Coronavirus

[AlanSubie4Life]

https://twitter.com/x/status/1389248436071919628

Nice summary of P.1, which has some immune escape and some increased transmissibility.

Good to think about this as things move forward, where I'd expect states where there are currently generally downward trends in cases (due to higher levels of natural immunity) to see increases in this variant because it does bypass some of those natural protections (like California, for example). Going back to the Oregon example - P.1, if it were to become established, would tend to make California look a bit more like Oregon, where higher levels of vaccination would be needed to control the outbreak. Especially given that the populations least likely to be vaccinated are more likely to have been previously infected, likely being the least careful, and likely the most vulnerable to future infection.

Just need to keep vaccinating (and keep getting infected, though that is not preferred of course). No reason we can't get to a decent level of herd immunity (never mind what the NY Times might say, lol).

 

[AlanSubie4Life]

I'm going to go out on a limb and make the prediction that by April 20th cases will start their terminal decline. We'll see! It's a tricky one, because there certainly could still be a lot of spread in young people & children as activity levels increase, and vaccination coverage is not uniform.

Why do I think this? We've reached a point where about 60% of people have either been infected or received a single dose of vaccine, and nearly half of them (>25% of the population) have very strong immunity (two doses or one dose + previous infection). That's something like 75% or more of adults (hard to say exactly since it depends on exactly how many children were infected) with some pre-existing immunity, so probably 55-60% of adults are actually robustly immune (due to single dose or prior infection not being 100% effective).

So there are going to be communities with low coverage where this spreads still and there are rising cases, but on balance I just can't see SARS-CoV-2 being able to make it much longer. You need an R0 value of 2.5 (on average) to overcome this immunity.

We'll see! Hard to predict within a week, though I'd be a lot more confident if I were making a prediction about three weeks from now (I definitely think we will see a substantial reduction from current case levels by then). Just thought I should make a lower confidence/bolder prediction.

(This prediction was obviously for the US.) Looking good so far! I guess we'll see if it ends up being the terminal decline, though. Still lots of vaccination taking place, though I would love to see a resurgence in the numbers there - they look like they are on their terminal decline too, unfortunately - we'll see if we get a second-dose bump in another week or two.

Meanwhile, the NY Times insists we'll never actually hit herd immunity and "experts" agree. There's a big difference between herd immunity and eradication, which I think might be the source of confusion there. I think we're going to hit herd immunity in the US (on average - obviously local communities could be far from herd immunity, but nature will run its course), but actual eradication would be much more difficult. And to some extent it's semantics - who cares as long as cases go close to zero, and deaths drop to minimal levels as well (and are amongst people who were given every opportunity to be vaccinated)?

I'm not sure what to think about that article. In some ways I agree, but I think completely ignoring the impact of natural infection (which doesn't universally prevent reinfection of course, but is quite effective, at least 40% to 90% depending on if variants are around) in the article is a bit misleading.

 

[TespaceX]

Well, FL is being FL.

All COVID restrictions to be dropped and banning any entity from asking whether someone has gotten a vaccine.

The state doesn’t even have a simple majority of the population with at least the first shot of a 2-dose vaccination.

 

[eevee-fan]

Well, FL is being FL.

All COVID restrictions to be dropped and banning any entity from asking whether someone has gotten a vaccine.

The state doesn’t even have a simple majority of the population with at least the first shot of a 2-dose vaccination.

I guess FL is trying to reduce the number of retirees LIVING in the state.

 

[winfield100]

I guess FL is trying to reduce the number of retirees LIVING in the state.

OT
I have folks wanting to buy my house in Florida that I live in full time, and am retired
We view it as an accelerated, wealth transfer to a younger generation.
There was a lot of activity of folks getting Moderna shots though
It will almost certainly increase the number of available places to buy and rent
edit:
there are a _lot_ of "karens" and illiterates

 

[dhanson865]

Even though the 4th wave was tiny I'm calling it 4 waves for the US.

so will we get a 5th, 6th, 7th wave? It seems like every 3-6 months we get a new wave. Do we get a mid summer spike like summer 2020? Do we get a fall/winter spike like 2020?

Vaccination could negate the coming spike attempts, but behavior may be a bigger factor.

 

[EVNow]

Just need to keep vaccinating (and keep getting infected, though that is not preferred of course). No reason we can't get to a decent level of herd immunity (never mind what the NY Times might say, lol).

Need the third dose with variants included.

 

[AlanSubie4Life]

It seems like every 3-6 months we get a new wave.

Humans are pattern-seeking machines. I wouldn't take this pattern and extend it to the future.

Do we get a mid summer spike like summer 2020?

If you define a spike as more than a 10k increase in the 7-day average sustained for more than a week (gets rid of old data dump spikes or you can just ignore that stipulation and look at the epi curves, but there is no such epi curve for the entire US I think), no, I would bet no.

Do we get a fall/winter spike like 2020?

Tougher. I don't think we will in places that have higher levels of vaccine coverage. You'd have to use a different definition of a spike at the local level for this. Regardless I expect CFRs to be down considerably, even if there is a spike.

Vaccination could negate the coming spike attempts, but behavior may be a bigger factor.

Vaccination looks to me like the far larger factor. Look at how open things are now, relative to last April/May, and in spite of that, cases are heading down. Also look at Israel and the UK. Assuming an effective vaccine, it's just math. The virus can't survive if there are enough vaccinations as long as the vaccination remains effective. If you have 25% of your population susceptible, the virus has to be twice as infectious to sustain spread as it does if 50% of your population is susceptible, all else being equal. If you bring that down to 12.5%, it has to be four times as infectious.

 

[EVNow]

FYI, anybody want vaccines come to eastern WA. We’ve got 4000 open appointments next week in Kennewick. Apparently, folks here don’t think it’s necessary.

We have tons of opening on the west side too - including Seattle metro East side (Issaquah, Redmond etc) . Anyone who wants a vaccine can now get one in WA. Went very fast from can't get any appointments anyday to thousands available daily. Mass vaccination sites helped.

ps : That J&J fiasco sure made a lot of sceptics firmly sit on the sidelines. Very poor handling.

 

[AlanSubie4Life]

Need the third dose with variants included.

Fortunately, there is minimal evidence that that will be needed - yet. I suspect that boosters will be needed eventually - but more for waning titers and as a means of suppressing spread, than to deal with variants. The MRNA booster currently in trials will be a blend of old and new when/if it becomes available. I'd actually be concerned if we needed a booster to deal with variants because we probably haven't seen the escape variant yet - so we'd have to restart the process then and move quickly - the currently contemplated blend would likely not work for such a hypothetical escape. Note that so far, there are no variants that are of the highest concern level, according to the CDC.

In the short term, next 2-3 months, that's when we're going to determine whether or not herd immunity can be reached as it has been (nearly - they still have some restrictions on indoor behavior) in Israel - and the boosters aren't going to help with that.

 

[madodel]

Had my second dose of Moderna yesterday and the event was supposed to be just 2nd doses but because they had so few people show up for the first dose 4 weeks ago they opened it to everyone. It was steady with a small line. There were no appointments. Just first come first serve.

I feel achy all over so I suppose the 2nd dose is doing its thing.

Today I woke up and felt great. Even did my workout as normal. My wife says this is typical from what she hears with Moderna to feel like you got run over by a truck for a day and then just fine. Fewer issues with Pfizer which is what she had.

 

[FlatSix911]

Need the third dose with variants included.

Your wish has been granted... we will probably receive annual immunizations just like the seasonal influenza variants.

 

[AlanSubie4Life]

Your wish has been granted... we will probably receive annual immunizations just like the seasonal influenza variants.

Yep, seems likely (at least for a period of time...then we will see). But if that is required for herd immunity we would have major issues. Let's hope it is not!

I think the long-term requirements for annual boosters will be dependent on the virulence of COVID post-vaccination, and the additional benefit of boosting, both of which are unclear at the moment. But certainly seems likely that one or two boosters are kind of baked in at this point.

 

[eevee-fan]

With the flu gone (hopefully) maybe this is nature's replacement?

 

[AlanSubie4Life]

With the flu gone (hopefully) maybe this is nature's replacement?

The flu is not gone. Its natural reservoir is birds. It'll be back. People will be puzzled, but will refuse to wear masks when they are sick, and workers in elder care facilities will come to work with known exposures and symptoms (because there is no provision to receive a paycheck without penalty when ill, etc.), kids will come to school with the flu, and then things will be back to normal. Assuming things go well with COVID herd immunity, flu will be back next winter - but that's a bit hard to predict - based on the lack of vaccination worldwide for COVID, and therefore continued NPIs, flu transmission patterns will almost certainly still be disrupted somewhat this winter, so a "normal" season seems unlikely.

 

[Jeff N]

so will we get a 5th, 6th, 7th wave? It seems like every 3-6 months we get a new wave. Do we get a mid summer spike like summer 2020?

I think it’s quite possible we will get a modest wave in the core southern states in June/July (like we had a larger spike last year there) due to inadequate vaccination when it gets hot and humid and people head indoors and crank the A/C. I’m talking about Louisiana, Mississippi, Alabama, Georgia, Arkansas, Tennessee, etc.

 

[wdolson]

I'd say in some places we are nearing diminishing returns. My county is at 60% with at least one dose, 40% with both, we had 4% confirmed infections, maybe add at least another 6% unconfirmed, that puts us around 70% with at least some form of effective immunity. Assume another 20% will refuse the vaccine completely so we might have 10% left willing and still waiting for the first dose.

Looking at the NYS chart we have the second highest vaccination rate, second only to Hamilton county, which is in the middle of the Adirondacks and is the least densely populated county east of the Mississippi with less than 5K residents. Surprised they could find them in the wilderness.
COVID-19 Vaccine Tracker

The difference in population densities is interesting. Washington State has 3 counties with less than 5000 people. The next county to the east of us has 12,000 people, but it's also geographically very large. The density is virtually zip.

Almost every state seems to be improving including Michigan but now Oregon and Washington are seeing a surge.

COVID-19 surges in Oregon, sickening younger adults and forcing a return to restrictions

The coronavirus is making a comeback in Oregon, leading Gov. Kate Brown to reimpose restrictions on restaurants and bars.

www.latimes.com

If you look at the county data, the bulk of new infections are in the eastern parts of both states where there are more COVID deniers. Siskyou County in California has a worse rate of infection (per capita) over the last week than every county west of the Cascades in Oregon and Washington.

FYI, anybody want vaccines come to eastern WA. We’ve got 4000 open appointments next week in Kennewick. Apparently, folks here don’t think it’s necessary.

We're getting to the point where most people willing to get the vaccine have gotten it and the next effort is to convince the tail end Charlies to get it. We will probably see another bump in vaccinations when the age level drops to 12.

 

[Jeff N]

If you look at the county data, the bulk of new infections are in the eastern parts of both states where there are more COVID deniers. Siskyou County in California has a worse rate of infection (per capita) over the last week than every county west of the Cascades in Oregon and Washington.

It’s true that California has some worrisome eastern county statistics but the highly populated coastal counties are generally in good shape. However, in Oregon the Multnomah and Clackamas counties in and around Portland have significant new infection counts and rates.

 

[EVNow]

Yep, seems likely (at least for a period of time...then we will see). But if that is required for herd immunity we would have major issues. Let's hope it is not!

I think the long-term requirements for annual boosters will be dependent on the virulence of COVID post-vaccination, and the additional benefit of boosting, both of which are unclear at the moment. But certainly seems likely that one or two boosters are kind of baked in at this point.

Astra-Zeneca / Oxford doesn't have much absolute immunity against the variants. In India people are getting infected with new variant - but they fare better if vaccinated. Large number of infections in US and other countries will create newer variants. As the immunity slowly goes down - by the end of the year most of us would require a booster to resist getting infected with new variants.

Unless all large countries get high efficacy mRNA and take strict control measures for a year to eliminate Covid - we may be in for regular Covid breakouts in various parts of the world. Annual vaccinations will be required to keep immunity levels high.

Remember "let it run its course - we'll have herd immunity soon" crowd ? They got it absolutely wrong - they didn't account for mutations.

 

[AlanSubie4Life]

Astra-Zeneca / Oxford doesn't have much absolute immunity against the variants. In India people are getting infected with new variant - but they fare better if vaccinated. Large number of infections in US and other countries will create newer variants. As the immunity slowly goes down - by the end of the year most of us would require a booster to resist getting infected with new variants.

Unless all large countries get high efficacy mRNA and take strict control measures for a year to eliminate Covid - we may be in for regular Covid breakouts in various parts of the world. Annual vaccinations will be required to keep immunity levels high.

Remember "let it run its course - we'll have herd immunity soon" crowd ? They got it absolutely wrong - they didn't account for mutations.

Sure, it is hard to predict how that will all play out. The real-world efficacy of the AdV vaccines against variants is a bit unclear - there is definitely some substantial neutralizing escape by some variants - with unclear impact on severe disease and outcomes - but that global situation wasn’t what I was referring to....

I was referring to the US, where we need to reach a form of herd immunity or at least get very close, in the next couple months. Boosters won’t be needed there in that timeframe otherwise we are in trouble.

As far as new variants is concerned that is also less clear...new variants are showing up all the time - but will they be more fit? Having a variant that actually escapes the vaccines (I’m talking about the effective vaccines) would be a real problem.