POST 186. August 8, 2021. CORONAVIRUS. “One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late,” she added, referring to patients who have to be put on a ventilator.” (A) “There is no one definition of what the end of a pandemic means.”.. “The question of when the crisis will be over is a layered one — with different answers from local, national and global perspectives.”

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“The infamous and popular tradition known as the Sturgis Motorcycle Rally will gather bikers as they cruise through the countryside from August 6 to August 15.

The event will attract crowds of enthusiastic bikers in South Dakota’s Black Hills starting this weekend. There is an astounding 700,000 people expected to show up in the small town for the rally…

The governor of South Dakota, Kristi Noem, is speaking out about how much risk is involved in the popular biking rally.

“The Sturgis rally is about hopping on your bike and exploring this great country through our open roads. Bikers come here because they WANT to be here. And we love to see them! There’s a risk associated with everything that we do in life. Bikers get that better than anyone,” Noem tweeted.” (F)

“When will the pandemic finally end?

“Even among the scientific community, you would get really different answers,” “There is no one definition of what the end of a pandemic means.”

A pandemic is by definition a global crisis. Lifting some U.S. public health measures and interventions “gave people a sense that the panic was waning,” Piltch-Loeb says. That euphoria blinded many to the worldwide reality, which remains bleak.

“Until this [virus] is controlled or more limited globally, it’s not going away,” Piltch-Loeb says. That means declaring the pandemic’s “end” may be a distant goal, requiring different conditions depending on who’s asked.

Where do diseases go?

When the worldwide spread of a disease is brought under control in a localized area, it’s no longer a pandemic but an epidemic, according to the WHO. If COVID-19 persists globally at what the WHO judges to be “expected or normal levels,” the organization will then re-designate the disease “endemic.”

At that stage, SARS-CoV-2 will become a circulating virus that’s “less consequential as we build immunity,” says Saad Omer, an epidemiologist and director of the Yale Institute for Global Health. (Read more about how we’ll live with COVID-19 as an endemic disease.)

Only two diseases in recorded history that affect humans or other animals have ever been eradicated: smallpox, a life-threatening disease for people that covers bodies in painful blisters, and rinderpest, a viral malady that infected and killed cattle. In both instances, intensive global vaccination campaigns brought new infections to a halt. The last confirmed case of rinderpest was detected in Kenya in 2001, while the last known smallpox case occurred in the U.K. in 1978…

There is no one definition of what the end of a pandemic means.

Most causes of past pandemics are still with us today. More than 3,000 people caught the bacteria that cause both bubonic and pneumonic plague between 2010 and 2015, according to the WHO. And the virus behind the 1918 flu pandemic that ravaged the globe, killing at least 50 million people, ultimately morphed into less lethal variants, with its descendants becoming strains of the seasonal flu.

As with the 1918 flu, it’s likely the SARS-CoV-2 virus will continue to mutate, and the human immune system would eventually adapt to fend it off without shots—but not before many people fell ill and died. “Developing immunity the hard way is not a solution that we should be aspiring to,” Omer says.

Finding ways to slow the spread of a disease and manage its effects is by far the safer path, experts say. Today, for instance, pest control and advanced hygiene keep the plague at bay, while any new cases can be treated with antibiotics.

For other diseases, such as the flu, vaccines can also make a difference. The available COVID-19 vaccines are highly safe and effective, which means getting enough people vaccinated can end this pandemic faster and with lower mortality than natural infections alone.” (B)

“Vaccination is one part of the solution and is a huge help, but we are unlikely to ever reach global herd immunity, which means there is always an opportunity for the virus to evolve. And we’re seeing this now with virus mutants. Vaccination will help us prevent the health system from being overwhelmed, but it’s not going to solve it completely.

Testing people is the only way to know whether individuals are presenting a hazard to other people and to understand how well the vaccines are suppressing infection. There are a variety of tests that can be deployed both nationally and internationally. Antigen-antibody tests provide reasonable data when you measure a population on a regular basis. Other tests—nucleic-acid tests, like PCR [polymerase chain reaction], and quantitative tests—provide other elements of specificity but may not be easily accessible to all nations, particularly middle-income and developing countries. To focus on global solutions, we may require a very complex network of different levels of tests designed to fill specific yet varying purposes.

The endpoint of this virus is that we will just start to live with it; it will become endemic in the population. And we can hope that it becomes less virulent over time, as diseases tend to. But there may be spikes, as there are with influenza, where occasionally a new variant comes about that is more deadly. We have to be prepared for the next thing to come along, potentially while we’re still dealing with this one.” (C)

“That probably sounds bleak, but don’t despair. The truth of the matter is that pandemics always end. And to date vaccines have never played a significant role in ending them. (That doesn’t mean vaccines aren’t playing a critical role this time. Far fewer people will die from Covid-19 because of them.)…

The viruses became endemic.

If the pattern holds, and it is expected to, SARS-2 will at some point join a handful of human coronaviruses that cause colds, mainly in the winter, when conditions favor their transmission.

When will that happen? That’s the big, unanswerable question. “I thought that we’d be out of this acute phase already,” admitted Maria Van Kerkhove, the World Health Organization’s leading coronavirus expert. Van Kerkhove’s thinking, though, is influenced by her adamant view that the world could stop the pandemic if countries would only take the steps countries like New Zealand, Vietnam, and others have done, and bring transmission under control.

“There’s nothing — there’s nothing — including the virus variants, that suggests we couldn’t be out of the acute phase already,” she told STAT in a recent interview. “Because this is controllable.”

Experience from the last four pandemics — the ones mentioned above — would suggest that viruses morph from pandemic pathogens to endemic sources of disease within a year and a half or two of emerging. But all of those pandemics were influenza pandemics. A different pathogen could mean we’ll see a different pattern…

Endemic SARS-2 would have a seasonal pattern, spreading in the winter months when kids are in school and when we spend more time indoors in proximity to each other. Florian Krammer, a vaccinologist at the Icahn School of Medicine at Mount Sinai in New York, said that early on some of these seasons may be more severe than others — but not pandemic severe.

“If this thing becomes seasonal and you have countries where the vaccination rate is low and the immunity background is low, those seasons in the beginning might be a little bit stronger. In countries where vaccination rates are high, they might be very low,” said Krammer.

He and others told STAT this transition will play out at different times across the globe. “I think we will see a huge difference between the West and everybody else who kind of didn’t get enough vaccines,” Krammer said. “Although there might be countries like Iran, where the infection rates have been incredibly high, and I think they have by now so much background immunity that if they bring it down now, it’s unlikely to come back as a wave.”

Lavine believes the shift could happen fairly soon in countries like the United States that have had both high levels of infections and large numbers of vaccinated people.

“In the U.S., I would say that is not far off,” she said. “Not to say that it’s just going to disappear, but the idea that it would no longer be this kind of pathogenic scourge, I think we might not be too far from that.”… (D)

“The question of when the crisis will be over is a layered one — with different answers from local, national and global perspectives.

There are no set-in-stone metrics for when it’s over…

The delta variant has spread just as fast through the U.S. as epidemiologists feared it would. It now accounts for more than half the cases in the U.S. and far more than that in certain states.

Lynn Goldman, an epidemiologist and the dean of the school of public health at George Washington University, says the U.S. has certain things working for it — and some against it.

The good news is we’ve shown the ability to lower rates of transmission and deaths from the virus. And of course, Americans have widespread access to COVID-19 vaccines.

The bad news is there’s resistance to the two main ways to prevent transmission — getting vaccinated and wearing a mask.

“And unfortunately, those two attributes tend to coincide within the same people and within the same population subgroups,” Goldman says. In other words, many of the same people who don’t want to get a vaccine also don’t want to wear a mask.

As a result, Goldman says, we’re likely to see continued transmission of the virus in the U.S., concentrated in the areas with lowest rates of vaccination.

Experts say the next big challenge will come this winter. Another wave is expected as people move inside during colder months. There will likely be some outbreaks as students go back to school — children under 12 are not yet eligible for the vaccines.

How dangerous the virus continues to be will depend on vaccination levels of the population and the lethality of the variant that’s circulating when winter comes. How quickly a state or local government is willing to go back into restrictive measures — like wearing masks indoors — will play a role too…

“For the short term, it will be seasonal, like what we see with the flu, simply because we don’t have enough vaccine to vaccinate everybody in the world,” Mokdad says.

If we do the right things, like increasing production of the vaccine, he says, it’s possible we eventually won’t have to worry about COVID-19 anymore…”  (E)

“Health experts say there are three main ways that pandemics end.

The first is that a virus can be eradicated.

The only disease that has been wiped out in humans is smallpox. A combination of factors — a very effective vaccine, people could be vaccinated after they were exposed to the disease, and it was easy to tell when someone had the disease — made eradication possible, said Dr. Catherine Troisi, an infectious disease epidemiologist at UTHealth School of Public Health.

People shouldn’t count on the elimination of COVID-19, though the fact that the virus “seems to be exclusive to humans” does make eradication a possibility, said Dr. John Carlo, CEO of Prism Health North Texas and a member of the Texas Medical Association’s COVID-19 task force.

“Through an aggressive vaccination campaign, we actually could eradicate it and completely shut it off,” he said.

The second way a pandemic can end is that a virus becomes what’s known as endemic. Endemic viruses, like influenza, are always present and circulating but don’t cause public health emergencies.

“Just like we see with flu, people still get sick, people die, but we don’t change our routines,” Troisi said.

The final way pandemics can end is though what’s known as a social ending. Essentially, people are no longer afraid, or no longer care, about the virus and return to their normal lives, Troisi said.” (G)

“Dr. Elliott says this pandemic is like no other and, unfortunately, he does not not see a short-term end to it.

Travel has changed which impacts the spread of the virus, there have been huge scientific advances since 1918, and there was no vaccine in 1918 but there are a few options now.

Beyond those points, Dr. Elliott says, the 1918 pandemic was a single type of influenza that did not mutate much. During the COVID pandemic, he says, there are more than 4,000 variants, some of which are re-infecting people or making people more contagious.

”What I think most people are expecting is that the Coronavirus is going to turn into an annual component of our viral milieu, meaning we have flu every year. Okay, we’re going to probably have SARS Coronavirus 2 every year. And so, we may be looking at vaccine boosters every year because we failed to get on top of this thing in the first year,” he said.” (H)

“We can still make progress on the vaccination rates, but we shouldn’t set our hopes too high. If our current slowed pace continues — which is an optimistic projection — 70 percent of the entire country will have gotten at least one dose by mid-December, according to an analysis published in the New York Times. It will be very difficult to exceed 70 percent until those under 12, who make up 15 percent of the population, are approved for the shot. We might not get higher than 70 percent even then. Vaccination rates are high for children, but only about 66 percent of 2-year-olds have received the complete recommended seven-dose regimen of childhood vaccines, and they have no say in the matter, so don’t automatically expect spectacular numbers of Covid-19 vaccination among kids.

As we settle in to live with Covid, we should recognize that too many people misunderstood the powers of the various vaccines. They mistook what the vaccines could do for what they wanted them to do. The vaccines don’t turn your body into a sterilizing chamber that extinguishes the virus. All that they do — and all that their makers ever claimed they did — was to trigger your immune system to create responses to combat a Covid-19 infection. Companies never said their vaccines would magically prevent you from catching the disease, only that they would dramatically increase your chances to escape illness, avoid a ventilator and dodge death. They understood from the beginning that “breakthrough” infections were in the offing. They also never said vaccines would prevent the vaccinated from transmitting the disease. They didn’t deliver magic, but they did deliver a miracle, one that could be even more miraculous if more of us would only vax up.

At some juncture, policymakers and civilians alike need to study what we’ve learned about Covid-19 and set a toleration point for what sort of Covid-19 contagion level we can accept. Should that toleration point be a level at which the burden doesn’t collapse our hospitals’ capacities? Should it look something like a recent week’s level of mortality rate, which translates to about 90,000 to 165,000 annual Covid-19 deaths? That death rate would be comparable to what we experienced during the 2017-18 flu season, when the flu hospitalized 810,000 people and killed 61,000. Every one of those flu deaths was tragic and every hospitalization arduous, but the toll didn’t translate into lockdowns or panic.

Setting a sensible toleration point for Covid-19 won’t come easy. Nobody wants to be the guy who says, “It’s regrettable but acceptable that this many people die.” But our day of reckoning is drawing near. We can’t hide in our burrows forever.” (I)

“College and universities. More than 400 colleges and universities are requiring students to be vaccinated for Covid-19. Almost all are in states that voted for President Biden.

Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get the Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force. In N.Y.C., workers in city-run hospitals and health clinics will be required to get vaccinated or else get tested on a weekly basis.

Federal employees. President Biden announced that all civilian federal employees must be vaccinated against the coronavirus or be forced to submit to regular testing, social distancing, mask requirements and restrictions on most travel. State workers in New York will face similar restrictions.

Can your employer require a vaccine? Companies can require workers entering the workplace to be vaccinated against the coronavirus, according to recent U.S. government guidance…

Many universities and businesses like Walmart, Disney, Google and Uber are requiring employees to be vaccinated before returning to campus or the office. New York City will require vaccinations for indoor restaurants, gyms and other activities. But carrying out such policies is unnecessarily difficult because of the archaic state of vaccination records…

California and New York State (and many countries) have shown that there is a better way. The basic idea is to turn the information on that card into a digital Covid vaccine record. Specifically, the record contains your name, birth date and vaccination history. That information is captured in a QR code that can be scanned easily. The QR code can be stored on a smartphone or printed.

It is important to stress that New York State and California have made this digital record an option for their residents — they did not require that anyone get it. Furthermore, the information captured by the QR code is merely what is already on that card. No one’s rights or privacy is at stake.

There have been inevitable start-up glitches, but these states have been leading the way. Nevertheless, it’s reasonable to expect the federal government to play at least a facilitating role in making this happen. Many people have gotten shots in two states or in one other than the state in which they live. Without federal coordination, creating reliable electronic documentation across jurisdictions will be a major database management problem.

Being unvaccinated in 2021 is similar to smoking in public, though it is more immediately hazardous. The unvaccinated are endangering themselves and those with whom they come into contact. It would be good public policy if those who refuse to be vaccinated are compelled to spend more time alone.” (J)

(A) ‘It’s too late’: US doctor says dying patients begging for Covid vaccine, by Sarah Betancourt,

(B) How will the pandemic end? The science of past outbreaks offers clues., BY JILLIAN KRAMER, https://www.nationalgeographic.com/science/article/how-will-the-pandemic-end-the-science-of-past-outbreaks-offers-clues

(C) How might the COVID-19 pandemic end?, https://www.mckinsey.com/industries/public-and-social-sector/our-insights/how-might-the-covid-19-pandemic-end

(D) How the Covid pandemic ends: Scientists look to the past to see the future, By Helen Branswell, https://www.statnews.com/2021/05/19/how-the-covid-pandemic-ends-scientists-look-to-the-past-to-see-the-future/

(E)How We’ll Know When The COVID-19 Crisis Is Over, by LAUREL WAMSLEY, https://www.npr.org/2021/07/10/1014374383/covid-19-coronavirus-pandemic-when-its-over

(F) Sturgis Motorcycle Rally 2021: South Dakota Governor Speaks Out on Rally ‘Risk’ as Opening Weekend Kicks Off, by Madison Miller, https://outsider.com/news/entertainment/sturgis-motorcycle-rally-2021-south-dakota-governor-speaks-out-rally-risk-opening-weekend-kicks-off/

(G) Will the coronavirus pandemic ever really end?, By Catherine Marfin, https://www.dallasnews.com/news/2021/07/15/will-the-coronavirus-pandemic-ever-really-end/

(H) FACT FINDERS: When will the pandemic end?, By Wendi Redman, https://www.kold.com/2021/08/07/fact-finders-when-will-pandemic-end/

(I) Opinion | It’s Time to Rethink What the ‘End’ of the Pandemic Looks Like, by JACK SHAFER, https://www.politico.com/news/magazine/2021/07/28/what-should-the-end-of-the-covid-pandemic-look-like-501373

(J) More Than Nudges Are Needed to End the Pandemic, By Richard H. Thaler, https://www.nytimes.com/2021/08/05/business/vaccine-pandemic-nudge-passport.html