EDIT:

There is one caveat to the argument below - that there WILL be evolutionary pressure to make the disease milder-looking - at least in the day1-5 infectious period. Since a milder day1-5 would mean the patient is less debilitated, moves around, quarantines less, and infects more people.

That is, evolutionary pressure would favor asymptomatic or milder symptoms during the day1-5 period.

This may in turn require lower viral loads - which should imply lesser viral debris in post-day8 period - and thus less hyperinflammation (and thus less death)

However, we have already seen how asymptomatic covid19 can still lead to creeping inflammation post-day8 which leads to long haulers.

And sometimes milder day1-5 still experience oximeter declines post-day8.

So perhaps it is true that evolutionary pressure will indirectly lead to less deaths, but may still lead to long haulers etc.

 

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I thought I should make a separate post to highlight this observation - which was mentioned casually in a previous post:

 

https://www.reddit.com/r/ivermectin/comments/rch34n/update_on_omicron_dec_9_2021_utility_of_3rd

Update on Omicron (Dec 9, 2021) - utility of 3rd booster, vaccinating during wave, "mildness" of Omicron and whether will remain true for US/EU, children 5-11years, and whether new variants necessarily have to be milder (or covid19 being biphasic maybe exception)

On the conventional wisdom that new variants will be easier to spread, but less dangerous

There is a thinking that disease usually evolve to become milder - since killing the host is not beneficial for the disease to spread.

That is a milder disease is easier to spread as the host lives longer.

However, this may not be true for covid19 - which is a biphasic disease. That is, the infectious phase is usually day1-5 - but patient dies usually much after day8 ie day10 or day14. And patient is usually not infectious after day8.

For this reason there is no evolutionary impact of how severely a variant kills it's patients because it has no impact on the infectious day1-5 period of the disease (patient is usually fine for day1-8 anyway and only die later).

For this reason, for covid19, it would not be surprising to have a new variant appear that is both more spreading, and also more deadly.

 

I mentioned this to some on Twitter:

https://twitter.com/stereomatch2/status/1468649863491559424?t=Xaz99etPDU-rikJ0Jf-TXg&s=19

@RWMaloneMD

Re: Omicron - for covid19 I wonder if conventional wisdom that "more infectious, but milder variants will dominate" holds true for biphasic covid19

Since live virus is near zero (patient non-infectious) by day5 of symptoms or day7-8 for sure

...

 

https://twitter.com/stereomatch2/status/1468650439088480259?t=rk-akSQuzOtZnpxHGXkeMA&s=19

Whether patient lives or dies (happens well past day10 or 14) does not overlap the infectious day1-7 phase of the disease

Thus there is no evolutionary pressure for virus to not eventually kill the patient

Thus variants may or may not be milder - is irrelevant for virus fitness

 

https://twitter.com/stereomatch2/status/1468655177074823171?t=KvuwQA-Ev7Zhd336HlKNcQ&s=19

ie the infectivity window (day1-7) of a patient is not impacted by whether they live or die (which happens much later after day8) - and patients seldom infect others post-day8

 

And here:

https://twitter.com/stereomatch2/status/1468939520489902080?t=BmH7anSdq9Fs75MMdfCtLw&s=19

@GVDBossche @BretWeinstein

While Omicron may be mild, I wonder what your take is on the decoupling of severity being a factor in evolutionary fitness of covid19:

https://twitter.com/stereomatch2/status/1468649863491559424?t=Xaz99etPDU-rikJ0Jf-TXg&s=19

 

Today this idea did get a mention in a Dr John Campbell video:

https://youtu.be/Ss1LSwjtrhA

International omicron doubling

Dr John Campbell

Dec 11, 2021

at the 21:05 minute mark:

https://youtu.be/Ss1LSwjtrhA&t=1265

Question from Michael - correcting that virus new variants not have to be mild - and Dr John Campbell agrees.

 

Conclusion:

If the conjecture is true, and Omicron does seem to be mild - we may not get the same opportunity for widespread inoculation with a subsequent variant.

So perhaps once Omicron is demonstrated to be "mild" - it could be used as a cheap vaccine (live attenuated vaccine).

 

Some questions

• while a patient can be infectious beyond day8 in some severe cases - as inflammation causes blood vessels to get leaky and for the virus to spread into other areas of the body. However with current measures in hospitals and in homes, there will be precautions which may limit infection in the later stages of the disease.

• one aspect not covered is the infection due to sewage - the longer an infectious patient in hospital or in the home is alive, the more sewage infested with live virus would be - however it is not clear what role sewage plays in infection in covid19. Since it is primarily a respiratory disease, sewage may be less of a vector. However it could become a vector for fish.

• what does covid19 via human sewage do to species in the oceans? Is there risk that a disease like covid19 could spread via raw untreated sewage (dumped by many countries right into the ocean) cause massive species collapse in the oceans? Or is such a scenario unlikely given the fragility of the virus - esp in salt water, and in the dilution that occurs in the oceans?