Thread by @SGriffin_Lab

I had one of my overly-long, verbose threads half-written on this, but the more I thought about it, I figured it was just worth emphasising a few things, all of which - weirdly - began with P...
1. Patience. We're all sick of this 4 waves in, same

bbc.co.uk/news/health-59…

chances missed, same late (in)action. It's clear that SARS-CoV2 WILL become endemic eventually, but not yet. It's too well adapted to humans to burn out, elimination is challenging. The best we can hope for is a VERY low endemic set point...but we're not there yet.
Endemicity is

a state that means things are predictable because the number of people susceptible to infection balances the inherent transmissibility of the virus. So, three things enter a sort of equilibrium - immunity, environment, and viral evolution.
We are still VERY much in a dynamic

scenario. Incomplete vaccination coverage (PLEASE vaccinate under 12s asap!), waning antibody responses, insufficient NPIs, and, quite clearly, importation of new variants that cause our population immunity to have to adapt...again, and again...and again!
BUT, we must be patient.

The vaccines ARE reducing the link between infection and severe disease, especially as omicron appears less severe than delta (which was more severe than others, so this DOES NOT MEAN MILD!!!). The more we vaccinate, the majority of people will experience lesser and lesser

severe symptoms, unless of course something about the virus changes again (spike is not the only protein!). The problem with the BBC piece is that we're saying that this is now set in stone, which it isn't. The current "majority" is not enough, in my opinion. This brings me on to

my next P...
2. Prevalence. Prevalence (the presence of infections over time) is a major issue for practical, economic, virus-geek and, critically, health reasons.
Last one first. We saw in the BBC piece that COVID will, from now, "only" affect vulnerable people, and we can

"protect" them. Well. This returns the rather sickening feeling I experienced back in the autumn of 2020 when a reluctant town in America bore witness to a champagne reception, toasting a certain "declaration". It's actually my 3rd "P", but let's go with it here...
GBD sought to

"protect" the vulnerable whilst allowing everyone else to get infected and generate "herd immunity". Now, I won't dwell on the immunological and virological flaws of this, they've been discussed ad infinitum, but importantly, there are a LOT of vulnerable people out there! How do

you possibly ID and "protect" them? This "GBD by vaccine" is scuppered by the people you're seeking to protect actually being those least likely to respond to the vaccines properly. Catch 22? Also, kids aren't fully vaccinated, some people can't have one, others (maddeningly)

choose not to. So, whilst this is an incredibly frustrating situation as our vaccines are VERY VERY good, the simple fact is that people will be at risk, mainly due to my second P...
In addition, what makes me RAGE about this is that vulnerable people have the same damned rights

as anybody else. They have lives, livelihoods, loves, and other stuff beginning with L. They don't WANT to be protected, many have been effectively social hermits since March 2020, they want to LIVE their LIVES.
Ask yourself, is it right that others are put at risk for my

benefit? Now, many folks will say we can't have zero risk, and, without wanting to speak on their behalf, I think the vast majority of vulnerable people likely accept and agree with this! Weirdly, if you've lived with a lifelong condition, potentially taking toxic meds that mess

up your immunity, you're probably used to a certain amount of risk in everyday life...the problem comes with the proposed complete abandonment of other measures and assuming that the vaccines will do the whole job. They won't, sadly.
So, reduce exposure by reasonable methods, why

not? I personally don't consider wearing a mask in a shop a restriction of my freedom, or for that matter breathing lots of fresh air inside modern, well ventilated buildings. Some do, I realise, and I'll no doubt get some replies with 99% in there somewhere...I ask you...

The BBC piece talks about accepting a certain amount of risk, and this is obviously going to be the case. However, I'm forced to skip ahead to my fourth P here, "pedantry", as the example of flu is, in my opinion, not quite right.
Now, I'm not one for condoning the "with" not

"for" nonsense, due to the impact caused regardless. However, it should be pointed out that the VAST majority of deaths associated with flu every year are due to secondary bacterial pneumonia. Again, I'm not in any way saying that's acceptable, and neither do our amazing public

health teams. We vaccinate against flu, including children, devoting huge resource. We have huge surveillance programmes (GISAID, anyone?!) and it's an incredibly well resourced research and pharmaceutical area. We could do more, certainly, and as I've said before here, flu based

platitudes are utterly pointless in terms of it not being a serious disease. But we're in a TOTALLY different place for flu in terms of the nature and extent of prior exposure within the population, so to compare the endemic behaviour of this to SARS2 seems wrong to me...2 wrongs

and all that...
So...back to prevalence. We know how to reduce this, but we're simply not doing it. Vax, vent, mitigate...we've had time, the investment is certainly worthwhile over the longer term, and, similar to the dreaded pingdemic, the current disruption caused by isolation

rules etc actually happens because there's LOTS of virus around! Masks are great, but Swiss cheese is by far the best way forward...
Exposure to high prevalence puts vulnerable at risk, exposes waning immunity to increasing challenge, meaning breakthrough/reinfection more likely

, and, as we've experienced on several occasions now, provides the breeding ground for further virus evolution...not ideal in a partially vaxd/waning community...remember, all VOCs so far have arisen in un/poorly vaccinated backgrounds.
So, we have a tough decision to make, and,

assuming they're sober, this needs to be made by the government and communicated properly. Is there a line in the sand they're prepared to tolerate? 2-300 deaths per day would effectively double deaths caused by respiratory viruses. The callous and offensive line from "one

scientist" that you "can't die twice" is not only horrendous to behold, but is clearly incorrect unless you believe that millions of vulnerable people are actually the rate limiting step of infections? Unbelievable.
Again, patience is needed. We're on the right track with the vax

, we can get there much faster though. I'm not exactly sure how SARS2 had "endemicity written all over it" as this depends upon multiple factors...it's certainly likely eventually, but the question is how much harm you're prepared to tolerate en route. How can we reach an

equilibrium when both the virus, and our immunity are still in a state of flux? The answer is, I think, you can't realistically...
But, we DO have the way forward. We CAN bring everyone along on this journey, or at least give them the means to ride alongside. We can't, however,

treat the UK as a bubble separate to the rest of the world. We are in an amazingly privileged position with our vaccine programme. It is therefore bizarre to see so many comparisons to January as justification for everything being alright...
This virus is still a relative unknown

, we hear of multi-systemic effects, neurological symptoms, and I haven't even had time to go into long COVID and the criminal neglect of morbidity when it comes to policy and planning...that would have taken another long and entirely verbose thread...🤪

So yes, endemic SARS2

will no doubt happen, but not yet, and hopefully not at a set point like we're seeing today. If that happens, and we tolerate this virus at that sort of level, then I'm afraid that famous inquiry we're all waiting for will be addressing an even more terrible failure going forward