Living with endemic Covid will not be painless

The author is a science commentator

According to some reports, the season finale of the pandemic is approaching. Omicron appears to be less severe than the Delta variant. Some of this will be due to immunity built up through vaccination and infection; research also suggests that the variant thrives more in the upper respiratory tract than in the lungs. Therefore, admissions are shorter and fewer patients require intensive care.

It has framed the belief that Sars-Cov-2, the virus that causes Covid-19, sits in the background along with other relatively benign coronaviruses that mostly induce symptoms of colds. The feeling of an imminent end is enhanced by the image of a “mild” variant combined with many references to “endemism” and “learning to live with the virus”. Nadhim Zahawi, a former British vaccine minister, recently said he hoped Britain would be “one of the first major economies to demonstrate to the world how to switch from pandemic to endemic”.

Researchers suggest that such framing is wrong. While its exact meaning is discussed, “endemic” refers to a disease that is constantly present in a particular area, regardless of severity. Malaria, for example, is endemic in tropical and subtropical regions and killed more than 600,000 people by 2020, according to the 2021 World Malaria Report. People live with it – but not painlessly.

“Endemicity does not mean mild illness, and mild illness does not mean endemicity,” said Elizabeth Halloran, director of the Center for Inference and Dynamics of Infectious Diseases in Seattle. “The movement towards endemicity has to do with reaching a dynamic equilibrium where one person on average infects another person. This may include seasonal or other fluctuations.”

The relatively stable presence of an endemic disease is a world away from the unpredictable increases and increases of the current pandemic. As epidemiologist Bill Hanage of Harvard University tweeted, “For the avoidance of doubt, Omicron is not endemic right now in the same way that the moon is not a hamster.”

Although vaccines will help, says Halloran, “there is not much we humans can do on purpose to move against endemic disease… Much depends on how the virus develops.” She can not predict its next step, other than that any new variant must either be more transferable or better at escaping immunity – or both – in order to get the better of Omicron.

Future difficulty level remains a major unknown. There is no law that dictates that a virus should become milder over time. “It’s very difficult to predict the evolution of virulence,” says Eddie Holmes, the evolutionary biologist who helped researchers in China publish the Sars-Cov-2 genome in January 2020. “It could go up, go down or stay “It’s certainly still possible for a more virulent variant to emerge in the future.” Continuous transmission helps to generate new variants; The World Health Organization added a record 15 million new cases to its dashboard last week.

Omicron has still triggered hospital increases, showing that the large number of people infected can wipe out any gain by a decrease in severity. A director of public health in the north-west of England suggested in the British Medical Journal that the Omicron rise could cause more non-Covid deaths than Covid deaths due to pressure on the NHS, and this risk had not been clearly communicated.

Other options must also be communicated. There are generally four long-term possibilities for a circulating pathogen: eradication, which is thought to have occurred with the less transmissible coronavirus that caused the Sars-1 epidemic of 2002-3, thanks to a joint effort on public health; global extinction, as with smallpox through vaccination; regional or local elimination that China is trying to achieve with its zero-covid policy; and endemicity, where the disease is a constant presence.

The pandemic coronavirus that infects before symptoms appear is so adept at finding new people to infect, including those it has infected before, that extinction and global extinction seem impossible. Local elimination requires containment policies and border controls, which many find too draconian.

It leaves endemic. Previous immunity to vaccination and infection alleviates the health burden, but endemic does not mean benign; it does not mean that the virus has given up developing; and, as with the malaria bed net, this does not mean permanently overriding suppressive measures such as vaccination, masks and ventilation.

Whether or not it is tempting, we must make sure that endemic design is over.

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