How does COVID "end"?

So far we had initial waves of COVID, and a significant up-ramping as the delta variant took hold. Now the omicron variant is out, and looking very scary. If it's really considerably more transmissible and also somewhat-to-very successful at evading immunity—both ifs—things have changed again. And if omicron turns out to be a dud, some future variant will not.

So, what now? What put on your prophecy hat—what do things look like a year from now? What do they look like five, ten or fifty years from now?

I feels to me like we are in an insoluble problem. We have:

1. A highly contagious respiratory virus.
2. An interconnected world.
3. First-world populations that contain a hard core of vaccine resisters.
4. Second- and third-world populations that have yet to receive full vaccine protections, and with resisters in them too (e.g., South Africa).
5. Widespread virus fatigue, with mask and social distancing increasingly ignored. Political movements in many countries that seek to minimize the risk and forestall concerted social action.
6. A virus that kills and injures mostly unvaccinated people—at least for now—but which can spread among vaccinated populations too.
7. A virus that, when you get it, impacts only temporary protection, so we're not going to get to an effective, lasting herd immunity, ever.
8. A pattern of "cooking" inside of immunodeficient individuals, producing significant variants over time. No matter what you do, these people will exist.
9. No ability to erade the virus entirely. Not only are we not going to be able to eradicate it in people, but infection has spread to a large number of other mamals. For example, COVID is already widespread in deer populations (source: https://www.npr.org/sections/goatsandsoda/2021/11/10/1054224204/how-sars-cov-2-i...
10. A virus that doesn't kill most people—so will not suffer significant evolutionary pressure to weaken—but which kills some and injures many others.

How does this "end"? Have we ever faced anything like this?

2. Not just an interconnected world, the largest human population ever.

Have we ever faced anything like this? Measles is thought to have jumped from cattle to humans early in their domestication, is airborne & very contagious, and it has lingering effects in addition to its acute phase. Like many zoonoses, measles is thought to have been most virulent in the beginning.

I think our young people will grow up more or less resistant to COVID-19, having been exposed to the virus and fortified by vaccines. More risk to older people whose immune response diminishes as we get on, but the new pills and other therapeutics may rescue individuals among us.

Eventually, SARS-CoV-2 disease will be at best like the Human Coronavirus (HCV) we live with as ~20% of our colds, and at worst like seasonal flu, which can be a significant killer some years. At best we will organize ourselves to bring this phase of COVID-19 pandemic to earlier close, but at worst much of the world will limp along for decade(s)...

This wasn't the first zoonosis, and it won't be the last. Unless we manage to knock the human population down to isolated bands (global warming...), it won't be the last pandemic, either...

I hope far more attention will be paid to ventilation and vaccine development in future, and that there will be fewer seasonal viruses making rounds as a result.

>1 timspalding:

My hope would be that gradually common sense will prevail and more and more people will get vaccinated.

>2 margd: Have we ever faced anything like this?

Well, yes. Didn't the 1918 influenza pandemic last for more than two years and kill tens of millions of people?

>1 timspalding: The disease itself is the least of the issues. It's the ongoing spanner in the works of our hopelessly complex and brittle world systems that will have historic repercussions, and the long-term political fallout is looking bleak. I'm pulling out all the stops to get my mother the documents she needs to apply for her Irish citizenship by descent, if that says anything to you. Unfortunately, due to certain oversights in the 1940s and the 1980s, that won't be transmissible to me.

This could go on for years and years. If there's a silver lining it's not just in the further development of vaccines but in other drugs being developed to knock down the most adverse effects of the virus if someone does get it---the monoclonal antibodies that are already here and the Merck and Pfizer pills that are expected to come out soon. It's the question of can science research and develop us out of this mess?

We are going to need much better outreach to those second and third world nations that are not getting enough vaccine coverage.

As far as the vaccine resisters I'm sorry but there's no way I'm reaching across to them. I am immune compromised and don't want to go anywhere near anyone who refuses to vaccinate and it doesn't matter whether they're family or not. They're out if that's the way they feel.

I'd argue for vaccine passports everywhere.

>5 lriley: I'm with you, Larry. Unfortunately not politically feasible in large parts of the US, and politically tumultuous to various degrees everywhere. It's the right policy, but implementing it has costs (granted, largely on account of idiocy, but real costs nonetheless).

Trying to arrange my third Pfizer shot Monday here in Zadar so I have a few days for it to settle in before I depart the country. Fingers crossed I get someone who speaks English on the phone.

>6 davidgn: Between the cancer, the chemo drugs and the autologous stem cell bone marrow transplant my immunity completely tanked. I am in complete remission but the caveat to that is multiple myeloma is considered not curable and is always expected to come back. In the meantime at 6 months post transplant I got these vaccines--polio, Heperix, Hep B, pneumococcal and Dtap. In February I'm to got boosters for all of them. In April I'll be eligible for a second covid booster. I've had 5 Pfizer shots already. There will be more boosters for all of the above for the next two years and MMR at the end of the two year period.

For me right now any kind of public transportation is not happening. Going into restaurants, arenas, grocery stores, shopping malls, movie theaters, gyms or other common public places is just not going to happen either. The cancer is one battle to fight. I don't need two and I don't want to be going back into the hospital anytime soon. As well I'm in a post transplant clinical trial and getting covid would probably kibosh all that.

Myeloma is serious enough. Because of it I fractured my L-5 vertebra in December last year. I'm still kind of getting over that and do not ever want to do anything like that again. I can walk and move around again but a lot of that was baby steps to get to where I am now and throw in the transplant in between. I can tell my unvaccinated sister about it but it's really a waste of time. She can't seem to wrap her head around all that and all her bullshit freedom issues is what matters more to her.

>7 lriley: It's like an addiction--no off-ramp for most anti-vaxxers. And even for "Christian" anti-vaxxers, no concern for impact of their decisions on others, whether vulnerable to COVID or simply in need of medical treatment. Here in Michigan, there are eight hospitals at 100% capacity and the feds have sent in two teams of healthcare workers to prop up two of our hospitals. Think what it will be like after Thanksgiving...and Christmas...and Omicron.

I bet next to no anti-vaxxers, much less the domestic and foreign purveyors of mis- and disinformation, will feel a twinge of conscience for all this suffering.

>5 lriley: I'd argue for vaccine passports everywhere

Me too. I've actually had one for 45 years, and I'm unable to travel internationally without it - it's for the yellow fever vaccination. When I first started travelling in Africa you also needed a second vaccine passport, this one for the cholera vaccination, but that requirement was eventually dropped. Vaccine passports are not a new thing and I don't understand the resistance to them. Same for resistance to the vaccines themselves. Apart from yellow fever and cholera, I'm regularly vaccinated against tetanus, polio, hepatitis, typhoid, rabies and ordinary 'flu - and now COVID.

>7 lriley: my unvaccinated sister

I'm really sorry to hear about your immunodeficient situation. I have an elder sister who is a cancer survivor and her immune system is also shot to pieces, so she has to be very careful like yourself. Fortunately we have no close family members who are not vaccinated, and if we had, my sister would have no qualms about telling them they're not to come and visit her.

Your example of your unvaccinated sister shows how ludicrous the "freedom" narrative is. Freedom for what? Freedom to put your own brother's life at risk?

>8 margd: so much of this is preventable. It’s really a tragedy that people turn a health crisis into a political debate and are so willing to sacrifice lives (maybe even their own) over all kinds of arbitrary ideas about what ‘freedom’ means to them.

>9 John5918: it does anger me. She has a lot of political resentment and she believes or has decided to believe a lot of the misinformation currently out and about and the goalposts for her are continually moving. I do wonder if Trump had pulled off his coup and these vaccines were out under his administration her and her husband would have vaccinated. I think that is very possible if only because a lot of right wing media would follow wherever Trump decided to lead them.

I don't think that there's an "end" to covid. We are coming to an accommodation with it, just as we have with other viruses, and we'll get on. What that accommodation will look like will largely depend on local populations' ability and willingness to avail themselves of effective vaccines. Well-vaccinated populations will enjoy relatively high levels of "normality", as we're enjoying now in the Boston area. Populations with high levels of vaccine resistance will suffer and die en masse.

>8 margd: And even for "Christian" anti-vaxxers, no concern for impact of their decisions on others, whether vulnerable to COVID or simply in need of medical treatment

I see this as a predictable result of generations of the cult of American individualism. At least since the end of the second world war, we've been indoctrinated in the strange and indefensible notion that our actions affect only ourselves, that we are responsible entirely and only for our own outcomes, that concern for others in our communities is either laudable or foolish but always a distant second in importance to concern for ourselves. Americans have imbibed this stuff for their entire lives. No wonder people find it hard to conceive of their actions as having impacts on others. This sociopathic conditioning is much deeper in these people than their religious beliefs. Most people are at least able to conceive of their religious beliefs as the sort of thing that can be true or false. The individualistic sociopathy is something deeper, it's never even questioned.

>5 lriley: >7 lriley:

I am very sorry to hear of your situation, and I am angry beyond words that your health is in danger from so many irresponsible people. You have my thoughts/prayers/whatevers for your continued health.

I think our young people will grow up more or less resistant to COVID-19, having been exposed to the virus and fortified by vaccines.

I'm not qualified to talk about this with any authority, but my belief is that exposure does not confer lasting immunity. As for genetic immunity, that's takes generations for people with a fitness advantage to out-breed people without it. So I don't see how our children will be more resistant--except, as you say, by vaccines.

Eventually, SARS-CoV-2 disease will be at best like the Human Coronavirus (HCV) we live with as ~20% of our colds…

Viruses weaking is real, but does it apply in situations like this? Again, I have no idea, but isn't this a response to evolutionary pressure? I can understand why something truly deadly might grow less so, as people with less severe forms of the disease don't die, and therefore pass it onto more people. Any weakening that also increases spread would also be advantageous. But so far I don't think we've seen that. On the contrary, we've seen the opposite--variants that spread better.

Can we expect this to change?

My hope would be that gradually common sense will prevail and more and more people will get vaccinated.

No, I agree, obviously. But it's a hope. Some level of refusal seems inevitable, and even with very high vaccination, it appears the virus can continue to spread. So I'm not sure this will solve things.

FWIW, Morality

The morality is clear. The virus lives today and kills today because it was in someone else yesterday. We all have a moral duty to avoid being part of that chain of death. If we don't do what we can to avoid catching COVID, and passing it on to others, we take on a share of responsibility for the deaths that follow. Just because people generally never know whom they killed makes it easier to ignore the moral issue, but is no excuse. You don't go throwing rocks off tall buildings, even if you never find out who you killed.

Anyway, I know people who took stupid risks. Who decided they were done, and didn't care if they caught it. Who lied about their vaccine status and got family members sick. And I know people who went places and took flights although they knew they were infected. I find it hard to respect them, or continue to have a relationship with them, particularly as such people rarely admit they did anything wrong.

As for the vaccine refusers and deniers, who put their families and communities at risk, and spread conspiracy theories and other bullshit far and wide, well, I'm shocked and disgusted at them. Even, or especially, if some belong to my religion, or are relations.

>13 timspalding: Even, or especially, if some belong to my religion

And just for the record, the religion which you and I share has made it quite clear that it sees no religious reason for refusing to be vaccinated. On the contrary, church leaders at the highest level, from the pope and the retired pope down through the bishops have set a public example of being vaccinated. One of the key principles of Catholic Social Teaching is the imperative for the "common good", and getting vaccinated to protect others (not simply to protect oneself) is a very obvious case in point.

>14 John5918:

Oh, I know, I know. But on the ground in the US, it's a shit-show. Most conservative Catholics are solidly in the Republican minimalist orbit, with trads going full into denialism and conspiracy theory. Abortion nonsense is rife. Bishops are split, but few are willing to stand up for their flocks. In my own world, my trad-leaning pastor won't encourage vaccinations or mask wearing from the pulpit, and doesn't seem to understand or care about ventilation. A number of parishioners have stopped going to a church with buttoned-up windows and 50% mask refusal—a rate that is particularly high among our African parishioners, I'm sorry to say. It's a giant pastoral disaster and a vicious counter-witness to the Gospel. Maine, meanwhile, is at a state-wide high in cases and hospitalizations.

>7 lriley: So glad to hear you're in remission, Larry. The last thing you need is people close to you who act so irresponsibly. Do everything you need to to take care of yourself.

I'm afraid if Omicron requires a new vaccine (which is looking like a yes), uptake is likely to deteriorate rather than the opposite.
My own depressing reading (now two days out of date, but that's not enough to change much)
https://www.nakedcapitalism.com/2021/11/probable-vaccine-escaping-covid-variant-...

Consider GM’s cheery advice (emphasis his):

Consider yourself fully unvaccinated from now on and go back to March 2020 precautions.

What happens when the great unwashed public works out that that is where they are, that their vaccine-conferred immunity is kaput even sooner than they expected, and regular boosting with the current vaccines may protect them against Delta, but not against B.1.1.529? What is going to be their appetite for taking two Covid vaccines and then their frequently boosters, even assuming that that a new mRNA vaccine can be developed rapidly? Remember that we already have riots in Europe right now the vaccine passports and lockdowns. What happens when you tell the vaccinated that they are no longer vaccinated at all? GM again:

Even the more formally educated true believers who have decided that it is all over because they got vaccinated don’t really understand anything about Class I/II/III neutralizing antibodies, NTD and RBD, what the Q493K+Q498R combination means, etc. stuff that is hidden in obscure papers that were never given the publicity of the “T cells give you lifetime protection” headlines.

Compliance will not be be there for more serious lockdowns, you can’t unring that bell…

Remember, as things appear now, B.1.1.529 is so different that it might not displace Delta but co-exist with it, meaning we may now have two pandemics underway.

And for the new one, minimal vaccine testing, for antibody response and then a new round of Emergency Use Authorizations, and then distribution, will easily take six months and longer is more likely. So the prospect of lockdowns is not crazy talk.

Now the one possible silver lining to this cloud may be that B.1.1.529 winds up being less lethal and/or generates less morbidity than recent variants. But we can’t pin our hopes on a lucky break.

Managed to get my booster today. Actually, moving everything forward on an emergency basis to get where I need to be before borders start closing again (which for now happens to be the British Isles). Wish I could accelerate more, but experience tells me the next 24 hours are going to be a loss. All my best to you, Larry, and to everyone else as you batten down the hatches.

>13 timspalding: "I don't see how our children will be more resistant--except...by vaccines"

My grasp of immunology is shaky, indeed, but I'm thinking that a child exposed to SARS-CoV-2 infection and/or vaccine(?) may be less likely to over-respond as an adult--and it's that cytokine storm that is killing many of us COVID-naive oldsters. Cross-posted from COVID thread:

A. Katharina Simon et al. 2015. Evolution of the immune system in humans from infancy to old age. Proc Biol Sci. 2015 Dec 22; 282(1821): 20143085. doi: 10.1098/rspb.2014.3085 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707740/

...Critical early protection against many infectious diseases previously experienced by the mother is given by the passive IgG antibody transferred from the mother transplacentally and in milk. Once that fades away, young children become more vulnerable to infections, though by then better armed with the maturing innate and adaptive immune systems. The risks are now much reduced by vaccinations, which stimulate protective immune responses in the maturing immune system. Nevertheless, children may still acquire viral, bacterial and parasitic infections that have to be fought off and controlled by immune responses. Besides promoting recovery, such antigen stimulation results in immunological memory ... Thus, over time, protection provided by the immune response increases, and young adults suffer fewer infections. This accumulation of immunological memory is an evolving feature of the adaptive immune response. The memory persists into old age ... but then may fade...

https://www.mediaite.com/tv/watch-stephen-miller-absurdly-claims-if-trump-were-p...
WATCH: Stephen Miller Absurdly Claims If Trump Were Still President ‘We Would Already Have Modified Vaccines’ For New Omicron Variant

Sadly, many GOPers appear to be on a mission to decrease the human-race numbers instead of ending Covid. They are turning working stiffs into stiffs. To them blue-collar workers are all just interchangeable cogs in the nation's economic engine.

And, some gal out there chose this loon to be the father of her children. That makes her a party in a child-endangerment scenario in my mind.

I do appreciate all the good wishes. For me the cancer battle needs to be my primary focus but at the same time I need to be careful about the situations I place myself in and cut down as much as possible on the odds of getting the Covid virus. Again that means avoiding public spaces. There are no guarantees though.

Several million dead worldwide. Around 800,000 of them in the United States and people want to go back to normal when normal isn’t here yet. At the same time we’re losing people in the medical field in droves from burnout.

There are a lot of young people who don’t believe there is any danger for them—athletes and celebrities who think that their own physical conditioning exempts them from any real danger. All the misinformation and skepticism. I really don’t see nearly enough focus or will to fight this virus from our own population….which calls for a unified purpose and I don’t see that changing however badly these holidays turn out.

To me the main hope is research and development from the scientific end. That the Merck and Pfizer Covid pills coming out will be game changers. That progress with monoclonal antibodies will continue. That vaccines will upgrade as new variants appear.

For now we don’t have a handle on this. It’s much more reaction than any kind of real control. As far as predictions it’s hard to say but if omnicron turns out to be worse than Delta millions more are going to die.

>19 lriley: Maybe your typo (omnicron) is spot on, since it seems to be everywhere now :-)

>13 timspalding: et al. Eventually, SARS-CoV-2 disease will be at best like the Human Coronavirus (HCV) we live with as ~20% of our colds…
Viruses weaking is real, but does it apply in situations like this?

I wonder if there's a crucial difference between 1918 and COVID: this virus, unlike H1N1 a century ago, is confronted with much more powerful medical responses that force it to mutate and that select vigorously for more virulent strains. Unless and until science comes up with a "clobber treatment" that is applied world-wide, I can imagine this dragging on for quite some time. This is an arms race, and the virus is a lot brighter than we are, by which I mean that it is engaged in the most massive parallel processing research project that perhaps has ever taken place (How many trillion trillion cores are available to this processor?). And every time a bunch of us gets on a plane, the virus holds an international conference to share that research.

Nonetheless, I'm cautiously optimistic for the longer term. What really scares the shit out of me is the possibility of a large war, as happens when things are destabilized. Then the virus wins.

How will post-Covid Britain look? For many, like it did in the brutal 19th century (Guardian)

While Boris Johnson talks of ‘building back better’, the reality is growing poverty and hunger – and a government that is fuelling them...

>21 librorumamans: Evolutionary biologist Carl Bergstrom doesn't expect selection for a milder SARS-CoV-2 because it's transmitted early, before it kills one, even before signs of disease appear (#106 in Covid thread).

If the disease appears milder as we go forward we can thank beneficial flip-of-the-coin drift in the virus, our increasing immunity from exposure and vaxx, better therapies, and improvements in environment, e.g., ventilation, mask-wearing, maybe nutrition, etc.

With our efforts to defend ourselves, we do seem to be selecting for a more transmissible virus...

Much of the "civilized" world faced a real-time, real-world I.Q. test---and failed it miserably and disastrously in the case of Covid-19 and its variant strains. The U.S. and U.K., with no excuse for it, were among those countries which failed most spectacularly to reason out the problem. There is MUCH about this débâcle which runs through many and varied other present-day controversies; so the fundamentals of this failure are deep and very important. Still, they're largely ignored (except by certain leading pundits and commenters on public policy-- Victor Davis Hanson and Joe Rogan, notably).

____________

Excerpt from City Journal

| Eye on the news |
"No Benefit, Many Costs: Yet another study finds that lockdowns did little to slow the spread of Covid" | by Joel Zinberg | February 4, 2022 | Tags: Covid-19Economy, finance, and budgets, The Social Order |

A new study from Johns Hopkins University’s Institute for Applied Economics supports what I and others have long maintained: lockdowns do not work, and their economic, social, educational, and psychological costs far outweigh any health benefits they might bring.

Early in the pandemic, epidemiological modelers predicted catastrophic casualties that could be averted only with stringent lockdown measures. In response, nearly every country around the world imposed lockdown measures by the end of March 2020. Yet little evidence existed to support such actions, and the modeling studies were fatally flawed. Now the Hopkins literature review and meta-analysis, by Professors Jonas Herby, Lars Jonung, and Steve Hanke, finds that lockdowns—“defined as the imposition of at least one compulsory, non-pharmaceutical intervention (NPI)” such as school and business closures and limitations on movement and travel—“had little to no effect on Covid-19 mortality.”

The authors reviewed thousands of studies and culled 34 that had reliable and sufficiently relevant data to review. The results were mixed: several studies found no statistically significant effect of lockdowns on mortality; other studies found a significant negative relationship between lockdowns and mortality; and others found a significant positive relationship between lockdowns and mortality—i.e., that lockdowns actually increased deaths from Covid-19.
When the authors performed a meta-analysis—a statistical technique that combines the results of multiple studies addressing the same question and uses the pooled data to draw conclusions—they found that lockdowns failed to show a large significant effect on Covid-19 mortality: “the effect is little to none.”

The Hopkins findings echo and confirm the conclusions in an April 2021 review by Canadian economist Douglas Allen that lockdowns had little or no impact on the number of Covid-19 deaths. Allen’s review of studies that distinguished between voluntary and mandated lockdown effects found that voluntary changes in behavior explained most of the changes in cases and deaths. In a January 2021 review, Danish economist Jonas Herby, a coauthor of the Hopkins study, found that voluntary behavioral changes were ten times as important as mandatory measures in limiting the growth of the pandemic. ...

Joel Zinberg, M.D., J.D., is a senior fellow at the Competitive Enterprise Institute and an associate clinical professor of surgery at the Icahn Mount Sinai School of Medicine in New York. He was general counsel and senior economist in 2017–19 at the Council of Economic Advisers, where he specialized in health policy.

>24 proximity1:

Is this the same paper which is reviewed in #103 at https://www.librarything.com/topic/336552?

Who the fuck is this Zinberg with his ‘I and others’? What others?