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WilliamAEden's profile
William Eden
William Eden
William Eden
@WilliamAEden

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William Eden

@WilliamAEden

Recovering economist turned biotech VC. Lossy compression not recommended. No, we have not picked all the low-hanging fruit yet. My other half: @diviacaroline

Reno, NV
becomingeden.com/start-here/
Joined November 2009

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    William Eden‏ @WilliamAEden 12 Dec 2021

    I figure it’s worth posting a summary thread about my current thoughts on COVID to refer back to: Like many great blunders in history, we went into this without an exit plan. The landscape has changed such that risk is now individual cost/benefit more than public health. 1/

    9:56 PM - 12 Dec 2021
    • 705 Retweets
    • 2,633 Likes
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    103 replies 705 retweets 2,633 likes
      1. New conversation
      2. William Eden‏ @WilliamAEden 12 Dec 2021

        I was fully on board with early COVID Zero attempts. Containing and eliminating this virus, like we did with SARS1, would have been an enormous boon to the world. But the extremely anemic response in the entire world outside of Asia and Oceania guaranteed failure. 2/

        23 replies 16 retweets 393 likes
        Show this thread
      3. William Eden‏ @WilliamAEden 12 Dec 2021

        The fallback plan was red/green zones with local containment, lots of quarantine when moving between them, contact tracing, etc. De facto we got a few jurisdictions with this system, but I hoped it could work in many more countries. But that ship has also sailed now. 3/

        2 replies 6 retweets 252 likes
        Show this thread
      4. William Eden‏ @WilliamAEden 12 Dec 2021

        The pandemic has now become endemic. The authorities seem to not have acknowledged this fact, despite it being blatantly evident. Doing so changes the optimal policy. This is where the lack of exit strategy is getting ugly… 4/

        7 replies 86 retweets 668 likes
        Show this thread
      5. William Eden‏ @WilliamAEden 12 Dec 2021

        One potential exit path was vaccines. The initial efficacy was way better than I hoped! It seemed like maybe there was a promise (implicit or explicit) that getting mass adoption would stop the pandemic and/or return things to normal 5/

        5 replies 8 retweets 291 likes
        Show this thread
      6. William Eden‏ @WilliamAEden 12 Dec 2021

        Unfortunately the biology of COVID is such that it’s like their distant cousins, the four endemic human coronaviruses that circulate and cause seasonal common colds. Immunity fades and you can catch each one annually. This is the future of COVID, forever. Face it. 6/

        15 replies 114 retweets 809 likes
        Show this thread
      7. William Eden‏ @WilliamAEden 12 Dec 2021

        On the flip side: it sure looks like immunity (from vaccines or infections) confers a very significant protection against *very severe* COVID outcomes, long after it stops preventing infections and transmission. This is a great thing! And changes the risk calculus. 7/

        5 replies 26 retweets 497 likes
        Show this thread
      8. William Eden‏ @WilliamAEden 12 Dec 2021

        The original justification for mass vaccination was that you could halt COVID spread, including to the people who couldn’t receive a vaccine. This makes some sense as a basis for policy! But it turned out to be false. 8/

        6 replies 49 retweets 460 likes
        Show this thread
      9. William Eden‏ @WilliamAEden 12 Dec 2021

        If you get vaccinated, you are protecting *yourself* from the worst of COVID, but you aren’t protecting others for more than a few months. This makes it an *individual* decision, and NOT in the domain of public health policy. 9/

        26 replies 184 retweets 1,230 likes
        Show this thread
      10. William Eden‏ @WilliamAEden 12 Dec 2021

        Similarly, masks do seem to offer some protection to both the wearer and others around them - but we can already individually choose to wear masks (including P100s or Versaflows or other measures) and get vaccinated. Anyone who wishes can protect themselves from COVID. 10/

        21 replies 21 retweets 352 likes
        Show this thread
      11. William Eden‏ @WilliamAEden 12 Dec 2021

        The current policy seems to recognize *only benefits and not costs* of public health interventions. But there’s both direct costs, and costs to the fabric of society. Everyone knows our civilization is in a fragile state. We must not tear ourselves apart. 11/

        10 replies 76 retweets 722 likes
        Show this thread
      12. William Eden‏ @WilliamAEden 12 Dec 2021

        Take vaccine mandates for example. They will likely succeed in pressuring people against their will to raise vaccination rates a few %. At the cost of **politicizing vaccines forever** and creating an unemployable undercaste of society. Surely they didn’t run the calculation. 12/

        15 replies 132 retweets 1,058 likes
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      13. William Eden‏ @WilliamAEden 12 Dec 2021

        There are conceivably situations where this is warranted - a disease which doesn’t mutate rapidly, has severe illness, and immunity is lifelong. And in some cases it could be worth non-pharmaceutical interventions to slow the spread while deploying a vaccine! /13

        3 replies 14 retweets 351 likes
        Show this thread
      14. William Eden‏ @WilliamAEden 12 Dec 2021

        Furthermore, risk is reduced even more by the emergence of effective treatment options, from repurposed drugs easier on to Paxlovid today. With COVID becoming endemic and seasonal we need to deploy these - and continue working on even better options. /14

        3 replies 9 retweets 337 likes
        Show this thread
      15. William Eden‏ @WilliamAEden 12 Dec 2021

        At this point, COVID is over when we decide it’s over. And there’s no justification for continuing emergency measures and heavy handed policy when the risks have become manageable, and almost entirely individual, when it is literally tearing apart our society. /15

        10 replies 223 retweets 1,344 likes
        Show this thread
      16. William Eden‏ @WilliamAEden 12 Dec 2021

        If I were named COVID czar tomorrow: -all pandemic restrictions and mandates ended immediately -an impassioned plea to consider vaccination -redirect resources to scaling therapeutics and developing better drugs and vaccines -take any measures you need to protect yourself 16/16

        48 replies 133 retweets 1,285 likes
        Show this thread
      17. William Eden‏ @WilliamAEden 13 Dec 2021

        Thanks everyone for your interest. The main pushback has been about hospital capacity creating a public interest, so let's talk about hospital capacity. It turns out we already have a good model for this, because we already have a deadly seasonal virus: influenza. 17/

        3 replies 19 retweets 352 likes
        Show this thread
      18. William Eden‏ @WilliamAEden 13 Dec 2021

        Every winter, huge numbers of people fall ill, many hospitalized, and an estimated tens of thousands die from a contagious disease with a partially-effective vaccine. But we don't mandate those vaccines, or masks, or shutdown hard-hit areas. 18/

        3 replies 27 retweets 402 likes
        Show this thread
      19. William Eden‏ @WilliamAEden 13 Dec 2021

        COVID is of course far more serious than the flu, but with previous infections and vaccinations greatly reducing the risk of hospitalization and death, it will more and more come to resemble the current state of affairs we already are used to. 19/

        9 replies 11 retweets 285 likes
        Show this thread
      20. William Eden‏ @WilliamAEden 13 Dec 2021

        Influenza pandemic surge capacity is a very well studied field. Most of the papers will tell you we aren't sufficiently prepared, as all such studies tend to find. And they're probably right - we should be investing in more surge capacity! For this pandemic and the next one. 20/

        2 replies 10 retweets 273 likes
        Show this thread
      21. William Eden‏ @WilliamAEden 13 Dec 2021

        We do have some experience with surge capacity due to influenza. In the last several years we've had a few worse outbreaks. And hospitals have procedures in place to expand capacity on a short term basis, see e.g. this story: https://time.com/5107984/hospitals-handling-burden-flu-patients/ … 21/

        2 replies 9 retweets 187 likes
        Show this thread
      22. William Eden‏ @WilliamAEden 13 Dec 2021

        In some ways, the COVID response has actually been *bad* for hospital capacity. The lack of revenue from non-COVID patients caused some hospitals to scale back due to budget. And mandatory vaccine requirements have closed entire wards of hospitals recently! 22/

        7 replies 19 retweets 316 likes
        Show this thread
      23. William Eden‏ @WilliamAEden 13 Dec 2021

        Hospital capacity seems to be treated as some fixed number that was created long ago by a mysterious process, but it is a variable that we can and should choose to deliberately increase. Policy efforts need to be aimed at supply, not just demand, for hospital beds. 23/

        6 replies 16 retweets 323 likes
        Show this thread
      24. William Eden‏ @WilliamAEden 13 Dec 2021

        But let's also investigate the premise: have we been seeing serious hospital overflow problems? Here is a graph of US ICU capacity from JHU. You can explore the data here: https://coronavirus.jhu.edu/data/hospitalization-7-day-trend … 24/pic.twitter.com/MW5TmXSbTy

        3 replies 13 retweets 207 likes
        Show this thread
      25. William Eden‏ @WilliamAEden 13 Dec 2021

        That is an aggregate graph of course, but go to the website and click through to individual states. There are a few times it got pretty close during the delta wave, but overloads generally are not occurring now. 25/

        2 replies 6 retweets 176 likes
        Show this thread
      26. William Eden‏ @WilliamAEden 13 Dec 2021

        Of course you can dig up individual news stories of people who have tragically died in waiting rooms or other horrifying statistics... but many of those have been investigated and the numbers were false, or the stories not as described. I'm going to stick to data on this one. 26/

        2 replies 10 retweets 190 likes
        Show this thread
      27. William Eden‏ @WilliamAEden 13 Dec 2021

        So what's my summary of hospital capacity? -We have enough right now -We absolutely should create more -This isn't a valid reason for current policy stances 27/

        9 replies 22 retweets 334 likes
        Show this thread
      28. William Eden‏ @WilliamAEden 13 Dec 2021

        Much more could be said about optimal policy responses, btw. We have overall done a HORRIBLE job. Rapid tests are cheap and abundant in Europe, they should be here too. It should be encouraged to stay home when you're sick with *anything* not just COVID. And so much more. 28/

        6 replies 16 retweets 290 likes
        Show this thread
      29. William Eden‏ @WilliamAEden 13 Dec 2021

        At the end of the day, we can't let the perfect be the enemy of the good. We can't let counterfactual Zero COVID world get in the way of policy today. We can't let past policy failures dictate current ones. Each must be evaluated on their merits - and our ones are lacking. 29/29

        30 replies 28 retweets 459 likes
        Show this thread
      30. End of conversation

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