Thread by @BillHanage

Some more thoughts prompted by this article - the notion of an 'end' to the pandemic is itself faulty in my opinion. But that emphatically does *not* mean interventions forever. It means that the transition to endemic disease can and should be managed 1/?

https://twitter.com/CT_Bergstrom/status/1434740267655991299

The reason 'end' is dangerous is that it suggests a date when everything changes overnight and we return to 'normal'. That takes no account of variants, waning immunity or the fact that most of the world is struggling to access vaccines, among many other things 2/?

However in vaccinated places it is true things are *much* better than they easily could be, but that doesn't mean the pandemic is 'over'. This is Oregon and Idaho *now*. 3/? nytimes.com/2021/09/06/us/…

While here in MA, despite a large well publicized outbreak in July cases have not skyrocketed. The deaths column has remained mercifully low. We can expect both to increase at least somewhat as the fall rolls around, but this shows that Delta spikes are not inevitable 4/?

Is the pandemic 'over' in MA? Of course not! There will likely be many further bumps in the road, not least because summers are quiet virus wise. That's why there are multiple interventions in place. They're not exactly intense though... 5/?

The urge to declare an 'end' is related to the wish for silver bullets I describe here also in the Post (never let it be said the paper only shows one viewpoint). But declaring an end is bizarre when you can look out the window and see it still going on 6/?washingtonpost.com/outlook/2021/0…

Fighting the virus is more like achieving sustained weight loss. We would all like there to be an easy way to do it, one simple trick. But years of research by people who know more about nutrition than I do have shown it is more complicated than that 7/?

Finally, none of this means the pandemic will be with us forever. It means that Delta is going to infect a lot of people, and the next few months will be hard. We can make them easier with vaccination and other interventions 8/?

(to be clear, the goal is to avoid uncontrolled Delta spikes which send vulnerable unvaccinated *and* those relatively few vaccinated folks who remain vulnerable, into hospitals in a surge. Some places are already struggling with that) 9/?

In due course, almost everyone will have immunity of some sort, and so the virus will never have again such unfettered access to so many hosts. Whether that will be the 'end' depends on the epi and clinical characteristics of breakthroughs and reinfections 10/?

Eventually the virus will become something of interest to specialists, and the public will be able to move on. It will cause disease and death, but not in the numbers we see now. Indeed, the article prompting this thread describes such a situation. But we're not there now 11/?

Now we are seeing record hospitalizations, even while vaccines are available that could prevent them. Once again, a future epidemiologists saw coming is playing out before our eyes.

It's an incredibly tone-deaf time to be talking about 'endings' 12/end