POST 233. February 2, 2022. CORONAVIRUS. “The same virus can cause endemic, epidemic or pandemic infections: it depends on the interplay of a population’s behaviour, demographic structure, susceptibility and immunity, plus whether viral variants emerge.”

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“Picture a not-too-distant future when you can book that summer trip to Italy or you don’t have to remember to take off your mask for graduation photos. After the past 25 months, forgetting the pandemic for even a little while may sound like a fantasy — after all, the coronavirus has gotten our hopes up before.

But infectious disease experts say there just may be an end in sight. Maybe.

Well, let’s say it’s not outside the realm of possibility for 2022.

“I think if we do it right, we’re going to have a 2022 in which COVID doesn’t dominate our lives so much,” said Dr. Tom Frieden, who was director of the U.S. Centers for Disease Control and Prevention under President Obama and is now the CEO and president of Resolve to Save Lives.

What the next part of the pandemic looks like and when it will get there are what Dr. Yvonne Maldonado, an epidemiologist and infectious disease specialist at Stanford Medicine, and experts at federal agencies, academic colleagues and local public health leaders spent the holidays trying to figure out.

There was a general consensus among the experts about what happens next: “We really don’t know exactly,” Maldonado said.

Scientists warn that omicron’s whirlwind spread across the globe practically ensures it won’t be the last worrisome coronavirus variant.

There are disease models and lessons from pandemics past, but the way the highly infectious omicron variant popped up meant the scientists’ proverbial crystal ball got a little hazy.

“None of us really anticipated omicron,” Maldonado said. “Well, there were hints, but we did not expect it to happen exactly the way it did.”…

“South Africa’s kind of our canary in the coal mine because they were able to pick up the omicron variant first,” Maldonado said.

South African scientists first spotted the variant in November. Cases there peaked and fell off quickly. They did the same in the UK. And that’s what experts think will happen everywhere.

“I anticipate in the short run — being the next six weeks, four to six weeks — that it’s still going to be pretty rough,” said Dr. John Swartzberg, an expert in infectious diseases and vaccinology and clinical professor emeritus at the University of California, Berkeley’s School of Public Health. “It will be about the middle of February before we start to really see that things are getting better.” (A)

““As the world entered the third consecutive year of the COVID pandemic, the experts from the WHO (World Health Organization) gave a statement that it might end this year if the ideal conditions remain constant.

“The omicron variant has divided the pandemic into two-phase and could possibly end in the Europe continent,” said WHO Europe director Hans Kluge. “By the end of March, 60 percent population could get infected by omicron variant,” he added.

While in India, the cases of COVID-19 continue to rise steadily, most of the states have reached their peak in the third wave. Other states will reach a peak within a week.

“Looking at the COVID-19 status and the natural infection, we can say that very soon, the majority of us will be getting an infection. And then this virus will convert into the endemic virus,” said AIIMS epidemiologist DR Sanjay Rai.”” (B)

“The nation’s top infectious disease expert is “as confident as you can be” that most states will have reached a peak of omicron COVID-19 cases by mid-February.

Dr. Anthony Fauci, speaking Sunday on ABC’s “This Week,” said several states in the Northeast and Upper Midwest have seen cases peak and begin to decline sharply but that cases are still rising in the South and West.

“You never want to be overconfident when you’re dealing with this virus,” Fauci said, adding that the coronavirus “surprised us in the past.”

Fauci said there may be “a bit more pain and suffering with hospitalizations” in parts of the country where a higher percentage of people have not been fully vaccinated or have not received a booster shot.

Fauci said the goal is to get infections under control to where the virus isn’t eliminated but the level is low enough that “it’s essentially integrated into the general respiratory infections” that Americans have learned to live with.”” (C)

“By March, 2022 a large proportion of the world will have been infected with the omicron variant. With continued increases in COVID-19 vaccination, the use in many countries of a third vaccine dose, and high levels of infection-acquired immunity, for some time global levels of SARS-CoV-2 immunity should be at an all time high. For some weeks or months, the world should expect low levels of virus transmission.

I use the term pandemic to refer to the extraordinary societal efforts over the past 2 years to respond to a new pathogen that have changed how individuals live their lives and how policy responses have developed in governments around the world. These efforts have saved countless lives globally. New SARS-CoV-2 variants will surely emerge and some may be more severe than omicron. Immunity, whether infection or vaccination derived, will wane, creating opportunities for continued SARS-CoV-2 transmission. Given seasonality, countries should expect increased potential transmission in winter months.

The impacts of future SARS-CoV-2 transmission on health, however, will be less because of broad previous exposure to the virus, regularly adapted vaccines to new antigens or variants, the advent of antivirals, and the knowledge that the vulnerable can protect themselves during future waves when needed by using high-quality masks and physical distancing. COVID-19 will become another recurrent disease that health systems and societies will have to manage. For example, the death toll from omicron seems to be similar in most countries to the level of a bad influenza season in northern hemisphere countries. The US Centers for Disease Control and Prevention estimated the worse influenza season during the past decade in 2017–18 caused about 52 000 influenza deaths with a likely peak of more than 1500 deaths per day.11 The era of extraordinary measures by government and societies to control SARS-CoV-2 transmission will be over. After the omicron wave, COVID-19 will return but the pandemic will not.” (D)

“What’s driving the optimism? The idea is that so many people are gaining immunity through vaccination or infection with Omicron that soon the coronavirus will be unable to find a foothold in our communities, and will disappear from our lives.

But in interviews with more than a dozen epidemiologists, immunologists and evolutionary biologists, the course of the virus in the United States appeared more complicated — and a bit less rosy.

By infecting so many people, Omicron undoubtedly brings us closer to the end of the pandemic, they said. The current surge in infections is falling back, and there is reason to hope that hospitalizations and deaths will follow.

The path to normalcy may be short and direct, the goal just weeks away, and horrific surges may become a thing of the past. Or it may be long and bumpy, pockmarked with outbreaks over the coming months to years as the virus continues to find footing.

In any case, it is not likely that the coronavirus will ever completely disappear, many scientists said, and herd immunity is now just a dream. The population’s immunity against the virus will be imperfect, for a variety of reasons.

“Maybe there was a short while where we could have reached that goal,” said Shweta Bansal, an infectious disease modeler at Georgetown University. “But at this point, we are well beyond that.”

Instead, the coronavirus seems likely to become endemic — a permanent part of American lives, a milder illness, like the flu, that people must learn to live with and manage.

But the future also depends on a wild card: new variants. Omicron surfaced only at the end of November. Most researchers believe other variants are coming, because too little of the world is vaccinated. Eventually some may be both highly contagious and have a knack for short-circuiting the body’s immune defenses, lengthening the misery for everyone.

“This is a choose-your-own-adventure story, and the ending is not written yet,” said Anne Rimoin, an epidemiologist at the University of California, Los Angeles. “Nobody is going to be able to tell us what will happen.”” (E)

“Whether justified or not, that glimmer has been flamed into a blazing beacon by some people, who interpret Omicron’s relatively mild effect on health if you’re vaccinated—a sore throat, some flu- or cold-like symptoms, or no noticeable symptoms at all—as a sign that SARS-CoV-2 may be reaching the end of its onslaught. If Omicron isn’t as virulent, then SARS-CoV-2 must be weakening, the thinking goes.

Even leading scientists have been tempted by the idea, admitting that of all the versions of SARS-CoV-2 that have hit humanity over the past two years, Omicron might be the preferable one to get infected with, since it doesn’t make the immunized that sick. And if more vaccinated people are infected with Omicron and develop immunity, that protection, combined with the protection that some people might have from being infected with previous variants, could reach the magical herd immunity threshold—which experts say could be anywhere between 70%-90% of people recovered from or vaccinated against COVID-19—that would finally make SARS-CoV-2 throw up its spike proteins in defeat.

According to some models, by the time Omicron works its way through the population, up to half of people around the globe will have been infected, and presumably immune to the variant. With fewer unprotected hosts to infect, viruses generally begin to peter out—epidemic influenza viruses are a good example—and optimistic models show that after a peak of cases by the end of January and beginning of February, SARS-CoV-2 may follow that path. Under that assumption, COVID-19 would begin its shift from being a pandemic disease to an endemic one, confined to pockets of outbreaks that erupt among immunocompromised populations or the unvaccinated, such as the youngest kids—but are manageable and containable because most people would be protected from the worst effects of the virus.

But there’s also the possibility of a darker timeline, in which the unpredictable nature of SARS-CoV-2 to date drives the next year and beyond. If that occurs, it could mean the sobering possibility that Omicron is not the beginning of the end, but just the beginning of a more transmissible, more virulent virus that could do even more harm than it has already.” (F)

“The word ‘endemic’ has become one of the most misused of the pandemic. And many of the errant assumptions made encourage a misplaced complacency. It doesn’t mean that COVID-19 will come to a natural end.

To an epidemiologist, an endemic infection is one in which overall rates are static — not rising, not falling. More precisely, it means that the proportion of people who can get sick balances out the ‘basic reproduction number’ of the virus, the number of individuals that an infected individual would infect, assuming a population in which everyone could get sick. Yes, common colds are endemic. So are Lassa fever, malaria and polio. So was smallpox, until vaccines stamped it out.

In other words, a disease can be endemic and both widespread and deadly. Malaria killed more than 600,000 people in 2020. Ten million fell ill with tuberculosis that same year and 1.5 million died. Endemic certainly does not mean that evolution has somehow tamed a pathogen so that life simply returns to ‘normal’…

The same virus can cause endemic, epidemic or pandemic infections: it depends on the interplay of a population’s behaviour, demographic structure, susceptibility and immunity, plus whether viral variants emerge. Different conditions across the world can allow more-successful variants to evolve, and these can seed new waves of epidemics. These seeds are tied to a region’s policy decisions and capacity to respond to infections. Even if one region reaches an equilibrium — be that of low or high disease and death — that might be disturbed when a new variant with new characteristics arrives…

Thinking that endemicity is both mild and inevitable is more than wrong, it is dangerous: it sets humanity up for many more years of disease, including unpredictable waves of outbreaks. It is more productive to consider how bad things could get if we keep giving the virus opportunities to outwit us. Then we might do more to ensure that this does not happen.” (G)

“The astonishing spread of the Omicron variant could help set the stage for the pandemic to transition from overwhelming to manageable in Europe this year, a top health official said on Monday, potentially offering the world a glimpse at how countries can ease restrictions while keeping the virus at bay.

That hint of hope came with a heavy dose of caution: Immunity from the surge of infections will probably wane, and new variants are likely to emerge, leaving the world vulnerable to surges that could strain health systems. In the United States, where vaccination rates are lower and death rates are considerably higher than in Western Europe, there are bigger hurdles on the path to taming the pandemic.

Dr. Hans Kluge, the director for the World Health Organization’s European region, warned in a statement released Monday that it was too early for nations to drop their guard, with so many people unvaccinated around the world. But, he said, between vaccination and natural immunity through infection, “Omicron offers plausible hope for stabilization and normalization.”

The question that remains, however, is what a new normal looks like — a picture that would have seemed disastrous in 2019 could be a big improvement in 2022 — and how long it could last.

The Omicron variant will undoubtedly leave behind much higher levels of immunity in the population, scientists said. But whether the world will have to endure deadly and disruptive future surges of the virus before the pandemic stabilizes is not at all clear.

And while Dr. Kluge said he believed that Europe could withstand new waves without resorting to lockdowns, countries there are still working to determine what other measures they may use. New antiviral pills are more readily available in Europe than in other parts of the world, scientists said, but countries still need to administer them more quickly.

Experts said that precautions like testing and isolating would remain essential. And if coronaviruses cases climb in the coming winters, scientists said, short-term mask mandates could be a way of suppressing cases to help hospitals dealing with other respiratory illnesses, too.

Tedros Adhanom Ghebreyesus, the head of the W.H.O., said on Monday that the emergency phase of the pandemic was still very much here.

It’s dangerous to assume that Omicron will be the last variant or that we are in the endgame,” Dr. Tedros said at an executive board meeting of the organization. “On the contrary, globally, the conditions are ideal for more variants to emerge.”

Over the past two years, people around the world have become exhaustingly familiar with the wicked way the virus evolves and confounds expectations. Last fall, with vaccination spreading and the Delta variant waning, there were predictions of a return to normal — only for the world to be blindsided by Omicron.” (H)

“..So this virus is circulating at an incredibly intense level around the world for a number of reasons. But the more the virus circulates, the more opportunities the virus has to change. Omicron will not be the last variant that you will hear us discuss, and the possibility of future emergence of variants of concern is very real. And more variants that emerge, we don’t understand what those the properties of those variants may be. Certainly, they will be more transmissible because they will need to overtake variants that are currently circulating. They could become more or less severe, but they could also have properties of immune escape. So we want to reduce the risk of future emergence of variants of concern.” (I)


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