Hi everyone,

With apologies for flooding the airwaves and timelines with way too many posts and tweets, here’s one more post, the last COVID-19 related one for a while.

I’ve been trying to provide high quality answers to the many questions I receive via email and various social media. I’ve also been trying to help many many people that found worrying news online & sent it to me, either for reassurance or simply to challenge me.

A few days ago I unfriended some people on Facebook that weren’t satisfied with my answers and they decided to chase me to WhatsApp to continue the discussion. I’ve had to block people on LinkedIn of all places. I didn’t even know this was possible.

Debunking out-there theories is tiring. Reassuring even well meaning people somehow takes away some of your own surety, which leads to the need to do yet more research. It is exhausting.

As the inestimable Ed Yong wrote in The Atlantic, “The Pandemic Experts are Not Ok”.

“Many of them told me that they feel duty-bound and grateful to be helping their country at a time when so many others are ill or unemployed. But they’re also very tired, and dispirited […]. As the pandemic once again intensifies, so too do their frustration and fatigue.” - Ed Yong, July 7, 2020

Even though I would not claim to be a pandemic expert, I too am very frustrated and tired, so I am taking a little break from posting and answering questions or debunking rumors.

I do want to publish this last bit which I wrote earlier in hopes of helping people who are trying to decide if their in person event should go ahead in August 2021. It may be useful to others as well.

COVID-19 scenarios

Written on the 15th of January 2021. The utility of these insights will fade rapidly.

This is not an attempt to predict the future.. correctly. Given the complexities this is almost impossible anyhow. In addition, future developments influence future developments so it is exceptionally hard to do.

As an example, almost everyone got wrong what would happen with Brexit on January 1st: there were no large queues of trucks waiting for customs. Nor did such queues materialise later. Turns out the market also thinks and instead of massive holdups at the borders, what we see is almost no trade at the borders. Only a few people (not me) predicted this perhaps even worse outcome.

Nevertheless, we can make an attempt to help us predict what might happen with COVID-19 in the short term. See this more as a guide to improve your hunches. It is rather easy to predict trends for the next few days. Empowered with more knowledge, it may be possible to extend this range of prediction somewhat further ahead.

Will the vaccines make a dent?

We know that in theory the mRNA vaccines should reduce the chances of people getting COVID-19 by around 90%. We have imperfect insight into how many people actually get infected. We have better insights into how many people get hospitalized or die with/from COVID-19.

It takes a few weeks from the first shot for the vaccine to become fully effective. The first country that should note a significant impact of vaccinations is Israel since they’ve managed to vaccinate a stunning percentage of their older population. Everyone is watching their graphs right now. If you squint you can see some of these move into the right direction, but it is not yet 100% convincing.

Key insight: if Israel reports either great or disappointing results, this will shift the mood tremendously.

Scenario: “It works in Israel” (we’ll know in 2 weeks)

Most COVID-19 deaths are in the over 75s. These have been vaccinated a lot in Israel, meaning their death rate could come down dramatically. This would reframe COVID-19 from something that overflows your hospitals to a “bad flu” again, something that younger people should just weather.

Societies might react to this in an unhelpful way, by stopping social distancing, restarting parties etc. This leaves unaddressed that younger people can also suffer serious COVID-19 effects, even if they don’t die from it.

Scenario: “It doesn’t work in Israel” (we’ll know in 4 weeks)

The numbers come down, but not by as much as suspected. There could be many reasons for this, but it would mean any optimism is gone until we find out why. And even if we do, people might not believe we have it figured out. Enthusiasm for (re-)vaccinations will be low.

Scenario: JNJ & AstraZeneca both look good (Beginning of February)

There are currently two blockbuster vaccines (BioNTech/Pfizer and Moderna). Both are ~90% effective, both are built on a very dynamic platform that can be adjusted quickly to new variants. However, we don’t have anywhere near the billions of doses we need. Later this month or early February, we will learn if the Johnson & Johnson/Janssen vaccine is any good. It might be. In addition, the Oxford/AstraZeneca vaccine has been plagued by messy figures. With their EMA filing, they may have solved this problem.

If both JNJ (which might end up as a single dose vaccine) and AZ look good, it would shift the mood a lot in the positive direction. And not only the mood, also the actual vaccinations.

Scenario: Both JNJ & AZ disappoint (Beginning of February)

This would be a bummer. The world might need to come together and do whatever is needed to speed up Moderna and Pfizer production in that case. But it would definitely be a downer.

Scenario: mutations continue to look as they do now

Various COVID-19 variants are currently under study. It is hard to draw firm conclusions. While the UK variant does look scary, it also somehow appears to respond to a tightened lockdown (in the UK). It has also been confirmed not to escape the vaccinations in a meaningful way. It could be that things stay like this. Still means we’ll all get to deal with a faster spreading variant, but for now it does not look like the end of the world.

Scenario: mutations increase rate of spread significantly

If this happens we need to vaccinate far far more people to achieve the same effect. We might also need to go to new disturbing lockdown scenarios, including removing people from their houses, possibly detaining them centrally, China style.

Scenario: mutations escape immunity or the vaccine

This will lead to the need to revaccinate people and also to root out COVID-19 entirely, even in less vulnerable populations, to prevent it from evolving into even more harmful forms. Might be going on in Manaus right now.

Scenario: spring helps (April)

In the Northern hemisphere, in spring 2020, COVID-19 melted away almost without effort. This might happen again, and it would cheer everyone up tremendously. It would also buy time for manufacturing sufficient vaccines. However, this is not guaranteed to happen. There have also been outbreaks near the equator, although other things may have been going on there.

Scenario: Medicinal breakthrough (February, April)

Several treatments for COVID-19 are on the way. Some of these have been tested as very successful in small scale trials. The question is if this will pan out on a larger scale. For some of these, we might figure this out in February (Calcifediol). For others it might take longer (inhaled interferon, ivermectin) to learn if they help.

Essentially, such medicinal breakthroughs are a game changer since they treat both existing COVID-19 as well as any new variants. This is because these medicines treat the effects and not the virus.

Scenario: Rapid testing gets accepted (?)

So here is the situation. Rapid tests are now 99% sensitive for detecting people with live COVID-19 in their saliva or noses. This is not controversial. It would be entirely possible to screen people for events within a few minutes and reduce the amount of COVID-19 positive people in meetings by 99%. The test needs to be repeated for every event.

There are however people that claim these tests do not detect all infectious people, because you might in theory still be infectious even though there is no live virus in you. This is likely an extremely theoretical claim.

So far however they are winning the argument, and we aren’t doing rapid testing. This could change and it might be extremely effective in driving down numbers - we can make events two orders of magnitude safer (for a few hours after a rapid test in any case).