Wednesday, 19 January 2022

The word to cling to this coming year… endemic

This much is clear: Covid-19 is sticking for a while longer. But we could soon put the word “pandemic” in our archives: At the outset of the pandemic, the prevailing hope was that time and vaccines would eventually wipe out covid-19. But as some countries transition into booster rollouts and are still struggling to contain outbreaks, it seems a zero-covid strategy might be out of reach, writes Nature.

The most optimistic case is now for the virus to become endemic, joining the swarm of illnesses such as common colds, HIV, measles, malaria and tuberculosis. Like other respiratory viruses, there will be times of year when covid infections peak — most likely the colder fall and winter months, in tandem with the flu season — but it will stop becoming such a determining factor in our lives the way it is now.

First things first: What does it mean for covid-19 to be endemic? It essentially means that the pandemic will not end with the virus disappearing, but that enough people will get immune protection through vaccinations and natural infections that covid-19 will be less transmissible and lead to less hospitalization and death, Harvard Associate Professor of Immunology and Infectious Diseases Yonatan Grad said in an interview. Another way to spot that covid-19 has become endemic is if the reproductive number is stable at one, explained Boston University epidemiologist Eleanor Murray to Vox. “That means one infected person, on average, infects one other person,” she said. This would cause case levels to be consistent and predictable — unlike the “boom and bust” waves so far in the pandemic, writes BBC.

It’s important to remember that even endemic diseases are still dangerous — just less so: For example, smallpox was once endemic and killed a third of people who were infected — while Malaria is still endemic and causes around 600k deaths a year. That being said, even endemic covid is likely to remain fatal for the old and vulnerable. “If you’re willing to tolerate zero deaths from covid, then we’re facing a whole raft of restrictions and it’s not game over,” Prof Julian Hiscox, chairman in infection and global health at the University of Liverpool told BBC. Instead, we should aim for endemic covid to have the same fatality rate as the flu, which kills 200-300 people a day over winter with nobody wearing a mask or socially distancing, Hiscox argues.

Some scientists say the omicron variant could be key to the virus becoming endemic: The new variant is less severe than its predecessors, the beta and delta strains, giving experts hope that it could give enough people natural immunity to help steer the covid pandemic into an endemic phase, they told CNBC.

While others say it could delay endemicity: Given that the omicron variant is seven times more infectious than its predecessors, it is leading to a massive increase in cases and, at times, hospitalizations and deaths. That could further stress healthcare systems that are already in dire straits, Angela Rasmussen, a virologist at Canada’s University of Saskatchewan told Vox. That’s why Rasmussen concludes that “omicron certainly has the potential to delay endemicity,” especially as existing vaccines prove less effective against the strain.

Nonetheless, some countries are rushing to consider the virus endemic: A handful of European countries — such as UK, France, and Spain — have begun to move their mitigation policies off emergency footing as their populations experience the less severe variant, according to the New York Times. The changes include shorter isolation periods and the elimination of pre-departure tests for travel, for example.

…despite warnings that it’s too soon: The World Health Organization (WHO) has said it’s too soon to suggest the world is moving into an endemic phase of covid in 2022 as there’s still a huge amount of uncertainty. “We still have a virus that’s evolving quite quickly and posing new challenges so we’re certainly not at the point of being able to call it endemic. It might become endemic in due course but pinning that down to 2022 is a bit difficult at this stage,” said Catherine Smallwood, a senior emergency officer at WHO Europe, during a press conference, reports CNBC.

And in Africa, it might be endemic whether we like it or not: Due to low availability of vaccine doses in several countries on the continent, people are learning to live with the covid-19 virus out of necessity. Africa needs to vaccinate 70-80% of the population by the end of 2022 or else the virus is sure to remain a permanent fixture on the continent, warned Africa Centers for Disease Control Director, Dr John Nkengasong, reports Deutsche Welle.

In fact, Omicron could make things worse: Scientists are warning that the emergence of omicron practically ensures that it won’t be the last variant to hit the globe, reports ABC News. The faster omicron spreads to a larger population, the bigger the chance there is for mutations to occur, leading to more variants, Leonardo Martinez, an infectious disease epidemiologist at Boston University, said. There are many ways a new variant could emerge, such as incubation in animals or people getting double infections, such as both omicron and delta, and creating “Frankenvariants.”

A new variant could be a major curve ball: A new variant that can outcompete omicron and cause significantly more severe disease could completely throw off the course of covid becoming endemic. There is also no certainty that existing vaccines will work against them.

The only certainty at the moment: More shots. The near certainty is there will be booster vaccines for the vulnerable come winter in order to top up their protection through winter. There will also be more shots developed if variants continue to appear and existing vaccines fail to provide immunity.

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