What endemic Covid will be like

Covid-19 discussion, bring your own statistics
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Woodchopper
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Re: What endemic Covid will be like

Post by Woodchopper » Fri Sep 10, 2021 8:41 pm

lpm wrote:
Fri Sep 10, 2021 6:04 pm
Haven't time to read it, but fundamentally this isn't how the endemic world will work.

Waning immunity leads to reinfection which re-establishes immunity.

And of course boosters can be used for vulnerable, over 80s etc

1,000 deaths a week implies something crazy like 25 million reinfections a year. A third of the population.

Never going to happen. A wave sweeps through the nightclubs or whatever, then dies out when immunity returns for that age group or geographical location.

Self correcting.
The latest headline daily figures from the UK government dashboard are: 988 patients admitted to hospital and 147 deaths within 28 days of a positive test.

Almost all of those are over 18, and 95-97 per cent of that population have antibodies. The PHE data shows that the hospital admissions aren’t the last of the population who weren’t vaccinated. We’re not going to get a significantly more immune population (unless everyone gets regular boosters).

About 147 deaths per day brings us to a bit over 50 000 deaths per year. Apparently, the government are expecting about 50 000 deaths per year as the new normal: https://inews.co.uk/news/boris-johnson- ... el-1170069

Circa 50 000 is enormously less than what would have happened pre-vaccination and with current levels of social distancing.

About a quarter of the population being infected each year is, as far as I remember, what usually happens with seasonal influenza. Vaccination is reducing transmission but not stopping it outright. Doesn’t seem bonkers to me.

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lpm
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Re: What endemic Covid will be like

Post by lpm » Fri Sep 10, 2021 9:18 pm

The current situation is still in epidemic mode - millions of people on 0 protection points fuelling the case load. We soon transition to the endemic situation of a population with 1 or 2 points having only partial immunity.

Although hospital admissions aren't the unvaccinated, that's due to the extreme age gradient. The fire is with the unvaccinated young who rarely get hospitalised and it's the leakage upwards that's the problem. This won't be the case in 2022. The virus will have no more easy super-spreader opportunities such as a nightclub packed with 0s.

And there's the hard reality of early harvest. The most vulnerable have died.

Flu infects around 5% to 10% a year I believe. I'm sure there will be bad years for Covid but I don't think they'll be any time soon.
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bob sterman
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Re: What endemic Covid will be like

Post by bob sterman » Fri Sep 10, 2021 10:13 pm

lpm wrote:
Fri Sep 10, 2021 9:18 pm
And there's the hard reality of early harvest. The most vulnerable have died.
Ageing and chronic illness are conveyor belts - creating new waves of vulnerable people each year - following new heart attacks, strokes, cancers, and neurological diseases.

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sTeamTraen
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Re: What endemic Covid will be like

Post by sTeamTraen » Fri Sep 10, 2021 10:19 pm

lpm wrote:
Fri Sep 10, 2021 9:18 pm
And there's the hard reality of early harvest. The most vulnerable have died.
The most vulnerable *who caught Covid* have already died. But arguably, once we were a few weeks into the first wave and people worked out what was going on, many of the most vulnerable stayed indoors to avoid Covid; they're the people who are still wearing masks in the street and not going on holiday anywhere.

Those two effects work in opposite directions and have unknown magnitude, so I don't see any particular reason to believe that the ~88% of the UK population who have not yet tested positive for Covid are more or less vulnerable (give or take vaccines) to dying from it.
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jdc
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Re: What endemic Covid will be like

Post by jdc » Fri Sep 10, 2021 10:20 pm

Woodchopper wrote:
Fri Sep 10, 2021 8:41 pm
About a quarter of the population being infected each year is, as far as I remember, what usually happens with seasonal influenza.
lpm wrote:
Fri Sep 10, 2021 9:18 pm

Flu infects around 5% to 10% a year I believe. I'm sure there will be bad years for Covid but I don't think they'll be any time soon.
CDC: https://www.cdc.gov/flu/about/keyfacts.htm have a symptomatic estimate: "8% of the U.S. population gets sick from flu each season, with a range of between 3% and 11%, depending on the season" and also refer to a 5% to 20% estimate "based on a study that examined both symptomatic and asymptomatic influenza illness"

There's also https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278149/ which gives global figures "Approximately 9% of the world’s population is affected annually, with up to 1 billion infections, 3 to 5 million severe cases, and 300,000 to 500,000 deaths each year"

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shpalman
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Re: What endemic Covid will be like

Post by shpalman » Fri Sep 10, 2021 10:28 pm

And we do make some effort to vaccinate people, especially the old and/or vulnerable, against influenza.

(it's not a massively effective vaccine though is it?)
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Re: What endemic Covid will be like

Post by jdc » Fri Sep 10, 2021 10:58 pm

shpalman wrote:
Fri Sep 10, 2021 10:28 pm
And we do make some effort to vaccinate people, especially the old and/or vulnerable, against influenza.

(it's not a massively effective vaccine though is it?)
CDC has a list by flu year, 2004-2020, here https://www.cdc.gov/flu/vaccines-work/p ... mates.html (ranges from 10-60%) and Oxford has a chart based on PHE data 2015-2020 here: https://vk.ovg.ox.ac.uk/vk/inactivated-flu-vaccine (ranges from 15-52%)

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Woodchopper
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Re: What endemic Covid will be like

Post by Woodchopper » Sat Sep 11, 2021 8:32 am

jdc wrote:
Fri Sep 10, 2021 10:20 pm
Woodchopper wrote:
Fri Sep 10, 2021 8:41 pm
About a quarter of the population being infected each year is, as far as I remember, what usually happens with seasonal influenza.
lpm wrote:
Fri Sep 10, 2021 9:18 pm

Flu infects around 5% to 10% a year I believe. I'm sure there will be bad years for Covid but I don't think they'll be any time soon.
CDC: https://www.cdc.gov/flu/about/keyfacts.htm have a symptomatic estimate: "8% of the U.S. population gets sick from flu each season, with a range of between 3% and 11%, depending on the season" and also refer to a 5% to 20% estimate "based on a study that examined both symptomatic and asymptomatic influenza illness"

There's also https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278149/ which gives global figures "Approximately 9% of the world’s population is affected annually, with up to 1 billion infections, 3 to 5 million severe cases, and 300,000 to 500,000 deaths each year"
Thanks, as far as I know the problem with estimating flu infections is that large numbers of people have asymptotic infections so they don’t appear on the case numbers.

It’s possible to get an estimate by randomly sampling the population and testing them for antibodies. That was done in these studies which found
30% in New Zealand https://pubmed.ncbi.nlm.nih.gov/30016464/
20.2% in the US https://journals.plos.org/plosone/artic ... ne.0048187
25.6% on Vietnam https://www.medrxiv.org/content/10.1101 ... 21249160v1

Gotta do other things soon, and delighted if there’s more out there.

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Woodchopper
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Re: What endemic Covid will be like

Post by Woodchopper » Sat Sep 11, 2021 8:36 am

lpm wrote:
Fri Sep 10, 2021 9:18 pm
The current situation is still in epidemic mode - millions of people on 0 protection points fuelling the case load. We soon transition to the endemic situation of a population with 1 or 2 points having only partial immunity.

Although hospital admissions aren't the unvaccinated, that's due to the extreme age gradient. The fire is with the unvaccinated young who rarely get hospitalised and it's the leakage upwards that's the problem. This won't be the case in 2022. The virus will have no more easy super-spreader opportunities such as a nightclub packed with 0s.

And there's the hard reality of early harvest. The most vulnerable have died.

Flu infects around 5% to 10% a year I believe. I'm sure there will be bad years for Covid but I don't think they'll be any time soon.
Perhaps I’m being too gloomy.

It seems like the big question is whether the 60 - 80 year olds in hospital were infected by viruses passing through the adult population (almost all of whom have antibodies already) or as you suggest that children are infecting each other and then passing it up the ages. The former would happen if people are being cliquish whereas the latter if there is quite a lot of mixing between the generations.

That’s an empirical question. Would be good to see whether anyone has found out.

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lpm
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Re: What endemic Covid will be like

Post by lpm » Sat Sep 11, 2021 10:06 am

Cliquicity matters during the transition, not the endemic world. At the moment we have 30 people with 0 protection points gathering together in class 6B. Earlier in the summer 100 people with 0 protection points gathered together in a Lincoln nightclub. Covid seems to enjoy these super-spreader events.

In 2022 it will be even distributions. 6B will have 27 people on one protection point, 3 on zero, and so will 6A and all the other classrooms. In over 50s, the low percentage of vaccine refusers might be grouped together a bit (e.g. ethnic minorities in a geographical location of London) but protection through infection will be more and more flat. Like brownian motion.

Covid waves will happen but peter out faster. Across the summer we've seen super-spreader events triggering other super-spreader events and this will continue in the autumn in schools and universities. But eventually these low protection groups will be more like over 50s currently - cases occur but don't start big chains of onwards infections. My guess is the 60 - 80 year olds in hospital were infected by children (or in a very short chain from children), not from long chains going through the adult population.
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Re: What endemic Covid will be like

Post by jdc » Sat Sep 11, 2021 3:10 pm

No data, but I've got some boring old speculation for you.

There's probably a fair few UK grandparents providing childcare still (especially post-vaccine), and the pre-Covid estimates I've seen are around 5-7 million providing "regular" childcare. So there's been a fair bit of opportunity for them to catch Covid from kids and pass it on to the people in their painting group or bridge club, especially during the summer holidays.

Vaccinated grandparents who hadn't spent time with grandkids may also be making up for lost time now they've been jabbed?

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