The mutations are far more likely if you give Regeneron to cancer patients and other immuno-compromised people. What an ethical problem... give a therapy knowing that the therapy will kill off the virus identified by the therapy but with a higher chance that mutations in the patient become free to propagate, or don't administer the immuno-therapy to the most vulnerable people in an attempt to stem early mutation? Since only the rich are getting Regeneron, it really is a case of class warfare.

In a world where we pump antibiotics into cattle, ethics don't really apply

Respectfully, I think the message you're presenting here is an endlessly shifting target that's going to seriously compromise vaccine takeup. The vaccine is highly effective and vaccinated people can safely resume normal life, although masks in public places will (and should) continue until anyone who wants a vaccine can get an appointment. Mutation risk is a legitimate concern, but not an overwhelming one that really needs to impact most people's personal decisions; Covid-19 mutating to escape vaccines is the same category of problem as the flu mutating to become more deadly.

If you wait to resume normal life until experts say Covid-19 isn't a problem at all, you're gonna be waiting somewhere between decades and forever, and you're gonna end up left behind by most of the world.

I think we’re mostly saying the same thing.

The end objective is to get the levels of COVID-19 down to as low as practical as quickly as practical with a population that has a high degree of immunity against current variants. If people are immune they won’t get infected and if they don’t get infected they won’t give the virus a chance to mutate via replication.

Concurring with you, and here's some entertaining food for thought. It seems to me that every virus must have a minimum host population that it needs to persist.

The way I think about it is like a tabletop game. You, the player, are a virus. You draw a strain card and roll a stat sheet. Then you pick a human to infect. They draw an immunity card. After that you roll a set of dice that determine if you get to "evolve". If you evolve you get to draw a new strain card, replacing your old strain card, roll new stats, and all players discard their immunity cards. Whether you evolve or not, you start a new round by picking a new human to infect and repeat. The big caveat: you can't pick a human with an immunity card.

Now, if the number of players in this game is low enough and the likelihood of you rolling an evolve action is low enough, then it's easy to see that in all probability you'll lose the game. Every human will get an immunity card before you roll an evolve.

So there are two variables: host population and likelihood of evolution.

Our goal with vaccination is to decrease the former as much as possible. If we get it low enough, the virus will lose the "game". Every other non-vaccinated human will gain herd immunity naturally before it has the chance to evolve. It will die out, and never be given a chance again.

Now, I'm not addressing herd immunity. That's about whether a virus can spread in a given population. This tabletop game doesn't incorporate a virulence mechanic. This is about whether a virus can mutate before the _globe_ achieves herd immunity. The point I'm addressing is this idea lurking in the back of people's minds: third world countries. Won't the virus just "fester" in countries with low vaccination rates until it mutants enough that it can become a new pandemic?

My suggestion is that it's not a given that that's the case, as long as whatever remaining non-immune population is small enough.

What is low enough? An actual virologist could probably guesstimate for some given probability threshold.

But the good news is that SARS-CoV-2 has really bad evolution stats. Many viruses have a "checksum" protein in their genome, just like most other organisms do, that actually work to prevent mutations. Some viruses have this protein "tuned" lower so that they mutate faster, but it's a trade off because that often results in more production of impotent viral particles. SARS-CoV-2, from what I've read in studies, has its "checksum" protein tweaked higher, so it just doesn't evolve as quickly as something like the common cold strains.

In other words, I completely agree with your point. Get vaccinated as quickly as possible and keep up masks and social distance for now. That will give us the highest possibility of winning this "game".

there's no race. If this virus can mutate into something that renders the vaccine ineffective it will. Brazil and Mexico and the rest of the developing world will give it ample opportunity no matter how quickly we roll out the current drugs. It took decades to hunt down smallpox.

There is a race because the more people that are infected with the current strains, the more chances that the virus will have to evolve into newer strains.

It is also believed that new strains are more likely to appear in places where the pandemic is out of control, with a large number of people currently infected and also a large number of people that already have some immunity to previous versions of the disease. This provides the selective pressure that can lead to new variants arising. Therefore, getting the pandemic under control using vaccinations and other measures is key to reducing the number of new variants that pop up.

There certainly is a race. The slower we go the more spread. The more spread, the more variation. The more variation, the more likelihood of a vaccine-resistant strain taking hold.

Even if it’s a long-term certainty, much better to be well-equipped to respond to it, which we simply are not at the moment.

My point is that this virus spreads unbelievably fast and even with the most optimistic vaccine scenarios it has literally billions of hosts in the developing world to infect who have 0 zero chance of getting a shot anytime in the next few years.

Of course the vaccines might be good enough to ward off infection from all future variants but that's just luck.

Isn’t it almost certainly the case that the ‘unstoppable’ thing it turns in to will basically be more akin to a general cold though? The thing that makes this virus deadly is also the thing we are coding against in the vaccine.

Not necessarily. For example, some of the more recent SARS-CoV-2 variants spread more easily because the virus causes a more severe infection, which is transmissable for a longer period of time. It's also not a guarantee that the virus will evolve into something weaker. There are serious diseases like measles and smallpox that have circulated for thousands of years while remaining as deadly as they ever were. Sometimes, the disease not being as deadly after a while can be a result of natural selection selecting for more resistant individuals (after many deaths), not of natural selection selecting for less deadly pathogens.

It can be more complicated than that, because in some circumstances increased virulence might also provide an evolutionary advantage for the pathogen. This article from snopes.com has a nice summary of the competing views: https://www.snopes.com/news/2021/02/01/will-coronavirus-real...

"""The trade-off model recognises that pathogen virulence will not necessarily limit the ease by which a pathogen can transmit from one host to another. It might even enhance it. Without the assumed evolutionary cost to virulence, there is no reason to believe that disease severity will decrease over time. Instead, May and Anderson proposed that the optimal level of virulence for any given pathogen will be determined by a range of factors, such as the availability of susceptible hosts, and the length of time between infection and symptom onset.

There is little or no direct evidence that virulence decreases over time. While newly emerged pathogens, such as HIV and Mers, are often highly virulent, the converse is not true. There are plenty of ancient diseases, such as tuberculosis and gonorrhoea, that are probably just as virulent today as they ever were."""

> There are serious diseases like measles and smallpox that have circulated for thousands of years while remaining as deadly as they ever were

Right and our vaccines have maintained efficacy against these things.

> It's also not a guarantee that the virus will evolve into something weaker

No but it is almost certainly the case if the past is anything to go on

What your saying is a likely long-term outcome. But the reason we see milder viruses circulating as an “end-game” is just because we don’t tend to deal with non-threats. There is no rule that mild strains are a given outcome of mutation. You just won’t see super-deadly variants last long-term because it quickly turns into an us or them battle that we have so far been able to win.