The end of the highly alert, constant concerns about COVID-19 may be near – possibly as early as early next year.
We still have to be smart and careful. We need to solve a few problems. We also need some luck.
But the basic consensus of four experts interviewed by PennLive is optimistic.
“If I were a gambling man, I’d bet we’re seeing the last big surge,” said Dr. John Goldman, infectious disease specialist for UPMC.
dr. Catharine Paules, infectious disease specialist for Penn State Health, said, “I’m starting to get optimistic that this might just be the last very bad winter in terms of COVID-19.”
The optimism stems from an accumulation of factors that could soon bring us to a tipping point in the COVID-19 crisis:
- We have made good progress towards vaccination, even with the disproportionately loud minority opposing it. Nearly 70% of all US residents have received at least one dose. Of those over 65, who make up the majority of people who have become seriously ill or died from COVID-19, about 86% were fully vaccinated last week. This month we started vaccinating children from the age of five.
- In addition to all vaccinated people, many unvaccinated people are infected, giving them some degree of immunity.
- We have developed good treatments, namely monoclonal antibodies, that save people who would have died earlier. Even better treatments are at hand, including antiviral pills that can prevent COVID-19 from taking over cells and spreading throughout the body. Two such pills have shown good results in clinical trials and will soon enter the government approval process.
Still, most experts don’t expect COVID-19 to go away completely.
“The virus will be with us. It will circulate among the population. But it will cause a much less severe form of the disease once everyone is vaccinated or immune,” Goldman said.
The hope is that COVID-19 will soon become “endemic,” which refers to a time when it settles at normal, steady levels.
“What we need to see is that COVID causes a much less serious disease. If it can become another respiratory disease where the disease is relatively mild because of the circulating immunity and effective antiviral therapies, etc., then we can start to think that life is a little bit more normal,” said Dr. Stanley Martin, the director of infectious diseases for Geisinger. “I expect those things to happen, hopefully in the coming months, although there are a lot of variables that can influence that direction and that outcome. So nothing is set in stone.”
Much of it comes down to “predictability,” said Matthew Ferrari, a Penn State biologist and director of The Center for Infectious Disease Dynamics.
He talks about a time when we will know what to expect from COVID-19, instead of constantly worrying about the worst possibilities and trying to avoid them.
For most of the pandemic, the biggest fear has been excessive deaths from COVID-19 — especially among the elderly and those with medical conditions that weaken their immune systems. Many of the prevention measures such as face masks and crowd size limits – the things that infuriate many and have become tiresome for so many others – were designed to protect the very vulnerable.
Close by is the fear of healthcare being overrun with COVID-19 patients: intensive care units are filling up. Hospital staff are overloaded and burned out. Doctors and nurses must choose who gets life-saving care.
Several parts of the United States, including Pennsylvania last winter, have resisted those conditions. Even this summer and fall, many southern and western states have seen or are seeing their health systems strained by the more contagious delta strain.
Some states allowed doctors to make life or death decisions based on factors such as the patient’s chance of survival. People in need of intensive care for things like heart attacks and car accidents faced delays and lack of resources. Some COVID-19 patients died for lack of things like an ECMO machine to take over for their hearts and lungs.
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The gulf of Pennsylvania last fall and winter pushed hospitals into danger. Fortunately, the gain that started this summer appears to be leveling off at about half the level of its worst gain.
Hospitals in Pennsylvania continue to be stressed by COVID-19, due in part to the more recent shortage of health workers. But it has usually caused problems, such as long wait times at the emergency room, rather than disrupting care for the seriously ill.
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Now rising tailwinds from things like vaccination and immunity and antiviral pills are reducing the chances of further increases in hospitalizations and deaths.
It brings us ever closer to the predictability that Ferrarri cites.
“Once we get to the point where, on average, we don’t constantly talk about what might happen in the future, and we can talk about what we know will happen in the future, then we know the crisis is going to happen. are over,” he said.
Ferrari said: “I think we are well on the way, I would suggest, towards some sort of normality and predictability regarding covid risks.”
How will we know this specifically?:
- Relatively low numbers of COVID-19 cases, for example. And with the protection against serious illnesses due to vaccination and immunity, and with better treatments, the number of cases will probably matter less over time.
- COVID-19 hospitalizations remain well below previous levels.
- Significantly lower death toll than during the worst of the pandemic.
Still, we must keep in mind that COVID-19 has consistently surprised experts – from the realization that people can carry it but not be sick to its minimal impact on younger people to the emergence of the more contagious delta variant.
Goldman notes that he previously predicted the worst would be over last spring. “I was clearly very wrong,” he said.
In the future, the biggest wildcard is the possibility of a new variant that evades treatments or vaccines.
So far, experts have been pleasantly surprised at how well the most commonly used vaccines resist variants.
Many do not consider it very likely that the most dreaded variant will occur.
On the other hand, many parts of the world, and some parts of the United States, have lower vaccination rates. Unvaccinated people make the virus more likely to mutate, increasing the chance of a more deadly version. Goldman predicts that at least 15% of US residents will choose not to get vaccinated.
There are still more things we need to figure out.
The duration of vaccination benefits is another positive. Granted, levels of antibodies seem to fade after a few months. Still, the body seems to retain the ability to quickly make new antibodies when it detects COVID-19. As a result, protection against serious illness, hospitalization and death has continued.
- READ MORE: Vaccinated people are 16 times less likely to die from COVID-19, new study finds
But we will probably need boosters.
“I think it’s safe to say that the immunity, whether you have it from a previous infection or from a vaccine, will wane over time. And because this virus will likely continue to circulate in the community, there will be a role for continued boosters, much in the same way we think about flu shots,” Martin said.
In addition, we may eventually conclude that people need annual COVID-19 injections, as they get for the common flu.
“This could be a virus where we need to be vaccinated more than once. We may need to adjust the strains used in the vaccine,” Paules said.
We also need success in vaccinating young children, according to Martin, who emphasizes that while most young children resist COVID-19, they are major carriers and spreaders of the virus.
While the experts interviewed by PennLive see cause for optimism, they don’t want to let anyone relax about COVID-19 just yet.
In addition, while Pennsylvania’s summer rise has been largely flat in cases for weeks, it hasn’t made the abrupt downtown rise that followed previous gains. A key barometer, the positivity rate for COVID-19 testing rose last week to more than twice the level of 5% associated with significant spread.
According to Ferrari, too many of us have resisted things like face masks and social distancing, making the crisis worse than it needed to be.
He and others emphasize the possibility of another fall and winter wave in Pennsylvania as cold weather drives us indoors and holiday gatherings bring us together and create better conditions for diffusion.
In addition, the return of the common flu, which has been suppressed by the tighter COVID-19 restrictions but is now expected to make a comeback, coupled with a COVID-19 wave, could once again overwhelm hospitals.
It means we may still not be past the need for more masks or restrictions on gatherings.
“I would prefer some kind of risk aversion until at least March this year,” Ferrari said.
Goldman said, “It’s kind of a race between the vaccines, the variants, and our social distancing fatigue.”
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