Thread by @ASlavitt

COVID Update: Today we hit the 2 year mark of the pandemic being declared by the WHO.

Here’s what we’re up against & what it means for what’s ahead. 1/

A- What makes SARS-CoV-2 unique?

There are more lethal bugs. There are more contagious bugs. But there are a combination of features which make this a particularly difficult enemy. 2/

SARS-CoV-2 is noteworthy for being a highly adaptable, shape-shifting virus.

To survive it’s has shorted the incubation cycle, altered its point of attack to avoid vaccines, become more infectious with kids & it’s only a couple of years in. 3/

Imagine you’re fighting a war. Your enemy is shooting at you with bows & arrows. It’s the only weapon they have.
Your scientists go away & build huge shields that arrows bounce off of.
When the shields are built & you believe you can win the war. 4/

But when you learn the bow can morph into a flamethrower, a machine gun and a bayonet, you have to re-think your defenses.

This is how it is to face this virus. We can’t create the perfect shield. What we need is the ability to keep transforming our shields. 5/

Giving the public one health message is hard. Preparing them to adapt to different bugs with different characteristics is even harder.

Particularly when they think what you told them last time doesn’t meet with reality any more and what’s true now might not be later. 6/

What we need is a strategy for the first 30 days post an appearance of a variant. Vaccines, diagnostics & therapeutics need to be tested again. If necessary new solutions developed. And based on the strength of our arsenal, we can decide if public health measures are warranted.7/

B- How does our immune system & scientific advances perform in the face of the virus & who is at most risk?

The best you can say about this bug is that it’s no longer novel. Trained by a vaccine, most of our immune systems react fine. 8/

But there are some catches:

Catch 1- the incubation period. Unless you’re freshly boosted thee bug will act faster at creating symptoms than your antibodies can. And your immune response will create symptoms to kill the virus. 9/

Catch 2- if you’re not vaccinated, your protection from prior infection will be partial at best & ineffective against new variant types

Catch 3- frail elderly, people who are immunocompromised & those w co-morbidities are at higher risk 10/

Catch 4- 40% of the globe, and much of the African content, is not vaccinated due to access issues. And there are still some low-income people in the US who need more opportunity to get vaccinated. 11/

C- What do we know about the risks from getting COVID?

Not enough. But we know a few things.

1- the complications from COVID are serious & the complications from the vaccine are almost entirely non-existent even after 10 billion arms.

12/

2- Some end up with long term symptoms are real even if they don’t die. We are at the front end of our understanding of what creates a propensity for long COVID. Thankfully vaccines significantly reduce the chances of long COVID. 13/

3- With cases being handled better by the immune system & vaccines, COVID is now about 60% worse than the flu. It’s on course to kill 200,000 Americans in a “good year” until more are vaccinated. 14/

D. If COVID were our only enemy it would be a different battle.

Give the virus Ron Johnson, Donald Trump, Scott Atlas & Ron DeSantis & we end up with people drinking drano & burning masks.

Mutation comes from replication. And these guys are nothing if not mutated replicants.15/

I’m not talking about mistakes. I’m only talking here about lies.

Leaders all over the world made mistakes or were outgunned despite their best efforts from time to time.

But those who fought the virus, were honest w the public & adjusted along the way aren’t the enemy. 16/

There were often only imperfect decisions to be made, dictated often by realities on the ground like the status of hospitals.

Most governors & foreign leaders did their best. Very few distinguished themselves. And a a small number have blood on their hands. 17/

The last 2 years have undoubtedly been worse than most people expected and more trying than all of us were prepared for.

We’ve gotten accustomed to changes which grate on us, we have seen revealed how unprepared we are, and we have felt the lack of unity to defeat it. 18/

We have taken advantage of people who work by the hour, taken health care workers for granted, and too many have ignored nations in need.

We thought we would defeat something that now we are trying to get prepared how to live with. 19/

It seems to be the case that when things get better for everyone but those on the fringes, someone decides it’s time to move on.

That most can protect themselves, the rest take their lumps. More & more have arrived at this place. 20/

But we have a shapeshifter of our own. And it’s called science. Our battery of resources will fight the bug to a standstill until we can finally beat it.

Even the bad facts will get roundly beaten by science eventually. I see many solutions in the works.21/

While it does, it has taken a grave toll. Unimaginable lonely deaths. Closed businesses. Kids who feel lost. Connections frayed & relationships heated.

Different types of suffering. But no need to compare— all of it real. 22/

We slowly but surely developed the tools to live a mostly normal life for most people in the most likely conditions.

While this is a lot of qualifiers, it must be a reminder that it’s how the world works.

Worse for the poor, the old & the sick. And always uncertain. 23/

My happiest reflection is when I think about how many people have saved untold lives with their work. Science is no longer nameless despite all those that toil in the shadows. Medicine isn’t nameless. ER docs & ICU nurses are personal heroes to so many. 24/

This thing is wily but not untamable. We are capable of making it worse or better for each other.

For all those who think it’s over now, there’s still work to do & I’m grateful to the many who continue to do it no matter thee circumstances. /end