In reply to Si dH:
> I agree with this. I think the only feasible way forward is mass vaccination, followed by regular updates of the vaccine as and when mutations occur that require it, similar to management of annual flu but required on a bigger scale.
The difference is we have a pretty good idea of the sorts of annual changes that flu viruses undergo, and we really don't know how this virus is going to change yet.
The fatality rates for SARS-CoV-2 are an order of magnitude higher than for common flus - at all ages - and yet they are an order of magnitude below what the virus' closest relations achieve. Further, there is a seasonal pattern to flu changes and we can look to nations ahead of us in the cycle to give time to pre-prepare a vaccine, where as the emergence of a new Covid strain is a largely random event, meaning that all vaccine creation, testing and deployment happens after it's too late if the variant turns out to have accessed SARS-CoV-1 or MERS-CoV levels of lethality. Most of the population of the world still hasn't caught this yet the number of worrying variants is on the up. I don't see us getting to a point where most of the world population is ever getting vaccinated against this. I'll be surprised if we get to 80% of the population vaccinated in the UK, which leaves 100% - (80% x 90% vaccine efficacy) = 28% of the population susceptible. Across Europa and North America alone, that ~ 330 million people for it to circulate in. To date, the virus has swept through perhaps 250 million people, and several variants have arisen that raise red flags on immune evasion; so far nothing has been confirmed as emerging with more lethality (I believe) but it seems likely that relying on vaccination to control hospital overload is going to leave a very large breeding ground for more variants.
I am not at all happy about this as a model for the future but realistically it's the best possible option that I think is going to be committed to. Luck may protected fools, small children and ships named Enterprise but it's not doing much for pandemic management. The vision you paint of the future is going to need exceptionally well run screening, sequencing, rapid response hard lockdowns around new variants and ground pounding, sequencing assisted contact tracing. The sort of thing that NZ have, and we don't. We did have a lot more capability in some ways for this before the merger of many local public health observatories in to PHE; this was reckoned by some from the former observatories to be a very dogma led decision and is one of the first places I would look to other parts of the world and our past to identify best practice for managing the future you paint. To manage this without ending up back in damaging nationwide lockdowns and healthcare overload, we're going to need either a run of luck for the next 5 years or so, or much much better, more responsive systemic and localisable response to outbreaks and variants.
What worries me is just not seeing the political or organisational capability to put this kind of stuff together in the UK. I think the formation of PHE led to a bit of a brain drain as well.
> The logic here being, that you need cases to be very low and your testing/sequencing capacity sufficiently high that if a mutation occurs, you can discover it, modify a vaccine and distribute it before the mutated variant rips through too many people. If cases are still moderate like we had this last summer, we won't be able to do that quickly enough.
Indeed.
I think we have to pre-emptively contain future new mutations given that we know it's not very transmissible and so has the potential to become more so, and given that we know it's nowhere near the lethality potential of its family of virus.
This means cases need to be low enough for sequencing to be completed, and contact tracing to be started within ~18 hours of a sample being taken - which I think needs a radical improvement on where we were last summer, both in terms of case rates and the organisational responsively of the testing systems.
I said "5 years or so" above - I think in time sufficient will be learnt about this type of virus that more powerful, less intensive pharmacological and therapeutic care is going to take the sting out of its tale, vaccine or not. Near where I work there used to be a Cat 3 lab built specifically to study SARS; it was shut down as of little interest about 7 years ago. Perhaps it'll be re-opened along with many more soon.
> Edit to add, it also strikes me that 'Global Britain' should be sharing our sequencing knowledge/skills with other countries and helping fund development of sequencing capabilities in poorer or middle income countries around the world. Since, it's something the whole world needs and which we are quite good at - and ultimately we can't succeed in isolation on this.
This thread isn't alone in worrying about the lack of sequencing capability in many countries; I know this troubles the public health people in one distant land. I suspect business will be booming for Oxford Nanopore for the foreseeable. We can certainly fund and train sequencing centres elsewhere.
In practice I think the way this virus is varying, and the practicalities of vaccinating everyone, mean that this virus is going to drive a wedge between less and more developed countries, just as it is driving a wedge into British society along fiscal lines.