Thread by @ASlavitt

COVID Update: I’ve had dozens of people ask me with Delta here, what is the COVID end game.

Because I don’t know, I interviewed 6 experts on various elements— variants, vaccines, global, policy, ev biology & historical precedence.

Will break it down here. 1/

First of all, one truism is that when cases are rising, more say the virus is here forever. When cases are dropping, people tend to believe it’s over.

We’re all caught up in that still which makes objectivity harder to find. 2/

Still, we have learned a lot with Delta’s emergence that seems to change the game.

Some theories seem more right than wrong to me….3/

1- The virus & science will continue to have a long battle with a virus continually mutating for survival.

How long? We are still seeing mutations from the 1918 flu 103 years later. 4/

2- Given Delta’s contagiousness & the fitness of future mutations in order to beat it, this means SARS-CoV-2 will be contagious enough that everyone will get the virus.

The aim is simply that more people get it be vaccinated when they do so fewer get COVID. 5/

3- The virus & the disease are not the safe thing.

The mRNA vaccines are a godsend & will help us minimize COVID-19 even while there remains an abundance of SARS-CoV-2.

I will explain that further. 6/

The vaccines don’t work like sunscreen, stopping the virus from entering your body. They fight for our cells.

What they do is train our immune system to recognize the virus, attack it, & fight it to a state where it minimizes damage. 7/

This is why there are many harmless breakthrough cases. Stick a swab in your nose while your immune system is waging the fight & you will test positive. 8/

This also explains a few things we see in Delta:
-immunosuppressed people need more vaccine
-higher Delta viral loads cause symptoms by making the fight harder
-while the immune system reacts, Delta can live in your nose for a short period & infect others 9/

3- Can the vaccines keep up with future variants? Most experts appear confident in the mRNA platform— even when a variant potentially beats a current vaccine.

Here’s how & why from my understanding… 10/

The science of the virus itself makes it a good target with the spike protein. And so long as the virus creates an immune response, mRNA can be adapted to simulate it.

It’s one reason why there isn’t an HIV vaccine. The body can’t mount a response on its own. Not so for SC2. 11/

mRNA is also most easily scaled & manufactured & can react to new mutants in 90 days. Regulations from FDA & other bodies are being adapted to keep up. We need nimble manufacturing & distribution as well. 12/

4- All of this means likely waves of COVID— regionally & seasonally— depending on community vax status. It means some less safe periods of time— when vaccines are catching up to mutations, when prevalence is high. And safer times. 13/

Here are some implications & immediate priorities.

1- Accelerate global vax effort. Instead of 70% by Dec 2022, we need 70% by March 22. The difference in giving the virus less time as we attack it is critical. A slow attack means more time for it to find ways to adapt.14/

2- US pockets of low vaccination are a critical priority. We are rapidly falling behind the ROW in vax levels due to hesitancy.

Vax requirements will eventually be fairly common place. The difference between this happening this year & next could be profound. 15/

3- The development of an oral anti-viral is an essential tool. Along with better ventilated buildings, we can keep transmission low & make infections shorter & milder. 16/

4- Research & development of treatments for long COVID must begin now & there is reason for hope that we will find both symptom relief & clues to better treatment quickly if we put our minds to it. 17/

So if the picture I pieced together from experts is close to right. And we execute against these 4 priorities, what does our new normal look like? 18/

In many ways it looks like the old normal for much of the world that we have so far largely avoided in the US & parallels how we deal with other challenges. 19/

These are things we should be willing to tolerate:

-Masks when we travel & in heavy seasons
-Staying home when we’re sick— always
-Weather reports as there on for smog or allergy seasons
-Periodic outbreaks
-Caution around key populations
-Showing we are vaccinated/tested 20/

But there is something we can decide not to tolerate:

Preventable deaths.

100 people die every day from the flu in a bad season, mostly elderly & kids. We should not accept this. And we should not accept even more from COVID. 21/

We can science our way through most of it. But we have to manage our way there as well— and that’s where the challenge lies.

Our ability to have a productive debate on these issues will need to get better.

22/

Domestically one can imagine 2 political parties— one for protecting the public, one for “liberty.”

The global cooperation & leadership needed for this is profound. Protectionism would lead us down a predictably more difficult path.

23/

Investments in basic research, in providing support for people with jobs which expose them to risks & for accessibility for people at risk or sick will expensive. But necessary. 24/

But if I think about what matters, it’s this— to create a future where we all of us get to have as bright a future as possible.

Small sacrifices & winning some big arguments are part of building that future. /end

*same