This year we kill it: Corona Virus Thread Mark II

[georgie_leech]

Unless I'm crazy, those numbers don't match very well? 0.3% of 462k would be about 1.3k; 39 is .3% of 13000 only. Something isn't matching right with those initial numbers.

[Chen]

Unless I'm crazy, those numbers don't match very well? 0.3% of 462k would be about 1.3k; 39 is .3% of 13000 only. Something isn't matching right with those initial numbers.

I wasnt super clear there. The statistics I have are:

Total cases: 838k
Percentage of cases under age 40: 55.1%
Therefore: 462k cases under age 40

Total deaths: 12851
Percentage of deaths under age 40: 0.3%
Therefore: 39 deaths under age 40

[Bartmanhomer]

This is the reason why the whole world needs to cooperate and realized that we're still in the middle of the pandemic and get vaccinated plus get the boosters.

[Aedilred]

Endemic doesn't mean mild, it just means that a disease is native to an area. So 'hoping that this is the one that makes the transition to endemic' is sort of like 'hoping that this is the one that makes the disease impossible to dislodge'.

Of course, at this point it is unavoidable that covid becomes endemic. It's simply too widespread and too infectious to eradicate. The idea that we could ever achieve worldwide "zero Covid" should have gone out of the window the moment we realised it had escaped Wuhan, and while some more isolated communities (like New Zealand) might be able to maintain a zero Covid policy it will only be by all but completely restricting access by the rest of the world, which is not socially sustainable.

Its becoming endemic isn't great, exactly, but it's also inevitable, so what we're really talking about is the point when the disease becomes mild enough, and/or the population has sufficient immunity to it, that we can tolerate it as part of the normal background illness risk that we all take for granted. And therefore "the switch from pandemic to endemic" is still something to look forward to (if not exactly celebrate), all things considered.

I'm not a virologist but it seems like Omicron might be the variant that facilitates this, since it seems to be significantly less dangerous to the population as it stands than previous widespread variants. Of course the population now is much more resistant to Covid than it was when it first appeared, too, after vaccination and naturally acquired immunity. It is frustrating, however, that vaccination rates seem to have stalled. The UK is an extreme example given its fast start, but it is disappointing that it seems to have topped out at 71.5% (fully vaccinated). Part of that is down to policy decisions like not vaccinating children (which are probably the prime reservoir for Covid at this point) but you'd hope we could push it to 80-90% even accounting for the unvaccinatable and diehard antivaxxers.

Maybe I underestimate the proportion of people who are medically unable to have vaccines.

[NichG]

'Endemic ebola' is a thing. 'Endemic COVID' means a lot of the harms and inconveniences of COVID become permanent facets of life, not that we 'go back to normal'. Even doubling the severity of our yearly flu seasons will mean three months a year when you can't get elective surgeries and medical appointments are significantly delayed. Not to mention that one day all of us will be old enough that even a milder version of COVID can be life threatening. Endemic COVID means a few years reduction in human life expectancy overall, more limits and risks if you ever need chemotherapy or other immune-suppressing procedures, etc.

What we really should want is for COVID to become sporadic - generally existing somewhere, but for the most part hitting enough transmission walls that it doesn't sit at high levels or become waves whenever there's a new variant.

With the original strain, 80% vaccination/prior infection rates would have been enough on their own to reduce COVID to a sporadic, rather than endemic, illness.

With delta's higher R, even a 100% vax rate would have been shy of getting COVID to sporadic without other interventions. However, with some permanent shifts in habits (masking indoors when possible, staying home when sick rather than working through it, better ventilation in businesses and schools, increased fraction of remote workers) maybe it would be possible to hit sporadic levels of not a hard zero. Several places managed to get down to e.g. 1-2 cases per 100k per day levels after the delta wave.

With omicron, it remains to be seen. On the one hand, R seems to be much higher, meaning immunity has to be that much more airtight to prevent constant cases. On the other hand, the waves have been falling at similar rates as their rise, suggesting that immunity vs omicron works pretty well. It'd be a nice consolation prize if it basically immunizes people so quickly that it has nowhere to run and is left only in pockets. But I could also see it being so hard to get down to zero that basically you can look forward to everyone losing 10 extra days a year to illness from now on, that they could have otherwise avoided.

[sihnfahl]

And now Omicron 2 is circulating.

It appears to have Omicron's ease of spread, but the jury's still out on whether or not it's a little more lethal, or can avoid existing immunity efforts as well.

[Bartmanhomer]

And now Omicron 2 is circulating.

It appears to have Omicron's ease of spread, but the jury's still out on whether or not it's a little more lethal, or can avoid existing immunity efforts as well.

I hate this virus so much. Seriously I'm starting to go crazy hearing this virus continued to mutate every single day. It getting to me now.

[warmachine]

Get used to it or throw away your sharp knives. Like Influenza, Covid has a huge population base but, unlike 'flu, it isn't stuck in the hemisphere in winter. We don't get a few months to manufacture vaccines against new strains, they'll just appear and run rampant. However, I say the good news is, if Omicron is anything to go by, the vaccines have defanged the worst of the genetic possibilities and new variants will just need wearing masks and opening the windows to slow the spread. An acceptable and liveable form of normal, for a form of normal where a million people worldwide die per year.

[NichG]

Given how quickly we got BA.2 after Omicron, I wouldn't be confident in concluding that the genetic repertoire has been exhausted. Almost the opposite - direct increases in transmission and replication between the original strain and delta, and between delta and omicron, don't look to me like the dynamics of something sitting on a Pareto front and making tradeoffs for every local improvement.

I wonder if that's something to be expected from the time immediately after something of zoonotic origins hops to humans? That initial hop would just have to be the minimum 'is able to replicate in humans just enough to transmit'. So given that, it seems normal to expect that there'd be a number of untapped adaptations to go from 'humans work as a host' to 'humans are an optimal host' that wouldn't just involve immune escape.

[warmachine]

To me, Omicron's large reduction in pathogenicity makes it defanged. Higher infectivity and immune escape is a bastard but as long as people act to curtail it, healthcare can cope, for some definition of coping with bad influenza level hospitalisations. Occasional outbreaks where everyone has to wear a mask and open the windows. And scientists have to keep telling governments to install ventilation in school's already.

[NichG]

To me, Omicron's large reduction in pathogenicity makes it defanged. Higher infectivity and immune escape is a bastard but as long as people act to curtail it, healthcare can cope, for some definition of coping with bad influenza level hospitalisations. Occasional outbreaks where everyone has to wear a mask and open the windows. And scientists have to keep telling governments to install ventilation in school's already.

I don't see enough evidence yet to preclude a more lethal variant from appearing in the future. If the reduction in lethality was a consequence of a necessary tradeoff - can't transmit higher without being less lethal - then maybe. But it would also be consistent with what we've seen if lethality is just changing more or less randomly and independently of increases in transmission.

[warmachine]

Indeed, predicting a trend from one change is little better than guesswork. However, public health requires public participation and that requires hope. Find hope where you can find it. Is it unjustifiable hope? I say after two years of study and an effective vaccine rollout (for the West), I reckon not.

[NichG]

Indeed, predicting a trend from one change is little better than guesswork. However, public health requires public participation and that requires hope. Find hope where you can find it. Is it unjustifiable hope? I say after two years of study and an effective vaccine rollout (for the West), I reckon not.

I don't think oversimplifying and overconfidence in communication has been helpful over the course of this pandemic. Early on we had models coming out of IHME saying 'all we need to do is flatten the curve until June 2020 and COVID will be over' with things like uncertainty regions shrinking to zero in a very reassuring way beyond a certain point (because they fitted a family of functions that wasn't actually capable of representing the possibility that there'd be another wave). And of course that didn't go the way they hoped, and a lot of credibility was lost. Then when the vaccines first became available, the raw data said '90-95% effective', but people were encouraged to see them as a silver bullet - 100% effective, you can stop masking if get your shots and just go back to normal - on the basis of the idea that getting people vaccinated was a greater good than harms arising from the imprecision of the messaging. Then when people started seeing breakthrough cases, when delta slashed the efficacy and omicron slashed it even more, the initial over-promise became a justification to just tune out and not trust anyone.

Not to mention messages of hope that weren't even backed by any intentional public policy, but were just wishful thinking - remember all of the early dancing around estimating the IFR from the CFR, throwing in assumptions about what percentage of COVID cases were reported? Where one group would confidently report IFRs of 0.1% and say 'its just like the flu', while another group would find IFRs closer to 1%.

It's very tempting to prioritize what you think people need to hear over what, for example, you'd be willing to stake your career or your life on. And while it may project less confidence to hedge with 'one possibility is that ... but we'll have to wait a few months to find out', its a lot better for preserving trust in the long run.

[Mastikator]

Get used to it or throw away your sharp knives. Like Influenza, Covid has a huge population base but, unlike 'flu, it isn't stuck in the hemisphere in winter. We don't get a few months to manufacture vaccines against new strains, they'll just appear and run rampant. However, I say the good news is, if Omicron is anything to go by, the vaccines have defanged the worst of the genetic possibilities and new variants will just need wearing masks and opening the windows to slow the spread. An acceptable and liveable form of normal, for a form of normal where a million people worldwide die per year.

Vaccines didn't defang omicron, evolution did. A virus that doesn't kill its host is more viable than one that does. That may sound like good news to people who aren't looking at one giant heaping elephant in the room called post covid. Because while omicron isn't more deadly than delta post covid is still debilitating and if more people get omicron then more people are debilitated by post covid.

One thing that worries me is talk of covid becoming endemic and "then things will go back to normal", except they won't, we will just get used to everyone being debilitated by post covid. This is already stopping people from functioning, from performing their jobs, this is slowly tearing society apart. The future is looking bleaker and bleaker.

[warmachine]

Alas, Covid breaks the standard wisdom as fatalities happen after the victim's infectious phase. Worse, there's plenty of pre-symptomatic and asymptomatic transmission. Not killing victims won't help spread. A variant outcompeting Delta by immune escape was inevitable but I say acquiring protection against the most lethal variants without needing the risk of infection counts as defanged.

[BaronOfHell]

Alas, Covid breaks the standard wisdom as fatalities happen after the victim's infectious phase.

Never before have I heard there was an infectious phase. If that is so, the most critical covid patients doesn't need to be isolated? We've heard plenty of cases in the news of people who weren't permitted to see their loved ones in their final moments due to corona, was this later shown to be have been unnecessary?

Even if the case was that there's no evolutionary benefit of being benign, would there be one of being more dangerous?

[Lord Torath]

Never before have I heard there was an infectious phase. If that is so, the most critical covid patients doesn't need to be isolated? We've heard plenty of cases in the news of people who weren't permitted to see their loved ones in their final moments due to corona, was this later shown to be have been unnecessary?

Even if the case was that there's no evolutionary benefit of being benign, would there be one of being more dangerous?

As I understand it, Delta, Omicron, and "Omicron's Little Sister (as I've heard the Omicron variant's variant described on NPR)" spread so quickly because they replicate exceedingly quickly before the body can ramp up its immune response to fight it off, even with the aid of vaccines. So yes, you are most contagious a day or so after you catch the virus. Does that mean that you are not contagious after that? No, just comparatively less contagious. The unvaccinated have a much slower immune response, and remain highly contagious for much longer. And if your body fails to fight off the virus, you remain contagious until the end.

As for your second question, I'd be spouting off from the top of Dunning-Kruger hill if I said anything, so I'll refrain (my first response is quite likely from the top of the same hill, so take it with a grain of salt).

[NichG]

Never before have I heard there was an infectious phase. If that is so, the most critical covid patients doesn't need to be isolated? We've heard plenty of cases in the news of people who weren't permitted to see their loved ones in their final moments due to corona, was this later shown to be have been unnecessary?

Even if the case was that there's no evolutionary benefit of being benign, would there be one of being more dangerous?

That's why my null model is that lethality is a random walk. I think we've seen one evolutionary step where higher transmission correlated to higher lethality (in delta, where overall viral levels in the host grew faster and peaked much higher than the original strain), and one where they've been anticorrelated (omicron, where the virus seems to have traded increased upper respiratory replication rate for a lower replication rate in the lungs)

We know that other similar viruses can be much more lethal (MERS at 40% CFR), or much less lethal (the various 'colds' include coronaviruses). So I wouldn't rule out significant changes from the current level of lethality in either direction without some more mechanistic reason of why e.g. COVID can't do what MERS does while retaining some other property useful to it.

That said, there might be such limits. MERS has a much higher affinity for replicating in the lungs than COVID does, and its R0 in humans is less than 1 in low density settings, even within-household. So there could be tradeoffs between adapting to grow in tissues from which you can shed a lot of virus and adapting to grow in tissues that cause the host to die. That would be really good news if true.

[Mastikator]

Never before have I heard there was an infectious phase. If that is so, the most critical covid patients doesn't need to be isolated? We've heard plenty of cases in the news of people who weren't permitted to see their loved ones in their final moments due to corona, was this later shown to be have been unnecessary?

Even if the case was that there's no evolutionary benefit of being benign, would there be one of being more dangerous?

There is no evolutionary benefit of being benign. The benefit is of
a) not killing the host and
b) staying infectious as long as possible

But crippled for life is totally fine. New variants of the virus is bad news.

[BaronOfHell]

But if a human gets sufficiently ill he/she isolates. If the severity of the disease is so low that people don't even know they are sick, I'd imagine that generates higher spread, unless isolation has little effect on the spread, in which case I'd wonder why do we have such a high emphasis on isolating ourselves, if we're infected?
Is it the word benign which is wrong, and should I have written asymptomatic in stead?

Also since the omicron strain apparently have escaped the immunity generated after being infected by the delta strain, is the reverse also true, i.e. if one is infected with omicron does it provide immunity against delta, or are the two strains running independently?

[NichG]

But if a human gets sufficiently ill he/she isolates. If the severity of the disease is so low that people don't even know they are sick, I'd imagine that generates higher spread, unless isolation has little effect on the spread, in which case I'd wonder why do we have such a high emphasis on isolating ourselves, if we're infected?
Is it the word benign which is wrong, and should I have written asymptomatic in stead?

It's something like ~50% of transmission events occur before symptoms show, ~50% afterwards. So there could be pressures here. The question is what the tradeoffs are from the virus' point of view, and also what are the dominant pressures in the contexts where the selective timescales are the shortest. For the first point, its something like 'can you reduce symptoms without reducing transmissability?', also considering that now most people have some degree of immune memory so the virus has to ramp up fast enough to transmit before the host's immune system reactivates and wipes it out. So what's the tradeoff there, what are the constraints that the virus is operating under?

For the second point, the issue is that a lot of the variants we're seeing have a ton of mutations already by the time they're circulating widely, which may suggest that they're evolving within a persistent infection within a single host rather than iteratively one mutation at a time in the general population. So if that's the case, stuff which has to do with escaping a host's immune response when that response is too weak to ever fully clear the virus is more likely to be featured. Of course if some variant does crop up within a persistent infection it still needs to be able to beat the other variants at spreading through the general population.

Seems like it would be an interesting multi-level selection problem to model actually. It should give rise to a very skewed distribution of mutations, something like 'for every 1 mutation that helps population-level spread, you'd expect 20 more that are beneficial for becoming more tenacious in the face of a weak immune response'. But I'd want to see what actually happens in a simulated model at least, because it does feel like the sort of thing that could behave counter-intuitively.

Also since the omicron strain apparently have escaped the immunity generated after being infected by the delta strain, is the reverse also true, i.e. if one is infected with omicron does it provide immunity against delta, or are the two strains running independently?

Rather than immunity being a yes/no thing, its more of a degree of protection/shape of infection progress thing, so I think this is all rather nuanced. Early on there were some results that showed that rising omicron levels didn't just add to the curve of delta cases, but were actually pushing the delta growth curve down. That'd suggest at least some degree of cross-immunity (and in fact, some degree of ability to block transmission). Whether that effect is larger or smaller e.g. the cross-immunity between delta and the original strain, the degree to which its cumulative, etc, I'm not sure.

There are a surprising number of short-turnaround omicron reinfections given that the downslope of the omicron surge in South Africa was so steep, which suggests to me that I don't yet understand the actual mechanisms driving the surge on either side. If immunity gained from an omicron infection vs future omicron infection is weak or short-lived, I'd expect multiple waves or a surge but then a high plateau. In SA, there seems to be some plateau but not as high as their delta plateau was. If immunity gained from being infected by omicron is strong, then you wouldn't expect breakthrough infections to be particularly common so soon after the initial wave (where presumably antibody levels are still high). There's some speculation that it's BA.2, but if that's the case I would expect to see a distinct second peak. I'm not seeing that in the SA data at least.

There is a recent huge spike in the UK data, but my understanding is that's because of a recent reclassification of the criteria to consider something a 'case' - previously they weren't actually counting reinfections as separate cases from the initial infection, and that changed starting in February. I'm not seeing secondary peaks in Italy, Germany, France, etc, though the earlier places are in their first omicron surge, the harder it'd be to detect a secondary surge taking place at the same time...

[Tyndmyr]

However, with some permanent shifts in habits (masking indoors when possible, staying home when sick rather than working through it, better ventilation in businesses and schools, increased fraction of remote workers) maybe it would be possible to hit sporadic levels of not a hard zero.

I believe the possibility of any of these is long gone, with the possible exception of remote workers, which is popular for a number of economic and convenience reasons. Staying home while sick is...probably smart in general, not just as a covid mitigation, but we're already back to people returning to work while still popping positive for covid in some cases, which is a great deal less cautious than we previously were. Masks are deeply unpopular, and better ventilation, while probably good, is the sort of capital intensive upgrade that is very difficult to pull off everywhere.

Buildings and HVAC systems are replaced on fairly long timetables, with some extremely old ones still in service, and environmental/efficiency concerns have generally resulted in tighter buildings with less air exchange, not more. You can't just toss great filtration on old units, either, because it murders the throughput, so you end up with way too little capacity.

I don't think oversimplifying and overconfidence in communication has been helpful over the course of this pandemic. Early on we had models coming out of IHME saying 'all we need to do is flatten the curve until June 2020 and COVID will be over' with things like uncertainty regions shrinking to zero in a very reassuring way beyond a certain point (because they fitted a family of functions that wasn't actually capable of representing the possibility that there'd be another wave). And of course that didn't go the way they hoped, and a lot of credibility was lost. Then when the vaccines first became available, the raw data said '90-95% effective', but people were encouraged to see them as a silver bullet - 100% effective, you can stop masking if get your shots and just go back to normal - on the basis of the idea that getting people vaccinated was a greater good than harms arising from the imprecision of the messaging. Then when people started seeing breakthrough cases, when delta slashed the efficacy and omicron slashed it even more, the initial over-promise became a justification to just tune out and not trust anyone.

Indeed. This is a lot of the stuff I was chatting about a couple of pages back. The credibility loss is going to hurt us in other areas, too. Sure, "science" isn't all one thing, but expert credibility is at a low in a number of ways. Look at the lockdowns, which now seem to be accepted to have not had a very significant effect. Science moves, yeah, but when it keeps moving to what the folks denounced as "conspiracy theorists" have been saying, that's absolutely brutal for expert credibility.

So, I anticipate people being rather more skeptical of expert opinion in general. It's hard to quantify how much of an effect this could have, because, hey, the future's an unwritten book, but there are potentially costs there.

Never before have I heard there was an infectious phase. If that is so, the most critical covid patients doesn't need to be isolated? We've heard plenty of cases in the news of people who weren't permitted to see their loved ones in their final moments due to corona, was this later shown to be have been unnecessary?

Even if the case was that there's no evolutionary benefit of being benign, would there be one of being more dangerous?

To the best of my knowledge, symptomatic patients can transmit covid, even quite some time after becoming sick.

There would seem to be some evolutionary advantage to be had in otherwise killed patients remaining alive, and being able to transmit longer, OR in symptoms being so mild that a patient continues to move about without taking precautions.

A great many diseases are infectious for a while before they become lethal, and we still generally see this same pattern in disease spreading.

This is a great deal less true for zoonotic diseases, such as rabies, because in those cases, they are not primarily evolving for spread within humans, but within some other animals, and lethality to us is largely incidental. This is one of the reason that coronaviruses are a problem to begin with. However, once it made the hop, it seems as if the vast majority of transmission is human to human rather than through an intermediary, so we should probably expect the same pattern so long as this holds true.

However, we probably do need to rethink how we approach zoonotic threats to begin with. The next coronavirus to hop over could also be quite lethal for this same reason. The advisability of doing research on potentially incredibly dangerous strains within major population centers is...well, there's a risk there. Particularly if you get into gain of function research, etc. Covid-19 is, at this point, not something we can put back in the box. But we might be able to mitigate risk for the next big thing.

But if a human gets sufficiently ill he/she isolates. If the severity of the disease is so low that people don't even know they are sick, I'd imagine that generates higher spread, unless isolation has little effect on the spread, in which case I'd wonder why do we have such a high emphasis on isolating ourselves, if we're infected?
Is it the word benign which is wrong, and should I have written asymptomatic in stead?

Asymptomatic is perhaps better, but I get what you're going for. Mild cases which are still spreadable, but not incapacitating. Most diseases are not going to be completely asymptomatic, because things like sneezing and coughing are helpful for spreading, so I wouldn't expect those features to vanish. Something's only going to be selected against if the deaths/isolation loss of infection are higher than any gain the feature provides. Covid probably won't become entirely asymptomatic or benign, but it will, over the long term, become generally less lethal.

Note the "over the long term". We could totally have another wave, or some variant could turn out to have some exceptional threat to a group other than the one it developed in. Predicting the short term is difficult, even for people with far more domain knowledge than I have.

Also since the omicron strain apparently have escaped the immunity generated after being infected by the delta strain, is the reverse also true, i.e. if one is infected with omicron does it provide immunity against delta, or are the two strains running independently?

Vaccine immunity isn't necessarily the same as natural immunity. The vaccines were developed against the OG variety, and focused entirely on the spike protein....which changed in the variants, extensively in the case of Omicron. Natural immunity tends to pretty randomly select what parts to react to, so two different antibodies created by the same disease are not necessarily identical.

So, there's probably some overlap for natural immunity, but not 100%. How much is a question that would require an awful lot of work to sort out. Delta is supposedly still circulating in non-trivial amounts, though older variants are getting somewhat rare. You can sorta squint and make some back of the envelope calculations based on that, and Omicron is likely contributing to the death of older variants, but it would be very difficult to extrapolate that to future variants.

[NichG]

I believe the possibility of any of these is long gone, with the possible exception of remote workers, which is popular for a number of economic and convenience reasons. Staying home while sick is...probably smart in general, not just as a covid mitigation, but we're already back to people returning to work while still popping positive for covid in some cases, which is a great deal less cautious than we previously were. Masks are deeply unpopular, and better ventilation, while probably good, is the sort of capital intensive upgrade that is very difficult to pull off everywhere.

Buildings and HVAC systems are replaced on fairly long timetables, with some extremely old ones still in service, and environmental/efficiency concerns have generally resulted in tighter buildings with less air exchange, not more. You can't just toss great filtration on old units, either, because it murders the throughput, so you end up with way too little capacity.

There's a saying that being poor is expensive, because you don't spend the moderate amounts that save you large amounts in the long run.

COVID has and will cost businesses an order of magnitude more than it'd cost to upgrade HVAC, much less just keep the windows open and pay more for heating.

I don't think you're wrong that people won't do it. Rather I suspect people will keep being stubborn and we'll just keep racking up preventable economic damages and quality of life damages while all the while saying we're doing it for sake of quality of life and the economy.

I wouldn't be surprised if access to COVID-safe conditions becomes a wealth and status thing. Big tech companies can advertise it as the same kind of perk as having an exercise room in the office or catered lunches. Wealthier neighborhoods can redo the HVAC of their schools and make back the investment in what that does for property values, etc. Why care about spending $10k for each family to do the school renovations when it means that everyone's house will sell for $100k more down the line, etc. 'We require businesses in our shopping center to send sick employees home for your safety' justifies raising the prices a bit, like organic labels or health-centric grocery stores, etc.

[farothel]

There's a saying that being poor is expensive, because you don't spend the moderate amounts that save you large amounts in the long run.

COVID has and will cost businesses an order of magnitude more than it'd cost to upgrade HVAC, much less just keep the windows open and pay more for heating.

I don't think you're wrong that people won't do it. Rather I suspect people will keep being stubborn and we'll just keep racking up preventable economic damages and quality of life damages while all the while saying we're doing it for sake of quality of life and the economy.

I wouldn't be surprised if access to COVID-safe conditions becomes a wealth and status thing. Big tech companies can advertise it as the same kind of perk as having an exercise room in the office or catered lunches. Wealthier neighborhoods can redo the HVAC of their schools and make back the investment in what that does for property values, etc. Why care about spending $10k for each family to do the school renovations when it means that everyone's house will sell for $100k more down the line, etc. 'We require businesses in our shopping center to send sick employees home for your safety' justifies raising the prices a bit, like organic labels or health-centric grocery stores, etc.

Hopefully they will put some of these things as requirements in the building code (or whatever it's called in your country), even if it's only for new buildings and extensive renovations.

[NichG]

Hopefully they will put some of these things as requirements in the building code (or whatever it's called in your country), even if it's only for new buildings and extensive renovations.

Yeah, that'd be good. Fingers crossed. Even just something like requiring CO2 monitors the same way fire alarms are required would be pretty cheap, and would give feedback as to the effectiveness of various low-tech ventilation solutions like the aforementioned open windows.

[Aedilred]

Vaccines didn't defang omicron, evolution did. A virus that doesn't kill its host is more viable than one that does. That may sound like good news to people who aren't looking at one giant heaping elephant in the room called post covid. Because while omicron isn't more deadly than delta post covid is still debilitating and if more people get omicron then more people are debilitated by post covid.

One thing that worries me is talk of covid becoming endemic and "then things will go back to normal", except they won't, we will just get used to everyone being debilitated by post covid. This is already stopping people from functioning, from performing their jobs, this is slowly tearing society apart. The future is looking bleaker and bleaker.

It's not "everyone being debilitated by post-covid" though, any more than the first bouts of covid killed everyone. Long covid and permanent side effects are still relatively poorly understood (given the novelty of the disease, this is not surprising, since there hasn't been time for the long-term effects to be fully seen) but they still affect a minority of people.

It is always worth trying to retain some perspective. Back at the start of this there were those of us on these threads who postulated that the mortality rate seemed to be around 1-2% and were shot down with claims that it was much higher and that would emerge in time. Nearly two years later, the "official" mortality rate stands at... 1.5%. Excess deaths are higher, and would suggest a mortality rate of around 5.3%, but that is also unsatisfactory for various reasons: that may be the truer death toll of the pandemic but that includes, along with a whole host of other things, pandemic responses as well as the pandemic itself, so doesn't reflect the actual dangerousness of the virus. The majority of people who catch it will, after the (themselves mild) acute symptoms wear off, be fine.

It is not and never has been something that needs to induce terror at a personal level unless you are particularly at-risk due to personal circumstances. This may run counter to some of the messaging over the last two years (although I gather that that messaging has varied widely) because the individual dangerousness of the disease may have been exaggerated to encourage compliance with public health measures instituted largely for the public (rather than personal) good. Balancing that public perception back up is going to be an interesting exercise.

The majority of people who catch covid are still fine in the long run. People getting covid and being debilitated in the long term is bad, both for them, and for society in general. But it is something to be dealt with in the same way as any other chonic public health concern, and does not need to cause the same level of distress and public disruption as the peaks of the crisis when covid is or has been a principally acute concern.

Covid is not going away and we need (collectively) to stop thinking that it might, to the extent anyone still does. But it is possible, indeed, in due course, likely, that it recedes in importance to the point where it is no longer any greater a health concern - either public or private - than the flu. If this experience has led everyone to conclude that we need to improve public health anyway, and we can and should reduce the impact of flu below where it was in November 2019 by investing more in infrastructure, institutions, education, etc. then, well, hooray. But we will - in probably not all that long - reach the point where the overall personal risk of behaving like we did in November 2019 is no longer any higher than it was in November 2019, notwithstanding that one of the bugs out there to catch is covid.

[Squire Doodad]

It's not "everyone being debilitated by post-covid" though, any more than the first bouts of covid killed everyone. Long covid and permanent side effects are still relatively poorly understood (given the novelty of the disease, this is not surprising, since there hasn't been time for the long-term effects to be fully seen) but they still affect a minority of people.

It is always worth trying to retain some perspective. Back at the start of this there were those of us on these threads who postulated that the mortality rate seemed to be around 1-2% and were shot down with claims that it was much higher and that would emerge in time. Nearly two years later, the "official" mortality rate stands at... 1.5%. Excess deaths are higher, and would suggest a mortality rate of around 5.3%, but that is also unsatisfactory for various reasons: that may be the truer death toll of the pandemic but that includes, along with a whole host of other things, pandemic responses as well as the pandemic itself, so doesn't reflect the actual dangerousness of the virus. The majority of people who catch it will, after the (themselves mild) acute symptoms wear off, be fine.

You appear to be not accounting for vaccines. The death rate is being counterbalanced by the vaccination rate. Furthermore, 1) Omicron thus far has had a lower fatality rate and 2) there's still a LOT of people dying. The flu kills a fraction of the amount COVID does.
If I remember correctly, during much of 2020 the recorded death rate was in the vicinity of 3%, with potential that estimates were being severely undercounted due to issues with insufficient tests available and overworked coroners and medical officials. Given the sheer amount of cases and the strain on the medical system, Omicron is very likely to have innumerable deaths being missed, even if the fatality rate is lower overall than Delta.

Also, "mild symptoms" are being used in a more...clinical sense, so to speak, not a mainstream sense. In the same way that "decent" means something completely different to Pokemon fans than to literary professors, "mild" does not mean "take a day or two off from work with rough cough".
And again, we may not know what the long-long term side effects are - Long COVID may turn out to fade in 0.5-4 years, but that's still both years of people being disabled as well as terrible in general.

Talking about how most people will have mild symptoms wholly disregards that COVID kills way more people than the flu (more than 1.5 times with your most conservative estimate of 1.5%), the impact of a disability should that happen, and that waves of people getting ill will also make it agonizingly difficult for other people to receive the care they need.

====

that may be the truer death toll of the pandemic but that includes, along with a whole host of other things, pandemic responses as well as the pandemic itself, so doesn't reflect the actual dangerousness of the virus. The majority of people who catch it will, after the (themselves mild) acute symptoms wear off, be fine.

I have absolutely no clue what you are referring to here. If someone dies because they're experiencing liver failure and no one has the resources to help them, they are not dying of COVID. It is wholly unrelated to COVID as an ailment, but it is related to COVID vis a vis being a pandemic with socioeconomic repercussions.

If anything, people suffering as a result of these socioeconomic consequences underscores the importance of stopping COVID.

[Aedilred]

I have absolutely no clue what you are referring to here. If someone dies because they're experiencing liver failure and no one has the resources to help them, they are not dying of COVID. It is wholly unrelated to COVID as an ailment, but it is related to COVID vis a vis being a pandemic with socioeconomic repercussions.

If anything, people suffering as a result of these socioeconomic consequences underscores the importance of stopping COVID.

It doesn't work as a mortality rate against covid cases because many of those deaths will be people who never contracted the virus. There is, of course, a wide margin of error on both the official death rate (since not all deaths are recorded, different jurisdictions assess cause of death differently, so deaths will be either over- or under-reported from place to place) and the number of confirmed cases (the latter probably an underestimate, since lack of testing capacity has been more of an issue than false positives). But if we take all the figures at face value, then since the start of the pandemic there are global excess deaths of around 24.3 million of which Covid directly accounts for 5.7 million - leading to the obvious conclusion that the cure has been significantly worse than the disease.

It is of course more complicated than that. But the argument you make above can nevertheless become dangerously circular:
1. We need to do something about covid
2. We must introduce measures to prevent its spread
3. The combination of these measures and covid is doing a lot of socioeconomic harm
4. We need to make the counter-covid measures more severe to put a stop to covid

The severity of the restrictions and the damage caused becomes self-justifying, because sight has been lost of the actual reason for taking them in the first place - which is not that covid exists, but that covid is dangerous.

And while the underlying intention - to eliminate covid altogether - is good, it's also at this point wishful thinking. Covid has spread to every country on the planet and it's ridiculously infectious. No country has maintained a successful zero-covid policy for any length of time. Getting rid of it for good is just not a practical option and putting all our chips on that number would be a terrible bet. We have, as a species, eradicated a specific human-borne disease before - once. It was less infectious than Covid, and it took decades*.

The best we can realistically hope for is that with vaccines, natural immunity, and the virus's own mutations, we reach an equilibrium where it is tolerable as part of the background noise. That will require a degree of readjustment in public perception, though, from the idea that Covid is something of which we should universally be terrified.


*Really, centuries, but at least this time we don't have to come up with the whole schools of virology and vaccination from scratch before we're able to do anything about it.

[Mastikator]

It is of course more complicated than that. But the argument you make above can nevertheless become dangerously circular:
1. We need to do something about covid
2. We must introduce measures to prevent its spread
3. The combination of these measures and covid is doing a lot of socioeconomic harm
4. We need to make the counter-covid measures more severe to put a stop to covid

The socio economic effects of covid are far worse than the socio economic effects of anti-covid measures. Furthermore anti-covid measures are a one-time cost assuming it succeeds, whereas the socio economic effects of covid are ongoing and ever increasing.

IMO I think the ship has sailed for eliminating covid, we could've done it in 2021 but we stupidly chose not to and now we must live with this turd in our collective beds for the rest of our lives. The idea that covid will become more bearable in the future is utter nonsense, it may be less deadly but a disease can weaken you for life and spread just fine (if not better). A disease that turn healthy people into a weakened form that can't work and become a burden on society is actually worse than a disease that just kills you. Not to mention that in this case it's one of the most contagious diseases of all of human history, if covid was even remotely as deadly the plague it would've eradicated us by now.

[pendell]

Indeed. This is a lot of the stuff I was chatting about a couple of pages back. The credibility loss is going to hurt us in other areas, too. Sure, "science" isn't all one thing, but expert credibility is at a low in a number of ways. Look at the lockdowns, which now seem to be accepted to have not had a very significant effect. Science moves, yeah, but when it keeps moving to what the folks denounced as "conspiracy theorists" have been saying, that's absolutely brutal for expert credibility.

While the Hopkins study is something I would like to believe, because it meshes with my own preconceptions, I have to point out that snopes called this out .

The first thing we noticed when we examined the actual study, not the media reports covering the study, was that this was a “working paper” by a group of economists, not epidemiologists. A working paper typically refers to a pre-publication study that has not yet undergone a scientific peer-review process. The authors state as much in a brief description at the top of the study

...

This opening paragraph contains one other important detail. This study was not endorsed by Johns Hopkins University. While many media outlets presented this working paper as if it was a “Johns Hopkins study,” this report would be more accurately described as a non-peer-reviewed working paper by three economists, one of whom is an economics professor at Johns Hopkins University.

Furthermore, the National Post noted that this paper did not come from Johns Hopkins University’s Coronavirus Resource Center. Rather, it comes from the university’s unaffiliated Krieger School of Arts and Sciences

So, again, while this is something I would like to believe, I think I have to dismiss this paper as a, ah, non-scientific talking point. I don't think we can accept it as the consensus of the scientific community, even of that community which works at John Hopkins.

Just because it jibes with my preconceptions doesn't mean I can accept it as valid; the world is not as I would wish. If it was, Firefly would have had a second season!

Second observation: Someone mentioned being crippled for life. In point of fact , I myself experienced that very thing in elementary school. For reasons unknown, when I moved from Las Vegas to Los Angeles, I developed crippling asthma -- like, I can't run for more than about two minutes before falling down gasping for breath -- and it has never fully gone away. That permanently ended my dreams both of an active-duty military career and of eventually becoming an astronaut. In the more immediate term, it make my life a living hell in the schools I went to, where football stars were as gods and "wimps" were heavily looked down upon. It's caused problems at work, when we had a fitness buff for a boss who 'invited' the team out to a marathon and I had to watch from the sidelines. I wasn't allowed in the picture afterwards, because I wasn't a participant.

I still carry an inhaler for attacks. The only reason I don't experience them is because I walk for exercise, or swim, or do anything besides heavy activity on land which would require large lungfuls of air and consequently gasping on the ground.

Yet ... life goes on.

Since I knew I couldn't make a living as an athlete or any job which required oxygen, I poured myself into intellectual studies. I had to take calculus three times before I passed it. Eventually, I found work as a software engineer, as a defense contractor, in the hospitality industry, in education. I've been successful in the field I "chose", meaning those fields which were actually available. I've even been able to go on archaeological expeditions for my university, since digging doesn't require running.

I'm not saying crippled for life is an easy thing to deal with. It's not. But it's not the end of life either. We pick ourselves up, we make the most of the cards we do have in our hand and play them to the best of our ability. Some people don't even get a pair in the five card draw that is life -- but even no pair can be a winning hand if you've got the skill at bluff.

My role model is Darth Vader. Can't walk unassisted, can't move unassisted, can't live outside his lung for five minutes .. but no one treats him with pity and he's effective in his chosen field. I'm surprised he's not a mascot for the special olympics!

Respectfully,

Brian P.