22 votes

The end is near: COVID is becoming endemic

25 comments

  1. [7]
    kfwyre
    (edited )
    Link
    This has been a lesson both I and my husband have learned. COVID made us change our habits quickly because of the immediacy of its threat, and we did those not because they were guarantees but...
    • Exemplary

    However, please note: with the exception of Alzheimers and freak accidents like lightning strikes, almost all those top 10 causes of death are abetted by risks some of us long ago rationally (or semi-rationally) decided to accept: smoking, drinking, overeating, driving, kissing, chainsaw-juggling and so on.

    Risks increase with age: no one dies at age 13 from their first cigarette. Covid death risk also increases with age; our national nervousness is age-stratified.

    This has been a lesson both I and my husband have learned. COVID made us change our habits quickly because of the immediacy of its threat, and we did those not because they were guarantees but because each mitigation strategy was a risk reduction. It also got us thinking a lot about life, death, and health, and we realized that there are other, less immediate threats out there, and we’re not adequately using mitigation strategies for those.

    We overeat. We don’t exercise like we should. We’re overweight. We know what these lead to, and it’s easy to just sort of ignore that because it’s not pressing.

    So, COVID has actually forced us to change things up. We take our health a lot more seriously and make much more of an effort than we ever have. My husband has lost over 50 pounds. I am so proud of him!

    I wish I could say it’s easy, but it’s been a lot of work. It’s also continual upkeep. Constant. I keep lapsing on my habits and then having to restart them. I’m in generally good spirits about it (I legitimately feel better when I do healthier things), but it’s also tough because I expect and feel like I deserve immediate results when I’m well aware that I’m actually playing a very long and slow mitigation game.

    That said, one thing that COVID did genuinely help me with is reframing my behaviors. I’ve done plenty of bouts of diet and exercise in the past, so I’m no stranger to the struggles and triumphs and failures those efforts bring, but this is the first time I’m looking at things through the lens of mitigation. In the past, not eating bad foods was always a battle of willpower — having to consciously overcome my want for them. Instead, I now look at not having those foods as a protective thing — like wearing a mask to the grocery store. Not eating the junk is lowering my chances of getting something that could hurt or kill me. The onset for those harms is undoubtedly way down the road, but it lies at the end of that road just the same, and I full well know it. Why go down that path if I don’t have to?

    This has helped me to feel like healthier eating and exercise are less fatiguing struggles and more proactive protections for myself. It’s not a perfect fix, and I still struggle with the urge to devour large amounts of delicious crap more than I should, but it definitely helps me keep focus on why I should make the choice against it. It also helps make it feel like each instance counts. In the past I would try really hard and then fall off the wagon and just stop in my efforts entirely. Now I’m looking at it as each individual choice matters, so even if I made the wrong choice yesterday, I can still make the right one today and that will always be a step in the right direction.

    23 votes
    1. [5]
      Adys
      Link Parent
      This is awesome to hear and I share your outlook. It's had a very similar effect on me, and while I didn't lose weight since the start of confinement I'm pretty proud not to have gained any....

      So, COVID has actually forced us to change things up. We take our health a lot more seriously and make much more of an effort we ever have.

      This is awesome to hear and I share your outlook. It's had a very similar effect on me, and while I didn't lose weight since the start of confinement I'm pretty proud not to have gained any. Rather i have gained new habits, new healthier "autopilot routines" so to say.

      Proud of you and your husband. Keep it up!

      7 votes
      1. [4]
        kfwyre
        Link Parent
        Thanks! Glad to know we’re in the same boat! I was also a quarantine maintainer-not-gainer, which I’m considering a victory as well. I’m now on the slow slope downward for weight loss. Feels...

        Thanks!

        Glad to know we’re in the same boat! I was also a quarantine maintainer-not-gainer, which I’m considering a victory as well. I’m now on the slow slope downward for weight loss. Feels great, but is also a ton of work!

        Have you been able to resume skating, or is that still shut down for you?

        4 votes
        1. [3]
          Adys
          Link Parent
          Thanks for asking. ❤️ It's resuming soon. Or should be at least. 9th of June (right after my birthday ha!), if cases keep going down. Frankly it's been hard not having it. My weight went back up...

          Thanks for asking. ❤️ It's resuming soon. Or should be at least. 9th of June (right after my birthday ha!), if cases keep going down.

          Frankly it's been hard not having it. My weight went back up for a while. I reached a threshold which rang alarm bells and I've been on a very strict low calorie IF diet the past few days and I'm back in the "normal" zone, I might even be lighter than when the rinks closed for the 9th!

          6 votes
          1. [2]
            kfwyre
            Link Parent
            Glad to hear you stand a good chance of being back on the ice soon. I know how important it is to you! Also a very early Happy Birthday to you!

            Glad to hear you stand a good chance of being back on the ice soon. I know how important it is to you!

            Also a very early Happy Birthday to you!

            1 vote
    2. Pistos
      Link Parent
      This is a great mindset that can apply to much of life in general.

      Now I’m looking at it as each individual choice matters, so even if I made the wrong choice yesterday, I can still make the right one today and that will always be a step in the right direction.

      This is a great mindset that can apply to much of life in general.

      5 votes
  2. [18]
    vord
    Link
    This reads like some serious survivorship bias. "It wasn't even that bad, what was all the fuss about?" Well, for one, it would have been exponentially worse if all of these measures were not...

    This reads like some serious survivorship bias.

    "It wasn't even that bad, what was all the fuss about?"

    Well, for one, it would have been exponentially worse if all of these measures were not taken. Hell, it likely wouldn't have gotten so bad if it was taken seriously from day 1.

    Beating back the variety surge is likely due more to the weather. There still have not been enough people fully vaccinated. This summer is the best time to try to kill this off, and returning to normal because rates are about the same as this time last year ain't gonna cut it.

    I highly advise everyone to not to go maskless indoors except around people whom you know and trust, and are vaccinated. Keep masks on, especially around kids. Especially keep masks on kids.

    Until the < 12 gets vaccinated, daycares and schools will be breeding grounds for varients, even in the slow season. Doubly so if they truly are the silent spreaders.

    12 votes
    1. [14]
      Adys
      Link Parent
      Where are you reading this in the article? It's not looking back, it's only looking forward.

      "It wasn't even that bad, what was all the fuss about?"

      Where are you reading this in the article? It's not looking back, it's only looking forward.

      11 votes
      1. [13]
        vord
        Link Parent
        It wasn't in the article, rather a summary of how the tone felt after finishing the article. The key influencing statement: In particular, from the very beginning many anti-maskers used this sort...

        It wasn't in the article, rather a summary of how the tone felt after finishing the article. The key influencing statement:

        But at some point, we each individually decide “OK, I can live with this much risk.” Then peer pressure kicks in. “Well, if you can, I can too.”

        In particular, from the very beginning many anti-maskers used this sort of "it's low risk, it's mostly just the flu, and we'll hit herd immunity anyway" logic. The article compares it to the flu, and the deadliness of it, quite frequently. But there is no mention about the lingering effects (say the permanent lung scarring) that have been found so far that don't exist the same degree for the flu. We might have only seen a fraction of COVID deaths that will come later, as they might just manifest as increased lung cancer deaths in 10-20 years.

        De-masking prematurely will cause the peer pressure as stated. But especially for the 2-16 crowd, it's going to kick in before we are ready. Kids 2-16 still aren't allowed to get the shot, about 1/3 of the population in the USA. If the adults de-mask, so will they. Sure, if everyone you hang out with is 16+ and fully vaccinated, that's probably pretty safe. But until the kids are also vaccinated, they'll be spreading it amongst themselves. And they're going to spread it mostly silently, breeding new variants over the summer/fall (when they're most social with least supervision), the full effects of which will only be realized come the holiday season. If we manage to get the majority of that 2-16 group vaccinated before September, we'll be in a much better position to minimize that. Doubly so if we prevent that 2-16 group from spreading it quietly through the summer.

        COVID might not mutate as fast as the flu, but so long as it's given the opportunity to keep mutating, there's a chance that it will mutate in a way which makes it more resistant to the heat, become fully airborne, or mutate faster. Either one of those could spell disaster, especially since the disease is far more latent then the flu.

        8 votes
        1. [11]
          Adys
          Link Parent
          I have a lot to say about this but it's late and I'm on my phone, i might do so tomorrow. In the mean time, can you explain why you are so specifically worried about the 2-16 crowd when masking...

          I have a lot to say about this but it's late and I'm on my phone, i might do so tomorrow. In the mean time, can you explain why you are so specifically worried about the 2-16 crowd when masking for that crowd hasn't been particularly explicitly recommended by experts?

          For example, here (BE) masks are mandatory everywhere but only 12+. There's also been quite a lot of speculation about the harmful effects of masks on development of communication skills for young children; I'll find them later if you're curious but I'd argue for some common sense here.

          This feels very cherry-picky tbh. Not to say there's no good reason to be worried about transmission via children (I was an early proponent of closing the schools far more strigently than Belgium did), but there is at least somewhat general agreement that masks don't belong on kids right now, because lots of downsides and little upside compared to adults.

          2 votes
          1. [10]
            vord
            Link Parent
            Because I have a kid, and MIS-C is a thing. But also, there's plenty to back it up. 2-16 need 80% or higher vaccination. Especially when in-person schooling kicks up again in the fall.

            Because I have a kid, and MIS-C is a thing. But also, there's plenty to back it up.

            2-16 need 80% or higher vaccination. Especially when in-person schooling kicks up again in the fall.

            7 votes
            1. [9]
              Adys
              Link Parent
              I agree with you, but this doesn't back up the masking argument IMO. And while silent spread through schools is extremely dangerous, it is so in an unvaccinated population. If most of the adult...

              I agree with you, but this doesn't back up the masking argument IMO. And while silent spread through schools is extremely dangerous, it is so in an unvaccinated population. If most of the adult population is vaccinated, the virus has nowhere to spread to, other than more kids who won't be affected.

              Furthermore asymptomatic patients still develop antibodies so children aren't as much at risk as before either.

              I get what you're saying but it feels like you're forgetting the equation:

              1. The most at risk are almost entirely vaccinated (with exceptions yes, you can never get to 100 percent)
              2. The less at risk are vaccinated or vaccinating
              3. Children are overwhelmingly not at risk
              4. Masking is not very effective in children because they're less likely to take proper precautions
              5. Masking has potentially severe psychological and developmental impacts on kids

              That said, vaccine trials for kids are ongoing and I'm sure they're next. The US will undoubtedly hit a vaccine wall very soon and they'll have too many doses, no question that they'll vaccinate kids with them.

              Sidenote, I followed COVID more than most people -- volunteered work with biotech and medical companies and what not. And while the most infuriating thing I came across is people not taking the virus seriously, the second most infuriating is people taking it too seriously. The latter has serious repercussions too, and responses need to be measured lest we end up in a society that completely loses its trust in science.

              7 votes
              1. [4]
                eladnarra
                Link Parent
                Many immunosuppressed and immunocompromised folks aren't properly protected even with vaccination, and last I checked it looks like their infections are more likely to lead to mutations/variants....

                If most of the adult population is vaccinated, the virus has nowhere to spread to, other than more kids who won't be affected. [...] The most at risk are almost entirely vaccinated (with exceptions yes, you can never get to 100 percent)

                Many immunosuppressed and immunocompromised folks aren't properly protected even with vaccination, and last I checked it looks like their infections are more likely to lead to mutations/variants. Kids (and parents) with certain conditions are still at risk.

                Masks are still recommended for kids in the US (by the CDC) when indoors like at school.

                6 votes
                1. [3]
                  Adys
                  Link Parent
                  Don't take this as me putting you on the spot but can you source this? I've not heard about that and I'm curious. A close friend of mine is highly immunocompromised, I tend to keep up to date with...

                  last I checked it looks like their infections are more likely to lead to mutations/variants

                  Don't take this as me putting you on the spot but can you source this? I've not heard about that and I'm curious.

                  A close friend of mine is highly immunocompromised, I tend to keep up to date with developments regarding that…

                  2 votes
                  1. eladnarra
                    Link Parent
                    Sure! It's not a certainty, but this review goes over a lot of it. Also: Persistence and Evolution of SARS-CoV-2 in an Immunocompromised Host (correspondance) And: Emergence of multiple SARS-CoV-2...

                    Sure! It's not a certainty, but this review goes over a lot of it.

                    The globally emerging strain first found in the UK, B.1.1.7, contains the spike glycoprotein mutation N501Y and shows signs of having emerged from an immunocompromised host [...] Persistent infection in immunocompromised patients may allow viruses to rapidly generate diversity under prolonged selection pressures that are absent in typical SARS-CoV-2 infections that transmit within days and resolve within weeks.

                    Also: Persistence and Evolution of SARS-CoV-2 in an Immunocompromised Host (correspondance)

                    Although most immunocompromised persons effectively clear SARS-CoV-2 infection, this case highlights the potential for persistent infection5 and accelerated viral evolution associated with an immunocompromised state.

                    And: Emergence of multiple SARS-CoV-2 mutations in an immunocompromised host (preprint)

                    We have recently reported our observations with a cohort of six B-cell depleted patients with COVID-19 (BLD-2020-010058, under review). Within this study, we observed notable findings in one of those patients, who exhibited a protracted, eventually fatal clinical course characterised by the presence of high concentrations of replication-competent SARS-CoV-2 in the respiratory tract for more than 134 days. Here, we present analysis of the viral evolution of samples from this patient over time with increased detectable rate of mutation in comparison to two other B-cell depleted patients as well as the general population of SARS-CoV-2 infected individuals, thus suggesting a unique interplay of host and viral factors.

                    Basically it seems to have to do with the long length of time that some folks are sick, plus potentially increased "selective pressure" from treatments like convalescent plasma. I don't think they know how often this happens, but it's something that needs more study and tbh worries me. When we throw immunocompromised folks under the bus by relaxing mask requirements while there's still community spread, we not only endanger them (very bad!), but also might be creating situations for more variants.

                    6 votes
                  2. hhh
                    Link Parent
                    I don't have a link right now but I remember reading this. The idea is similar to how bacteria develop immunity to antibiotics better when they're not completely wiped our/people don't take their...

                    I don't have a link right now but I remember reading this. The idea is similar to how bacteria develop immunity to antibiotics better when they're not completely wiped our/people don't take their full course of antibiotics---as in the bacteria that already were somewhat resistant survive and continue to thrive and develop resistance.

                    3 votes
              2. [4]
                vord
                Link Parent
                That ship has long sailed my friend. That "Intelligent Design" entered the lexicon at all is all the evidence I needed of that. Not even to get started on the anti-vax movement. I'm not concerned...

                measured lest we end up in a society that completely loses its trust in science.

                That ship has long sailed my friend. That "Intelligent Design" entered the lexicon at all is all the evidence I needed of that. Not even to get started on the anti-vax movement.

                I'm not concerned about the current 'children at risk' situation. I'm concerned about the long-term risk. Kids are not likely immune to the hidden lung scarring that's been found in older people. Even if they're not directly at risk they remain a cesspool for developing new variants. The psychological damage is done to the generation...what's another 3 months after 1.5 years?

                I am curious to know about the repercussions of taking COVID too seriously.

                3 votes
                1. [3]
                  Adys
                  Link Parent
                  The lung scarring is a result of the vascular symptoms. Asymptomatic patients (children) don't get those. I don't want to speculate, but saying "not likely" is a reach. I agree, you don't need to...

                  Kids are not likely immune to the hidden lung scarring that's been found in older people.

                  The lung scarring is a result of the vascular symptoms. Asymptomatic patients (children) don't get those. I don't want to speculate, but saying "not likely" is a reach.

                  Even if they're not directly at risk they remain a cesspool for developing new variants.

                  I agree, you don't need to convince me. But this is troubling:

                  The psychological damage is done to the generation...what's another 3 months after 1.5 years?

                  An extra 20% is what it is. To a kid, 3 months is 1.5 summer breaks. I remember as a child, 3 months was fucking forever. To a 10 year old, 3 months is 3.6% of their entire life; twice that if you only count the years of life they really remember.

                  This here is what I mean by "taking COVID too seriously". There are risks. There are also bigger risks elsewhere. A large part of taking COVID very seriously was:

                  • Ward the disease as long as possible so we can develop vaccines
                  • Ensure other hospitals don't get overwhelmed
                  • Lower death counts as much as possible
                  • Prevent a collapse of various parts of society due to too many people falling sick at once
                  • Stop country-to-country transmission in its tracks

                  All of these except the last one have been successfully done. We failed at the last one, but that ship has sailed.

                  I understand that we really rammed into people's heads how important it was to take COVID seriously, take precautions etc. But the context of why we did needs to be taken into account.

                  And, I'm sorry, but it really ticks me off to see someone essentially say "Well, we fucked up this generation's mental health anyway, the damage is already done, no harm in doing more". A week ago you yourself were lecturing me on empathy. Do you realize what you're saying here?

                  9 votes
                  1. [2]
                    eladnarra
                    Link Parent
                    Just want to chime in here to mention that there are possible long term effects other than lung damage; long COVID is seen in kids as well as adults, and lots of us who have similar chronic...

                    Just want to chime in here to mention that there are possible long term effects other than lung damage; long COVID is seen in kids as well as adults, and lots of us who have similar chronic conditions/symptoms got sick when we were kids/teens. ME/CFS is shitty whatever your age, but it sucks when your life comes to a complete standstill before you've even graduated high school...

                    4 votes
                    1. Adys
                      Link Parent
                      I absolutely agree, but I don't know how productive this will be without numbers. It feels like a trolley problem right now: "Would you rather some unknown amount of children get life-altering...

                      I absolutely agree, but I don't know how productive this will be without numbers. It feels like a trolley problem right now: "Would you rather some unknown amount of children get life-altering long term psychological and mental issues, or some other unknown amount of other children get life-altering long term physical issues?"

                      I'd obviously rather not have anyone get any issues, but failing that, my personal approach has always been in favour of what has life-altering repercussions for the least amount of people.

                      5 votes
        2. vektor
          (edited )
          Link Parent
          Here's a thought: Non-pharmaceutical interventions potentially increased the risk for mutations. Warning: Conjecture ahead. Non-pharmaceutical interventions will decrease R. As long as we can't...

          Here's a thought: Non-pharmaceutical interventions potentially increased the risk for mutations. Warning: Conjecture ahead.

          Non-pharmaceutical interventions will decrease R. As long as we can't achieve proper pandemic control sustainably (R<1 long-term), we will continue to see waves (or one loooong wave) occasionally until we can.

          What that means is that any given virus will have a long history of being passed around. A virus exists within a given host for about half a week before it is passed on (for how long it exists thereafter doesn't matter to evolution). So by having this "shape" of the epidemic, we guarantee that each individual strain has had the potential to mutate and be selected for many times. Additionally, as the total number of infected people is quite large, we also guarantee a large number of samples we draw from the lottery of mutation. Beyond that, we give mutated strains a good chance to start dominating, after which they can start developing additional mutations.

          If we take the no-interventions scenario instead, what we see is a few weeks of build-up of case numbers, and then a veritable explosion. With a multiplication of case numbers per week of x2 or x4, the majority of the population is infected virtually at the same time, in a window of a few weeks. This basically eliminates the possibility of a single strain developing multiple mutations by them not having an awful lot of hosts to go to after having developed one. Of course, the variety of different mutations floating around after the explosion is going to be huge, but they will compete for the same hosts. And they can't recombine to form "the superbug".

          Just to be clear, the hypothetical wave in the latter scenario would be slightly abated by people voluntarily distancing without central guidance. It would still be ~ an order of magnitude worse than what we've seen in NYC, Wuhan or Italy.

          Again: Conjecture, so salt is advised.

          1 vote
    2. ChuckS
      Link Parent
      You say this, but my son and daughter both have been in school, in-person, five days a week, for the entire 20-21 school year. We never received notice of any possibility of in-school...

      Until the < 12 gets vaccinated, daycares and schools will be breeding grounds for varients, even in the slow season.

      You say this, but my son and daughter both have been in school, in-person, five days a week, for the entire 20-21 school year. We never received notice of any possibility of in-school transmission. I don't think schools are the community-spreader locations everyone feared they would be at the start of this.

      My sister is in healthcare and she told me there's a theory that the MMR vaccine is giving children an immunity boost and is the reason why children don't seem to be as likely to become symptomatic or experience serious complications as adults.

      Otherwise I'm fully on board with everything you're saying. My kids are young, 6 and 4, and my wife and I are going to continue masking everywhere until they are able to get vaccinated.

      4 votes
    3. [2]
      teaearlgraycold
      (edited )
      Link Parent
      Are you implying that rates being the same as a year ago means we’re where we were a year ago? At least where I am you’ve got about 60% of people fully vaccinated and some extra percentage with...

      and returning to normal because rates are about the same as this time last year ain't gonna cut it.

      Are you implying that rates being the same as a year ago means we’re where we were a year ago? At least where I am you’ve got about 60% of people fully vaccinated and some extra percentage with natural immunity. The people getting sick are in the minority that remains.

      3 votes
      1. vord
        Link Parent
        No, but I am saying that lifting restrictions too soon will be disastrous. I'm not a medical professional, but I've been around long enough to see the writing on the wall.

        No, but I am saying that lifting restrictions too soon will be disastrous.

        I'm not a medical professional, but I've been around long enough to see the writing on the wall.

        5 votes