I do think what Plague Inc is doing..is far from a simulation of an infectious disease...
The pathogen in PI receives "updates" from a handler, and cannot be cleared from a host without intervention (nobody in PI recovers from the pathogen unless a cure is distributed). This reminds me more about computer malware than any biological agent...
I would agree with 1., yeah. Generally a disease that doesn't transmit during the "dormat" period would not be much different from a disease that is very acute.
I think "mild acute illness that lays dormat and comes back later" can blur the lines a bit. Say, if we have a disease similar to HIV that causes flu-like illness in the acute phase and was highly infectious at point of time (but doesn't show up to be a serious illness until much later and wasn't transmissive during the dormat period) would probably make the non-transmissive dormat period relevant for our responses.
I'm the most curious of 2...I know it is unlikely for herpes/EBV/measles to kill someone after they recover from an acute infection, but I wonder if a very different virus could cause "serious illness later in life" in a larger proportion of people, without being significantly more deadly in the acute phase.
--Which, I would call it "the plague inc. winning disease", since the easiest winning strategy of PI was to infect as many people as possible before bringing in the serious symptoms that kill...It is of course impossible for a disease to "mutate" serious symptoms in every infected person simultaneously, but what if it already has a "delayed payload" built in, when it's spreading uncontrolled...
And maybe this is a particular scenario to watch out for when considering possible engineered pathogens.
Vaccination using cowpox seems to be the kind of technology that didn't require a lot of "prerequisites" in its way. I wonder how different history would've been if cowpox was discovered much earlier, and cowpox-vaccination became a widespread practice in at least some regions before the 1000s or so.
Could smallpox eradictation be achieved on a national/regional level in a pre-industrial society? And how much would that change the course of history?
Not quite sure what "actual examples" we can possibly conjure up, but I suspect this is somewhat related to the issue of technology-related X-risks.
The only thing I see anyone talking about the comparison between SSPE and long-covid is this popular-level article from Peter Doherty, and he seems to be unaware of any evidences suggesting whether it's likely or not (only, "hopefully unlikely").
I used to believe that pandemics in themselves are not enough to be an extinction level event. Now I'm not quite sure...IF something attains the prevalency of Covid but leads to serious illness with a high mortality rate (eg. SSPE) in a large proportion of people (instead of the measles/SSPE relationship) several years down the line, the result is going to be catastropic (and I don't see why there will be any evolutionary pressure that prevents a virus from behaving like this).
On the other hand, some animal species seem to have handled their equivalent of HIVs...https://www.pnas.org/doi/10.1073/pnas.0700471104
Information about viral persistence has been on the popular press for a while, but it didn't impact the public perception of covid (at least, not enough to affect the trajectory of our pandemic policies).
I wonder if there are more follow-up autopsy studies on covid persistence (that would allow us to look really closely, and in all the organs including the brain). The logical next step is to check if the presence of persistent covid is different in people who recovered from covid, compared to those who died during hospitalisation.
I think it is justifiable to make "testing for presence of persistent covid virus" a standard procedure for all autopsies. It'll make autopsies more expensive and resource consuming but I think it would likely still be a negligible proportion of societal resources...and might give us a quick answer on long covid and its associated risks (eg: it would sound like big trouble if ~80% of healthy people who died from drowning/vehicle accidents/homicide had viable covid reservoirs in their major organs...)
Of course, that requires a lot of influences on the policy makers. But maybe current long-covid research groups can do some follow up autopsy studies? That might be a start as well, at least in gauging how bad the situation can be.
Hi Siebe, I like your post and agree largely with your conclusions.
Currently I'm wondering if there are any studies being done that can adjust our knowledge about the probabilities of extreme tail risk events (e.g., covid causes SSPE-like illness in a substantial fraction of people, or that it contributes significantly to cancer risk like HPV, or...), and if long-covid researchers are keeping an eye out for these probabilities.
Hopefully, it'll be easier for decision makers to spot tail risk events, but I'm not confident about this.