Thread by William Eden

twitter.com
3 Recommenders
3 Mentions
Recommend
Post
Save
Complete
Collect
Thread
I figure it’s worth posting a summary thread about my current thoughts on COVID to refer back to:

Like many great blunders in history, we went into this without an exit plan.

The landscape has changed such that risk is now individual cost/benefit more than public health. 1/
I was fully on board with early COVID Zero attempts. Containing and eliminating this virus, like we did with SARS1, would have been an enormous boon to the world.

But the extremely anemic response in the entire world outside of Asia and Oceania guaranteed failure. 2/
The fallback plan was red/green zones with local containment, lots of quarantine when moving between them, contact tracing, etc. De facto we got a few jurisdictions with this system, but I hoped it could work in many more countries. But that ship has also sailed now. 3/
The pandemic has now become endemic. The authorities seem to not have acknowledged this fact, despite it being blatantly evident. Doing so changes the optimal policy. This is where the lack of exit strategy is getting ugly… 4/
One potential exit path was vaccines. The initial efficacy was way better than I hoped! It seemed like maybe there was a promise (implicit or explicit) that getting mass adoption would stop the pandemic and/or return things to normal 5/
Unfortunately the biology of COVID is such that it’s like their distant cousins, the four endemic human coronaviruses that circulate and cause seasonal common colds. Immunity fades and you can catch each one annually. This is the future of COVID, forever. Face it. 6/
On the flip side: it sure looks like immunity (from vaccines or infections) confers a very significant protection against *very severe* COVID outcomes, long after it stops preventing infections and transmission. This is a great thing! And changes the risk calculus. 7/
The original justification for mass vaccination was that you could halt COVID spread, including to the people who couldn’t receive a vaccine. This makes some sense as a basis for policy! But it turned out to be false. 8/
If you get vaccinated, you are protecting *yourself* from the worst of COVID, but you aren’t protecting others for more than a few months. This makes it an *individual* decision, and NOT in the domain of public health policy. 9/
Similarly, masks do seem to offer some protection to both the wearer and others around them - but we can already individually choose to wear masks (including P100s or Versaflows or other measures) and get vaccinated. Anyone who wishes can protect themselves from COVID. 10/
The current policy seems to recognize *only benefits and not costs* of public health interventions. But there’s both direct costs, and costs to the fabric of society. Everyone knows our civilization is in a fragile state. We must not tear ourselves apart. 11/
Take vaccine mandates for example. They will likely succeed in pressuring people against their will to raise vaccination rates a few %. At the cost of **politicizing vaccines forever** and creating an unemployable undercaste of society. Surely they didn’t run the calculation. 12/
There are conceivably situations where this is warranted - a disease which doesn’t mutate rapidly, has severe illness, and immunity is lifelong. And in some cases it could be worth non-pharmaceutical interventions to slow the spread while deploying a vaccine! /13
Furthermore, risk is reduced even more by the emergence of effective treatment options, from repurposed drugs easier on to Paxlovid today. With COVID becoming endemic and seasonal we need to deploy these - and continue working on even better options. /14
At this point, COVID is over when we decide it’s over. And there’s no justification for continuing emergency measures and heavy handed policy when the risks have become manageable, and almost entirely individual, when it is literally tearing apart our society. /15
If I were named COVID czar tomorrow:
-all pandemic restrictions and mandates ended immediately
-an impassioned plea to consider vaccination
-redirect resources to scaling therapeutics and developing better drugs and vaccines
-take any measures you need to protect yourself

16/16
Thanks everyone for your interest. The main pushback has been about hospital capacity creating a public interest, so let's talk about hospital capacity.

It turns out we already have a good model for this, because we already have a deadly seasonal virus: influenza. 17/
Every winter, huge numbers of people fall ill, many hospitalized, and an estimated tens of thousands die from a contagious disease with a partially-effective vaccine. But we don't mandate those vaccines, or masks, or shutdown hard-hit areas. 18/
COVID is of course far more serious than the flu, but with previous infections and vaccinations greatly reducing the risk of hospitalization and death, it will more and more come to resemble the current state of affairs we already are used to. 19/
Influenza pandemic surge capacity is a very well studied field. Most of the papers will tell you we aren't sufficiently prepared, as all such studies tend to find. And they're probably right - we should be investing in more surge capacity! For this pandemic and the next one. 20/
We do have some experience with surge capacity due to influenza. In the last several years we've had a few worse outbreaks. And hospitals have procedures in place to expand capacity on a short term basis, see e.g. this story: time.com/5107984/hospitals-handling-burden-flu-patients/ 21/
In some ways, the COVID response has actually been *bad* for hospital capacity. The lack of revenue from non-COVID patients caused some hospitals to scale back due to budget. And mandatory vaccine requirements have closed entire wards of hospitals recently! 22/
Hospital capacity seems to be treated as some fixed number that was created long ago by a mysterious process, but it is a variable that we can and should choose to deliberately increase. Policy efforts need to be aimed at supply, not just demand, for hospital beds. 23/
But let's also investigate the premise: have we been seeing serious hospital overflow problems? Here is a graph of US ICU capacity from JHU. You can explore the data here: coronavirus.jhu.edu/data/hospitalization-7-day-trend 24/
That is an aggregate graph of course, but go to the website and click through to individual states. There are a few times it got pretty close during the delta wave, but overloads generally are not occurring now. 25/
Of course you can dig up individual news stories of people who have tragically died in waiting rooms or other horrifying statistics... but many of those have been investigated and the numbers were false, or the stories not as described. I'm going to stick to data on this one. 26/
So what's my summary of hospital capacity?
-We have enough right now
-We absolutely should create more
-This isn't a valid reason for current policy stances

27/
Much more could be said about optimal policy responses, btw. We have overall done a HORRIBLE job. Rapid tests are cheap and abundant in Europe, they should be here too. It should be encouraged to stay home when you're sick with *anything* not just COVID. And so much more. 28/
At the end of the day, we can't let the perfect be the enemy of the good. We can't let counterfactual Zero COVID world get in the way of policy today. We can't let past policy failures dictate current ones. Each must be evaluated on their merits - and our ones are lacking. 29/29
Mentions
See All