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Comment by bko | Hacker News Reader

Serious question: does anyone have a plausible end game mapped out? No one bothers talking about what's going to happen 1, 2, 5, 10 years from now. There's no talk about herd immunity or anything besides the immediate concern of getting the last holdouts vaccinated. Places like NYC have 90+% vaccination rate and a lot of political effort is being put on that last 10% hold out, but then what? Is vaccine as a bi-annual service really practical? Is a better vaccine going to come out? Is it just going to mutate into a dud?

https://www1.nyc.gov/site/doh/covid/covid-19-data-vaccines.p...

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Leaving aside variants, the end game is for the virus to become endemic and everybody to encounter it every few months or years.

But you cannot do that while the non-immune part of the population is large enough to overwhelm the healthcare system if they get infected rapidly. Hence the focus on getting as many people vaccinated as possible, and keeping more or less non-pharmaceutical interventions in place.

Over the last months, removing non-pharmaceutical interventions has worked relatively well for some Western societies like Denmark (high vaccination rate) or the UK (lower vaccination rate + many previously infected), but not so well for others like Germany.

Variants change the game, but don't completely reset us to square one: Vaccines still provide some protection, but factors like higher transmissibility may work against that. mRNA vaccines can be adjusted relatively quickly.

We're seeing some congruence in the mutations acquired by different variants and most experts I listen to don't expect the virus to keep mutating forever. There is a limited number of options and population immunity will only become more broad.

On the other hand, the variants seen so far have surprised us quite a bit. Given that, it remains difficult to map out a clear path on the scope of years.

The UK and Germany have very similar vaccination rates averaged across the entire population, but the UK has very high vaccine uptake amongst elderly people who're most at risk whilst Germany doesn't. If you're relying on vaccines to prevent the hospital system being overwhelmed that probably has a disproportionate impact because they're massively more likely to be hospitalized.

The end-game is not so much that the virus adapts (which can happen but mutations are not that easily predicable) but that our immune systems become adapted. We can see this already. Previously infected and/or vaccinated people can get omicron but it will be very mild disease. Next year there will be another variant and people will get sniffles again. Next year another variant that could easily cause severe disease to immuno-naive person but for those who already got 2-3 vaccinations plus mild omicron or whatever it will be just sniffles again.

That's how most cold viruses work. It was clear from the beginning that covid belongs to this category. We just hadn't had previous exposure yet, therefore it was so severe. We overreacted when we thought that we can eliminate cold virus by strict isolation measures.

Here is an pretty good NPR article that discusses the same concept: https://www.npr.org/sections/goatsandsoda/2021/10/29/1050465...

Also the article in Science by the computational biologist interviewed for the article: https://www.science.org/doi/10.1126/science.abe6522

They predict that SARS-CoV-2 will eventually become something akin to the common cold, as long as 1. immune protection against severe disease persists, and 2.) the virus continues to be relatively mild in kids.

> that our immune systems become adapted.

Perhaps, but the first person in the US known to have died from Omicron had already had Covid once before. According to the news, he was also in his 50s with other underlying health conditions.

I think, much like the flu, Covid will continue to be a threat to people who are elderly and/or already in poor health. And much like the flu, yearly deaths will probably decrease somewhat but continue to number in the tens or hundreds of thousands.

For today's elderly or otherwise at risk, that may very well be the case. It's going to be the younger people today who are either vaccinated or survive infection, that become the much more resistant adult and elderly population years and decades from now.

A better question might be why would the political class ever want an exit strategy for something that gives them perpetual emergency powers?

...that they aren't really using effectively (for their own personal or political gain, or to combat the spread of the virus).

This conspiracy theory doesn't pass the laugh test.

I'd love for some governments to start wielding emergency powers in an effective way, even if it were just for graft, to show that they're not clueless.

They aren't? Lockdowns are stupid and have affected mom and pop stores disproportionately, making the rich richer. Seems pretty effective to me.

https://www.theguardian.com/technology/2021/feb/03/amazon-re...

Yeah it's more like no leader can be caught making any mistake / taking any risk / any measure that goes towards freedom / normalcy, and so while the public doesn't demand it it won't happen. Hard to say where the public stands on this, though it was interesting reading a Reddit thread concerning lockdown measures being enacted in Ontario again, total 180 from the habitual Reddit opinion. So it might be coming, it's obvious people are tired and are ready to understand a one-sided policy is not sustainable.

>Hard to say where the public stands on this, though it was interesting reading a Reddit thread concerning lockdown measures being enacted in Ontario again, total 180 from the habitual Reddit opinion.

I found the thread (<https://www.reddit.com/r/ontario/comments/riqusg/ontario_ann...>) after reading your comment. Wow, you're right about it being a total 180 from the usual Reddit opinion. (Sort by Best or Top, not New.) This comment getting 100 upvotes is one example of the change in sentiment:

>Why don’t they just permanently shut down all small businesses and call it a day. That’s clearly their goal here.

That's not to say that the mods have changed their views; thus the thread being locked, to prevent more wrongthought from appearing.

Their friends got way richer. The number of billionaires skyrocketed in the last 2 years.

Is it really a theory that your government has used every major crisis to erode your freedom and privacy?

Yes, and not without cause!

Things like the Patriot Act, which is about as unpatriotic as could be, were rolled out in response to 9-11. We also have the ludicrous Bank Secrecy Act; not to mention the Wagner Act following the Great Depression.

I've found many people don't understand the truly limited scope of the Federal government, as most Ameicans don't understand it either. But our Federal government has only a very narrow set of responsibilities and those responsibilities are the only things they can do (10th ammendment). They are quite clearly enunerated in Section 1 Article 8 of the Constitution, which in itself is not without controversy over the wording, specifically regarding "general welfare of the US". But thankfully we have a letter from Madison to Pendleton in, I think, 1712 which specifies why that specific language was adopted, and it was done so to remain consistent with the Articles of Confederation, and that specific wording was thought to be the least controversial (how wrong they were!).

Thus, programs like Social Security, ACA, and all other social welfare programs that I can think of are unconstitutional, and day-by-day our federal representatives push for more.

Of course, we amended the Constitution out of relevancy with the 16th Ammendment, giving the government the perfect gunpowder for the spark which was "reinterpreting" S1A8.

I suppose its impossible to make a 5 year plan when the game is changing month after month. With countries having 50% vaccination rate, there's always place to brew new variants that might or not be resistant to vaccines and medicine.

Is there any reason to believe being vaccinated means you're less of a breeding ground for variants? Surely it's not 100%, and if it's not, new variants will always come, including gradually evading vaccines, no?

Mutations evolve in infected people. Vaccines reduce infection, both directly and via reduced spread. Hence fewer mutations.

But muations happen all the time. Is a particular mutation viable, does it spread, then outcompete?

Thankfully emperical evidence shows thr neutralizing antibodies response, due to vaccination, reduces spread of COVID.

> With countries having 50% vaccination rate, there's always place to brew new variants that might or not be resistant to vaccines and medicine.

Is it true that new variants are more likely to evolve among more unvaccinated people? US has had significantly more cases that South Africa (per 100k people) for most of the time. I assume mutations are more likely to happen in places with more cases. Not sure if vaccine plays a selective pressure on vaccine mutation (bad or otherwise).

https://ig.ft.com/coronavirus-chart/?areas=usa&areas=zaf&are...

You’re right. Mutations are more likely, the more infections you have.

Vacckne resistant strains of viruses tend to evolve in unvaccinated populations.

There's nothing indicating vaccines do anything to stop or make variants less likely. Arguably they could make more virulent variants more likely to survive.

Look at the rate of deaths. Last December was about half the death rate of december before that. It's looking like this year will be half of the prior year. This is despite the number of cases generally being higher in the latter years generally. Some dependence on when the virus first hit. Long term side effects and hospitalizations are going to correlate with the death rate more than the infection rate.

I find the the NYT data viz to be the best and most accessible: https://www.nytimes.com/interactive/2021/us/new-york-covid-c...

There is strong reason to believe that despite omicron's higher spread factor, it won't increase exponentially forever and will instead drop off rapidly as its done every year in every geography sometime soon. It's not a dud yet, but it's trending towards that through a combination of better treatment, vaccinations, immunity, and particularly vulnerable people dying.

Omicron looks like it could reach a much higher number of infected in new york soon, but I doubt we will see a higher rate of hospitalizations or deaths than last year in spite of this. We should have the evidence to confirm or deny these assumptions in a few weeks once we're comfortable with any lagging data issues.

> it won't increase exponentially forever

Nothing can increase exponentially forever.

2^x disagrees with you.

Less snarky though; the phrase "forever" still implies a long horizon of exponential growth. The reality is that exponential spread of disease rapidly drops down much earlier than most people assume. Far far below 100% of the population.

Mathematical concepts do not translate into the real world, it's that pesky little difference between theory and practice. You'll never run out of numbers but you will run out of everything else and usually a lot sooner than you think.

edit: you probably should mark your edits if they materially alter your comment after someone has already replied.

Recent Denmark numbers for Omicron, including Covid-recovered, https://news.ycombinator.com/item?id=29633285

  0% fatal, 0.13% ICU, 1.2% hospital
  4.3% Covid-recovered 
  76% double vax, 7% booster
  14% unvax, 2% single vax
  77% no travel history

IF (will take several weeks to confirm) Omicron is mild and highly transmissible, then people may be infected and recover with protection against a range of variants. While natural antibodies fade, there is likely some ongoing protection from T-cells and memory B cells, e.g. studies showing some SARS1 protection after 17 years.

Omicron infections appear no less severe than Delta:

https://news.ycombinator.com/item?id=29646061

> "no evidence of Omicron having lower severity than Delta, judged by either the proportion of people testing positive who report symptoms, or by the proportion of cases seeking hospital care after infection."

Isn't the ultimate test of severity death? I know its a lagging indicator but the numbers are so low (14 in UK total) compared to historical (over 100 deaths per day). And no omicron is the majority of cases, wouldn't you expect more deaths if it were as infectious?

https://www.snopes.com/fact-check/omicron-deaths/

Yes, deaths are an indicator.

There have been zero US deaths from Omicron.

There was one US death with Omicron: https://twitter.com/dancohen3000/status/1473480933579923456?...

Has anyone done a study on the track record of Imperial College London?

Here are the Denmark Delta numbers for comparison, 19,137 Delta cases:

  0.07% fatal, 0.11% ICU, 1.5% hospital
  0.9% Covid-recovered 
  50% double vax, 3% booster
  44% unvax, 3% single vax

Tue Dec 21 update from South Africa, https://timesofindia.indiatimes.com/world/rest-of-world/most...

> Dr Angelique Coetzee, the senior doctor who first identified the variant, said that the line of treatment for Omicron patients is "quite easy". "We start immediately after the diagnosis with low dosage cortisone and something like ibuprofen to help with the muscle pain and headaches and that's it. That's what we give. There's nothing else. There's no oxygen, not even antibiotics required," she said. Briefing about the symptoms associated with the variant as it reaches the fifth week of its outbreak, Coetzee said, "Most of the cases reported so far manifest symptoms like body aches, headache, tiredness." "They may or may not have a cough; it is mostly dry cough with a sore and scratchy throat. According to a recent study, it affects the upper respiratory tract and doesn't affect the lower airways like the delta variant," she added.

For anyone on their edge of their seat to commit a stats fallacy, don't forget that the base proportion of the population vaccinated is ~4x higher than the unvaxxed. The unvaxxed are comprising a massively higher share of the infections than their share of population here.

Or our reality is forever changed unless one revolutionary treatment that is cheap, OTC, and reduce the death rate down to below 1%.

Otherwise, what end game are we talking about?

In my mind the end game is either a natural mutation into something that isn't that big of a deal or a technology exmachnia.

Something like a vaccine agaisnt all coronaviruses or perhaps some other clever solution no one has thought of.

The longer this goes on the more Manhattan project we're going to get about it.

How long any of that takes I don't even have guesses for anymore.

The vaccines are pretty great. I am happy to believe that if a strain of COVID occurs which the vaccines are less effective against, then the strain will necessarily be less severe.

This is plausible because the vaccines target the spike protein.

While it is too early to say definitively—evidence so far seems contradictory—Omicron may be such a mutation.

Bi-annual is not necessary, even if immunity wanes within six months due to the seasonal nature of the beast. So at worst we are looking at something like the yearly flu vaccination. And also very probably younger and healthier people will be able to skip that altogether, just as with the flu vaccine.

> Is vaccine as a bi-annual service really practical?

Sure, why not? The flu vaccine's annual. Hopefully we don't end up there, but if the medium-term end-state is "it's manageable, but everyone needs a booster every six months", that seems... not the worst possible outcome?

I don't think we're going anywhere until we have a real cure. You can have 10 vaccinations but if your immune system is shite they are not gonna amount to anything. And half of the world is still unvaccinated so even with our boosters we're not gonna end variants.

The pill just got approved so once manufacturing ramps up we should be good to go because they don’t target the spikes.

The real issue is variants arising in other parts of the world where healthcare access is not great.

Omicron is basically the common cold when it comes to symptoms and deaths. Could be the real "vaccine".

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