Believing Exponential Growth

Verghese: You were prescient about the shape of the BA.5 variant and how that might look a couple of months before we saw it. What does your crystal ball show of what we can expect in the United Kingdom and the United States in terms of variants that have not yet emerged?

Pagel: The other thing that strikes me is that people still haven’t understood exponential growth 2.5 years in. With the BA.5 or BA.3 before it, or the first Omicron before that, people say, oh, how did you know? Well, it was doubling every week, and I projected forward. Then in 8 weeks, it’s dominant.

It’s not that hard. It’s just that people don’t believe it. Somehow people think, oh, well, it can’t happen. But what exactly is going to stop it? You have to have a mechanism to stop exponential growth at the moment when enough people have immunity. The moment doesn’t last very long, and then you get these repeated waves.

You have to have a mechanism that will stop it evolving, and I don’t see that. We’re not doing anything different to what we were doing a year ago or 6 months ago. So yes, it’s still evolving. There are still new variants shooting up all the time.

At the moment, none of these look devastating; we probably have at least 6 weeks’ breathing space. But another variant will come because I can’t see that we’re doing anything to stop it.

Medscape, We Are Failing to Use What We’ve Learned About COVID, Eric J. Topol, MD; Abraham Verghese, MD; Christina Pagel, PhD

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