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Is Covid here to stay? What experts are saying about the transition from pandemic to endemic

Is Covid here to stay?  What experts are saying about the transition from pandemic to endemic

SEATTLE – Early in the pandemic, many people embraced hopes that Covid-19 could be halted and buried for good once the vaccines are rolled out.

But hopes of a zero-Covid country are long gone for most scientists.

“Everyone is no longer 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’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 numbers of cases — a status known as endemicity. That would make the coronavirus like many other viruses that humanity has learned to deal with, such as the flu. However, it remains unclear whether the coronavirus will remain a greater health risk than other endemic respiratory viruses.

There is some evidence that government and public health officials are already working with that idea. The latest wave of the ommicron variant has served not only as a reminder that the coronavirus is still mutating in unexpected ways, but also as a signpost: federal messages and local government actions once aimed at stopping the spread of the virus and relied on extreme measures such as local lockdowns, is now focused on reducing risks and allowing vaccinated and boosted people to live relatively normal lives with precautions.

With Covid expected to become a fixture – and given how quickly the ommicron strain is spreading – some infectious disease experts now believe that almost anyone can become infected in their lifetime.

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

Even if endemic Covid becomes unavoidable, it doesn’t mean people should stop taking preventive measures, experts say. Instead, they are starting to think about a future where Covid precautions, such as masking and the occasional encouragement of social distancing, could become somewhat commonplace. Vaccinations would remain central, as would precautions for vulnerable people.

And in the short term, as the omicron variant rages, it remains critical that people – including the vaccinated – try to avoid becoming infected now as the pandemic intensifies. The health care system may soon be under siege, hospital staff are exhausted and there are not enough treatment tools, such as monoclonal antibodies and antiviral pills.

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

A virus becomes endemic when people gain overall immunity to a disease through vaccination or infection. Decreasing immunity means that the virus does not die out completely.

In an endemic disease, each infected person transmits the virus to one additional person on average. But it’s a “dynamic balance,” Halloran said, and the virus’ prevalence can increase and decrease depending on factors such as the season.

No model can predict how quickly society could make the transition to endemism, 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 becoming extinct and pushes them towards becoming endemic.

“Mutations are pretty unpredictable right now and we don’t know what will happen after omicron,” he said.

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

“Ultimately, yes, there will be kind of a repeating pattern, an average level of epidemic prevalence,” Tkachenko said. “We can’t say it will be so low that we don’t care.”

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

Endemic diseases often settle in more predictable and stable patterns. Influenza, for example, peaks somewhat predictably during colder months. But researchers can’t say for sure how harmful an endemic level of Covid could become.

“The really open question for me — or perhaps for public health or for all of us — is when it becomes endemic and people become 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 computer biologist at the Fred Hutchinson Cancer Research Center.

Bedford said he thinks endemic Covid could mean most people would become infected every three years on average, and most cases are quite mild.

Bedford’s back-of-the-napkin math — when the delta variant was the primary strain — suggested 50,000 to 100,000 people could die each year in the US from endemic Covid, according to a presentation he shared this fall. In the decade leading up to Covid, flu caused 12,000 to 52,000 deaths per 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 the flu makes sense. Vaccination will be key to protecting vulnerable groups.

“With Covid, even if you’re vaccinated, some people will die, and the average age of those individuals is in their 80s,” Riedo said. “They have multiple comorbidities. They cannot tolerate a small disturbance in their physiology.”

Those who have not been vaccinated and die from Covid are on average 10 to 15 years younger, with fewer health problems, Riedo said, adding that the same is true for the flu.

Endemic Covid will not affect everyone equally. Immunosuppressed people 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, who make up 4 to 5 percent of the U.S. population: “Every six months you go in to get antibodies, and you have rapid tests for them, and if you’re positive, you start.” them with new drugs’, such as drugs that help prevent viruses from reproducing.

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

“Covid isn’t the first time they’ve had to think about double layers of protection or 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. , DC “Cold, flu, measles and getting anything would be a problem for their health and safety.”

Not every virus becomes endemic or stays that way.

Strict control measures of the first SARS virus, which did not spread asymptomatically, allowed health officials to eradicate it effectively. The virus that causes smallpox was eradicated by global vaccination efforts.

some experts still believe it is possible to eradicate the coronavirus per country, although it would require huge investment and the costs may not outweigh the benefits.

Four other coronaviruses circulate in humans and cause the common cold. Scientists suspect they may have evolved from pandemics before weakening in severity as people gained immunity.

But this is the first time researchers measure a coronavirus on its way to becoming endemic. More surprises may lie ahead.

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

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Anna Wintour

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