Has Covid come to stay? What experts say about the transition from pandemic to endemic
Has Covid come to stay?  What experts say about the transition from pandemic to endemic

Has Covid come to stay? What experts say about the transition from pandemic to endemic

SEATTLE – Early in the pandemic, many people seized the hope that Covid-19 could be stopped in its tracks and buried forever when the vaccines rolled out.

But the hope of a zero-Covid country stalled for most scientists long ago.

“Everyone has stopped talking about getting rid of Covid,” said Dr. Elizabeth Halloran, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle, about her fellow researchers. “It does not disappear and that means it will be endemic.”

Most scientists now expect the virus to circulate indefinitely with lower and more predictable case numbers – a status known as endemic. It would make coronavirus like many other viruses that mankind has learned to deal with, such as the flu. However, it is still unclear whether coronavirus remains a greater health risk than other endemic respiratory viruses.

There are indications that government and health officials are already working with that idea in mind. The latest wave of the omicron variant has not only served as a reminder that coronavirus is still mutating in unexpected ways, but also as a guide: Federal messages and the action of local authorities, which once focused on stopping the spread of the virus and invoked extreme measures such as local shutdownsis now centered on reducing the risk and giving the vaccinated and the boosted the opportunity to continue with relatively normal lives with precautions.

As Covid is expected to become a solid component – and given the rapid spread of the omicron variant – some infectious disease experts now believe that almost anyone can become infected during their lifetime.

“It seems to me that it is almost inevitable that you will get infected,” said Dr. Francis Riedo, an infectious disease physician at EvergreenHealth, a hospital system in Kirkland, Washington. “The real question is how serious that infection will be.”

Although endemic Covid will become unavoidable, it does not mean that people should stop taking preventative measures, experts say. Instead, they are beginning to consider a future in which Covid measures, such as masking and occasional encouragement to social distance, may become something common. Vaccinations will remain central, as will precautions for vulnerable people.

And in the short term, while the omicron variant is raging, it remains crucial that people – including the vaccinated – try to avoid becoming infected now that the pandemic is on the rise. The healthcare system may soon be under siege, hospital workers are exhausted and there are not enough treatment tools, such as monoclonal antibodies and antiviral pills.

“There is definitely a responsibility to society,” Riedo said. “If you look at the countryside, there are huge shards unvaccinated and not infected yet, but will be. And what can we do to help them?”

A virus becomes endemic as humans grow overall immunity to a disease through vaccination or infection. Decreased immunity prevents the virus from dying out completely.

For an endemic disease, each person who is infected transmits the virus to an additional person on average. But it is a “dynamic equilibrium,” Halloran said, and the incidence of the virus can grow and decline depending on factors such as the season.

No model can predict how quickly society can make the transition to endemicism, said Sergei Maslov, professor of biotechnology at the University of Illinois at Urbana-Champaign, whose research suggests that ever-changing social interactions prevent pathogens from dying out and pushes them towards becoming endemic.

“Mutations are pretty unpredictable at this point, and we do not know what will happen after omicron,” he said.

It typically takes a few years for a new viral pathogen to move from pandemic to endemic, said Maslov’s research partner, Alexei Tkachenko, a scientist at the Brookhaven National Laboratory in Long Island, New York.

“Eventually, yes, there will be a kind of recurring pattern, an average level of incidence of the epidemic,” Tkachenko said. “We can not say that it will be so low that we do not care.”

That’s what Pfizer executives said this week they believe Covid will become endemic in 2024. The director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, wrote last week with colleagues that it is unlikely that the virus will be eradicated and that they expect “periodic outbreaks and endemics.” It found a study in February in the journal Nature almost 9 out of 10 researchers working on coronavirus thought Covid would become endemic.

Endemic diseases often manifest themselves in more predictable and stable patterns. Influenza, for example, rises somewhat predictably during the cold months. But scientists can not say with certainty how harmful an endemic level of Covid can become.

“The really open question for me – or maybe for public health or all of us – is when does it become endemic and people get infected, how much serious illness and death does it cause?” said Halloran.

An endemic version of Covid could look somewhat like the flu, according to a projection by Trevor Bedford, a computational biologist at the Fred Hutchinson Cancer Research Center.

Bedford said he believes endemic Covid may mean that most people will be infected around every three years, on average, with most cases quite mild.

Bedford’s backside-of-the-napkin math – when the delta variant was the primary strain – suggested that 50,000 to 100,000 people could die in the United States each year from endemic Covid, according to a presentation he shared in the fall. In the decade that preceded Covid, the flu caused 12,000 to 52,000 deaths a yearaccording to statistics from the Centers for Disease Control and Prevention.

Long Covid, a poorly understood disease that follows infection, can increase the social cost of endemic Covid.

Riedo, an infectious disease doctor, said the comparison with the flu makes sense. Vaccination will be the key to protecting vulnerable groups.

“With Covid, even if you are vaccinated, some people will die and the average age of those people is in their 80s,” Riedo said. “They have several comorbidities. They can not tolerate a slight disturbance in their physiology.”

Those who are unvaccinated and die of Covid tend to be younger by 10 to 15 years on average with fewer health problems, Riedo said, adding that the same goes for the flu.

Endemic Covid will not affect everyone equally. Immunosuppressed humans may not benefit as much from vaccinations and may need additional protection to reduce the risk of endemic Covid.

Riedo outlined a potential treatment plan for immunosuppressed people that makes up 4 percent to 5 percent of the U.S. population: “Every six months, you go in for antibodies, and you have quick tests available to them, and if you’re positive, you start. those on new drugs, ”such as drugs that help inhibit viruses from multiplying.

If risks are more significant during peaks of endemic Covid, layers of protection, such as masks and spacing, can still prevent infection and help manage the risk, especially for at-risk populations.

“Covid is not the first time they have had to think about dual protection or have to think about how to protect themselves during epidemics or environments that put them at risk,” said Erin Sorrell, assistant professor of microbiology and immunology at Georgetown University in Washington, DC “Getting colds, flu, measles, getting anything would be a problem for their health and safety.”

Not all viruses become endemic or remain that way.

Strict control measures of the first SARS virus, which did not spread asymptomatically, enabled the health authorities to eradicate it effectively. The virus that causes smallpox was eradicated through a worldwide vaccination effort.

Some experts still believe that it may be possible to remove coronavirus country by countryalthough it would require huge investment and the cost might not outweigh the benefits.

Four other coronaviruses circulate in humans, causing the common cold. Researchers suspect that they may have evolved from pandemics before weakening in severity when humans gained immunity.

But this is the first time researchers are measuring a coronavirus on its way to becoming endemic. There may be more surprises in store.

“Who would have thought of omicron?” said Halloran. “Is it in your crystal ball?”

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