Summary

• COVID-19 spreads primarily through airborne transmission. Everything follows from the inhaled deposited dose we receive or avoid.
• (Lack of) symptoms != (lack of) infectiousness. 30-40% of cases are asymptomatic. The only way to know is to test.
• Long COVID is a serious threat that will be felt for decades, especially given how little we know about post-acute infection syndromes in general.
• Build a COVID castle to manage risk: rapid testing => ventilation + filtering + UV disinfection => masking => vaccines => treatments.
• Use tooling like microCOVID to evaluate risk and ride the waves.
• We can/must/will prevail over COVID. Accelerate this by advocating for vaccines that can be delivered as a intranasal spray and ones that are variant-proof ("universal").
• Technical solutions to prevent future pandemics include building a global system to detect novel pathogens, creating more universal vaccines and treatments in advance, and upgrading indoor ventilation.
• Policy solutions for pandemic prevention include universal paid sick leave, intelligently regulating the human-wildlife interface, enhancing our biodefense posture, and reconsidering gain-of-function research altogether.

Context

"When will I feel safe again?"

In the spring of 2022, I found myself pondering this question again, as we all have for ~2 years now when it comes to COVID-19. One of my friends had just tested positive after an indoor gathering of 15 people, all vaccinated with 3 doses of mRNA vaccines, and asymptomatic. My friend was wearing a KN95 mask most of the time, while most of the other attendees were not. They only stayed about an hour, but still contracted the Omicron variant of SARS-CoV-2.

What went wrong? Is COVID unavoidable and inevitable? How dangerous is it really? What about Long COVID? How are we supposed to live the rest of our lives? Why do the answers we hear to these questions keep changing every few months? How do we know what's actually true or not?

The summary above is the beginning of my quest to provide answers. It's a distillation of everything I've learned from diving deep into this pandemic over the past 2 years. The plan is make this post the first in a series, a knowledge map that links out to deep-dive follow-ups.

I should pause now to give a strong disclaimer: I'm a geek and a nerd, not an expert. I'm a software engineer by trade, not a physician, epidemiologist, or virologist. Keeping this in mind, I will scrupulously source every material assertion. I will label my own opinions as such and defer to the experts wherever possible. But I will still make mistakes despite careful review, so I invite your constructive feedback (tactfully stated!) on Twitter at @KyCodeHuynh.

Put more cheekily, you should be careful with what you read from a stranger on the Internet. But the Internet is also a wonderful way for humanity to assemble collective wisdom. This is me weaving my part of the quilt. I hope you find it useful.

Changelog

• 2022-10-16: I revamped this post to stand better on its own and broke out a technical vs. policy split in solutions for pandemic prevention.
• 2022-10-10: I pulled in the latest research on the origin and prevention of pandemics, and pointed out how alarming it is that it was "plausible" that SARS-CoV-2 had a lab-associated origin. While the latest balance of evidence now favors zoonotic spillover for this particular pathogen, we need to avoid the unforced error of introducing our own worst nightmares through gain-of-function research. That will let us focus on tackling the natural origins of pandemics and countering bioterrorism.
• 2022-08-13: I have since decided against continuing this series, as my focus and bandwidth is now elsewhere. I will still occasionally update the summary outline of key points as-needed. For today's update, I pulled in intranasal spray and universal COVID vaccines as key interventions and rewrote the tooling point to make it clearer.