However, even when the entire population of a region has immunity through infection or vaccination, there may still be significant circulation of the virus due to waning immunity and viral evolution. 4/17
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Together, this would suggest perhaps 40k or 100k deaths per year in the US from COVID at endemic state. Most infections would be relatively mild (just like flu), but there's enough of them that even a small fraction of severe outcomes add up. 15/17
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100k deaths would be 30% attack rate with 0.1% IFR, while 40k deaths would be 20% attack rate with 0.06% IFR. In general, like with seasonal flu I would expect significant season-to-season variability. 16/17
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This is not cancer or heart disease, but it's still a substantial public health burden. That said, yearly boosters just like flu vaccine, therapeutics like molnupiravir, improved ventilation and rapid testing can all contribute to reducing this ongoing burden. 17/17
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Most studies pin Delta at 2+x higher IFR than Alpha. Now we've been countering this with vaccination and improved treatment, but starting with an artificially biases the comparison.
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I'm very familiar with increased severity of Delta (https://bedford.io/papers/paredes-sarscov2-variant-outcomes/ …), but fair point. Eventual IFR is the biggest unknown to me in this list of 4 parameters.
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0.6% was for the original Wuhan version though - Alpha and the Delta increased this quite significantly, potentially as much as two fold.
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The age-specific IFR for repeat infections is something we URGENTLY need more data on. I fear it could end up over 0.1%, i.e. both more infectious and more lethal than seasonal flu.
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This drop would be driven entirely by immunity, as far as I understand. Do you see any likelihood that SARS2 might evolve into a variant that is less fatal to humans?
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I don't see this happening with a superantigenic virus. I disagree with your projection and point to recent data from Iran.
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I see no reason to assume positive outcomes
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