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1. 2021-01-10 15:36 Kristian G. Andersen open
   > EPI_ISL_792683 Holy shit... I actually DM'd Oli a couple of days ago asking for his take on reinfections in Manaus now they're surging again. Didn't get a reply, but I wouldn't be surprised if they're observing a lot. I guess we'll learn from Nunoand him. It's gonna take years to get this bug to a near-normal level...
2. 2021-01-10 15:41 Andrew Rambaut open
   Nuno's virological post is going to drop very soon. They are just polishing up the coverage on the genomes.
3. 2021-01-10 15:47 Andrew Rambaut open
   But having lackluster immunity doesn't really matter - you get infected and then you clear it (unless you are saying that having lackluster immunity will stop you generating your own immunity?). I.e., no worse off than before. You may encourage escapes to come up but they are not particularly advantageous for transmitting to the next person. What will really select for escape is if there are lots of properly immune people (in the absence of escape) but not atthe herd immunity threshold. At that point an escape mutant has a significant advantage over the wildtype.
4. 2021-01-10 15:48 Andrew Rambaut open
   But I feel that we need some serious modelling done here.
5. 2021-01-10 16:01 Kristian G. Andersen
   I'm hopeful that the mRNA vaccines with two doses will provide (near) sterilizing immunity. The issue with one doseis that you still have immunity, but you can't stop infection so the virus gets a chance to evolve in that milieu and the viruses that can escape will propagate. Sure, having full immunity will create a much stronger selection pressure (ifyou can't infect, you can't live), but if the virus can escape full immunity, then we have a much bigger problem on our hands.
6. 2021-01-10 16:10 Andrew Rambaut open
   So that is what the Manaus experiment will be about. Did 501Y, 484K and 417T appear in combination because it isreinfecting people.
7. 2021-01-10 16:10 Kristian G. Andersen open
   Yeah - Manaus (and Israel) will be really really important.
8. 2021-01-10 16:15 Kristian G. Andersen open
   If we start seeing reinfections (or vaccine failures) in Manaus / Israel driven by escape, then we might have torethink our entire vaccination strategy. Stockpiling enough supply to vaccinate most of the population while (massively) driving down infections via NPIs - then go out and vaccinate as many people as possible as quickly aspossible.I don't think humans have the ability to do that. In fact, I'm getting increasingly pessimistic that we have the ability toeven control the first few years of the "Reign of COVID-19". I'm seeing too many indicators currently that are makingme very uncomfortable.
9. 2021-01-10 16:17 Kristian G. Andersen open
   (coupled with too much wishful thinking - we so desperately yearn for positive news that we forget that things don't just automatically get better).

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