This upset a lot of people. So maybe I should explain what I mean.

1) We are currently attempting to live “with” Covid- with sustained community transmission and continued lifting of restrictions https://twitter.com/drdompimenta/status/1381596861547610112

2) As we vaccinate more and more, our restrictions become more effective, so we can lift some of them and keep transmission reducing.

Currently cases aren’t still falling:

3) So the question is, as it always is with COVID, where are we going?

COVID cases can only continue to rise as unvaccinated individuals increase their interactions.

But we have vaccines now so who cares?

4) Firstly yes we have vaccines, but they aren’t 100% effective.

95% reduction in deaths is really amazing, but that still leaves 5%. In small numbers we might accept that as a society, but if we have widespread transmission, we aren’t talking small numbers.

5) Secondly, the vaccines haven’t been given to everyone yet. The vaccines do appear to reduce transmission, but we aren’t giving them to the main drivers of transmission, which are the young and much more mobile.

6) Again, the risks to this group are low, but not as low as we would like.
At 33 my risk of death from Covid is 5x that of flu.

And if we have widespread transmission we will see very rare serious events occurring very frequently.

7) Then we have long Covid- affecting approximately 1 in 10 of 18-49 year olds with long term symptoms: lung, heart, brain disease, even potentially male infertility.

With widespread transmission, these will be common problems in young people. https://www.kcl.ac.uk/news/study-identifies-those-most-risk-long-covid

8) As we segment the population, into a high transmission low vaccination younger group, and a low transmission high vaccination group, we create a perfect boiling pot for mutation.

9) Every time the virus makes a copy it might make a mistake.

Usually that mistake is meaningless, but very rarely it changes the virus to make it better able to infect others than other strains of the same virus.

10) It’s a lot like a lottery. And the more tickets you buy, the more likely you are to win.

So a bubbling pot of widespread transmission, alongside a whole population the virus is chomping to get into, is a perfect lottery, one the virus has a great chance at winning.

11) Mutation variants globally in countries of high infection already show the ability to escape vaccines, at least partially.

This is mostly lab based, but it demonstrates the principle. We are fighting a moving target.

12) So when I say we haven’t figured it out yet, I’m saying we won’t tolerate young people getting sick in substantial numbers, or vaccinated people getting sick from mutants.

And when we realise that, we will realise the only long term route to normal life is elimination.

13) Which we could do RIGHT NOW. A little while longer to vaccinate and continue suppression, could get cases into single digits, enough to test and trace into zero.
The less cases, the less chance of mutation, the more long term our success.

14) But we’ve reopened, accepting new infections in the young and children, the risk of mutation, and accepting the deaths in the fraction of vaccinated people who still are vulnerable.
We still persist in this idea we can find a balance with Covid. But no country ever has.

15) And when we look around the world we will start to realise what we are missing, and perhaps then will change our minds.

Or perhaps I’m entirely wrong and it’ll all be okay. I hope so too. But hope just isn’t enough. And it isn’t science either. /end