August 16th, 2021

How will COVID evolve? I have looked into this question a few different ways and it always, in general, comes back to the same answer: the virus will mutate into a more infectiously fit but less morbid variety. Viruses have one goal, reproduce and survive. This sounds an awful lot like the function of our DNA for us.

A really nice article in The New Yorker this week has looked into this topic as well. "During this pandemic, we’ve developed and deployed vaccines in real time. Meanwhile, sars-CoV-2 is replicating not in a dozen flasks but in tens of millions of people, some of whom have been immunized,

all of whom exert selective pressure for the virus to find new, more efficient replication strategies. The virus will continue to mutate every moment of every day, for years, for decades. The fear is that it will hit upon a second citrate moment: a mutation, or set of mutations, that enables it to circumvent our vaccines, which so far have proved spectacularly effective and resilient. For those who remain unvaccinated—the majority of humankind—there is also the horrifying prospect of a variant that is vastly more contagious or deadly. Every few months, we learn of a version of the virus that seems somehow worse: Alpha, Beta, Gamma, Delta. The coronavirus appears destined to march its way through the Greek alphabet—a prizefighter getting quicker, slicker, stronger with each opponent. What are the limits to its evolutionary fitness? Are they knowable? And, if so, how close are we to reaching them?"

There are three major events that will likely occur. 1) We have seen the largest adaptation already and only minor changes will occur as the delta strain is exceedingly fit already. Only minor changes will occur.
2) The virus will mutate and evade the vaccine to a large extent but suffer a loss of infectiousness and morbidity.

3) A complete lock change will occur in an exceedingly rare mutative event that makes the virus capable of sidestepping the current vaccine completely. While possible, this is highly unlikely based on the virological history of pandemics. The good news remains in the event that this occurs is that we can rapidly produce a new targeted vaccine against this change. The problem here is the logistics of producing and distributing another vaccine in rapid fashion.

"Starr told me. “The fact that the same antibodies bind to both of them should give us some confidence.” With new coronavirus variants, we may see a partial decrease in immunity, but, “given the polyclonal response,” Starr said—the fact that vaccines generate not one type of antibody but many—“when one set of antibodies drops the rope, another will pick it up. I don’t think there will ever be a variant that completely escapes our immune systems. We’re never going to wipe the slate clean and be back to a totally naïve population. Over time, the infections we do get will be more likely to be mild or asymptomatic. Whether that process takes a year, five years, ten years, or longer, I don’t know.”"

The next 24 months will be interesting for our society and our resilience. The fourth wave has been a psychological blow to America and we need to recognize it for what it is. The vaccines still work. We are ok. And we will get through this.

Dr. M

Khullar The New Yorker