We sure went quickly from "it's just another seasonal respiratory virus like flu and colds" to "several surges per year are to be expected as immunity wanes and immune-escaping variants evolve".
Reminder 1: that waning, escaped immunity is what is currently keeping severity low.
Reminder 2: Vaccines become outdated as new variants evolve, and there is no effort to be predictive with updated vaccines. They're generally already behind variant evolution before they even roll out. We could do better than this.
Reminder 3: "Hybrid immunity" is why severity is low, not the virus becoming more benign. That immunity has to be maintained by updated vaccination or infection. If vaccine uptake is low and/or they're only available to "the vulnerable", then most immunity will be by infection.
Lower acute severity of SARS-CoV-2 vs. 2020-2022 is welcome, but there's a danger in reading too much into it, in the same way that it's misguided to deny climate change because it's been cold where you live.
A few thoughts as to why our optimism should be cautious.
🧵
1. The lower acute severity seen right now is very likely due to host immunity, not to a reduction in inherent virulence. That immunity comes from two sources: vaccination and past infection (or both, so-called "hybrid immunity").
Cont'd...
There are issues with relying on "hybrid immunity" to keep us safer from severe acute illness:
i. It doesn't necessarily stop transmission. More infections means more variant evolution, often specifically in the direction of increased immune escape.
We have both continuous and continual SARS-CoV-2 variant evolution happening. What do I mean? 🧵
Viruses evolve at (at least) two levels: among hosts and within hosts. Among hosts, the main determinant of viral fitness (i.e., reproductive success and continued existence of that lineage) is getting into new hosts.
In very general terms, traits like transmissibility and infectiousness are under selection at the among-host (interhost) level. When there is some degree of immunity in the population, characteristics like immune escape also become very relevant to viral fitness.
Is SARS-CoV-2 running out of evolutionary space? Is variant evolution slowing down? Is immune escape unlikely anymore? Let's explore. 🧵
Here are some phylogenies (evolutionary trees) of the major SARS-CoV-2 variant lineages from . One is in radial format, the other unrooted, but they show the same information and are both scaled to divergence (number of mutations). nextstrain.org
And here are some plots of mutations over time, again from . There is no sign of this rate of accumulation of mutations slowing down (if anything, more recent variants are above the trend line). nextstrain.org
When you're accustomed to extreme privilege, feeling uncomfortable becomes feeling unsafe, and those feelings become more important than other people's lives.
And that's the most generous explanation for why one of these bothers some folks way more than the other. There are far more disturbing explanations, of course.
“I have almost reached the regrettable conclusion that the Negro’s great stumbling block in the stride toward freedom is not the White Citizens Councilor or the Ku Klux Klanner but the White moderate who is more devoted to ‘order’ than to justice.” - MLK
The best we get now is *relative* lows. Here are numbers of hospital patients with COVID in Canada. It's as low as it has been since the first Omicron wave (early 2022), on par with the relative lull of mid-summer 2023. But still much higher than summer 2020 and summer 2021.
*Maybe* it will continue to drop as thr weather warms and if there are no new major variants that displace JN.1* in the meantime (fingers crossed, and wastewater signal is low), but the reality is that the baseline has never come back down in Canada post-Omicron.
Relative lows do not mean no risk, they mean less risk. If you've been putting off doing things while cases were higher, a relative low is a better (but again, not risk-free) time to do them than during a relative high, obviously.