SAN FRANCISCO — It is “reasonably likely” to expect the pandemic to draw to a close as soon as a month from today, though COVID-19 is likely to stay, according to UCSF’s Chair of the Department of Medicine, Dr. Robert Wachter.
He expects infections to fall and community immunity levels to rise from a combination of vaccinations, antiviral medication and omicron infections as the pandemic enters a new phase — turning endemic.
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This sentiment is echoed by other infectious disease experts in the field.
“The end game is really bringing down the virus to low levels where we just live with it. And what omicron will do is bring the virus down to low levels in the community because it’s causing so much immunity,” say Dr. Monica Gandhi, an infectious diseases doctor and Professor of Medicine at UCSF. “It’ll bring it down to a controllable phase, which we call endemicity. So after this surge, we should be in the end game of the pandemic and into endemic.”
“In the next few weeks, we expect that the numbers are going to start to drop off pretty soon in California, and there’s evidence that that’s happening elsewhere also. So what we’re really hoping will happen is to move to a phase where we know that we have to live with this virus,” Professor of Pediatrics (infectious diseases) and of Epidemiology and population health at Stanford Medicine, Dr. Yvonne Maldonado says.
All four doctors interviewed told ABC7 News in San Francisco that they believe the SARS-CoV-2 is here to stay but expressed cautious optimism that we are turning a corner for the better.
“It has to end to become endemic at some point in time, so yes, my guess is that it would be this year. I based that largely what we’re seeing in other countries that are probably more vaccinated than we are. The bottom line is that if we’re going to control transmission, we need to be vaccinated and boosted,” UCSF epidemiologist Dr. George Rutherford says.
All four doctors point to vaccinations as the main pathway to achieve endemicity.
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“Out of 1.2 million people in one particular healthcare study who were fully vaccinated, only 36 people in that group died. And there were about 2,500 infections. So it was about a 0.2% rate of infection. So if you are vaccinated, and you are potentially exposed and get infected with omicron, your risk of serious disease, death or other complications is going to be extremely low. So again, I can’t emphasize enough how important it is for people to be vaccinated because that is going to be our way out of this pandemic,” says Dr. Maldonado.
“I do think that there’s a chance that we can get rid of the pandemic – meaning large surges of hospitalizations and deaths, and maybe get to a point where we have a circulation of the virus with less hospitalizations and deaths and maybe the same or more infections, but not leading to the bad outcomes. And we’re going to have to learn how to live with that with vaccinations. And and we’ll have to learn more about whether we can stop masking at some point later this year. If if the disease becomes less severe,” she says.
However, Dr. Wachter says although he can project a fall in infections with some confidence for the spring and perhaps the summer, he isn’t as confident to say the same of the fall and winter later this year. “A lot of that depends on if there is a new and worse variant.”
He says how much immunity from an omicron infection alone is also still unknown. “For unvaccinated people, if their only immunity is from an infection, it really all depends on how good that immunity is and how long it lasts. If it starts waning, and they’re vulnerable again, then we could see another significant surge. But I’m moderately optimistic,” Dr. Wachter says.
The staggering spike in COVID-19 cases nationwide fueled mainly by the highly contagious omicron variant has many Americans questioning how long it will take for the pandemic to finally subside for good. While no crystal ball can provide an exact timeline, several medical experts help lay out what the future might hold.
The changeover for an infectious disease from a pandemic to an endemic occurs when the virus is found regularly in a particular area or among people. The key difference in an endemic condition is that the virus is more manageable with greater population immunity.
The common cold and flu are examples of endemic viral infections that are frequently encountered by the public. Medical Director for Infection Prevention at the Mount Sinai Health System, Dr. Bernard Camins, believes the Sars-Cov-2 virus will eventually become endemic over time.
“The definition of endemicity is that it [Sars-Cov-2] will come back yearly, especially when winter comes. When it becomes endemic, though, it should not affect a large portion of the population — only certain groups,” Dr. Bernard Camins said to NBC New York.
It may take a matter of years before Sars-Cov-2 stops hindering widespread travel plans, hospitalization rates, and healthcare systems, Dr. Camins adds.
With the omicron variant spreading rapidly, what symptoms should you look for?
Omicron May Be Mild, But What About Future Variants?
It is important to understand while cases of the omicron variant are milder than others, another SARS-CoV-2 strain could very well appear in upcoming months that may pose more of a threat with a different set of mutations or just as virulent as delta.
Most of the world is not immunized. While most Americans and Europeans may be vaccinated, other countries, such as South Africa and India, are lagging in vaccination rates.
A virologist at the Feinstein Institutes for Medical Research, Dr. Bettie Steinberg, says it is possible and likely that the world sees more variants appear.
“Just like omicron did from South Africa, variants will appear that have enough differences from the strains that we have some immunity to, to give us another spike,” suggested Dr. Steinberg, who suspects more surges will come over the years — hopefully, short-lived.
Dr. Jeffrey Shaman is a professor of environmental health sciences at Columbia University’s Mailman School of Public Health.He affirms the COVID-19 vaccine will offer partial protection if that time comes the same way it did during the delta spread.
To paint a narrative that this is the first step where we’re seeing a logical progression towards something that was milder is a flawed evolutionary argument, from my perspective.
– Dr. Jeffrey Shaman, Columbia University Mailman School of Public Health
There are two arguments on why the Sars-Cov-2 may produce milder infections, Dr. Shaman explained to NBC New York. On one hand, when a pathogen is in a host for a prolonged period of time, it has a tendency to become more transmissible and less virulent.
“When a virus stays in a host, there’s going to be select pressure exerted such that if a variant emerges that is more transmissible than the other variants, it’s going to move through the host population faster,” said Dr. Shaman.
The winning, faster-spreading variant would outcompete and either replace or displace the contenders. However, Dr. Shaman states there is an innate limit to how much a virus can physically mutate.
On the other hand, the doctor says the framework for a milder virus is possible because it is disadvantageous for a pathogen to kill its host. The rationale behind this thought is that if the virus kills its host before replicating and infecting others, it’s short-circuiting the whole reason of existence. That only holds if the virus is transmitted before it exterminates the host.
Much of the transmission of Sars-Cov-2 takes place before people experience symptoms, especially in severe cases. To Dr. Shaman, the selected pressure is gone because of that reasoning.
Furthermore, Dr. Shaman carefully states not enough people have died from Sars-Cov-2 in comparison to the total population.
“Because of underreporting, maybe 20 million people have died from COVID-19, which is a huge number, but it’s a drop in 7.7 billion hosts, particularly at the rate we reproduce ourselves,” explained Dr. Shaman.
To this researcher, this coronavirus has not yet depleted its pool of people to infect, and there is not enough evidence to show a selected pressure toward a milder variant.
Are We Entering the Endemic Phase?
The somewhat hard truth is that time can only tell. Expert perspectives tell NBC New York that there is a chance the world may be entering a post-pandemic phase this year.
But it will take years of hindsight to understand this. The virus could be moving toward a certain pattern. Dr. Shaman gives the example of possibly seeing a future where the world sees just two variants annually.
“For instance, in 2022 we get three waves. In 2023, we get one wave. In 2024 and 2025, there are two waves, and by 2026 just one wave. We’ll say roughly two variants per year come along that are causing outbreaks, and it’s only having looked at a five-year record that we’re going to start to say it’s the pattern [the virus has] fallen into,” explained Dr. Shaman.
According to the latest Centers of Disease Control and Prevention data, there have been almost 60,000,000 cases of COVID-19 in the U.S. over the last 30 days with over 830,000 deaths.
In New York state alone, over 90,000 new positive COVID-19 cases were reported on Saturday. More than half of those, close to 47,000 cases, were found in New York City.
New York Gov. Kathy Hochul is “cautiously optimistic” that COVID trends show a slowing rate of growth for the first time omicron was detected in the Big Apple.
Dr. Rochelle Walensky, the director of the CDC, is not yet convinced that omicron has peaked yet for the nation but is hopeful after reviewing New York’s seemingly plateauing numbers.
With over one in five COVID tests resulting positive, those patients getting sick with COVID-19 during the omicron surge may have some added immunity. Dr. Steinberg mentions those breakthrough cases for the fully vaccinated may act as a booster when it comes to immunity – at least to that variant.
She states whether this infection will provide immunity for a future variant is still a question due to possibly further mutations. With the increased population becoming infected by omicron, this could provide immunity for a while.
“Immunity wanes with time, and then you can be more susceptible. But because so many people are infected right now, I suspect that this particular surge isn’t going to last very long. The virus is going to run out of targets,” said Dr. Steinberg.
With omicron causing record infections in the U.S., many are left wondering which COVID-19 test is most effective.
How Can We Get to a Post-Pandemic World?
While there is no clairvoyance to determine the exact date the world will enter a post-pandemic era, some scientists express it may be time to alter the public’s thought process.
Perhaps residents should come to terms with the concept that COVID-19 is here to stay, they say.
“In my opinion, knowing what I know, we have to learn how to live with it. When we have surges like this, I’m not necessarily advocating for lockdowns again or shutting down businesses, but I do think people need to be careful,” said Dr. Camins.
Dr. Steinberg says people can look at COVID-19 prevention like dressing in layers for the winter – every addition helps.
“One layer is vaccination. Another layer is the fact that a lot of people who get it, will have some immunity, at least for a while. And a third layer will be better treatment,” explained Dr. Steinberg.
Dr. Purvi Parikh, an allergist and immunologist with Allergy & Asthma Network, adds even milder strains can still pose negative impacts on the healthcare system, such as delaying care for other emergencies.
“I hate that word ‘mild’. It is becoming less severe, I’ll say it that way. But that being said, we’re still seeing people hospitalized, especially unvaccinated individuals. I do think it’s a good sign at least strains are starting to move in that direction of not as deadly, fingers crossed,” Dr. Parikh said.
With the rapid spread of the omicron variant of COVID-19, when are people who have contracted the virus most contagious?
SEATTLE — Early in the pandemic, many people seized on the hope that Covid-19 could be stopped in its tracks and buried for good once vaccines rolled out.
But hope for a zero-Covid country fizzled for most scientists long ago.
“Everyone has stopped talking about getting rid of Covid,” Dr. Elizabeth Halloran, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle, said of her fellow researchers. “It’s not going away, and that means it’s going to be endemic.”
Most scientists now expect the virus to circulate indefinitely with lower and more predictable case numbers — a status known as endemicity. That would make the coronavirus like many other viruses that humanity has learned to deal with, such as influenza. It remains unclear, however, whether the coronavirus will remain a greater health risk than other endemic respiratory viruses.
There are some indications that government and public health officials are already operating with that idea in mind. The latest wave of the omicron variant has served not only as a reminder that the coronavirus is still mutating in unexpected ways, but also as a signpost: Federal messaging and local government action, which once focused on stopping the virus’s spread and relied upon extreme measures like local lockdowns, is now centered on reducing risk and allowing the vaccinated and the boosted to go on with relatively normal lives with precautions.
With Covid expected to become a fixture — and considering how fast the omicron variant spreads — some infectious disease experts now think most everyone could be infected during their lifetimes.
“It seems to me it’s almost inevitable you’re going to become infected,” said Dr. Francis Riedo, an infectious disease physician at EvergreenHealth, a hospital system in Kirkland, Washington. “The real question is how severe that infection is going to be.”
Even if endemic Covid becomes inevitable, however, it doesn’t mean people should stop taking preventive measures, experts say. Instead, they are beginning to consider a future in which Covid precautions, such as masking and occasional encouragement to socially distance, could become somewhat common. Vaccinations would remain central, as would precautions for vulnerable people.
And in the near term, as the omicron variant rages, it remains critical that people — including the vaccinated — try to avoid becoming infected now, when the pandemic is spiking. The health care system could soon be under siege, hospital workers are exhausted, and there aren’t enough treatment tools, like monoclonal antibodies and antiviral pills.
“There’s definitely a responsibility to the community,” Riedo said. “If you look at the country, there are huge swaths unvaccinated and not infected yet but will be. And what can we do to help them?”
A virus becomes endemic as people grow overall immunity to a disease through vaccination or infection. Waning immunity keeps the virus from dying out completely.
For an endemic disease, every person who is infected transmits the virus to one additional person on average. But it’s a “dynamic equilibrium,” Halloran said, and the prevalence of the virus can wax and wane depending on factors like the season.
No model can predict how soon society could make the transition to endemicity, said Sergei Maslov, a professor of bioengineering at the University of Illinois at Urbana-Champaign, whose research suggests that ever-changing social interactions prevent pathogens from dying out and pushes them toward becoming endemic.
“Mutations are pretty unpredictable at this point, and we don’t 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 Brookhaven National Laboratory in Long Island, New York.
“Eventually, yes, there will be some sort of repeated pattern, an average level of prevalence of the epidemic,” Tkachenko said. “We cannot say it will be so low we don’t care.”
Pfizer executives said this week that they believe Covid will become endemic by 2024. The director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, wrote last week with colleagues that the virus is unlikely to be eradicated and that they expect “periodic outbreaks and endemics.” A survey in February in the journal Nature found that nearly 9 of 10 researchers working on the coronavirus thought Covid would become endemic.
Endemic diseases often settle into more predictable and stable patterns. Influenza, for example, spikes somewhat predictably during colder months. But researchers can’t say for sure how damaging an endemic level of Covid could become.
“The really open question for me — or maybe for public health or all of us — is when it becomes endemic and people become infected, how much severe disease and death does it cause?” Halloran said.
An endemic version of Covid could look somewhat similar to the flu, according to a projection by Trevor Bedford, a computational biologist at the Fred Hutchinson Cancer Research Center.
Bedford said he thinks endemic Covid could mean that most people would be infected about every three years, on average, with most cases quite mild.
Bedford’s back-of-the-napkin math — when the delta variant was the primary strain — suggested that 50,000 to 100,000 people could die in the U.S. every year from endemic Covid, according to a presentation he shared this fall. In the decade that preceded Covid, influenza caused 12,000 to 52,000 deaths a year, according to statistics from the Centers for Disease Control and Prevention.
Long Covid, a poorly understood disease that follows infection, could increase the social costs of the endemic Covid.
Riedo, an infectious disease physician, said the comparison to flu makes sense. Vaccination will be key to protecting vulnerable groups.
“With Covid, even if you’re vaccinated, some people are going to die, and the average age of those individuals is in their 80s,” Riedo said. “They have multiple comorbidities. They can’t tolerate a small perturbation 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 holds true for influenza.
Endemic Covid won’t affect everyone equally. Immunosuppressed people might not benefit as much from vaccinations and could need additional protection to reduce the risk of endemic Covid.
Riedo outlined a potential treatment plan for immunosuppressed people, who make up 4 percent to 5 percent of the U.S. population: “Every six months, you go in to get antibodies, and you have rapid tests available to them, and if you’re positive, you start them on new medications,” such as drugs that help inhibit viruses from reproducing.
If risks are more significant during spikes of endemic Covid, layers of protection, like masks and distancing, could still prevent infection and help manage risk, particularly for at-risk populations.
“Covid is not the first time they’ve had to think about double layers of protection or had to think about how to protect themselves during epidemics or environments that put them at risk,” said Erin Sorrell, an assistant professor of microbiology and immunology at Georgetown University in Washington, D.C. “Getting the common cold, the flu, measles, getting anything would be an issue for their health and safety.”
Not every virus becomes endemic or remains that way.
Strict control measures of the first SARS virus, which didn’t spread asymptomatically, allowed health officials to effectively eradicate it. The virus that causes smallpox was eradicated through worldwide vaccination efforts.
Some experts still believe eliminating the coronavirus country by country could be possible, although it would take huge investments and the costs might not outweigh the benefits.
Four other coronaviruses circulate in humans and cause common colds. Scientists suspect that they might have developed out of pandemics before they weakened in severity as people gained immunity.
But this is the first time researchers are measuring a coronavirus on a path toward becoming endemic. More surprises could be in store.
“Who would have thought of omicron?” Halloran said. “Is that in your crystal ball?”
First, the bad news. With unpredictable outbreaks still occurring around the world, and variants like Omicron raising questions about the virus’s contagiousness, we are very much still in a pandemic.
The good news: while it’s difficult to predict the exact timing, most scientists agree that the Covid-19 pandemic will end and that the virus will become endemic. That means the virus will probably never be eliminated entirely, but as more people get vaccinated and become exposed to it, infections will eventually arise at a consistently low rate, and fewer people will become severely ill. An area where vaccination and booster rates are high will probably see endemicity sooner than a region with lower rates.
What does that transition look like?
In practical terms, there will be an announcement. The World Health Organization and local health agencies will officially declare the global pandemic over, a designation informed by certain biological and statistical benchmarks: the virus’s contagiousness, mortality rate, and power to overwhelm hospitals, to name a few.
In some places, like the US and other wealthy nations with ready access to vaccines and antiviral treatments, endemicity could look a lot like the present: People emerging from despair, diners piling into restaurants, and vaccine cards being checked with decreasing rigor. But there could be other, more profound societal changes as well.
To understand how daily life will change if Covid-19 becomes endemic, we can turn to history for a useful (if imperfect) guide.
A shift in attitudes and behaviors
People generally respond to epidemics with fear and panic, on the individual level and as a society. According to Charles Kenny, a director at the Center for Global Development and author of The Plague Cycle, these reactions reliably take shape in some now-recognizable ways: shutting down borders, sequestering the sick, and withdrawing from society.
Until the advent of modern medicine, all people could do was hope (and pray) for outbreaks to subside on their own. When it became clear that a disease was inescapable –or endemic– societies would often make strides to reframe the illness as a regular part of life. This may also become true of Covid-19.
Kenny’s book offers one potential preview. In 17th-century Japanese cities, attitudes about smallpox shifted as the disease became endemic; by then, most people had already been exposed as children and subsequently recovered. Once people accepted “that everyone’s going to get smallpox”, Kenny says, they ritualized and normalized it as a childhood milestone, making it a part of the “growing-up story”.
It’s too soon to say how this process of normalization will unfold with regard to Covid. However, if infections turn out to become a normal part of the winter months, they may simply get absorbed into what’s known as cold and flu season. Much as with smallpox in Japanese cities, that change will be reflected in people’s language and day-to-day expectations. Already, some are beginning to use the term “Covid season”.
Effective medical interventions also make it easier for societies to accept the thought of coexisting with illness. “My parents were terrified [of polio],” says Nancy Tomes, a history professor at Stony Brook University and author of The Gospel of Germs. Tomes, on the other hand, was a part of “the generation that went to the local high school and got the sugar cube,” referring to a common dispensation method for an orally administered polio vaccine.
“We stopped worrying about polio after that,” Tomes says.
Though Covid remains prevalent, the advent of effective vaccines swiftly altered the scope of its threat. In March, when just 9.2% of Americans were fully vaccinated, the Centers for Disease Control and Prevention relaxed its social distancing guidance to allow immunised people to gather indoors. And on Thanksgiving, Joe Biden declared that the US was “back” from pandemic hibernation – despite the nearly 100,000 new Covid-19 cases still being confirmed each day.
Finger-pointing and misinformation
Unfortunately, history suggests that some negative pandemic-related behaviors tend to persist after a disease becomes endemic or is eliminated. One of these is the disproportionate targeting of groups perceived as “outsiders” within the dominant society. When the pandemic subsides, says Kenny, the social restrictions likely to remain “are the ones that affect minority groups”.
Imposed in 1987, America’s xenophobic and homophobic travel ban on people with HIV lasted for 22 years. And today, people wrongfully associated with Covid, like those from Asia or Africa, are still being harassed and shut out despite the full understanding that the coronavirus isn’t discerning of race.
A propensity for misinformation and conspiracy theories has also been associated with epidemics – “a shit show”, says Tomes, with a legacy “that goes all the way back to every epidemic that we have any written records of”. Some of these mistruths prove to have staying power. “There are still people who don’t believe that HIV causes Aids,” she says.
During pandemics, groups of people also become susceptible to developing extreme views on topics that stir up strong opinions – like vaccination and personal liberty – which they not have initially held. Even once a pandemic has ended, that phenomenon of “group polarization” may remain “lingering in the background,” says Steven Taylor, a psychology professor at the University of British Columbia and author of The Psychology of Pandemics. That polarization is liable to “get stirred up again when something similar arises” in the future.
Knowing what we can’t know (yet)
Importantly, the return to normalcy won’t happen evenly across the globe. After people in wealthy nations ease into endemicity, those in the global south may continue to grapple with the coronavirus for a long time, as has been the case for a host of tropical diseases that have been all but forgotten in places like the US.
Like all the infectious diseases that gripped the world before it, Sars-CoV-2 will hopefully fade into distant memory, for better or worse. This forgetfulness can bring relief, growth and recovery, but it could also leave us woefully unprepared for the next pandemic. The 1918 flu taught us that masking and social distancing could reduce deaths, says Kenny – a lesson that we relearned too late in 2020.
The best way to stop a contagious virus like COVID-19 is through a worldwide vaccination program. Patrick T. Fallon/AFP via Getty Images” src=”https://s.yimg.com/ny/api/res/1.2/WoanGTpJBqTpug41Lb7Rig–/YXBwaWQ9aGlnaGxhbmRlcjt3PTcwNTtoPTQ3MA–/https://s.yimg.com/uu/api/res/1.2/cE4j7X4gbbCmwB4ZK1mdsg–~B/aD05NjA7dz0xNDQwO2FwcGlkPXl0YWNoeW9u/https://media.zenfs.com/en/the_conversation_us_articles_815/cd4bd62f51122de3e985d65ce08525ee” data-src=”https://s.yimg.com/ny/api/res/1.2/WoanGTpJBqTpug41Lb7Rig–/YXBwaWQ9aGlnaGxhbmRlcjt3PTcwNTtoPTQ3MA–/https://s.yimg.com/uu/api/res/1.2/cE4j7X4gbbCmwB4ZK1mdsg–~B/aD05NjA7dz0xNDQwO2FwcGlkPXl0YWNoeW9u/https://media.zenfs.com/en/the_conversation_us_articles_815/cd4bd62f51122de3e985d65ce08525ee”/>
Now that kids ages 5 to 11 are eligible for COVID-19 vaccination and the number of fully vaccinated people in the U.S. is rising, many people may be wondering what the endgame is for COVID-19.
Early on in the pandemic, it wasn’t unreasonable to expect that SARS-CoV-2 (the virus that causes COVID-19) might just go away, since historically some pandemic viruses have simply disappeared.
For instance, SARS-CoV, the coronavirus responsible for the first SARS pandemic in 2003, spread to 29 countries and regions, infecting more than 8,000 people from November 2002 to July 2003. But thanks to quick and effective public health interventions, SARS-CoV hasn’t been observed in humans in almost 20 years and is now considered extinct.
On the other hand, pandemic viruses may also gradually settle into a relatively stable rate of occurrence, maintaining a constant pool of infected hosts capable of spreading the virus to others. These viruses are said to be “endemic.”
Examples of endemic viruses in the United States include those that cause the common cold and the seasonal flu that appear year after year. Much like these, the virus that causes COVID-19 likely won’t die out, and most experts now expect it to become endemic.
We are a team of virologists and immunologists from the University of Colorado Boulder studying animal viruses that infect humans. An essential focus of our research is to identify and describe the key adaptations that animal viruses require to persist in the human population.
What determines which viruses become endemic?
So why did the first SARS virus from 2003 (SARS-CoV) go extinct while this one (SARS-CoV-2) may become endemic?
The ultimate fate of a virus depends on how well it maintains its transmission. Generally speaking, viruses that are highly contagious, meaning that they spread really well from one person to the next, may never die out on their own because they are so good at finding new people to infect.
When a virus first enters a population with no immunity, its contagiousness is defined by scientists using a simple mathematical term, called R0, which is pronounced “R-naught.” This is also referred to as the reproduction number. The reproduction number of a virus represents how many people, on average, are infected by each infected person. For example, the first SARS-CoV had an R0 of about 2, meaning that each infected person passes the virus to two people on average. For the delta variant strain of SARS-CoV-2, the R0 is between 6 and 7.
The goal for public health authorities is to slow the rate by which viruses spread. Universal masking, social distancing, contact tracing and quarantines are all effective tools to reduce the spread of respiratory viruses. Since SARS-CoV was poorly transmissible, it just took a little bit of public health intervention to drive the virus to extinction. Given the highly transmissible nature of the delta variant, the challenge for eliminating the virus will be much greater, meaning that the virus is more likely to become endemic.
In August 2020, about 500,000 motorcyclists rode the streets of Sturgis, South Dakota, at the city’s annual motorcycle rally. Masks were encouraged but not required. COVID-19 cases throughout the state increased.Bryan R. Smith/AFP via Getty Images
Is COVID-19 ever going away?
It’s clear that SARS-CoV-2 is very successful at finding new people to infect, and that people can get infected after vaccination. For these reasons, the transmission of this virus is not expected to end. It’s important that we consider why SARS-CoV-2 moves so easily from one person to the next, and how human behavior plays into that virus transmission.
SARS-CoV-2 is a respiratory virus that is spread through the air and is efficiently transmitted when people congregate. Critical public health interventions, like mask use and social distancing, have been key in slowing the spread of disease. However, any lapse in these public health measures can have dire consequences. For instance, a 2020 motorcycle rally brought together nearly 500,000 people in Sturgis, South Dakota, during the early phases of the pandemic. Most of the attendees were unmasked and not practicing social distancing. That event was directly responsible for an increase in COVID-19 cases in the state of South Dakota and nationwide. This shows how easily the virus can spread when people let their guard down.
The virus that causes COVID-19 is often associated with superspreading events, in which many people are infected all at once, typically by a single infected individual. In fact, our own work has shown that just 2% of the people infected with COVID-19 carry 90% of the virus that is circulating in a community. These important “supercarriers” have a disproportionately large impact on infecting others, and if they aren’t tracked down before they spread the virus to the next person, they will continue to sustain the epidemic. We currently don’t have a nationwide screening program geared toward identifying these individuals.
Finally, asymptomatically infected people account for roughly half of all infections of COVID-19. This, when coupled with a broad range of time in which people can be infectious – two days before and 10 days after symptoms appear – affords many opportunities for virus transmission, since people who don’t know they are sick generally take few measures to isolate from others.
The contagious nature of SARS-CoV-2 and our highly interconnected society constitute a perfect storm that will likely contribute to sustained virus spread.
What will our future with COVID-19 look like?
Given the considerations discussed above and what we know about COVID-19 so far, many scientists believe that the virus that causes COVID-19 will likely settle into endemic patterns of transmission. But our inability to eradicate the virus does not mean that all hope is lost.
Our post-pandemic future will heavily depend on how the virus evolves over the coming years. SARS-CoV-2 is a completely new human virus that is still adapting to its new host. Over time, we may see the virus become less pathogenic, similar to the four coronaviruses that cause the common cold, which represent little more than a seasonal nuisance.
Global vaccination programs will have the greatest impact on curbing new cases of the disease. However, the SARS-CoV-2 vaccine campaign so far has touched only a small percentage of people on the planet. In addition, breakthrough infections in vaccinated people still occur because no vaccine is 100% effective. This means that booster shots will likely be needed to maximize vaccine-induced protection against infection.
With global virus surveillance and the speed at which safe and effective vaccines have been developed, we are well poised to tackle the ever-evolving target that is SARS-CoV-2. Influenza is endemic and evolves quickly, but seasonal vaccination enables life to go on as normal. We can expect the same for SARS-CoV-2 – eventually.
How will we know if and when SARS-CoV-2 becomes endemic?
Four seasonal coronaviruses circulate in humans endemically already. They tend to recur annually, usually during the winter months, and affect children more than adults. The virus that causes COVID-19 has not yet settled down into these predictable patterns and instead is flaring up unpredictably around the globe in ways that are sometimes difficult to predict.
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Once rates of SARS-CoV-2 stabilize, we can call it endemic. But this transition may look different based on where you are in the world. For instance, countries with high vaccine coverage and plentiful boosters may soon settle into predictable spikes of COVID-19 during the winter months when the environmental conditions are more favorable to virus transmission. In contrast, unpredictable epidemics may persist in regions with lower vaccination rates.
This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts. It was written by: Sara Sawyer, University of Colorado Boulder; Arturo Barbachano-Guerrero, University of Colorado Boulder, and Cody Warren, University of Colorado Boulder.
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Sara Sawyer is a co-founder of Darwin Biosciences, an infectious disease diagnostics company based in Boulder, CO. She receives funding from the National Institutes of Health.
Cody Warren receives funding from the National Institutes of Health.
Arturo Barbachano-Guerrero does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
LISBON—In this soccer-crazed capital of a soccer-obsessed nation, the stadiums are full again. Portugal, a country ravaged earlier in the year by the Delta variant of the coronavirus, now has the highest Covid-19 vaccination rate in Europe and offers a glimpse of a country trying to come to grips with what is increasingly looking like an endemic virus.
Tens of thousands of screaming soccer fans crammed into the Estadio da Luz here Wednesday to watch hometown favorites Benfica take on Bayern Munich. They amassed on the subway to the stadium, at the entrance as officials patted them down and, after the game, at food trucks where they downed sandwiches and beer as they tried to forget the drubbing their team had just received.
The government recently lifted a 30% capacity limit at stadiums imposed to control Covid-19. But things haven’t returned to what they were: Fans need a certificate showing they are vaccinated, recently recovered from the disease or tested negative. Masks are obligatory throughout stadiums.
Close to 100% of people over the age of 50 have received at least one vaccine dose, according to the Portuguese government. For those between the ages of 25 and 49 it is 95% and from 12 to 17 it is 88%. Some 89% of Portugal’s entire population of 10 million has had at least one vaccine dose, not far behind the rate in the world-leading United Arab Emirates, compared with 65% in the U.S. and 73% in the U.K., according to Oxford University’s Our World in Data.
On Oct. 1, Portugal ditched most of its Covid-containment rules, but in many ways life in Lisbon is a throwback to the deepest days of the pandemic. Hand pumps dispensing disinfectant gel are ubiquitous and some churches still rope off seats to ensure social distancing even though it is no longer obligatory. The Covid-19 certificate is required at large events and masks are still mandatory on public transportation, in schools for students 10 and older, and for employees in shops, restaurants and bars.
Portugal dropped most of its coronavirus restrictions on Oct. 1.
Masks are still mandatory on Lisbon’s subway and other public transportation.
At the same time, subways are full. Lisbon’s fleet of rickshaw taxis, known by the Thai term tuk-tuk, whisk tourists along the narrow streets of the city’s old town. Nightlife pulsates in various parts of the city all week, tram lines popular with tourists skip stops because they are bursting with passengers and almost every day finds a new massive cruise ship docked at the harbor.
Portugal’s cautious return to normality, despite a vaccination rate that is the envy of public-health officials around the world, is being watched as a possible way forward for other countries as their vaccinations inch higher and they contemplate when to ditch their remaining restrictions. The Portuguese approach contrasts with the U.K.’s, where a combination of fewer vaccinated people and almost no restrictions has led to a surge in infections and a rising death rate.
Soccer fans arriving at the Estadio da Luz in Lisbon last week to watch Benfica play Bayern Munich.
Soccer stadiums in Portugal can operate at full capacity, but spectators must show that they are vaccinated, recently recovered from Covid-19 or tested negative.
Benfica fans watching the Bayern Munich match at a food stall outside the stadium. Benfica lost 4-0.
“I need tourists, otherwise I have no business, but I look at the infection numbers every day and if it goes up even a little bit I get nervous,” said Paula Marques, who runs a souvenir shop in Lisbon. “I hope the pandemic is a thing of the past here in Portugal, but to be honest I still worry a little bit about what will happen as it gets colder.”
Portugal got through the first wave of the pandemic in early 2020 relatively unscathed. But a steep rise in cases in November last year and then a savage surge in January shattered the illusion some here had that this small country tucked away in the southwest corner of Europe could escape the worst of the pandemic.
Tourists last week thronged Lisbon’s Cais do Sodré neighborhood, a nightlife hotspot.
At the peak in January, an average of about 290 people were dying a day in Portugal from the virus. Adjusted for population, that equates to more than 9,500 in the U.S. The worst daily average over a week in the U.S. never topped 3,500 deaths.
Maria Mota, executive director of Lisbon’s Institute of Molecular Medicine, has one image indelibly imprinted in her memory from that period that still makes her jittery. Working late one evening at her lab, from her window she counted 52 ambulances lined up outside the emergency room of the country’s largest hospital waiting to drop off patients.
Portugal is now in a “transitional period” that likely will delineate the pandemic from the new reality of endemic Covid, said Dr. Mota. With memories of the trauma of January still fresh in the collective Portuguese memory and with question marks remaining over what will happen as the cold returns and more life resumes indoors, most people are likely to proceed cautiously, she said.
Cruise ships regularly dock at the harbor in Lisbon.
People meeting along the Tagus River in Lisbon last week.
Tourists at sunset last week along the Tagus River in Lisbon.
“Nobody will ever forget this past January, but now Covid is endemic and we need to learn to live with the virus,” said Dr. Mota. “Almost the whole population is vaccinated here and the virus still circulates, showing it won’t go away.”
As in other countries with a large proportion of the population vaccinated, a stubborn persistence of infections in Portugal hasn’t led to a significant increase in the rate of hospitalizations or deaths.
“Things are getting better, but it’s slow,” said Miguel Campos, who drives tourists around Lisbon in a tuk-tuk. “We are taking baby steps. We have a mix of optimism and hope that this return to normal will continue.”
’Things are getting better, but it’s slow,’ said rickshaw taxi driver Miguel Campos, of the Covid-19 situation in Portugal.
Paula Marques, who owns a souvenir shop in Lisbon, said her business relies on tourism and that she worries infections might rise when the weather gets colder.
Before the pandemic there were 800 rickshaw taxi drivers in Lisbon, but now only about 200 work during the week and 500 on weekends, said Valentim Gaspar, another rickshaw taxi driver. For now, the balance between drivers and tourists makes it possible to earn a decent living, he said.
The Portuguese almost universally attribute their vaccination success to Henrique Gouveia e Melo, an ex-submarine commander brought on to run the inoculation drive after a shaky start. He projected confidence and tapped into the population’s generally favorable attitudes to vaccinations, according to public-health experts. The vaccine rollout began in January just as the worst of the pandemic peaked in Portugal, providing a clear incentive for anybody who might have been unsure about getting vaccinated.
On a soccer-mad continent, Portugal stands out for its dedication to the sport, making the return to full capacity in stadiums all the more symbolic for many people. Spain, which also has one of the highest vaccination rates in Europe, recently returned to full capacity at its stadiums, but food still can’t be sold. Italy this month increased stadium capacity to 75% from 50%. In most of Germany, there are still limits on capacity.
“It’s time to open everything up because if somebody hasn’t gotten vaccinated at this point, then they aren’t going to get vaccinated,” said Hugo Vale, a 32-year-old engineer, as he drank beer with friends outside the stadium ahead of the Benfica-Bayern game.
Close to 100% of people over the age of 50 have received at least one vaccine dose, according to the Portuguese government.
Delta has out-competed all previous COVID-19 variants and is currently dominant (File)
Washington:
The latest coronavirus wave in the United States driven by the Delta variant could soon peak, but experts warn against complacency and expect the virus will be part of everyday life for years to come.
The seven-day-average of daily cases as of Monday was 172,000, its highest level of this surge even as the growth rate is slowing and cases are headed down in most states, according to data compiled by the Covid Act Now tracker.
But more than 1,800 people are still dying a day, and over 100,000 remain hospitalized with severe Covid — a grim reminder of the challenges authorities have faced in getting enough Americans vaccinated in the face of misinformation and a polarized political climate.
Bhakti Hansoti, an associate professor in emergency medicine at John Hopkins University and expert in Covid critical care, told AFP she saw the US following a similar trajectory to India.
Countries in western Europe have also seen similar downturns in their Delta surges.
But while Hansoti breathed a sigh of relief when the spring wave ended, “I’m a little hesitant this time around,” she admitted.
The possible emergence of newer variants of concern and the advent of colder weather leading to more socialization indoors could lead to a rebound, “unless we learn from the lessons of the fourth wave.”
Angela Rasmussen, a virologist at University of Saskatchewan in Canada, added she was not certain the fourth wave was over.
“If you look at the fall-winter wave, there were periods in which there was a steep exponential increase, and then it looked like it was falling — and then there would be another increase.”
To ensure gains are sustained, rapidly increasing the number of people vaccinated is vital. Currently 63.1 percent of the eligible population over-12 are fully vaccinated, or 54 percent of the total population.
This places the United States well behind global leaders like Portugal and the UAE (81 and 79 percent fully vaccinated), despite its abundance of shots.
The administration of President Joe Biden last week announced a number of new measures to ramp up the immunization campaign, including new vaccine requirements on companies of over 100 employees, but the impact is yet to be clearly seen.
Two Americas
Beyond vaccinations, experts want to see other interventions continue.
Thomas Tsai, a surgeon and health policy researcher at Harvard, said hotspots need to follow through on masking, adding that the US should also look to other countries that have adopted widespread rapid testing for schools and businesses.
Such tests are available either for free or at a very nominal cost in Germany, Britain and Canada but remain around $25 for a two-pack in the US, despite the Biden administration’s efforts to drive costs down through a deal with retailers.
Of course, the impact of all measures depends on their uptake, and in this regard, a clear and consistent pattern has emerged of two Americas: liberal-leaning regions are far more compliant than conservative.
Prior to the Delta wave, some experts declared that, between the percent of people vaccinated and those who had gained immunity through natural infection, the country was approaching the point of herd immunity.
Rasmussen said those predictions had proven incorrect and it remained too early to say when this threshold would be reached.
“There are still parts of the country where the adult vaccination rate is less than 50 percent,” she noted.
Going Endemic
Though Delta has out-competed all previous variants and is currently dominant, SARS-CoV-2 continues to evolve rapidly and virologists fear that more dangerous variants might emerge.
“I don’t want to be a doomsayer, but I also want to have some humility, because I don’t think we know a lot about the basic function of many of these mutations,” said Rasmussen.
Still, experts are hopeful that vaccines will continue to blunt the worst outcomes for most people and look forward to their authorization in children under-12 in the months to come.
It’s expected that certain populations like the elderly and those with weakened immune systems may need boosters as well as high community vaccination rates to protect them.
Rather than eradication, the goal has shifted toward taming the virus for vaccinated people such that in rare cases of breakthrough infections, the disease is more flu-like.
However, uncertainties remain: for instance, people with breakthrough Covid infections might still get long Covid.
Greg Poland, an infectious diseases expert at Mayo Clinic, predicted humanity would be dealing with Covid “well past the lifespan of the next many generations.”
“We are still immunizing against aspects of the 1918 influenza virus,” he said.
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)
Doctors hope vaccines push COVID into background by next year
Briona Arradondo reports
TAMPA, Fla. – The vaccines are expected to help put the world on track to a sense of normal again and push COVID-19 into the background, but plenty of people want to know exactly when the pandemic will end.
Some epidemiologists said the COVID-19 pandemic could turn into an endemic early next year while others said it will likely be longer because the rest of the world needs vaccines.
“So endemic is just when you have a disease that is at a typical level, a level that is expected within a population,” explained Dr. Cindy Prins, a University of Florida associate professor of epidemiology.
Currently, COVID-19 is still infecting mass group of people, so it is nowhere near fading out to the background. But pandemics have evolved into endemics in the past.
“We’ve had flu pandemics, right? We’ve had the swine flu that I think a lot of people remember from 2009. And we still encounter that variant of flu sometimes, and it’s part of the vaccine now anyway,” said Prins. “So people still get infected, but we don’t see that kind of high level of cases that we saw initially in 2009.”
COVID treatment clinics pop up around Florida
Monoclonal antibody treatment centers are opening around the Tampa Bay area.
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Infectious disease scientists are studying virus models for COVID-19. USF Health’s Dr. Edwin Michael is a virus modeler and shared when COVID could be behind us.
“It’ll begin to decline and it’ll fade away in like early next year. Perhaps, February next year, we will see the back of this,” said Michael. “The worst-case scenario, it’ll become an endemic like flu. You know, we’ll just have to deal with it, but it’ll be in the background. Most people are protected, but that means we have to get reboosted, take the vaccines.”
Michael said an endemic by February is only possible if more people get the vaccine to counteract the spread of the delta variant, practice public health guidelines and a nastier virus mutation doesn’t take over.
“Then you get flare-ups, you know, but you don’t get a global pandemic because the rest of us are immune to those things,” said Michael.
Since new variants can prolong the pandemic, Prins said she believes it may take longer February to bring COVID-19 to an endemic.
“Part of the issue right now is that even in the US, we still have a fairly large unvaccinated population. But then if you go outside the US and in particular to some of the more underdeveloped nations, they haven’t had access to vaccines. They have large portions of their population that are not vaccinated, and so this is a global effort,” said Prins.
Prins and Michael said they believe COVID-19 will stick around but be more like the flu or measles and mumps where enough people get the shot to build immunity.
As US government officials prepare to brief the public about Covid-19 vaccine booster shots, there is an emerging consensus coming from influential corners of the national news media: people should anticipate that Covid-19 is here to stay. It’s time to adjust expectations accordingly.
The word “endemic” is coming up in the coverage more often. Quartz ran an explainer on Tuesday. When a virus is no longer novel, and is a feature of life like the flu, it is endemic. This came up when STAT’s infectious diseases reporter Helen Branswell surveyed three dozen experts about their own risk tolerance amid the summer surge. Citing Johns Hopkins scholar Dr. Amesh Adalja, she wrote “he (and others) believe Covid is going to become endemic — we’re going to have to learn to live with it. For fully vaccinated people, Adalja said, the risks even from contracting Covid are pretty low.”
This reality is becoming a part of corporate calculations, as well. I noticed that Jim Cummings, the chief HR officer for CNN’s parent WarnerMedia, brought it up in an internal memo last week. He said Warner is moving ahead with more office reopenings in September despite the surge. “Ultimately,” he wrote, “the bigger question for us and, indeed, the entire world is when and how we start to live with COVID as an endemic reality. Right now, we think the best way to address all of these considerations is to move forward as planned while doing everything we can to mitigate risk — and that, of course, first and foremost requires everyone in the office to be vaccinated. And it also includes the flexibility to work at home.”
This reality needs to be reflected in news coverage from top to bottom and left to right. “We need to think in terms of RELATIVE RISK REDUCTION,” Dr. Celine Gounder wrote in a Twitter thread on Tuesday. Relative risk reduction does not mean that the risk drops to zero. With the vaccines, for example, it means that the risk of winding up in the hospital is drastically reduced. “Vaccines aren’t an immunity on/off switch for individuals,” Gounder wrote. “Vaccines work additively & synergistically at a population level.”
So about those vaccines…
Biden will speak about Covid-19 vaccine booster shots Wednesday at 4:30pm ET. The White House’s Covid-19 team will also hold a briefing on the same subject. The booster boosting “will include details on the first data on waning immunity among the vaccinated inside the US,” Dr. Sanjay Gupta reports, citing a senior federal health official. “Top health officials have previously said they were closely monitoring such data from Israel and Europe, but had not yet seen evidence from the US supporting the need for a booster. That is expected to change” on Wednesday…
J&J recipients shouldn’t be cast aside
Oliver Darcy writes: “In the spring, many Americans listened to public health officials — and, frankly, medical analysts on cable news — and sought out the first available coronavirus vaccine. For millions, that was the Johnson & Johnson vaccine. But since then, these J&J recipients have been left in the dark about what to do amid the Delta surge and possibility of the vaccine’s waning efficacy. Amid all the talk of a third shot for those who received the mRNA vaccines, little discussion has been devoted to what these people should do. It’s important for news orgs to not treat this like a side issue, but a significant one given that a significant number of people received the shot. Journalists should represent the J&J recipients who want answers. Gov’t officials should be pressed on this. At a bare minimum they should be asked this: When will the gov’t have guidance for J&J recipients? This month? Next month? October? November? People deserve answers…”
“Finding a new, tolerable way to live with this virus”
That’s what all of this — the fights about masks, the frustration about vaccinations, the focus on ventilation, etcetera — is ultimately all about.
“The coronavirus is not something we can avoid forever; we have to prepare for the possibility that we will all get exposed one way or another,” Sarah Zhang wrote in The Atlantic story I cited up top. (To buttress her point, I assume I already have been exposed.) “With the flu, we as a society generally agree on the risk we were willing to tolerate,” Zhang wrote. “With Covid-19, we do not yet agree.”
The transition to “endemic” Covid is psychological in nature. Phrases like “tested positive” and “case counts” have to take on a different meaning, especially among the vaccinated. “When everyone has some immunity, a Covid-19 diagnosis becomes as routine as diagnosis of strep or flu — not good news, but not a reason for particular fear or worry or embarrassment either. That means unlearning a year of messaging,” she pointed out. The big takeaway from Zhang’s article: “Endemic Covid-19 means finding a new, tolerable way to live with this virus. It will feel strange for a while and then it will not. It will be normal.” Read on…
