Thread by @arijitchakrav

(🧵, 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…

Calm-mongering serves to form an Overton Window about what futures are - and are not- discussable in polite conversation, when it comes to The Virus That Must Not Be Named. "Experts" have debated seasonality, herd immunity, hybrid immunity & viral attenuation for years. (4/)

Much of this is closer to fantasy in the context of 𝐂𝑂𝑉𝐈𝐃. The chance this virus will attenuate (evolve to become milder), to pick one example, is very low.

We discussed in an earlier 🧵 about what evo bio teaches us about emergent diseases:

(5/)

https://x.com/arijitchakrav/status/1845569743635583471

But still, the oft-baffled experts wax (& wane) lyrical about these possibilities.

Here's the thing- endless discussions like these are reckless, because they promote a false picture of a disease being tamed.

Nothing could be further from the truth:
(6/)

https://x.com/arijitchakrav/status/1847460174413390225

But risk is not being discussed in the public sphere.

The conversation that needs to happen in public is "is it a good idea to let this virus spread without mitigation?What are the potential downside risks of untrammelled viral evolution?"

This topic seems to be off limits.(7/)

So let's do it then. Let's talk about downside risks.

Taleb's Turkey teaches us that it's important to be able to have rational conversations about downside risks, particularly ones that haven't happened yet.

(8/)

https://x.com/arijitchakrav/status/1845090728755568795

There are 2 major risk scenarios worth discussing-attritional risk is the 1st.

Repeated 𝐂𝑂𝑉𝐈𝐃 infections over a lifetime can only cause cumulative damage.(It should be obvious, but) additional infections can't undo existing LC damage (sequelae).(9/)

peertopublic.com/posts/understa…

We can debate whether damage will accumulate faster or slower, but lower per-infection frequency of LC doesn't mean much if the plan is for everyone to get it 1-2x/yr. And we don't know how long LC effects last- some last at least 3yrs ("up to" ;>)

(10/)

https://x.com/RadCentrism/status/1793491216673411444

Many viruses have health effects that take decades to manifest. For slow-onset (delayed) sequelae, the extent of the health burden visible today may be a very small fraction of the total locked-in burden, as explained in this 📬 from @gckirchoff &me:
(11/)peertopublic.com/posts/the-dang…

Just to be clear, there's many plausible candidates for "long term damaging effect of 𝐂𝑂𝑉𝐈𝐃 that's not fully visible yet". Cancer , e.g.- you can make the case that 𝑆𝐀𝑅𝑆-𝐂𝑂𝑉-𝟐 may be carcinogenic- could be decades before that epidemiological "signal" is visible.(12/)

We don't know how long the sequelae last, or if we're done with finding new sequelae.

The true burden of 1-2x infections/yr is still unknown. (Known burden<total burden).

For any kind of rational risk mitigation though, the downside of the situation has to be discussable. (13/)

Might the health burden of repeated infections be larger than is visible today? By how much?

How much additional disease burden of Long 𝐂𝑂𝑉𝐈𝐃 can our societies accept?

These are questions that should be being discussed now in the public domain. (14/)

The risk of sudden catastrophe is also on the table. Repeated viral evolution leaves the risk of higher IFRs open.

(Note that IFR doesn't have to reach SARS levels- a Delta-like IFR (1.5%) could still rival the 1918 flu in death toll)

(15/)

https://x.com/arijitchakrav/status/1847461061475078543

As a thought exercise, let's consider what would happen in such a scenario (see screenshot).

An outcome like this is plausible and within the tail risk of the current pandemic. (More likely than the virus suddenly losing its virulence.) (16/)

medrxiv.org/content/10.110…

What will we do if such a situation arises? What's the plan?

Is there a plan?

When the strategy with every new outbreak is to sweep it under the rug, how will this work out with the downside scenarios for this pandemic?

(17/)

https://x.com/Mark_Ungrin/status/1848411567723057220

Of course, such a "glancing blow" can be delivered more than once by this virus. Let's see what happens if we let the pandemic run for years,with repeated waves of disease. As we've seen, the worst historical pandemics killed 10-40% of people & caused decades of instability (18/)

If every wave has a chance of leading to "attenuation" or a Gray Swan event (GSE) as described in our preprint, it turns out that collapse is a distinct risk unless the odds of a GSE is & odds of attenuation are high (h/t @gckirchoff again, full post on this coming soon) (19/)

This simple thought exercise speaks to the idea that the house always wins if you gamble long enough. To allow repeated waves of 𝑆𝐀𝑅𝑆-𝐂𝑂𝑉-𝟐 is to place a bet on viral evolution. We'll return to this topic in much greater detail later, but the bottom line is: (20/)

We are engaged on an uncontrolled experiment without historical precedent. We are allowing ourselves to be repeatedly exposed to a substance (this virus) that we don't fully understand. We don't know what the long-term consequences of that exposure are. (21/)

Is there any other substance that we do this with?

It's a wildly irresponsible & reckless course of action and - get this - asking "what's the risk here?" is now the imprudent & dangerous thing to do.

"War is peace". Orwell's 1984 was not intended as a how-to manual. (22/)

That's compounded by the fact that the virus itself is changing, it's evolving. It's doing the thing that experts assured us that it wouldn't do, and it's doing it in ways that experts assured us it wouldn't. Still we debate whether it will become mild or seasonal or polite.(23/)

The question we should be asking is "what are the consequences of another punc eq event like Omicron BA.1? " Because it's not off the table, not by a long shot. What's the plan if it comes to pass?
Risk mitigation is best done with worst-case scenarios, not wishful thinking.(24/)

This🧵was grim af, I know, but the first step in mitigating risk is acknowledging it exists, and making it discussable.

False promises can only go so far, action -not spin- is what's needed to fix the problem.

In the next 🧵, I talk about how the problem remains fixable.(25/)

This is the 5th 🧵 out of 6 in the “How does it end” series.

H/T to @TRyanGregory & @madistod for stimulating discussions that led to the creation of this series, @gckirchoff for the very cool interactive widgets & @0bj3ctivity for thoughtful feedback (26/)

@TRyanGregory @madistod @gckirchoff @0bj3ctivity Earlier🧵s here (27/):

Part 0: foreword
x.com/arijitchakrav/…

Part 1: emergent pathogens
x.com/arijitchakrav/…

Part 2: pandemics
x.com/arijitchakrav/…

@TRyanGregory @madistod @gckirchoff @0bj3ctivity Part 3: predictions, past and future: (27/27)

https://twitter.com/arijitchakrav/status/1847457263511798012