Been doing some thinking about how the pandemic will end (@TRyanGregory & @madistod have been great sounding boards).
In particular, focusing on two questions relevant for sc2:
1. What does biology teach us about emergent pathogens? 2. What can past pandemics teach us?
(1/)
TL; DR is we’re all gonna die.
Just kidding. (Actually true if you wait long enough, but that thought is not an original one).
Some interesting titbits, details to follow): (2/)
1. There is a wealth of biology literature on pathogen emergence & what happens to virulence.
It’s a very well studied problem and the stuff you hear “experts” say on the topic is quite different from what the literature says on it. The “experts” are using 1980s textbooks. (3/)
2. This is a historic time to be a historian (of infectious disease at least).
Phylogenetic analysis is making history into a science. Molecular techniques are building new pictures of ancient events.
Many of the old stories were a bit “off”. (4/)
Taken together, the emerging picture of historical pandemics tells a different one than we hear repeated by the “experts”.
There are significant implications for sc2. (5/)
In particular: 1. The tail risk may be larger than is currently anticipated. Much larger. 2. The pandemic will end one day. If we are shooting for endemicity as the end goal, that day will be many decades or centuries in the future. 3. Viral evolution is not our friend. (6/)
SC2 is still very much a solvable problem. Studying history and biology carefully gives us many clues as to how to win.
Allowing unrestrained viral evolution puts us on a path to defeat. People may be underestimating how ugly that could look. (7/)
“Learning to live with” sc2 is a reckless choice, one that can go sideways at any moment.
The fact that it hasn’t happened yet is just ‘survivor bias’. We wouldn’t be having the conversation if it had already.
History & biology argue that we need a change of direction. (8/8)
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(🧵It's the Сονіd, ѕtυріd!): Viewing the US election through the lens of the ongoing ЅАRЅ-Соν-2 раndеmіc.
(My hot take on what happened, and where things are headed. Prelude to the final 🧵in the "How does it end" series)
(1/)
The post-mortem season for the elections is in full swing, and commentators on the left & right have lots of theories about why the Dems lost.
US elections are part of a global trend- incumbent parties in developing countries have lost vote share in every election this year(2/)
A common explanation for this is cost of living. Polls worldwide show dissatisfaction with the cost of living (the gap between the cost of goods & purchasing power), which by some measures is wider than ever before.
(Note that cost of living doesn’t map 1:1 with inflation.) (3/)
(🧵, CAN WE TALK ABOUT IT?):Over the last 5yrs, we as a society have developed a set of norms about 𝐂𝑂𝑉𝐈𝐃. As someone who's been actively publishing on the subject, I notice it very strongly. People will ask "why are you still masking", then wince when they hear my reply(1/)
I find it almost amusing, because our friends & famly know I work on the subject, & they're usually the ones that bring it up first. But my reply is obviously not what they want to hear, so I often get the "that was too much" look from my wife & kids in these situations (2/)
This plays out in the public sphere as well. "Expert" opinion that's soothing or reassuring is platformed, even if it's repeatedly wrong. This is a form of propaganda ("Calm-mongering" @Tryangregory ), & distracts us from the reality : (3/) typingmonkeys.substack.com/p/calm-mongeri…
(🧵NO ONE COULD HAVE PREDICTED THIS): To answer the question "What does the future hold for 𝑆𝐀𝑅𝑆-𝐂𝑂𝑉-𝟐?" it's worth examining how predictable its evolutionary trajectory has been so far. Evolution is stochastic, but stochastic processes can still yield predictions. (1/)
Paradoxically, while evolution is highly unpredictable at a molecular level, predicting its consequences and anticipating its risks is actually quite easy. We'll dive a lot deeper into this idea in a later TT, as it's a crucial one for understanding our current situation. (2/)
While "expert" prognostications from the early pandemic were wildly off-base, it was possible to reason deductively. We (my collaborators & I, h/t in particular @madistod & @debravanegeren) called out many of the risks within the first year, in the peer-reviewed literature. (3/)
(🧵2/5, HISTORY): What does history teach us about pandemics?
This is a topic that's been covered by others, but much of what's been said is worth taking a closer look at, in context.
Let's look at some historical pandemics/epidemics & see what we can learn. (1/)
It's worth starting by defining what a pandemic is- and isn't. To quote Michael Osterholm (in '09): “(A) pandemic is basically a…novel agent emerging with worldwide transmission.”
It's an epidemiological, not a social, construct. Pandemics don't go away if you ignore them. (2/)
In the last 🧵, we looked at what biology tells us about emergent pathogens.
The key take-home: the evolution of their virulence is unpredictable- it often increases.
Host & pathogen are locked in a Red Queen's Race (3/). It's not a stable equilibrium.
(🧵1/5, EMERGENCE): What happens to virulence after a new pathogen emerges? Popular thinking on the subject is that pathogens evolve become less virulent over time when they co-exist with their host species, based on the logic that virulent pathogens don't spread effectively.(1/)
This perception is occasionally echoed by experts as well, for example in this Science article: “𝑆𝐀𝑅𝑆-𝐂𝑂𝑉-𝟐 is going to become a common cold. At least that’s what we want.” (If wishes were horses, then zoonotic spillover would be nothing to worry about, I guess?) (2/)
The idea dates back to the "Law of Declining Virulence", propounded by medical doctor Theobald Smith in the 19thC (far from the last MD to confidently hold forth on the topic of evolution). Unfortunately, it's not supported by experimental data (see screenshots for example). (3/)
It's been ~5yrs since 𝑆𝐀𝑅𝑆-𝐂𝑂𝑉-𝟐, the virus that causes 𝐂𝑂𝑉𝐈𝐃, made its fateful jump into humans. Now seems as good a time as any to ask "is it over yet?" (For the 10th time, but who's counting?)
Let's talk about how this ends, shall we? (1/)
Every few months over the past 5 yrs, we've been reminded that the pandemic is over now, or perhaps it ended a long time ago, no one really knows.
The important thing is that it'll never go away, so we have to learn to live with it.
But not to worry, it's all very mild. (2/)
The dead moth buried in that word salad is the belief that newly emergent pathogens must eventually become endemic, that this process is about managing our own feelings about the situation.
A seven-stages-of-grief thing that we must all eventually accept. For our own good. (3/)