Zvi, what are your thoughts on covid in the USA during the winter?
On the one hand:
The delta wave is ending, and there are no new variants on the horizon.
Vaccinations rates are high and slowly rising.
The overall rate of immunity (from vaccines + natural infection) is high and probably rising (although this is a fight between fading vaccine effectiveness vs natural infections & vaccine booster shots).
On the other hand, winter is traditionally the worst time for colds and flus, including the monster covid wave of 2020. It seems hard to believe we’ll skate through winter 2021 without somewhat of a bump in covid cases.
If you have thoughts about the course of covid beyond this winter (like the prospect for future variants or how necessary it will be for most of the population to take booster shots at a regular cadence), I’d be interested in that too.
If we get a whopper flu season in 2022 or 2023 (perhaps 2-3x worse than normal), it will be interesting to watch how the media and culture responds—will they go into covid-esque hysterics about the overcrowded hospitals and demand flu lockdowns? Or will it act as a nudge in the other direction, convincing people that the lockdowns and NPIs have got to stop somewhere? Or, perhaps we’ll never get a whopper flu season—maybe Delta will remain the transmissibility king of all the infectious viruses, even after stabilizing and going endemic? Perhaps our transition to remote work, covid-caution in shared indoor spaces, and mRNA vaccines means a permanently more hygienic world?
Overall, I’m very interested in the question of whether covid cases ever crash to suppression levels (as would perhaps have happened in a world without the Delta variant), versus only very slowly trailing off into the background of ordinary pre-covid colds & flus. I think this is very important for predicting how culture will evolve going forwards. A sharper transition from pandemic to negligible covid would encourage more of a snap-back to pre-covid “normality”: more mass concerts, more comfort visiting shared indoor spaces, fewer masks and NPIs, less remote work. Versus a world where covid lingers interminably and there’s no sharp transition into the post-pandemic world will make it harder for culture to coordinate a “return to normal”.
I’m not sure which side I’m cheering for, but it’s clearly an important question regardless. (Remote work and better tech adoption across the board have been highlights of pandemic culture. A slightly increased focus on scientific progress is obviously welcome. And the pre-covid world sometimes strikes me as being a little too heavy on present consumption, like travel vacations, with not enough long-term focus. But of course all the masking and social distancing and reduced socializing has been miserable, and the madness of constantly-changing restrictions is terrible for both business and living an enjoyable human life.)
I don’t think it’s clear that mRNA flu vaccines will be as effective as mRNA corona vaccines.
One reason why SARS-CoV2 is an “easy” target for vaccine is that it has a very low mutation rate (as do other corona viruses). Influenza viruses evolve much faster. A standard problem of flu shots is that they are not designed against the virus that circulates in the winter, but rather against viruses that circulated half a year ago. For the corona virus, this does not make a big difference, but for flu viruses, it can render the vaccine (partially) useless.
The mRNA technology has some advantages because the cycle of development and production is shorter. But it is still long enough that the problem does not go away completely. We should not expect mRNA flu vaccines to be as effective as mRNA corona vaccines.
Flu shots already target 4 strains. The size of mRNA vaccines are so small that they could put 100 in one shot, but could the immune system handle it? But the short development time of mRNA vaccines means that they can target better. The same should be true of recombinant protein vaccines—the real promise of mRNA is that it’s new and sexy and the FDA will let them try. But targeting is only a small part of the flu vaccine problem. Good targeting raises the effectiveness from 30% in mismatch years to 50% in match years. The problem is the flu vaccine isn’t that good even when it is matched.
Zvi, what are your thoughts on covid in the USA during the winter?
On the one hand:
The delta wave is ending, and there are no new variants on the horizon.
Vaccinations rates are high and slowly rising.
The overall rate of immunity (from vaccines + natural infection) is high and probably rising (although this is a fight between fading vaccine effectiveness vs natural infections & vaccine booster shots).
On the other hand, winter is traditionally the worst time for colds and flus, including the monster covid wave of 2020. It seems hard to believe we’ll skate through winter 2021 without somewhat of a bump in covid cases.
If you have thoughts about the course of covid beyond this winter (like the prospect for future variants or how necessary it will be for most of the population to take booster shots at a regular cadence), I’d be interested in that too.
One thing that I think will be consequential, in a kind of hilarious way, is that we’re probably going to skip two flu seasons in a row, which will possibly set us up for a whopper flu season down the road. Last winter the flu was practically nonexistent, crowded out by covid. This winter, based on my read of this Metaculus forecast, the flu season is expected to be only half as intense as a typical pre-covid year—peaking at around “4% ILI” instead of around 8%.
https://www.metaculus.com/questions/7621/peak—ili-in-va-during-2021-2022-flu-season/ https://www.vdh.virginia.gov/epidemiology/influenza-flu-in-virginia/influenza-surveillance/
If we get a whopper flu season in 2022 or 2023 (perhaps 2-3x worse than normal), it will be interesting to watch how the media and culture responds—will they go into covid-esque hysterics about the overcrowded hospitals and demand flu lockdowns? Or will it act as a nudge in the other direction, convincing people that the lockdowns and NPIs have got to stop somewhere? Or, perhaps we’ll never get a whopper flu season—maybe Delta will remain the transmissibility king of all the infectious viruses, even after stabilizing and going endemic? Perhaps our transition to remote work, covid-caution in shared indoor spaces, and mRNA vaccines means a permanently more hygienic world?
Overall, I’m very interested in the question of whether covid cases ever crash to suppression levels (as would perhaps have happened in a world without the Delta variant), versus only very slowly trailing off into the background of ordinary pre-covid colds & flus. I think this is very important for predicting how culture will evolve going forwards. A sharper transition from pandemic to negligible covid would encourage more of a snap-back to pre-covid “normality”: more mass concerts, more comfort visiting shared indoor spaces, fewer masks and NPIs, less remote work. Versus a world where covid lingers interminably and there’s no sharp transition into the post-pandemic world will make it harder for culture to coordinate a “return to normal”.
I’m not sure which side I’m cheering for, but it’s clearly an important question regardless. (Remote work and better tech adoption across the board have been highlights of pandemic culture. A slightly increased focus on scientific progress is obviously welcome. And the pre-covid world sometimes strikes me as being a little too heavy on present consumption, like travel vacations, with not enough long-term focus. But of course all the masking and social distancing and reduced socializing has been miserable, and the madness of constantly-changing restrictions is terrible for both business and living an enjoyable human life.)
By late 2022 and much more probable by 2023 mRNA flu vaccines will be available and they will be just as effective as covid vaccines.
I don’t think it’s clear that mRNA flu vaccines will be as effective as mRNA corona vaccines.
One reason why SARS-CoV2 is an “easy” target for vaccine is that it has a very low mutation rate (as do other corona viruses). Influenza viruses evolve much faster. A standard problem of flu shots is that they are not designed against the virus that circulates in the winter, but rather against viruses that circulated half a year ago. For the corona virus, this does not make a big difference, but for flu viruses, it can render the vaccine (partially) useless.
The mRNA technology has some advantages because the cycle of development and production is shorter. But it is still long enough that the problem does not go away completely. We should not expect mRNA flu vaccines to be as effective as mRNA corona vaccines.
The big promise of mRNA technology is that a vaccine can be made against several strains in the same shot
Flu shots already target 4 strains. The size of mRNA vaccines are so small that they could put 100 in one shot, but could the immune system handle it? But the short development time of mRNA vaccines means that they can target better. The same should be true of recombinant protein vaccines—the real promise of mRNA is that it’s new and sexy and the FDA will let them try. But targeting is only a small part of the flu vaccine problem. Good targeting raises the effectiveness from 30% in mismatch years to 50% in match years. The problem is the flu vaccine isn’t that good even when it is matched.
I actually think we should be mandating flu shots in addition to covid shots.
Biden administration: “Mandates work! Get a covid shot or else!” Also Biden administration: “Pretty please, get your flu shot”
(Seriously though, get your flu shot)