Last week I met Jeremy Farrar in Berlin and since then I’ve kept going over some of what he said, since it seems pretty crucial for the next phase of the pandemic in Europe. So a quick thread
(You can also hear him say some of this in our new @pandemiapodcast episode)
@pandemiapodcast At least in Europe, "what you're witnessing, I think at the moment is the shift from epidemic/pandemic state into an endemic state”, Farrar said.
“And none of us are really quite sure what that endemic state is going to look like.”
@pandemiapodcast The argument is simple: #SARSCoV2 is clearly not going away any time soon. As vaccines blunt some of the impact of the virus at the societal level, #covid19 may still be terrible and still cause disease and death but maybe at a level society can or will or has to accept.
@pandemiapodcast But what level of disease and death is deemed acceptable and thus what “endemic” looks like is going to differ from society to society. Farrar has been calling for an honest debate about this: “I think all countries are going to have to have this debate.”
@pandemiapodcast This goes far beyond Europe, of course. “If you are New Zealand, I don't know how you plot your exit from this” Farrar told me. “China's in an even harder position, because it's got 1.4 billion people and its vaccines are not as effective as the vaccines used in Europe.”
@pandemiapodcast The problem: "I think that politicians across the world are sort of pretending you can have your cake and eat it: You can have zero deaths, no control measures, vaccinate if you want to or not vaccinate - and it will all end.
I just don't think that's realistic.”
@pandemiapodcast This is a crucial point: A country with a given vaccination coverage will have to accept either a certain level of death or a certain level of restrictions (or a mix).
Different countries may end up with different set points for endemic #covid19.
@pandemiapodcast The countries that are likely worst off in the early part of this endemic phase are those like US where immunisations AND control measures like masking have become polarized.
With low immunization levels and few restrictions, they are stuck with high levels of disease and death.
@pandemiapodcast I asked Farrar about the situation in the UK where about 100 people were dying a day of #covid19. What level of #covid19 deaths did he think the UK specifically might have to accept?
@pandemiapodcast He said he was for lockdowns last year, "because the health consequences were so profound, 1000 deaths a day, 1200 deaths a day in the UK. It was just unacceptable, in my view, and the health system came very close to collapse …
But we're in a different world with vaccination.”
@pandemiapodcast Without vaccines, there would be >1000 deaths a day in UK, he says."That's how dramatic the impact has been.”
But: "We're going to have to accept a certain number of ill health and deaths from COVID, as we do for malaria, as we do from flu. The question is, what is that level?"
@pandemiapodcast So what number: "I think around 100 deaths a day, throughout the year, 30,000 deaths a year, in the current situation with the current vaccines, current treatments, current capacity within the system, I think is a level that would have to in the end be acceptable."
@pandemiapodcast There are two big problems with all this, of course, that he acknowledges:
1. Long-term sequelae of #covid19 (long covid)
2. Letting the virus replicate means letting new variants evolve
@pandemiapodcast So what are the key takeaways?
1. Vaccinate, vaccinate, vaccinate: That is what gets you out of the worst of this
2. If you don’t vaccinate enough, you will end up with tough measures or a lot of deaths, probably both.
3. Be honest about this in public.
@pandemiapodcast And, on the global scale:
Share the vaccines, so that all countries can vaccinate, vaccinate, vaccinate.
Every country needs to protect the most vulnerable.

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More from @kakape

14 Sep
Only 2 African countries have vaccinated more than 40% of their population, says @DrTedros at #Covid19 presser.
“That's not because African countries don't have the capacity or the experience to roll out vaccines. It's because they have been left behind by the rest of the world."
@DrTedros “More than 5.7 billion doses have been administered globally, but only 2% of those have been administered in Africa”, says @drtedros
"This leaves people at high risk of disease and death exposed to a deadly virus against which many other people around the world enjoy protection."
@DrTedros "This does not only hurt the people of Africa. It hurts all of us”, says @drtedros.
"The longer vaccine inequity persists, the more the virus will keep circulating and changing, the longer the social and economic disruption will continue."
Read 27 tweets
11 Sep
Earlier this year I was watching Denmark for signs of how the Alpha variant would behave. That was partly because their amazing sequencing effort gave such a clear view of what was happening.
Now I’m watching Denmark again, but for a different reason.
Yesterday, Denmark abandoned the last corona restrictions. With more than 95% of the over-60s vaccinated, the country hopes to be able to treat #covid19 more like the flu going forward. It’s an experiment and we will see how it plays out.
I will be watching it closely because Denmark will give us some clues to what “living with the virus” might look like. It could also give us important information on the speed at which immunity wanes and the frequency and seriousness of breakthrough infections.
Read 11 tweets
11 Sep
Gestern wurden in Dänemark die letzten Corona-Beschränkungen aufgehoben und das war für uns Anlass eine Folge @pandemiapodcast zum “Ende der Pandemie” aufzunehmen:
Was heißt eigentlich “Ende”? Was passiert in Dänemark jetzt? Und wie steht Deutschland da?
viertausendhertz.de/pan29/
Die Masken wurden in Dänemark schon im vergangenen Monat abgelegt. Nun ist auch kein Impfnachweis mehr nötig für Konzerte und andere Großveranstaltungen. Das Leben ist weitgehend so wie vor Corona. Dänemark markiert damit den Übergang von der Pandemie in die Endemie.
Die Dänen sagen nicht, dass das Virus keine Rolle mehr spielt. Sie sagen, dass es nicht mehr eine so große Gefahr für die Gesellschaft birgt, dass es mit außergewöhnlichen Maßnahmen bekämpft werden muss.
Oder, wie @LoneSimonsen2 sagt: “Wir haben dem Virus die Zähne gezogen.”
Read 9 tweets
8 Sep
"Today, the #DRC declared an outbreak of meningitis in the north-eastern Tshopo Province, with 261 suspected cases and 129 deaths reported”, @DrTedros says at start of @WHO presser.
A reminder that #covid19 "is far from the only health threat to which WHO is responding”, he says
@DrTedros @WHO "Over 50,000 people have died with #COVID19 every week since October last year and for the past month, deaths have remained at almost 70,000 a week”, says @DrTedros.
Solutions to save lives are there, he says, “but those solutions are not being used well nor shared well."
@DrTedros @WHO "Some countries with the highest vaccine coverage are now seeing a decoupling of #COVID19 cases and deaths, which is allowing them to reopen their societies without their health systems being overwhelmed”, says @DrTedros.
Read 12 tweets
1 Sep
Since this question comes up quite a bit:
Once the @WHO runs out of Greek letters to name variants of #sarscov2 it plans to start using the names of stars or constellations such as say Virgo, Draco or Orion.
„They will be less common stars/constellations, easy to pronounce“, @mvankerkhove wrote me. „We are just checking internally with our regional colleagues to ensure none of them cause any offence or are common names in local languages.“
We will see what ends up on the list (examples in the first tweet were just from me to illustrate it). Probably best not to call a variant „sirius“ variant since that might lead to some misunderstandings ;)
Read 5 tweets
1 Sep
So after a year and a half of live tweeting @WHO press conferences from afar through zoom, I‘m actually attending one in person today (WHO having been kind enough to move their press conference to Berlin for the day to make this possible ;))
@WHO “Last week, the number of #COVID19 cases and deaths reported to WHO declined for the first time in more than two months”, says @DrTedros. “This is welcome, but it does not mean much.” Cases still increasing in many countries and shocking inequities persist, he says.
@WHO @DrTedros Waning immunity may make third shots necessary in the most vulnerable populations such as immunocompromised people, says @drtedros. “But for now, we do not want to see widespread use of boosters from healthy people who are fully vaccinated."
Read 6 tweets

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