Much respect for Dr. Gilbert but I don’t agree with this. Viruses don’t always become attenuated (less virulent). When they do, it’s because there is an evolutionary selection pressure driving it. No such pressure exists for SARS-CoV-2.
An example of this type of selection pressure would be a virus that is so virulent, it kills its host before it can be transmitted to another one.

A virus is essentially a machine programmed to make more viruses. To do that, it needs to be spread to new hosts.
So variants that are so virulent they kill a host before that host can pass it along, that is under negative selection pressure. The more virulent viruses won’t be passed on. But attenuated variants will. They are under positive selection.
For SARS-CoV-2, this has never been an issue. This virus can be transmitted to a new host before an infected person develops symptoms. Even those who die from COVID are most contagious before they become severely ill.
Furthermore, we know most about the mutations in spike but all the variants contain mutations throughout the genome. We don’t know what they do but they can all have an impact on pathogenicity.
In short I don’t think we can said either certainty that the virus has “nowhere to go” in terms of mutations that can make it worse for us. After so many premature declarations of victory, a little humility is in order. We should expect the worst, but hope for the best.
I do agree, though, that mass vaccination is how we exit the pandemic sustainably. That means getting vaccine supplies out globally. Until that happens, I’m not ready to make any rosy predictions that the worst is behind us.
I desperately want this to end, like everyone else. But we know how that can happen, and it’s not through wishful thinking. Let’s do what we need to do. Let’s get vaccines to the world.

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More from @angie_rasmussen

21 Sep
Fellow J&J recipients: big press release out on impact of boosters. While the confidence intervals are huge, there’s evidence that boosting with a 2nd shot (of J&J) increases effectiveness.

jnj.com/johnson-johnso…
We need to see the full dataset but hopefully when it’s examined in detail, it will support a recommendation for those who got J&J to get a second shot. All the data (for any COVID vaccine) suggests there’s substantial benefit to boosting.
And I’m not sure where we are at with J&J supply, but last I saw, there wasn’t a lot. ACIP/FDA should consider recommending heterologous (mix and match) boosting with a mRNA vaccine. There’s data with AstraZeneca + mRNA that supports the safety of this approach.
Read 4 tweets
17 Sep
Yesterday my spouse said that we need to be both extra careful and hopeful. We can’t get in a car accident or appendicitis or anything that would require hospital care. There’s simply no capacity because of COVID.

I wish this had happened earlier but better late than never.
On July 11, all restrictions were lifted. I mostly go to work or run essential errands. I always wear a mask despite being fully vaccinated. We’ve gone out for dinner or drinks a handful of times and sat outside each time. Yet everywhere (except work) the scene is the same.
The majority of people are unmasked. Last Friday I picked up a bottle of wine. I was the only masked person in the long TGIF line at the liquor store. Distancing was not observed at all. A person in front of me merrily told another customer she was stocking up for a party.
Read 6 tweets
2 Sep
My excellent colleague @akelvinlab has this right: we will have more variants as long as SARS-CoV-2 continues to replicate.

Also worth pointing out that we don't know much yet about C.1.2, but we do know that it's not "mutating faster." That wouldn't even necessarily be bad.
C.1.2 is an emergent lineage of variants, meaning it's actually a cluster of several different variants. Here's the preprint describing it, by @CathrineSch07 and colleagues:
medrxiv.org/content/10.110…
Misinterpretation of panel C in the above figure led to 🚨MUTATES TWICE AS FAST 🚨 insanity a few days ago. That's wrong.

The amino acid substitution rate (new mutations that result in a change in a protein) is on par with other emerging variants.
Read 19 tweets
31 Aug
Just came back to Canada after being a groomsman in the wedding of one of my dearest friends. This trip was a joyous occasion but also a stark reminder of how badly the US has failed in its COVID responses, and continues to fail.
1. US requires an antigen test to reenter. In Canada, you can get a company to come to your home to administer a proctored test at your convenience for about $75 US. We were asked to show our test results multiple times at YXE & YVR. US CBP did not ask for our test results.
2. At the wedding, I learned to my chagrin that there were going to be some eligible attendees who refused vaccination. The wedding was fully outdoors, but I was still concerned. I thought maybe I could provide rapid tests for all guests as a gift to the couple.
Read 13 tweets
19 Aug
So here's the final chapter in my thread just answering the lab leak community's "just-asking-questions" questions.

These threads all concern our paper exploring the evidence, fresh out of peer review today in @CellCellPress. Give it a look!
cell.com/cell/pdf/S0092…
But first, catch up with thread 1 here, where I present the evidence for SARS-CoV-2 zoonotic origin:
And thread 2 here, where I present evidence against lab origin, which I'll continue here:
Read 29 tweets

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