COVID, entering the end game as an endemic disease
COVID is going to be endemic. To have a sense of what that is like think: the common cold, flu and measles.
In part this is because of vaccine hesitancy and higher virulence of new COVID strains
This means in any 5 year period the chances of avoiding COVID is close to zero even if vaccinated. (You may well not have symptoms though).
Vaccination will make COVID infection for the vast majority like the common cold
But, significant groups eg elderly, immune compromised, diabetic etc. Will continue to have elevated mortality risk and even a minority of healthy individuals will die.
There will be long-term impairment from Long COVID. After effects of severe COVID infections that will place a minority of people in cognitive decline with “brain fog”. It’s uncertain if this will reverse as some suggestion we might have treatments that work (including vaccines themselves). See Lancet paper link end
Masks may have some defence against super spreading events and some indoor transmission, but over a 5 year period will not prevent inevitable infection. Part of their use would be indoors to protect unvaccinated or immune compromised.
Near term, the range of plausible outcomes in the UK in the next 4 to 8 weeks ranges from mortality/hospitalisation wave overwhelms hospitals to the wave is manageable. Vaccines have impaired the link between infection and mortality, but unclear if it will be enough. Very reasonable assumptions can see both scenarios. (I currently believe most regions will fall under manageable but some local areas with lower vaccinations may be very stressed cf. Missouri in US, Ed Yong article for Atlantic - links at end. I weight my belief about 60% and base it on looking at the Warwick models, the Imperial models and the work of James Ward (links at end). Anyone who has tried scenario modelling can see from these models that very small changes in assumptions are leading to very different outcomes. Also, that local factors will diverge greatly from national averages.)
If my outlook is correct this has implications on personal levels and medium term “new normal” living.
Boosters or regular vaccines (like flu) will be annual ( prelim Israel data is suggesting waning protection maybe after 6-12 months) events
if you are immune compromised you may want to consider asking for triple or quadruple boosters to try and ensure a response and if you are able to track t-cell memory or a more comprehensive protection test then do so.
Long COVID disease will have to be dealt with
a structural larger burden on healthcare systems is here to stay
mental health resilience and related challenges will need addressing
certain low friction public health measures eg masks indoors, might remain in some form
And so, overall as second order effects
-new ways of working are here to stay in some form
-the value of giving people in person meetings will rise
(And so my November post last year has held up well, except that the lab leak hypothesis is now maybe 50/50, IMO and also my list of 58 items that COVID will affect
Further general observations and notes:
Rich countries have not in particular helped poor countries very much. Some rich countries are even letting vaccines expire rather than sending abroad. (Note even recently expired vaccines probably work). This does not bode well fo other international co-operation challenges eg climate.
Vaccine hesitancy is not well understood by many. The vaccine hesitant are a mixed group of people often vulnerable, and there is certain analogy eg with remain vs brexit. Many remainers/vaccinated look down on brexiteers/anti-vaxxers without understanding the valid fears many in this group has. Sure there are some crazies but it’s not everyone. And even the vaccinated have a right to fear side effects, even if extremely low risk. Again, see Ed Yong in Atlantic, link end.
There is much we do not know and may never know. I was struck by an expert epidemiologist back in March 2020 telling me at a conference that we really don’t understand the patterns of many previous epidemics eg Spanish flu, Swine flu. And for instance, no single factor, nor any easy combination of 2 or 3 factors can explain how the virus has impacted India. There is a complex interaction between genetics, age, health, gender (and factors like them) and immune cross-protection (eg previous colds), strains, and super-spreaders etc. We don’t know why males are impacted more, why children are impacted less. etc.
It is mostly not in the remit for those in public to have the humility of being able to express “not knowing” and maybe the general public indeed favour certainty over uncertainty. Perhaps those who study and forecast complex systems like the weather or financial markets have an edge in that we know we often do not know. In any case, I am comfortable to say that is much we don’t know and won’t know.
And so, my overall conclusion is that this does likely end in….within the next year either you get the vaccine or you get the virus. And eventually you will get the virus any way… but without the vaccine your chance of a bad outcome (death, hospital, long COVID) is 10x to 100x worse.
Links:
At the complexity of COVID factors.
58 predictions of how life might change:
https://www.thendobetter.com/investing/2020/4/24/58-covid-predictions-over-the-long-term
James Ward is a mathematician and runs SEIR personal models. His Twitter threads are good.
https://twitter.com/JamesWard73
I base my view on his models as well as Warwick and Imperial. The easiest way to get to Warwick and Imperial are via the UK govt SAGE papers: https://www.gov.uk/government/collections/scientific-evidence-supporting-the-government-response-to-coronavirus-covid-19#history
If you track the models for a while, you can see why the high estimates occur in Warwick and Imperial.
The Ed Yong story and science reporting is consistently very strong and human. https://www.theatlantic.com/author/ed-yong/
Lancet paper on cognitive impairments of Long COVID: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00324-2/fulltext#seccesectitle0013