Covid-19 is hopefully going to be short-lived thanks to the vaccines, but even if it weren't for that it would likely become more virulent but less deadly over time like the other Coronaviruses that are endemic in humans.

There is a also a big difference in lives lost at the end of life versus at the beginning.

Over the last year it's be come more virulent and more deadly.

We have no idea how well the vaccines are going to work. We have a situation right now where a country(india) with 100 million people vaccinated is getting 350,000 cases a day, and it's doubling every 10 days. That's a scenario where the evolution around the protection a vaccine offers becomes a very real and distinct possibility.

Evolution is a somewhat random process at its heart, but I stand by what I said as the likely outcome, because that's the path new diseases normally take. It's early days yet.

> We have no idea how well the vaccines are going to work

I think we have a petty good idea by now actually. A bigger question is how much will it be hampered by people afraid or unwilling to be vaccinated? I have never in my life seen such widespread and illogical fear of vaccines.

We may have to just accept that there will be an ongoing toll in the unvaccinated population that keeps the virus circulating in quantity and keeps the hospitals busy. Until sufficiently many develop natural antibodies through infection.

> We have a situation right now where a country(india) with 100 million people vaccinated is getting 350,000 cases a day, and it's doubling every 10 days. That's a scenario where the evolution around the protection a vaccine offers becomes a very real and distinct possibility.

Yes, that's a tail risk that's real and terrifying. I think the risk is small given such a mutation would possibly render the virus much less virulent. The vaccines tend to target the spike protein, without which it can't even infect humans. But nature finds a way. We can and will also adapt the vaccines in that case though. The money, motivation, and technical expertise are all there. But nobody knows how likely a risk that is.

So that's why malaria is less deadly now? I've seen this said many times with zero backing, and it just really doesn't correlate with the history of disease. The reason we don't deal with the majority of deadly diseases is vaccines, not because they've evolved to become less deadly.

>I think we have a petty good idea by now actually

We have an idea of how well they work on the original covid-19 strain that we saw last year. We don't know how well they will work on actually eradicating the virus.

>I think the risk is small given such a mutation would possibly render the virus much less virulent

Based on what? It's already evolved to evade antibodies produced by infections from the first wave (P1 strain in Manaus specifically is a good example). Those have been mutations in the spike protein, and have made the virus more virulent and deadlier.

Apparently our DNA is literally encoded with lots of viruses, as they've evolved to become utterly harmless to people. Our bodies are loaded with various bacteria and viruses that have evolved a symbiotic relationship to the point where we'd die without them, and they can't live without us.

I seriously doubt they started out that way.

Diseases can be severely lethal far longer than you or human memory can survive.

It's interesting, in the UK we had ridiculous reaction to the MMR jab after a fraudulent claim, fired up by the media - from the ever populist Daily Mail to Private Eye [0], which led to a collapse in MMR takeup and a resurgence in measles.

But we haven't seen that with covid, perhaps because the printed press is (mostly) on the side of the current government (flag waving populists), and the vaccine rollout has been branded aprt of the generational "battle" between the UK, standing alone against Europe (many in the UK don't realise WW2 ended 76 years ago).

I wonder if we'd had a Corbyn or Starmer led coalition in charge if things would be different.

Or imagine if the lib dems had held on to 20-30 seats that the tories gained in 2015 -- likely another coalition, with a 5 year fixed term, no brexit referendum, and then the GE having to be delayed (it would have been set for May 2020)

[0] https://behavioralscientist.org/how-fraud-and-a-broken-publi...

Source?

Malaria's victims are mostly under 5 years of age. In terms of life-years lost, Malaria is far far worse.

You also have to take into account the health of those involved. Saving a life only for that person to live a few low quality years in poor health is worth less than saving the life of a healthy young child.

The resulting measure is the QALY, the quality adjusted life year.

Unfortunately there has not been nearly enough research or discussion about QALYs and their applicability to the coronavirus. There are a few studies out there, though, here's one: https://onlinelibrary.wiley.com/doi/full/10.1002/hec.4208

TLDR: the mean discounted QALYs lost by someone dying of the coronavirus in the US is 4.3.

Globally, malaria kills 1-3 million people annually despite many people having some natural resistance to it and there being many effective treatments for it and it already having been eradicated in many areas. Covid killed the same amount in a much larger population that had no pre-existing defenses or treatments.

https://www.nature.com/articles/502S2a

There are far more influenza deaths over the last 3 decades than ebola, but ebola is far more severe and greater concern.

I think that's probably wrong? The most likely outcome would be that after the initial pandemic subsided (with lots of deaths), most people would catch it when they were reasonably young and then be mostly protected.

This is different from malaria, which is much more deadly.

We have a number of Coronaviruses endemic to humans that cause the common cold (among other viruses.) That's probably how covid19 would turn out, left to its own devices.

(Both are RNA viruses. https://en.wikipedia.org/wiki/Orthornavirae)

Part of what's so exciting about the vaccines is that the antibodies seem to decay at a slower rate, meaning that it could result in longer immunity (though we obviously don't know for sure yet).

If that were the case we would see large amounts of re-infection, since the pandemic started over a year ago

Then why hasn't that happened with malaria?

Getting malaria doesn't inherently make you less likely to get it again (if anything, it's the other way around)

A child dying robs them and the world of 60+ years of human life. An 80 year old dying of COVID-19 was not going to live much longer anyway, so the loss is less severe. Old people have already had the opportunity to live a "full" life.

Imagine two societies – one where a disease kills 50% of < 10s every year, and another that kills 50% of > 70s every year. Which society would do better? Which society would you rather live in?

A society of just children wouldn't work, just as a society without wouldn't work.

Yes, of course more 55-74s have died – there are far, far more of them than there are >85s. Normalized, COVID is far more lethal (8x more lethal) for >85s than for your range. Here's the mortality rates:

55-74: 0.28%

85+: 2.5%

https://www.statista.com/statistics/241488/population-of-the...

https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

The actual numbers are more representative than lethality percentages when we're talking about contribution to society.

https://www.nature.com/articles/s41598-021-83040-3

And, dismissing the death of someone by saying "they were going to die soon anyway, so what" is disgusting.

It may be "disgusting" - but it's also statistics

It was sad when my grandfather died a couple years ago at 87 - but not exactly "unexpected"

Compare that to friends who lost their 18-year-old daughter before she graduated high school

Which one is shocking? Which one "hurts more"?

Deaths rates follow a bathtub curve - ultimately leading to a 100% mortality rate (ie, everyone dies eventually)

If you have to choose between saving a 5-year-old and an 85-year-old, the "smart money" says "save the kid"

If you don't have to choose, then by all means - save both

But that's not how economics works: choices must be made

My parents are 60+ yr old surgeons. They work during the pandemic not because they have to. It's because you run the QALYs and the morality is clear. You participate or make way.