VE against infection and it was sold as being 90% effective and as that waned people declared them to be ineffective. That should never have been the yardstick though. And in fact before those results were announced Fauci was trying to condition the population to expecting a 50% VE against infection number as being good enough. The 90% efficacy results just blew that all away though. What gets lost is that they're still >90% effective against severe disease/death and nothing has changed there. And you can see it in the headlines with Omicron. It is almost still certainly as intrinsically virulent as D614G, if not actually more intrinsically virulent than Delta itself, but hospitalization rates and death rates are plummeting. That is the human humoral immune system working. I'd argue everyone should probably get boosted because of the maturation in immune response which is measured against Omicron. Once we're done with that though I fully expect that people can stop getting any future vaccines and they'll just get a cold next time they catch SARS-CoV-2 until they wind up being over 65 or a cancer patient or something -- just like every other ILI-causing virus. (Or you know keep getting boosters like you get flu shots -- I'm honestly not sure what I'll do about it, but its going to look a whole lot more like yearly flu shots than the world-record mass immunization campaign we've seen up until now).
    - jacquesm 5y ago
      The mutation rate and the number of infected people is what is driving this, as long as we have this many people infected at the same time mutations will be hitting us to the tune of a new one every four to five months or so. The vaccines are quite effective against a variant that is no longer in play and hasn't been for quite a while.
lamontcg 5y ago
We clearly do not have a choice about endemicity. It will be endemic given that it very clearly evolves antigenically to achieve escape from waning neutralizing antibodies and it has animal reservoirs all over the place, including white tailed deer. It was pretty easy to see eradication was off the table in summer of 2020. At this point is kind of fucking stupid to talk about it. Even if you could snap your fingers and make it go away in humans it would just spill back from animal reservoirs. You'd have to eradicate all the deer, mink and every species you don't know about that has been infected with it. At this point it isn't humanly possible. We won't be taking precautions forever though. Reinfection and vaccine breaktrhoughs will be mild. T-cells and B-cells don't wane the same way Nabs does and protection against severe disease and hospitalization will be durable. There will be loss of protection as you age, but we already have that with all the ILI illnesses and viruses that lead to pneumonia and death in old people. There won't be some worse virus that somehow punches through T-cells, that's getting into the realm of science fiction. While there's about 20 epitopes on spike that need to change for the virus to escape Nabs there's a few thousand T-cell epitopes that would need to change and many of those will be concentrated in conserved regions of the genome that can't mutate or the virus stops working. And once you have a mature B-cell response your body can quickly respond with NAbs to prevent the viremia that leads to multiorgan infection. In fact with vaccine boosters it seems we may already have this level of protection, even against Omicron, and the jury is of course still out as to how durable that is and it may be more durable than initial shots were. Once the virus completes the vaccination campaign the hard way then the pandemic is over and the human race has a new cold/flu virus, and we should treat it like a cold/flu virus. It is also unlikely that we'll continue boosting with vaccines. We're unlikely to get enough people boosting with vaccines every year to make a dent in spread and boosting will mostly be confined to people over 65 and those who are immune compromised. We won't ever boost our way to zero virus. The "its just a flu" people were dead wrong in 2020, but very soon they're going to be entirely right. That doesn't fit neatly into the way that we carve up our society into Team Blue / Team Red though so its difficult for a lot of people to understand.
- jacquesm 5y ago
  > The "its just a flu" people were dead wrong in 2020, but very soon they're going to be entirely right. This is quite infuriating. We had a pretty good window when we could have done something about this and we totally squandered it. > You'd have to eradicate all the deer, mink and every species you don't know about that has been infected with it How much transfer is there in animal populations? Do we have any idea of the size of the populations affected? How does this translate to the original spillover event? After all, there must have been an animal reservoir prior to someone in Wuhan becoming the index patient. We do similar things for various other animal borne plagues with varying degrees of success but there is more than one example of a successful eradication.
deleted 5y ago
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iamdamian 5y ago

I'm not sure why we wouldn't be able to go back to normal, and taking a stance that we never will strikes me as somewhat defeatist. I'm more of an optimist. Having a small percentage of the population that's at greater risk of serious implications from infection (respiratory or otherwise) is something we've learned to live with before (see: the flu) without masks, mandates, or dramatically rearranging the way we live.

johnchristopher 5y ago
> I'm not sure why we wouldn't be able to go back to normal, There are no path back to normal unless the virus disappears. We have vaccines that work for a limited time, we'll soon have pills@home. It will still not be `back to normal`. > and taking a stance that we never will strikes me as somewhat defeatist. We'll also never have FTL spaceships or teleportation star trek style. > I'm more of an optimist. Having a small percentage of the population that's at greater risk of serious implications from infection (respiratory or otherwise) is something we've learned to live with before (see: the flu) without masks, mandates, or dramatically rearranging the way we live. Covid is not the flu. Hoping it'll magically turn into a flu or that we can manage it like a flu is ignoring the reality currently unfolding. 40 years later and we still need condoms. We are not back to sex as it was in the 70's. Generations of teenagers have had their first time with a condom. This is what is normal now.
- lamontcg 5y ago
  > We have vaccines that work for a limited time This is flat out FALSE. There are two different possible endpoints for vaccine efficacy. One is efficacy against infection, one is efficacy against severe disease and death. Efficacy against infection is very difficult because it is mediated by circulating neutralizing antibodies. It is just difficult to get sterilizing immunity against a muscosally invading respiratory virus in the first place. And then neutralizing antibodies wane over time. Efficacy against severe disease is almost certainly going to be more durable because it is mediated by memory T-cell and B-cells having been already formed due to prior exposure to a related antigen. Unfortunately the result of the phase 3 trails on the mRNA vaccines were way too good on VE against infection and it was sold as being 90% effective and as that waned people declared them to be ineffective. That should never have been the yardstick though. And in fact before those results were announced Fauci was trying to condition the population to expecting a 50% VE against infection number as being good enough. The 90% efficacy results just blew that all away though. What gets lost is that they're still >90% effective against severe disease/death and nothing has changed there. And you can see it in the headlines with Omicron. It is almost still certainly as intrinsically virulent as D614G, if not actually more intrinsically virulent than Delta itself, but hospitalization rates and death rates are plummeting. That is the human humoral immune system working. I'd argue everyone should probably get boosted because of the maturation in immune response which is measured against Omicron. Once we're done with that though I fully expect that people can stop getting any future vaccines and they'll just get a cold next time they catch SARS-CoV-2 until they wind up being over 65 or a cancer patient or something -- just like every other ILI-causing virus. (Or you know keep getting boosters like you get flu shots -- I'm honestly not sure what I'll do about it, but its going to look a whole lot more like yearly flu shots than the world-record mass immunization campaign we've seen up until now).
  - jacquesm 5y ago
    The mutation rate and the number of infected people is what is driving this, as long as we have this many people infected at the same time mutations will be hitting us to the tune of a new one every four to five months or so. The vaccines are quite effective against a variant that is no longer in play and hasn't been for quite a while.

lamontcg 5y ago

We clearly do not have a choice about endemicity. It will be endemic given that it very clearly evolves antigenically to achieve escape from waning neutralizing antibodies and it has animal reservoirs all over the place, including white tailed deer. It was pretty easy to see eradication was off the table in summer of 2020. At this point is kind of fucking stupid to talk about it. Even if you could snap your fingers and make it go away in humans it would just spill back from animal reservoirs. You'd have to eradicate all the deer, mink and every species you don't know about that has been infected with it. At this point it isn't humanly possible. We won't be taking precautions forever though. Reinfection and vaccine breaktrhoughs will be mild. T-cells and B-cells don't wane the same way Nabs does and protection against severe disease and hospitalization will be durable. There will be loss of protection as you age, but we already have that with all the ILI illnesses and viruses that lead to pneumonia and death in old people. There won't be some worse virus that somehow punches through T-cells, that's getting into the realm of science fiction. While there's about 20 epitopes on spike that need to change for the virus to escape Nabs there's a few thousand T-cell epitopes that would need to change and many of those will be concentrated in conserved regions of the genome that can't mutate or the virus stops working. And once you have a mature B-cell response your body can quickly respond with NAbs to prevent the viremia that leads to multiorgan infection. In fact with vaccine boosters it seems we may already have this level of protection, even against Omicron, and the jury is of course still out as to how durable that is and it may be more durable than initial shots were. Once the virus completes the vaccination campaign the hard way then the pandemic is over and the human race has a new cold/flu virus, and we should treat it like a cold/flu virus. It is also unlikely that we'll continue boosting with vaccines. We're unlikely to get enough people boosting with vaccines every year to make a dent in spread and boosting will mostly be confined to people over 65 and those who are immune compromised. We won't ever boost our way to zero virus. The "its just a flu" people were dead wrong in 2020, but very soon they're going to be entirely right. That doesn't fit neatly into the way that we carve up our society into Team Blue / Team Red though so its difficult for a lot of people to understand.

jacquesm 5y ago
> The "its just a flu" people were dead wrong in 2020, but very soon they're going to be entirely right. This is quite infuriating. We had a pretty good window when we could have done something about this and we totally squandered it. > You'd have to eradicate all the deer, mink and every species you don't know about that has been infected with it How much transfer is there in animal populations? Do we have any idea of the size of the populations affected? How does this translate to the original spillover event? After all, there must have been an animal reservoir prior to someone in Wuhan becoming the index patient. We do similar things for various other animal borne plagues with varying degrees of success but there is more than one example of a successful eradication.

deleted 5y ago

[deleted]