system11 wrote:
It will never end anyway, it will turn into an ongoing whack-a-mole as the virus continues to mutate which is what they always do. Eventually (or quickly) the vaccines will stop working and need adjustment. I still think the only real way out is that over time it becomes less dangerous and/or we come up with a drug cocktail that nukes the symptoms from orbit.
I'm firmly in the 'lockdown effects are worse than Covid deaths' camp now when everything is taken into consideration. Do you shorten and ruin the lives of millions to prevent the deaths of thousands? It's not the call I'd make.
I think it more appropriate to call it evolution rather than mutation. It's worth remembering that this virus has only recently crossed species and will evolve as it settles into its new host. Its likely evolutionary course is to become like the other human coronaviruses, simply because that is the path evolution has already taken.
The nature of coronaviruses mean the human immune response to one usually crosses over in some extent to others - the same is also true for the vaccine driven immune response. It may be necessary to tweak the vaccine to keep the effectiveness as high as possible (very easy for the mRNA vaccine and the Oxford/AstraZeneca one is specifically designed to be easily modified, starting its life as a generic tunable vaccine). If the virus changes so significantly that the current vaccines are essentially useless, the path of the illness will change too - this main result in it being milder, more easily treatable or more/less infectious. It's unlikely it'll evolve to be worse, you can't replicate very well if you quickly kill off your host.
The impact of the virus itself is twofold:
1. Being a new virus to humans, some aspects of it can cause severe erroneous responses by the immune system, driven by small variations in immune response that normally wouldn't matter
2. Those with a weaker or compromised immune system risk the virus overwhelming their natural defenses and winding up in hospital
Point 2. comes into play significantly when paired with Point 1, but Point 2 is also true for most viruses - but existing immunity in the population keeps incidence and transmission low. This is why the health system is under pressure in winter, viruses spread more readily and eventually hit those who are vulnerable. It's also why we have a flu vaccine - and despite this otherwise healthy people still die as a result of flu. Toss a new virus in there to which there is limited immunity and you're in trouble.
The endgame has two reasonable scenarios:
1. Flu-like vaccination schedules, adjusted for current variants and carried out annually/biannually (depending on how long the effect lasts) for those most at risk. Natural immunity and first round vaccinations for everyone provides the general population with the necessary immunity to keep transmission low (no reason to suggest otherwise, given the vaccines all show strong antibody and t-cell response). Some excess deaths will be tolerated, as is currently the case for a poorly effective flu vaccine. Chris Whitty has already hinted this is the expected UK approach after the vulnerable categories are vaccinated by the end of March
2. Virus adjusts fully to the human body and becomes effectively identical to existing human coronaviruses. No requirement for ongoing vaccinations. It's impossible to know how long this will take and it might not be too far off already, or it may take years
Lockdown is neither economically nor socially viable for much longer, which I suspect is why Chris Whitty covered it in the recent briefing - with the vulnerable having their first round vaccinations, by Easter that covid burden will be gone from the healthcare sector. You can then open up again, tolerating infection amongst the general population because a) the volume vaccinated will offer some level of herd immunity b) almost everyone outside of those vulnerable groups will be fine* when exposed to the virus. Vaccination is the sensible route out because, crushing though lockdowns are, you can't just leave the vulnerable groups to die in an overloaded hospital while your medical staff keel over from the strain on them - they make up a surprisingly large section of the population! You'd think the virus was literally everywhere - it's not, even our peak daily cases are about 80k out of a population of 65 million-ish. It just shows how easy it is to overload healthcare when a fraction of that 80k a day are espcially vulnerable, and how quickly a fraction of that can add up to tens of thousands of deaths.
* "Fine" meaning no worse than a severe form of any other viral infection. Had bronchitis? That's your lungs fucked for a month afterwards. Had pneumonia? Welcome to a good few months recovery. Ever had flu? Welcome to hell, it usually is most definitely not just a bad cold. Some reports of "long covid" are genuinely where an adverse immune response has occurred due to the nature of the virus, but a lot of it appears to be from people who don't realise how bad any viral infection that's not a boring old rhinovirus can be.
Edit: might not have been Chris Whitty but the dude who, at the first of our glorious new series of covid briefings, stood the other side of what passes for a Prime Minister these days.