Years from now, when 2020 is a distant memory, a face mask will still dangle from your rear-view mirror, one epidemiologist predicts.
“As long as any of your readers are alive, we’ll have some form of COVID,” said Andrew Noymer, an epidemiologist and demographer at UC Irvine, whose crystal ball on the pandemic has been unnervingly accurate.
“That’s not to suggest we’re going to have half-a-million deaths a year and clog emergency departments. Things will settle down — mostly on the back of a million dead Americans who can’t die twice, disproportionally people who lost the genetic lottery and have some cell receptor that’s particularly interactive with this virus.
“But COVID is going to be here,” he said. “There won’t be masking orders coming down from the government, but some will have masks dangling from their rear-view mirrors for the rest of their lives.”
As the omicron variant’s stunning infectiousness sends case counts soaring, some glass-half-full experts opine it may push us more swiftly from pandemic to endemic — which, translated, means morphing from pants-on-fire emergency to persistently annoying background noise.
Others scoff.
“It’s pushing us more swiftly into a raging pandemic with no guarantee that endemicity is around the corner,” said Dr. John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at UC Berkeley, by email.
“I don’t have sufficient hubris to say that it will be with us forever. Still, it will be with us for a long time but in what form (e.g., more like a cold) is anyone’s guess.”
UCLA professor of medicine and epidemiology Dr. Timothy F. Brewer isn’t sure there’s a meaningful distinction between pandemic and endemic at this point in COVID-19 anyway.
“After 40 years, is HIV still a pandemic or is it endemic?” Brewer asked. “Does it matter to how we should or do respond to HIV? What is clear is that, unlike SARS and MERS, SARS-CoV-2 is efficiently transmitted from human to human, which makes elimination problematic.”
Berkeley’s Swartzberg expects that, in the long term, vaccines will protect us from serious illness, and we’ll come to accept getting a cold from it. “Still,” he said, “I suspect I’ll never be on public transportation again without a mask.”
‘Like the flu’
The flu is endemic. That means it’s always there. Immunity isn’t robust enough to deny the virus a host, but vulnerability isn’t so great that infections spread like wildfire.
Endemicity is possible with COVID-19, but when that will happen is anyone’s guess, said Richard Carpiano, a public health scientist and medical sociologist at UC Riverside.
“In general, endemicity can come about from several factors, such as high rates of vaccination and prior infection conferring a significant amount of immunity in the population as well as lower transmissibility of a virus. However, for COVID, the omicron variant is more infectious than prior variants and is re-infecting people who previously had COVID months back.
“Likewise, studies indicate that our current vaccines are less effective against omicron versus other variants,” he said by email. “But worse, a substantial portion of the globe is unvaccinated or under-vaccinated, and response policies vary greatly throughout the U.S. and the world. Altogether, these are not good signs for the coronavirus endemicity in the immediate future.”
UCI’s Noymer engaged in keyboard-to-keyboard combat with other experts early in the pandemic over their contentions that COVID-19 would turn out to be like the flu.
He was certain it would be a much graver threat. And lately, he’s disturbed to see so many experts doing much the same thing, likening COVID-19 to the flu and painting endemicity as some sort of safe, happy place.
“Endemicity does not mean COVID just becomes another flu. It means COVID becomes endemic COVID,” he said. “There will be 1 million dead, give or take, by the time the two-year anniversary of COVID in this country rolls around. The flu kills 60,000 Americans in a bad year. That’s terrible, it’s 60,000 souls, but in the realm of terrible things, flu is not really that bad. And so the argument that COVID is just another flu gets me anxious.”
Berkeley’s Swartzberg would agree. “Ask the 830,000-plus dead Americans if this is just like the flu,” Swartzberg said. “And what about those suffering from ‘long COVID’? Have you heard of ‘long flu’?”
No long-term predictions
The virus is definitely not “just the flu,” Carpiano said.
The analogy may help people understand how COVID-19 could, at some point, become endemic in terms of case prevalence and annual variability — that is, some years much worse than others — but to think of the coronavirus as akin to flu in terms of infectiousness and severity is misguided, he said.
“We are still figuring out the health consequences of Long COVID, which afflicts a substantial portion of COVID sufferers,” Carpiano said.
“If we know anything about COVID, it is that it is difficult enough to predict what will happen just in the short-term — like this time next year. Certainly, COVID will not be eradicated like smallpox, but, as a general rule, no one should be making long-term predictions.”
Source: Orange County Register
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