There might be another strain in the future. I don’t know how likely this is, but that’s the most likely way that things ‘don’t mostly end’ after this wave
I agree, and I also don’t really have great mental handles to model this, but this seems like the most consequential question to predict post-Omicron life. My two biggest surprises of the pandemic have been Delta and Omicron, so sorting this out feels like a high VOI investment.
Here’s a messy brain dump on this, mostly I’m just looking for a better framework for thinking about this.
The amount of transmission obviously matters, since more generations provide more opportunities for mutation. All else equal, VOCs are more likely to arise where cases are high.
Is a partially vaccinated population more likely to generate VOCs? Either in the sense of a large number of single dosed people, or a large proportion unvaccinated, or some complex interaction of the two?
If mutation and selection is happening within an immunocompromised individual (as opposed to gradually accumulating in a population), does this imply regions with high HIV-AIDS rates are most likely to produce VOCs? Are there other clusters of immunocompromised people, or are they fairly evenly distributed?
The two VOC (Beta and Omicron) with the most immune evasion arose (or were at least first detected) in South Africa. Is that a coincidence? Is the presence of a BSL-4 (the only such institution south of Gabon)? Origin vs detection is confounded by the relative abundance of sequencing resources in SA vs the rest of Africa, which makes detection in SA quite likely even if VOCs emerge elsewhere, but the pattern of spread of both Beta and Omicron are more consistent with SA origin.
Is any of this modifiable through policy decisions? The WHO is urging wealthy countries to forgo boosters in favour of distributing doses to the developing world, which is on-brand lunatic messaging given current events, but post-Omicron wave could this actually be good policy? Maybe this depends on sorting out some of the above?
I agree, and I also don’t really have great mental handles to model this, but this seems like the most consequential question to predict post-Omicron life. My two biggest surprises of the pandemic have been Delta and Omicron, so sorting this out feels like a high VOI investment.
Here’s a messy brain dump on this, mostly I’m just looking for a better framework for thinking about this.
The amount of transmission obviously matters, since more generations provide more opportunities for mutation. All else equal, VOCs are more likely to arise where cases are high.
Is a partially vaccinated population more likely to generate VOCs? Either in the sense of a large number of single dosed people, or a large proportion unvaccinated, or some complex interaction of the two?
If mutation and selection is happening within an immunocompromised individual (as opposed to gradually accumulating in a population), does this imply regions with high HIV-AIDS rates are most likely to produce VOCs? Are there other clusters of immunocompromised people, or are they fairly evenly distributed?
The two VOC (Beta and Omicron) with the most immune evasion arose (or were at least first detected) in South Africa. Is that a coincidence? Is the presence of a BSL-4 (the only such institution south of Gabon)? Origin vs detection is confounded by the relative abundance of sequencing resources in SA vs the rest of Africa, which makes detection in SA quite likely even if VOCs emerge elsewhere, but the pattern of spread of both Beta and Omicron are more consistent with SA origin.
Is any of this modifiable through policy decisions? The WHO is urging wealthy countries to forgo boosters in favour of distributing doses to the developing world, which is on-brand lunatic messaging given current events, but post-Omicron wave could this actually be good policy? Maybe this depends on sorting out some of the above?