Jlang, Feel free to continue with the ad homine

Jlang,

Feel free to continue with the ad hominem attacks. Your ascribing of Dunning Kruger effect to me is laughable projection, but each to his own. I don’t imagine that these behaviors will result in a second opportunity to me moderator.

Your continued dismissal of viral replication and mutation rates as moot remains unfounded. Please explain how variants are able to develop, without mutations from which selective pressures can choose the new and more fit.

Selective pressure in the immune compromised favors variants that succeed against the impaired immune systems of those same compromised patients. The strength of selective pressures matters. This is the basis for the development of variants of concern as poised to lesser variants of interest and simple genetic drift.

More broadly in medicine, the immunocompromised contribute to the development of resistance to effective drugs, as the host immune system is unable to eradicate the circulating population of pathogens, selecting for resistance to the administered drug. Without a drug against which to develop resistance or a robust immune response to evade, there is little to drive change.

Covid circulating unchecked across the world with known case well over 200M provides ample opportunity for mutations to drive emergence of variants.

Perhaps a better, more compressible analogy is the development of fighting prowess. Which will be the more formidable opponent, he who has spent a year fighting other seasoned combatants in a tough neighborhood (normal immune system) or one who has spent 20 years terrorizing kindergarten playgrounds (immune suppressed)? Success against a weakened opponent generates ability to succeed against a weakened opponent.

I agree in part with your statement that,

“ Healthy hosts don't allow the virus as much time to "pick the lock" or increase affinity.. immunocompromised hosts do. Immunocompromised hosts allow the virus several bites at that apple, merely swatting it away instead of smashing it outright.”

However, hundreds of millions of immune competent patients have contracted Covid, selecting for variants able to “pick the lock” of a formidable emplacements, not simply break into a wet paper bag.

The immunocompromised do constitute an ongoing reservoir of viral replication and resultant mutation. Stamping that out worldwide is necessary and unfortunately is not likely to happen with current vaccines.

Spike targeting vaccines select for revolution of variants with novel spike confirmations. We collectively have likely made a mistake by not designing vaccines with inactivated Covid virions or multiple expressed antigens.

Valenva among others is developing an inactivated whole virus vaccine. Fingers crossed that this is the vaccine that may allow true control of the circulation of Covid.