CALL TO ACTION

WARNING. PANDEMICS ARE DEADLY. IT IS NOT OVER. COMPLACENCY IS DEADLY.

MERS Coronavirus Case Fatality Rate is 35%. One in three infections result in DEATH.

Likelihood of increased [SARS-CoV-2] severity phenotype: Realistic possibility. (SAGE)

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Scenario One

  • A variant that causes severe disease in a greater proportion of the population than has occurred to date. For example, with similar morbidity/mortality to other zoonotic coronaviruses such as SARS-CoV (~10% case fatality) or MERS-CoV (~35% case fatality).
  • Likelihood of increased severity phenotype: Realistic possibility.
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Executive summary

  • The biggest threat to the UK’s health security and response to the SARS–CoV–2 pandemic is the emergence (and establishment within the UK) of variants that either have increased transmissibility, increased disease severity, escape prior immunity, or a combination of these characteristics [high confidence]
  • Substantial global circulation of SARS–CoV–2 will lead to the evolution of new variants and continued risk of importation to the UK [medium confidence].
  • Increased international vaccination by donation/sharing of purchased doses, or supporting increased manufacture, has the potential to reduce the appearance and establishment of variants internationally, as well as the risk of their importation to the UK [medium confidence].
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Executive summary

  • It is highly likely that vaccine induced immunity to SARS-CoV-2 infection, and potentially severe disease (but probably to a lesser extent) will wane over time. 
  • This is likely to be first detected by vaccine failures in vulnerable cohorts (for example a high rate of infections in people vaccinated over time, including hospitalized cases). 
  • It is therefore likely that there will be vaccination campaigns against SARS-CoV-2 for many years to come, but currently we do not know what will be the optimal required frequency for re-vaccination to protect the vulnerable from COVID disease.
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Scientist Opinions:

  • “Delta is already a really strong competitor. It could get significantly worse.” –  Dr. Michal Tal, Immunologist, Stanford University
  • “There’s some sort of tipping point where immune evasion becomes a bigger fitness advantage than transmission… There’s no scenario we choose where we don’t impose selective pressure on this virus.” – Stephen Goldstein, evolutionary virologist, University of Utah
  • “The longer the virus persists, the more opportunities it’ll have to sample what makes it more fit.” Oliver Fregoso, virologist at UCLA
  • “Immunocompromised people probably have a role to play [in SARS-CoV-2’s evolution]” – says Ravindra Gupta, virologist, University of Cambridge
  • “[New variants will continue to appear at unprecedented speeds] until we get to the point where the virus is not allowed to replicate this often, or this quickly” Jennifer Dien Bard, clinical virologist, Children’s Hospital Los Angeles
  • “[Where transmission occurs unabated] that is definitely a risk,” Lisa Gralinski, coronavirologist, University of North Carolina at Chapel Hill
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Roberto Burioni & Eric J. Topol Nature Medicine. Correspondence. Published: 21 June 2021.

  • To the Editor—For the first time in the history of medicine, the evolution of a virus can be observed ‘as it happens’. Throughout this, molecular tools of unprecedented accuracy are also assisting by providing an extraordinarily detailed picture of the interactions between the virus and the immune system of its human host…
  • Some evolutionary virologists believe complete or nearly complete resistance to the current vaccines is an inevitability8, which is a prediction that cannot be discounted or ignored.
  • Therefore, while the world needs to remain on full alert in order to promptly detect the emergence of ‘vaccine-piercing’ variants and, in that case, rapidly update the available vaccines, there is reason for very cautious optimism. In any case, what is certain is that the emergence of such vaccine-evading variants, if at all possible, will be made more likely by viral spread and replication. May this serve as a reminder that, once infection rates have been controlled in the most advanced countries, it will be crucial to do the same in the developing ones and achieve the same success in more-difficult ‘socio-sanitary’ settings.
  • For this reason, it will be in humanity’s own interest to not be greedy and instead provide vaccines at an affordable price to all mankind: history has in fact taught that when dealing with the global control of an infectious disease, the most effective way to be selfish is to be generous.
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