COVID Endemicity

"There is nothing in evolutionary biology that necessitates the disease becoming milder as it passes through humans. So we need to really just keep vigilant and not just say, 'It's over. Yahoo'."

"We know this virus pops in and out of animal reservoirs. I'm still not sold this was some kind of laboratory misadventure because we've seen it go into mink and zoo populations."

"[We need to heed the approach that recognizes the link between human animal and environmental health to increase virus surveillance in animal populations with the capacity to leap to humans]."

"Hundreds of thousands of children die from malaria every year. That has been a stable phenomenon over time."

Ross Upshur, Dalla Lama School of Public Health, University of Toronto

There is no universal definition of the epidemiological parameters of the end of a pandemic."

"And that pandemic closure is better understood as occurring with the resumption of social life, not the achievement of specific epidemiological targets."

David Robertson, Princeton University and Peter Doshi, University of Maryland

"It doesn't end. We just stop caring. Or we care a lot less."

"I think for most people, it just fades into the background of our lives."

Jennifer Nuzzo, epidemiologist, Johns Hopkins Bloomberg School of Public Health

Getty, The Atlantic

"We need to learn to live with it [narrative; what does it mean]?"

"And who decides what that looks like? At the basis of this is the notion that a certain amount of illness and death is acceptable, and that action is only merited to prevent those limits being exceeded."

"[The non-scientific definition of endemic is basically] the amount of disease from which people are willing to avert their eyes."

Exhausted, we are unable to counter it with non-pharmaceutical interventions and many are sickened and die."

"I am not saying this likely. I think this is unlikely. But I would not exclude it [the vague scenario that a variant can emerge blending the virulence of Delta and Omicron's penetrating of acquired immunity]."

"Of course, If you take the non-technical meaning of 'endemic' as 'something we don't really bother about that much' -- which applies sadly to the way most people think about malaria, TB and the like because they tend to be diseases associated with poverty -- that makes it a decision for humans, and the point at which humans decide they've got an amount of disease they can handle."

Bill Hanage, epidemiologist, Harvard University

"The term [endemic] carries a pretty high level of subjectivity and reflects to some extent what amount of death is seen as normal and acceptable, for whom. It's contingent."

Esylit Jones, Historian, University of Manitoba

A health care worker hands out a Covid-19 test kit at a drive-through testing site in California.

Gina Ferazzi/Los Angeles Times via Getty Images 

"We can boost quickly. We know what measures we can go back to [masking or reducing capacity at indoor events]. We've learned a lot in the hospital -- which treatments work best, how to maintain oxygen levels without intubation. Even the worst-case scenario has a rosy lining in just how much we've learned."

"We've all come to just kind of learn a new normal. And that is protecting us quite a bit, and will continue to protect us in future waves."

Sarah Otto, evolutionary biologist, University of British Columbia

It is now recognized as inevitable that the coronavirus we have all become familiar with and now must learn to live with, will on occasion 'break out' now and then, in waves perhaps reflective of new variants where it can make temporary breakthroughs against the medical vigilance meant to control its predation on vulnerable humans by appearing in cancer units and hospitals and long-term care homes. 

 

"Endemic is not a synonym for 'easy'", cautioned immunologist Dawn Bowdish of McMaster University. We are in the endemic era, she states: "There is no chance that COVID will ever be eliminated from the population now. It has spread everywhere, there are animal reservoirs and new babies are being born with no immunity, therefore new hosts to infect", she explains.

It cannot yet be settled whether SARS-CoV-2 is endemic, not quite yet. And when it has been acknowledged that that state has been reached, once its course becomes more predictable and stable, there are no guarantees it won't still be problematical or less of a threat, even when it becomes a seasonal event. It is still in its initial evolutionary stage, with unexpected mutations. Variants with troubling properties will still challenge medical science, but the hope is that it will stabilize and settle down.

All the social behavioural changes we've undertaken in the last two years in efforts to restrain its infectiousness; the masking, the social distancing, the hygiene practices and more, will also become an integral, albeit less intrusive part of our daily lives. A point at which hospitals too can settle down to what is considered normal calls on their services when the memory of overwhelming numbers of sick people desperately needing attention will be a cautionary memory.

For the present, the current wave of the latest iteration; more communicable and seemingly less serious as a disease's outcomes, still equates with mass hospitalizations, ICU care, and large death numbers reflective of the very infectiousness of Omicron. And it is still the elderly, the immune-compromised among whom the disease strikes its biggest toll. Along with infecting the unvaccinated more frequently and more seriously.

On a global scale, seven-day reported case averages work out to a staggering 2.6 million. With commensurate numbers of 'excess' deaths. Once what is considered to be a stable rate of transmission has been reached in defined geographical locations minus the huge waves felling populations, the technical definition of endemicity will have been reached. When it exists in a population, it fluctuates, but eventually settles into a somewhat expected pattern.

"We don't know" how close to endemicity we may be, says Dr.Hanage. Much depends on how robust and durable immune responses in the population will be, among those who have been vaccinated or who have recovered from infection, or both. "Neither enter a state where they develop lifelong immunity to infection, so additional outbreaks are not only possible but expected", he explains.

Throw your masks in the air like you just don't care. Getty