The TRUTH about COVID-19 variants such as Omicron, Delta and others to come. Future health care. Why better antivirals more important than vaccines in future health care. COVID-19 variants: impact on business, public health, government

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What is the truth about COVID-19 variants such as Omicron, Delta and other variants that may emerge in future, and impact on future health care? Vaccine effectiveness in longer term, actual numbers of people in different nations who have already been exposed to Coronavirus and had very mild COVID-19 illness, possibly now immune as a result.

I am writing as a physician and Futurist, as an advisor to many pharma companies, governments and other industries, and also as someone who for over two decades has repeatedly warned of huge risks from new viral pandemics. (updated December 22nd 2020, November 11th 2020).

Statistics are very confusing. Here are some important facts..

* "How AI Will Change Your Life - A Futurist's Guide to a Super-Smart World" - Patrick Dixon's latest book on AI is published in September 2024 by Profile Books. It contains 38 chapters on the impact of AI across different industries, government and our wider world, including future impact of AI on health care, AI in Pharma innovation, AI in genetics and biotech.

Lucky escape so far with original viral mutation which is causing COVID-19

Many other mutant viruses like the one causing SARS which emerged in 2003, strike the very young as well as the very old. Imagine the global tragedy and national panic we would be facing if 50% of the deaths so far had been in very young children or babies.

The fact is that COVID-19 is killing mainly people who would otherwise have had a limited life expectancy - still immensely sad for them and their families, but as a general rule, deaths of young children and babies usually have a far greater emotional impact on families and communities for obvious reasons.

The truth is that every time someone is infected with the virus causing COVID-19, there is a chance of a new mutation, where the person's own cells make an error in manufacturing new viruses.

Most such errors result in completely defective virus, or less effective transmission, but sometimes mutations happen which give the new mutation an advantage - which is why we rapidly detect such mutations on screening.

With most viral pandemics, the virus tends to weaken as it spreads, becoming more effective in transmission, killing fewer carriers. So a new variant can sometimes become a natural protector, causing milder disease or no symptoms at all, but generating some kind of cross-immunity.

The most lethal new viruses we see each decade tend to be wiped out fairly rapidly, because those infected tend to die before many others are infected.

It's the less lethal mutations, paradoxically that can often cause most global deaths.

The greatest spread tends to happen with viruses that produce only mild symptoms or none, but are highly infectious, so people carry on as normal at home and at work, shedding virus widely.

Hundreds of COVID-19 mutations have already been detected - most very minor. We use these minor mutations all the time as "signatures" to be able to map out reasons for spread.

- Any COVID-19 mutation may result in higher viral shedding, blood levels etc - so each person becomes more infectious

- Any COVID-19 mutation may result in better protection from the immune system

For example, future mutations could cause more frequent illness in children and babies.

The truth is that only a few hundred million people have so far been exposed to the virus, of which a small minority are part of any official statistics for positive COVID-19 tests.

But over 7 billion people have still not been exposed. That means 7 billion more potential opportunities for major COVID-19 / coronavirus mutations.

Mutation of Coronavirus in UK (December 2020) and Denmark (November 2020)

In Autumn 2020 a new variant / mutation of COVID-19 virus was detected in the UK. By December 15th it was clear that the mutation was accelerating spread by up to 70%.

We now know it has over 20 different points of variation from the version that hit the UK in March.

We don't know exactly when or in what country the mutation took place, but similar changes have been seen in virus samples in more than 5 other nations.

In early November, we saw another very serious mutation in Denmark.

The Danish government slaughtered over 17 million mink on mink farms, after widespread infection by COVID-19 in mink animals led to a new variant, which jumped back into humans, infecting over 200 people in a very short time.

As of December 2020 it was impossible to tell if someone infected recently with COVID-19 would be vulnerable to being attacked by the mutated version.

The most important point is that if such a jump can happen once, it can happen many times, each one a risk of significant further mutations, which could possibly render most of the current vaccines useless.

The virus causing COVID-19 has infected cats, dogs, lions, tigers, bats, ferrets and so on - although until the Mink episode, efficient spread back to humans has been very unusual.

By mid November 2020, less than 60 million infections had been detected globally. Even if 90% of cases have been missed, that implies that only 600 million have encountered the C0VID-19 virus - out of a population of 7.8 billion people. Every time a single new person is infected, there is a small chance of mutation, so we have to be vigilant.

With any mutations the key questions are:

- Any changes in sickness rates / death rates?

- Any changes in typical illness patterns? Or age, gender, ethnicity of those becoming sick?

- Any changes in infectivity?

- Any changes in incubation period?

- Does the mutation mean people with immunity to "old" COVID-19 (infection or vaccine) are not protected against the new strain?

But all these questions always take some weeks / months to confirm.

Just take vaccine effectiveness against COVID-19 for example - it will take of course two years to be sure a vaccine protects people for two years. It will take five years to prove five year protection, and so on.

The rate of new infections is slower than expected (doubling time)

In March, most nations were reporting that numbers of new infections were doubling every 4-5 days. This is a critically important statistic.

To compare, HIV cases of new infection at the height of the global AIDS crisis in the early 1990s, were doubling every 12 months.

With 10 doublings, a single case becomes 1000; or 1000 becomes a million; or a million becomes a billion. So a COVID-19 doubling time of 4-5 days was extremely serious.

Even worse in London, where the doubling time was just 2 days.

That's 40 days to go from a single case to a thousand, and from a thousand to a million in less than 3 months - which is what happened.

However, when you look at WHO charts for all nations of the world from April to December, you can see that doubling times have stabilised globally since May / June at around 20 days or longer, as have numbers of diagnosed new infections and recorded deaths.

And even the new COVID-19 mutation in the UK was only causing doublings every 7-10 days - again slower than back in March 2020.

That's a radical slow down for reasons that are not clear because it's the same in emerging markets, in megacities with dense slum districts where lockdown has been impossible.

And even where lockdown has been hugely relaxed, we are seeing pockets of new local infections, but massive second waves have been slower to get going than many experts feared. Indeed, in many parts of Africa and Asia, recorded cases and deaths have been falling from September to November.

You might think that the figures are all wrong anyway and such nations may only be detecting a small proportion of cases.

While that may be true, so long as that error remains consistent, the trend appears to be valid. And it may be because of many other small mutations that are eroding the capacity of various other strains to spread.

Tests for coronavirus can miss 30% of COVID-19 cases

Recent research suggests that negative tests don't mean as much as you might think.

The reason is that the test is for fragments of virus which are hard to detect, even more so when the immune response begins, which happens just a few days after symptoms develop.

Failure to detect people who are indeed infected is a nightmare for hospitals trying to separate sick people into infected or non-infected, especially for units like dialysis for kidney failure, where a single infectious patient who is missed can result in major contamination.

Tests for antibodies can miss 66% of those recovered from COVID-19

Recent research suggests that antibodies tests may miss two out of three people who have recovered from COVID-19.

The reason is that a very important part of immune responses to the coronavirus is delivered by a type pf white cells themselves, called T-cells, rather than by antibodies made by white cells. These T-cells are not detected by antibody tests.

By early July 2020 in London for example, 17% of the population was testing positive for COVID-19 antibodies, but an estimated 51% of the population had evidence of T-cell immunity.

The reason this is so significant is that most experts agree that once levels of previous exposure to any infectious virus reach around 70%, spread tends to slow right down.

Of course, this assumes that exposure in the past will protect you in the future which was still unclear on that date. (See below)

80% of coronavirus pandemic infections do not cause any illness

An important study of over 3000 people on a cruise ship found that 80% of infections with coronavirus did not result in COVID-19 symptoms. This has been verified in many other studies since.

Symptoms can be vague and non-classic eg aches, diarrhoea, tiredness, hoarse voice etc without fever or cough

And almost all COVID-19 deaths in nations like the UK are in those over 80, or in people with complicated medical problems.

Many other types of coronavirus infection produce only short term immunity

With every week that goes by, our knowledge of COVID-19 increases dramatically around the world, with tens of thousands of researchers and billions of dollars being spent.

The most important question we face is HOW OFTEN people can become sick more than once with COVID-19. We know already that some people are becoming sick for a second time, after proven COVID-19 illness some months earlier.

We know that in many people with milder infection, antibody levels to COVID-19 virus often fall dramatically after just a few weeks. But we don't yet know to what degree T-Cell immunity persists, and how helpful that is in protecting against repeated infection, in absence of antibodies. It will take until at least July 2022 to resolve these questions.

Sadly we already know very well that other similar coronaviruses produce only short term protection in humans, so someone can get the same cold for example, year after year.

These questions really matter for vaccine production too: because it might well mean that people have to be vaccinated over and over again to stay safe (see below)

Previous infection by other coronaviruses may help protect against COVID-19

Since March 2020 we have been seeing hints that previous exposure to other similar viruses may help protect you from becoming sick with COVID-19.

And research published in CELL journal showed that serum from people who have been exposed to common cold viruses has some reactivity against the coronavirus causingCOVID-19.

Other studies in Nature and Science Journals also suggest cross-reactivity in T-cells and antibodies between common cold coronaviruses, the 2003 SARS virus and the COVID-19 virus.

Of course this could help explain a number of things - which don't make sense when we just look at differences in degrees of lockdown etc:

Why some populations from different nations appear to have lower infection or mortality rates than others
Why in many towns and cities we have seen very rapid spread, slowing right down long before 60-70% are infected (so called herd immunity)
Why these slowdowns seem to be happening independently of lockdown etc
Why children seem to have a degree of immunity in many nations and even when infection takes hold, illness usually very mild
Why adults living in households with young children seem to have lower rates of COVID-19 illness and 25% lower risk of death (taking other differences into account)

If recent exposure to common colds do indeed help strengthen immunity against COVID-19 illness and prevent death, then it raises the interesting possibility of trying to deliberately spread common cold viruses, as a kind of natural low-grade vaccine. No clinical trials would be needed. Cold viruses have probably been around for thousands of years.

However we need to be sure that pre-exposure to common colds does not risk a major immune over-reaction in some people. More research is urgently needed but we will have answers to most of these questions by March 2021.

What does all this mean?

Implications of all the above are very important - if all above confirmed:

Spread of coronavirus pandemic is likely to be far wider than most people realise
This is especially the case in nations with limited testing capacity
And "natural immunity" may be greater than we think, making mild disease or no symptoms more likely
This means that recorded death rates / thousand people infected may be too large by a factor of 5
So a nation that thinks 1% of those infected are dying, may in fact only be seeing a death rate of maybe 1 in 1000 or less
That's really good news if it's confirmed that the mortality rate from infection is far lower than feared
Particularly as we know that 80% of deaths in most nations are in those over the age of 75, and are rare in those under that age unless they were at significant risk of dying anyway from multiple other serious medical problems

What COVID-19 seems to be doing mainly is shortening the life by a year or two at the most, of many elderly people who already had a short life expectancy because of existing ill health. Because of that, we can expect deaths of people over the age of 80 in many nations to be lower over the next 1-5 years - because a population who might have been expected to be very sick or dying in future, have already died.

One thing is clear

85% of people on the earth live in emerging nations, most of whom are on very low incomes, in nations with very low health budgets and little capacity to effectively lock down whole populations.

I predicted back in March that with densely packed communities in their cities, spread of the pandemic was likely to be rapid, relentless, impossible to resist, resulting in huge short term impact from COVID-19, but also short term recovery.

That turned out to be correct in that the pandemic appears, as I say, to have done it's worst already in many emerging nations, by November 2020.

And also incorrect in that for reasons that are unclear, a much smaller proportion of populations in many nations appears to be getting infected than we would have expected from rapid infection rates in many developed nations,

Vaccines against COVID-19 likely to be too late for most of humanity

The fastest we have ever developed any vaccine before has been four years, but new vaccines are already in clinics. In some cases with claims of 90% or higher protection. But:

We don't know as I say how long that protection will last
We don't know if such vaccinations can be safely repeated
We don't know if the vaccine will work against mutations
Such vaccines are impossibly expensive for many emerging nations where 85% of humanity lives

For most of the world, any such vaccine would still come far too late, even if several start to go into mass production by early 2021, with all the problems of funding, access and scaling up for 7.8 billion people.

Some vaccines require astonishing technology to be effective. For example, Pfizer's vaccine has to be kept ultra-cold at no warmer than minus 70 degrees centigrade. In contrast, the AstraZeneca / Oxford University vaccine only has to be kept in a fridge, and costs much less.

Imagine the challenges of keeping a vial at minus 70 degrees continuously from European factory to warehouse to plane, to Kinshasa airport, to DR Congo warehouse to packing case, to lorry, to hospital car park, to clinic freezer, to actual patient. Central Africa is already short of 1000 clinical freezers. And what happens if your power supplies are unreliable?

To be realistic then, a vaccine will only be likely to have value to 85% of the world's people who live in emerging markets if we find that natural immunity only lasts a short time, but also find that a vaccine creates lasting immunity.

Humanity remains vulnerable to many new viral pandemics

We see on average one important new mutant virus every year - 2003 saw SARS and Bird Flu for example. So the risks are just as high as they were in the past few years for more pandemics.

But as the global population soars from 7.8bn today to 11.5bn in 2060, and as more migrate to densely packed cities, the risks will increase.

And every time, unless something changes, we will have to start from scratch to develop a new vaccine.

But there is an answer: one that has been almost completely neglected since the discovery of penicillin in the 1940s.

We still lack a single antiviral medicine that is as effective against any type of virus as penicillin was against bacteria in the 1940s, and other antibiotics since. If a child is dying of bacterial meningitis, chances are in many nations that their lives will be saved by antibiotics. But if they have a viral meningitis, we have almost nothing to offer, except supporting life functions and hoping their own immune system will overcome the infection.

Imagine a new medicine becomes available, and parents of such a child are told the good news: we have a drug which will stop the meningitis and your child can go home soon. But imagine the doctors also telling the parents that very sadly, their child will need to take this antiviral for the rest of their entire lives, as it only suppresses, and does not cure.

I think any such parents would think that the antiviral was a very poor treatment. Welcome to the world of HIV and AIDS, where antivirals have converted HIV infection to a chronic condition for tens of millions of people, but without curing any of them.

The only effective answer to more viral pandemics is better antiviral medication

We urgently need a wide range of effective antiviral medicines, as weapons against future pandemics, that can be used immediately in hospitals around the world to do one or more of the following

Block cell surface receptors - preventing the virus from gaining access
Block gene translation - preventing cells from being converted into virus factories
Block gene manufacture and release- preventing the cell from exploding with release of hundreds of new virus particles

Expect therefore, alongside vaccine research, huge global investment into antiviral medicine.

We cannot afford for the whole of humanity to be held to ransom for a year or two, in lockdown every time there is a new viral pandemic, while we go into overdrive trying to create a specific vaccine. That's just a strategy for playing catchup each time without addressing the fundamental problem.

Our world in 2020-2021 deserves far better than this. We have 80 years of wasted time to catch up on. Governments, charitable foundations, pharma companies and thousands of smaller biotech companies will need to work together to find the answer we so urgently need. Just as I have been warning for decades now.

So what outlook for "normal life" in 2021?

I am expecting that in much of Europe, and in many other parts of the world, life will feel relatively normal by June - July, with combined impact of:

Mass-scale testing - like Slovakia which tested 75% of nation twice within a week in November 2020 - with quarantine of those infected
Vaccination - national programmes, plus a vigorous "unofficial" or even illegal trade in privately available vaccines, for companies and individuals willing to pay - most likely needing to be repeated regularly
Previous exposure by millions to the COVID-19 virus - slowing down spread
Continued "sensible measures" including some restrictions re larger gatherings, most vulnerable people
COVID passports / travel documents or certificates becoming widely available eg for people wishing to go on holiday abroad / attend larger events
Further insights into simple ways to reduce risk of infection / serious illness eg initial research suggesting risks from low Vitamin D levels
Improved medical outcomes - as we learn more about how to treat COVID-19 illness with existing therapies / techniques, and as teams become more experienced
Rapid tracking of new mutations with hyper-aggressive public health measures to contain - if more lethal / dangerous than "old" COVID-19 virus
New therapies - proven impact on mild, moderate or life-threatening COVID-19 illness

I am also expecting that COVID-19 will be an illness that hospitals see for many years, and that all medical students will be taught about for years to come.

And yes, most people will return to the offices which they deserted at the height of the pandemic, but with new working skills and technology, less often and usually for more focussed reasons eg meeting people.

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