The End of the Pandemic Is Near | Tomas Pueyo on Anderson Cooper 360, January 21st 2022

4 reasons why the end of the pandemic might come after the Omicron wave:
1. Omicron is much less virulent
2. Vaccines reduce deaths by 90%, with boosters more
3. New treatments—especially Paxlovid—reduce fatality rates between 90% and 100%. As their production and distribution ramps up, the consequences of catching COVID will be dramatically reduced.
4. 90-95% of the population will have some immunity (in countries like the US) due to Vaccines and Omicron. Other countries will be similar given how contagious Omicron is.

The main concern that people have is: this assumes that a new variant won't appear with both more transmissibility and virulence. There are 6 reasons why this is less likely than we think:

1. History
The same thing happened in the 1918 flu. The 1st wave was deadly, the 2nd was deadlier, the 3rd was milder, and then no more waves were recorded. COVID also had deadlier variants in the middle. Omicron would be the last one if history repeated itself.

2. Patterns of respiratory viruses
~200 viruses cause colds, including 4 coronaviruses. How frequently do you hear them suddenly becoming deadly? It doesn't happen much. Only influenza viruses do it, and even then, they seldom cause scary pandemics.

3. Slower speed of evolution than the flu
But they do sometimes. A bad flu emerges every now and then because the flu virus evolves really fast.

SARS-CoV2 evolves ~half as fast. If it takes years between bad flu epidemics, why would it take much less for a slow-mutating virus?
You might ask: then why has SARS-CoV2 evolved so fast? Because it could evolve inside of the 7 billion humans that had no previous immunity.

Which leads to:

4. Fewer hosts for evolution
After Omicron, 90-95% of ppl will have some immunity. More immunity, fewer infections, fewer opportunities to evolve, slower evolution, slower arrival of new variants

5. Diminishing returns
Earlier evolution is always faster because there's more room for improvement. The more the virus improves, the harder it is to keep improving. There's only so many tricks to discover, and it has discovered a bunch already.

6. Infection strategy
Alpha and Delta were more contagious because they reproduced more efficiently. That also meant faster host infestation, and more deaths.

This is not Omicron's strategy: it sticks better to cells of the upper respiratory tract, so it attacks the lungs less.

That's the root of its increased contagiousness and lower virulence. For a new variant to evade immunity from Omicron AND be more deadly, it would need some trick where it also infects the lungs. But why would that be optimal for transmission? Unlikely.

More details in my newsletter:
https://unchartedterritories.tomaspue...

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