Pssst. Sit down. Brace yourself. Sooner or later, we’re all going to get COVID-19, many experts say.
Even if we’re fully vaccinated.
“The idea that we’re going to live our lives without ever getting it is a fantasy — and a dangerous one,” said Andrew Noymer, an epidemiologist and demographer at UC Irvine. “A lot of people just don’t understand that. We’re all going to get it.”
While many experts agree, this idea — like most everything in science-as-it-unfolds-before-your-very-eyes — is not universally embraced.
“That’s a particularly dystopian view,” said Dr. George Rutherford, professor of epidemiology and biostatistics at UC San Francisco. “I don’t plan to get it, and I don’t think people who’ve been vaccinated have to plan to get it.”
All bets are off, though, for the unvaccinated. “Unless you live off the grid like a hermit and don’t come in contact with other people,” Rutherford said, “it’ll find you.”
But most experts agree on one thing: Ditch plans for the COVID party to just get it over with. With as many as a third of patients suffering “long COVID,” even if their cases were mild, “it’s playing with hand grenades,” Noymer said.
COVID-19 for all
Once upon a time, hopes were that most people could escape COVID-19 infection. But the delta variant — about as contagious as chickenpox and the force behind summer surges — has changed all that.
“While initially we thought that we could aim for perhaps elimination of the virus, bringing it to very low levels, the delta variant has been a great example of how humble we have to be when we look at the future,” said Dr. Jorge Salinas, an infectious diseases expert at Stanford.
“Now there is growing consensus that there will be some level of transmission of this virus on and off for the foreseeable future. We may be able to bring levels down to very manageable level, with some seasonal increases, but this virus will very likely not go away. And, therefore, the possibility of being exposed to it is present for all humans. A good proportion of humankind will be exposed at some point, and may even develop disease.”
Dr. Monica Gandhi, an infectious diseases expert and professor of medicine at UCSF, agrees. “Delta is a very transmissible variant of COVID-19, so spreads readily and is hard to contain,” she said. “I think we will all be exposed to delta at one point or the other.”
But, for the vaccinated at least, exposure and infection do not mean severe disease and possible death, as many who’ve shaken off “breakthrough” infections will affirm.
“When I say we’re all going to get it, I don’t mean we’re all going to die from it,” Noymer said. “I’m not saying, ‘Brace yourself and make sure your will is in order.’ But, unless we’re all going to do a New Zealand, there are going to be reintroductions of the virus. The vaccines, we now know, are not perfect. Breakthrough cases are kind of a thing. And we’ve seen that many cases were asymptomatic even before the vaccines, and even more so after, and maybe even more so after we boost.”
That, along with low vaccination rates at home and especially abroad, means COVID-19 will continue to circulate and spread.
“COVID is here to stay. We’re not going to eradicate COVID. Ten years from now there’s still going to be COVID,” Noymer said.
Not inevitable
Just because COVID is the guest who simply won’t leave the party doesn’t mean that vast numbers of vaccinated people will get infected, UCSF’s Rutherford said.
From a structural biology standpoint, there are simply a finite number of mutations possible on the virus’ receptor binding domain — the key part of its spike protein that allows it to latch onto, and invade, cells.
“None of this is certain, but I suspect delta is the far right edge of bad variants in terms of transmissibility,” Rutherford said.
And while not quite an impenetrable shield, the vaccines have proven to be extremely protective. Vaccination, along with the other common-sense precautions we’ve been taking over the past year-and-a-half, clearly cut down on transmission and infection, he said.
Immunologist Anthony Leonardi doesn’t see mass infection as inevitable either.
“In my opinion, we will have technology soon that confers passive immunity,” he said. “And further, second-generation vaccines are in the pipeline that look very promising.”
The next wave of therapeutics promises to block infection altogether.
“Unfortunately, they will take time for development, but I think within a decade SARS-CoV-2 infection will not be so common,” he said.
In the meantime
Until then, we know how to protect ourselves, the experts say.
Natural infection will produce immunity in those who survive it. But vaccination decreases the risk of severe disease and death 10- to 25-fold.
“The vaccine protects an individual from getting severe disease from this variant, which is why it’s so important to get vaccinated,” Stanford’s Gandhi said. “For those who are vaccinated, this will likely boost their immune response. For those who are unvaccinated, they will likely gain immunity — but getting the vaccine is safer than risking disease to get immunity.”
It’s a societal responsibility to keep transmission as low as possible, to reduce the risk to those who are most vulnerable to the disease and to reduce the stress on the nation’s health care system, and those who toil on its front lines, many argue.
“I think we’ll gradually — and, of course, looking to both sides before taking every step — have to get used to the idea that some level of transmission will occur, but we also need to be comforted by the fact that vaccines protect us, and even if I catch it, I will not die because I am vaccinated,” Stanford’s Salinas said.
“It allows us to enjoy life and live it without COVID-19 being an omnipresent obstacle. I do think the vaccines and other interventions allow us, without completely forgetting the trauma of the pandemic, to start moving on.”
Those who remain unvaccinated, however, will continue to dwell in what Salinas called “the pandemic era,” with a much higher risk of dying from infection.
Hang around like the flu
Dr. Bruce Patterson, a virologist and CEO of IncellDx, counts himself among the 90% of infectious disease and virology experts who believe COVID will become endemic — meaning it will hang around indefinitely, like the flu.
“So, even with development of herd immunity and immunization, it will continue to affect the global population indefinitely, although with less transmission and less hospitalization (and) death,” he said by email.
“One of the big concerns with endemic COVID that not enough people are talking about is that about a third of people develop long COVID without ever having experienced a severe case of COVID-19. In fact, most of our patients developed long COVID after a mild or moderate or even asymptomatic case of COVID-19. The health care community will need to have much greater understanding of the physiology of long COVID, and more awareness about what to look for.”
Source: Orange County Register
Be First to Comment