Thread by @danielgoyal

How will the pandemic end?

To appreciate the magnitude of lunacy behind the UK, US, and some other nations pandemic strategy, it is helpful to try and “game out” how the pandemic will “end”.

Here are some scenarios…

1. Waves of new variants with increasing immune tolerance to SARS-CoV-2.

Only someone very brave or very foolish would bet against more variants. As the population develops immunity to one variant the conditions become favourable for another to take hold.

We don’t know what such variants may look like. They may be more severe or less severe, they may cause more illness in the young or less, they may be more responsive to vaccines or less. No doubt, on this path uncertainty remains high.

But likely our immune systems will develop broader defences, particularly with vaccines needed to protect against these new variants. Crucially, our immune systems seem to be learning to not over-react to SARS-CoV-2 (this overreaction is a hallmark of severe disease).

So in this scenario, training the immune system through infection or vaccine leads to a better chance of developing a higher tolerance of society to SARS-CoV-2 without so much death and disability. All the while hoping a more severe variant doesn’t emerge.

In this scenario, those who protected their people from the initial waves and used vaccines to train the immune system can ease protections with much less deaths.

The difference under this scenario will be stark. UK and US will have lost a lot of people and caused a lot of disability to “train” the immune system through infection versus other nations who waited to permit infection after vaccinations.

2. Vaccines and treatments markedly diminish the threat posed by SARS-CoV-2.

This has already happened to some degree. Dexamethasone was a game changer, as were vaccines. The tools to treat or prevent severe disease may expand further and to the point where so long as one has…

…access to treatments, then SARS-CoV-2 will become similar to a bacterial chest infection - vaccination helps and so long as you get treatment early enough there’s little to worry about (long-term consequences aside for just now).

In this scenario there may be some clawback for the US and UK in that future waves can be mitigated and death count lower than other countries who cannot afford such treatments. But the comparison will remain with other wealth countries that did much better - Norway, Japan, NZ..

3. Elimination
Many consider an elimination strategy to be impossible. I assume they mean impractical or highly improbable. It is of course entirely within the realms of possibility to make Covid like measles, rare. In this scenario a new variant rears its head that forces…

…a global elimination strategy.

Not only would such a variant be more destructive in the poorly adapted countries like US and UK, the eventual forced elimination would reflect even worse on the US and UK….with a massively unnecessary death toll.

The only scenario that I can think of that makes any sense for the UK or US is based on 3 assumptions:

1. Everyone will get infected
2. Vaccines will take too long to have an affect on mortality
3. SARS-CoV-2 will not produce many variants.

All of which are now wrong!

Perhaps there was a thinking that everyone will be infected, so best to get it out the way. In this regard the belief would be that despite our exceptionally high death rate to begin with other countries would eventually catch up.

Then vaccines came and reduced mortality hugely, and then variants came that could reinfect and escape.

What exactly is the strategy or “end-game” for the UK and US, I’m not sure I can tell.

What though is very clear, is that almost any scenario played out - on the current course - leaves such countries looking like backward, regressive states that failed spectacularly to protect its people. The comparison will be stark!

The pandemic will end (cease to be so dominant in causing death and disability - ?due to some combination of 1 & 2). If the US, UK, etc.. don’t start learning from our more learned counterparts, they will forever be remembered as leaders who needlessly let their people die.

Disclaimer: I only discuss the basic scenarios here. My more esteemed colleagues are better placed to explain the possible trajectory of the pandemic: @dgurdasani1 @chrischirp @DrEricDing @timcolbourn @devisridhar @SGriffin_Lab
But hope my basic summary helps expose the lunacy!