Covid Update - 30 Jan 2022

I believe we are seeing the end of this wave of Covid and, in general, a return to normal over the coming weeks.

In January in the UK, the case fatality rate for Covid was 2x that of seasonal flu and continues to drop. At the pandemic's beginning, the CFR for Covid was 20x+ that of the seasonal flu. As antibodies and antivirals are fully rolled out, Covid will be "just the flu."

Nationwide, cases are dropping like a rock, and our hospitalizations have clearly peaked. We should see the peak in deaths from this wave either this week or next.

This week's biggest news is the rise of a substrain of Omicron, called BA.2 [the "normal" Omicron is called BA.1]. Early analysis suggests that it is more infectious than BA.1 and is becoming the dominant strain in most countries in Europe.

The great news is that it doesn't show any signs of significant immune evasion against BA.1. This means that it won't significantly impact places that are already deep in their Omicron waves [like the US]. It likely means that our dropoff for case count might take a little longer.

Countries still pursuing a zero Covid strategy will have worse outbreaks when the Omicron breakthrough occurs. I no longer believe that any sort of zero Covid strategy is viable.

Initial reads of the vaccines show them to be slightly less effective against BA.2 for symptomatic infection, but this isn't a huge concern to me. Denmark, which has one of the highest case counts globally, is ending all Covid restrictions next week.

Israel has continued to release data on their experiments with 4th doses for high-risk people. After an initial read-out that looked unimpressive, they released new results this week that look more promising. A 4th shot reduces severe infection by threefold in high-risk people, which is excellent. The flip side is that the baseline risk for severe disease is already pretty low with just three shots. The experts I follow are still mixed on whether the protection increase warrants the fourth shot.

We now have access to various treatments to prevent severe disease and death, but they remain in short supply. Beyond short supply, the drugs aren't available for all. Paxlovid, Pfizer's antiviral, has drug interactions, so people taking high cholesterol medication can't use it. Of the injectable antibodies, only Sotrovimab is effective against Omicron. The supply shortages will be solved sooner rather than later, so we should expect the hospitalization and death rates to drop further.

Part of the reason I'm bullish on the future is that we're taking the needed steps to head off future pandemics. This week NIH has started to fund a pancoronavirus vaccine that would target all SARS-1, MERS, and SARS-CoV-2 variants. The work is being funded at four different institutions, which significantly increases their chances of success.

This week Moderna also started a Phase I trial for an mRNA-based HIV vaccine. Almost 40 million people worldwide have AIDS today. If successful, this vaccine could mean the beginning of the end of one of the largest pandemics in modern history.

The asymptomatic test rate at UCSF has been 4% the last few days, down from 16% just ten days ago. I'm still sticking to outdoor dining/drinks, mainly because my baseline risk is extremely low. I'm on sabbatical and have been doing a lot of meditation and hiking. The weather has been really nice to it's no effort to be outside. If I were in a different position, I'd be more likely to be back inside.

I have plans to go to Tahoe with 15 people in two weeks and a large indoor party in three weeks. Given what I see in trends, I expect to attend both events.

I expect I only have a couple more updates to write. Once the case count gets low enough, I'll stop, and hopefully, it'll be for good this time.