My friend's mom was just admitted to a hospital on the East side of Michigan with really, really bad Covid. Opening day for baseball is today, cases are surging like crazy and everyone is just pretending like it's over. I hope that things improve in 6 weeks, but I'm really pessimistic at the moment.

Michigan is at 30% vaccinated with at least one dose according to https://data.lansingstatejournal.com/covid-19-vaccine-tracke...

So things are better than in most places and will continually get better.

Yeah, it will eventually get better, but I have family who are physicians who are swamped again and friends with relatives in ERs and ICUs.. Hard to be too optimistic at the moment. NYTimes' latest concurs;

https://www.nytimes.com/2021/04/01/us/michigan-covid-outbrea...

> Michigan has more recent cases per capita than any other state, and has seen them soar in recent weeks, to more than 5,600 cases a day from about 1,000 on Feb. 21. The nation’s top five metro areas in recent cases per capita are all in Michigan: Jackson, Detroit, Flint, Lansing and Monroe.

...

> Health officials partly attributed the rapid rise in cases to the B.1.1.7 variant that was originally identified in Britain and is widespread in Michigan. But they have also observed a broader return to prepandemic life seen in a relaxing of mask wearing, social distancing and other strategies meant to slow the spread of the virus — many weeks before a substantial portion of the population is vaccinated. On Thursday, Michigan officials announced that they had identified their first case of the P.1 variant, which has spread widely in Brazil and has now been found in more than 20 U.S. states.

...

> Dr. Joneigh S. Khaldun, the state’s chief medical executive, said on Tuesday that 50 percent of state residents over 65 were fully vaccinated, a sign of progress that the most vulnerable population is closer to protection from Covid-19.

> But she said the most significant increase in hospitalizations in the state is in people in their 50s, a group still at risk of becoming severely ill or dying from Covid-19. Younger people have driven the rapid increase in cases recently, she said, including high school students who participate in sports and have contracted the virus through those activities.

More people getting covid means more chances of a mutation that makes it spread easier or is resistant to current vaccines. A surge now is a bad thing.

What is the likelihood that any given mutation increases vs. decreases contagiousness or resistance?

It doesn’t matter how likely any individual mutation is to increase transmissibility or resistance. We won’t ever see the ones that decrease transmissibility or resistance, because they’ll be outcompeted by the Brand X virus, as well as any nastier mutants.

Then why has it taken this long to see a global pandemic? Surely it must matter to some extent how likely any given mutation is to increase transmissibility or resistance.

That's probably random, but the mutations that increase contagiousness will be the ones surviving natural selection.

I recall a general principle in virology that given a virus found in the wild, the more contagious it is, the less harm or death it causes. (If it killed every host it would have no long-term survivability)

Most mutations probably just render the thing unable to replicate and it "dies," much the same way flipping a random bit is more likely to cause a program crash than do anything useful at all.

The relative rate doesn't matter, the absolute rate does (how often does it mutate at all and survive to infect another host).

> A surge now is a bad thing.

It's always been a bad thing and will continue to be a bad thing.

I'd argue that it's worse now. Where I live we have over 20% vaccinated right now and that number increases every day. This adds a bias for mutations that are vaccine resistant. A mutation that gives a slight disadvantage, but means the vaccine won't stop it, would have gone nowhere a year ago. Now that same mutation has a large population where it can easily outcompete the current virus.

That's a good point. I guess the worst situation would be almost herd immunity, with the majority being vaccinated but a minority of unvaccinated people constantly circulating the virus. The vaccinated population then represents verdant fields:

https://www.youtube.com/watch?v=yybsSqcB7mE

It’s a little worse now in terms of selective pressures, but, at least hospitals aren’t overflowing currently.