Thread by @tomaspueyo

I only see 2 ways out of COVID:
1. An endemic disease that kills a few hundreds of thousands/million of ppl every year
2. A disease eradicated through global vaccination campaigns

I fear there's no 3. A virus that becomes less lethal over time and blends in like a cold

Note that 1 and 3 are pretty similar. In both cases, the disease is endemic and kills a few people every year. The cold doesn't, but the flu does, at ~0.13% of the sick every year.

But what if it wasn't 0.13%? What if it was 0.4%? Would we accept that? It's the ≠ btw 1 and 3

The reason why think we can get to 3 is because that's what probably happened to the 1918 flu: it's H1N1, and after killing so many ppl, it ended up evolving to kill less so it could spread more.

The problem is that this is unlikely to happen to COVID, because *we isolate ppl very sick with COVID in hospitals*.

The 1918 flu was like: "Damn, I'm killing these ppl, and then I don't spread! So I die. Better if I tone it down a bit, so they survive and I spread."

(for the evolutionary orthodox: random selection makes deadlier viruses reproduce less by killing the host).

This doesn't happen with COVID. When somebody is really sick, that person goes to the hospital, is isolated, spends weeks there, and then dies.

The virus has ample room to keep growing faster and faster and bringing death earlier. It has no penalty.

And these 2 things tend to go together: more effective virus reproduction means better transmission and more death.

So the virus will likely keep evolving this way.

Smallpox didn't evolve to extinction.
Cholera didn't.
Typhoid fever hasn't.
Yellow fever hasn't.
Malaria hasn't.
They didn't melt away. We conquered them.

The 1918 flu was an outlier because death was an obstacle.

What evolutionary process would COVID follow to spread better while killing less? I can't see it.

So unless we are ok accepting this level of deaths per year—we might—the only way out is a coordinated vaccination campaign of the entire world with a vaccine that the virus can't easily escape

If you assume that Omicron's R0 is ~6, and we assume the R is not going to dramatically keep increasing, it means we'd need ~80-85% of all the world population to be vaccinated with this new vaccine.

That gives us a margin of 10-20% of anti-vaxxers.