Thread by @tmprowell

🧵 I’m not sure what I’m about to say has been made clear to ppl w/o a science or #MedTwitter background. It may be a genuine source of confusion (ie good faith questions), so here goes. Many are saying “If #Omicron makes a given person less sick (which appears to be true)…” /1

“Shouldn’t we just go ahead & get it over with? You know, masks off & almost everyone gets infected & then we’ll be done with it?” I get why someone might think or ask that. It makes sense. But it’s not the right thing to do, & here’s why. /2

There are the things you have prob heard before: even a tiny % of infected ppl dying is a lot of dead if most of the 🇺🇸 (or the 🌍 ) gets #Omicron. And there are overwhelmed hospitals, which cause deaths for other reasons. But this 🧵 isn’t about any of that. /3

It’s about the fallacy that everyone getting infected with #Omicron is a guaranteed end to the #COVID19 #pandemic. Because there are people who might say “Let’s do whatever it takes to end this ASAP, even if there’s carnage along the way.” Well, here’s the thing. /4

There is absolutely no guarantee whatsoever—none—that getting #Omicron will keep you from ever getting #COVID19 again. In fact, it almost def won’t. In the short term, it reduces your risk to have been infected before, but long-term (meaning many months or more)? No. /5

But this 🧵 isn’t even about that either. It’s about how #CovidVariants come to be in the first place. Mutations occur when viruses replicate in hosts (ie, all of us). These mutations can make a virus spread more or less easily, make it more or less able to evade immunity… /6

that we have from prior infections or vaccinations, make it more or less responsive to treatments like monoclonal antibodies, or make it more or less likely to cause severe illness/death. The process is actually kind of random… /7

If the mutations happen to make a virus less good at spreading thru the population, that #COVIDvariant will peter out, or never even get a foothold to begin with. If the mutations confer an advantage, that variant will become the main one, sometimes very fast, as #Omicron did. /8

But the point is that these mutations &, with them, new #CovidVariants are generated when the virus replicates or reproduces itself. When we say “Masks off, let it rip!” w/ a virus that spreads as easily as #Omicron, we’re giving it MANY chances to mutate into a worse variant. /9

There’s nothing that prevents the next #CovidVariant from being just as contagious as #Omicron, but less susceptible to our vaccines or to prior infection. Nothing to keep the next variant from being just as contagious but ultimately more lethal. /10

Will that happen? I don’t know. No one does. I sure as hell hope not. But it could. We’ve had infectious diseases wipe out huge swaths of the population quickly (eg Black Death killed somewhere btwn 1/3-1/2 of all Europeans in 6 yrs). /11

We have a handful of meds authorized to reduce risk of dying of #COVID19. They are in such short supply that even our highest risk #immunocompromised patients in the US cannot reliably access them. We certainly don’t have enough for the whole world or even the whole US… /12

To get them. Their supply is being scaled up quickly but we are still SEVERAL months away from having enough even to treat all those at increased risk of death from #COVID19. We’ll get there, but we most definitely aren’t there now. /13

So we have to realize that when we choose to throw in the towel on #WearAMask & declare it’s time to “live with it,” we actually don’t know what “it” is. Nor whether we can live with it. Because we don’t know what the next #CovidVariant will look like. /14

What I can tell you I’ve learned as a doctor is that we aren’t as prepared for a #pandemic as we liked to believe. That’s we healthcare, we the USA, & we the world. We got lucky —if you can call it lucky when we’ve lost almost 900K Americans in <2y & continue to lose 3K/day— /15

But we got lucky that thus far #COVID19 has killed “only” 1 out of every 70 or so people with a confirmed infection. If the next #CovidVariant is equally contagious but kills a higher %, we’re in real trouble. What are the odds of that? Well… /16

If you want to take two other airborne viruses that have caused outbreaks in the lifetime of most of you reading this, SARS-CoV (ie the original “SARS”) killed 1 in 10 of those who tested positive. For MERS, 1 in 3 of those who tested positive died of it. /17

So when I tell you we are lucky that Mother Nature gave us a practice virus to learn on with all of the #CovidVariants to date, listen to me. We have to stay humble & recognize that if we abandon masks now, we are giving this virus a mindboggling # of chances to mutate. /18

This #pandemic has been bad & long enough. I don’t want to give this virus an unlimited # of shots on goal to become a #CovidVariant far worse than any prior. I definitely don’t want to restart the #pandemic clock because now we have a variant our vaccines DON’T work against. /19

If you’re thinking or tweeting, “Ok, so you’re saying we have to #WearAMask forever?” the answer is no. As I said earlier in the 🧵, we have highly effective therapeutics, incl some likely to remain effective even in face of future #CovidVariants, we just need more supply. /20

And we now have 10B doses of #COVID19 #vaccine administered worldwide (>60% of 🌍 population #vaccinated) in a little over a year. Not too far in the future, we will have enough people protected that the virus will have a tough time finding a susceptible person to infect. /21

Between these 2 things— a harder path for the virus to travel to propagate itself & an abundant supply of meds to serve as a safety net if we do get infected—it won’t be as likely that we’ll get infected or nearly as worrisome when it does happen. So this 😷 isn’t forever. /22

But deciding not to #WearAMask now, in the midst of both a 🇺🇸 & global surge of #Omicron, is shortsighted. If your goal is to end this #pandemic, #GetVaccinated, #GetBoosted, & #WearAMask while we get others there with us. Stay safe. Let’s finish this. I’m ready & then some. /End