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Discussion thread VII - COVID-19: Endemic Stage

Pathfinder

Pathfinder

Editor, Senior Moderator
UK -

Endemic Covid: Is the pandemic entering its endgame?

James Gallagher
Health and science correspondent
@JamesTGallagheron Twitter

Published 2 days ago

...
"We're almost there, it is now the beginning of the end, at least in the UK," Prof Julian Hiscox, chairman in infection and global health at the University of Liverpool, tells me. "I think life in 2022 will be almost back to before the pandemic."
...
There will be people - mostly the old and vulnerable - who will die from endemic Covid. So there is still a decision to be made about how we live alongside it.

"If you're willing to tolerate zero deaths from Covid, then we're facing a whole raft of restrictions and it's not game over," Prof Hiscox explains.

But, he says, "In a bad flu season, 200-300 die a day over winter and nobody wears a mask or socially distances, that's perhaps a right line to draw in the sand."

Lockdowns and restrictions on mass gatherings will not come back and mass testing for Covid will end this year, he expects.

The near certainty is there will be booster vaccines for the vulnerable come the autumn in order to top up their protection through winter.

"We need to accept the fact that our flu season is also going to be a coronavirus season, and that is going to be a challenge for us," says Dr Groppelli.

However, it is still uncertain how bad winters will be as the people who die from flu and Covid tend to be the same. As one scientist put it, "You can't die twice."
...
https://www.bbc.co.uk/news/health-59970281
 
COMMENT|ONLINE FIRST

COVID-19 will continue but the end of the pandemic is near

Christopher J L Murray
Published: January 19, 2022 DOI:https://doi.org/10.1016/S0140-6736(22)00100-3

...
Surprisingly, IHME models1 suggest that the transmission intensity of omicron is so high that policy actions—eg, increasing mask use, expanding vaccination coverage in people who have not been vaccinated, or delivering third doses of COVID-19 vaccines—taken in the next weeks will have limited impact on the course of the omicron wave. IHME estimates suggest that increasing use of masks to 80% of the population, for example, will only reduce cumulative infections over the next 4 months by 10%. Increasing COVID-19 vaccine boosters or vaccinating people who have not yet been vaccinated is unlikely to have any substantial impact on the omicron wave because by the time these interventions are scaled up the omicron wave will be largely over. Only in countries where the omicron wave has not yet started can expanding mask use in advance of the wave have a more substantial effect. These interventions still work to protect individuals from COVID-19, but the speed of the omicron wave is so fast that policy actions will have little effect on its course globally in the next 4–6 weeks.
...
A question remains in relation to the countries pursuing zero COVID-19 strategies, such as China and New Zealand. China has local omicron transmission in January, 2022.9, 10 Given the high transmissibility of omicron, it seems unlikely that China or New Zealand will be able to permanently exclude the omicron wave. For zero COVID-19 countries, the question will be one of timing. Later omicron surges will allow further progress on increasing vaccination coverage and better understanding of the impact of the omicron variant in a fairly immunologically naive population.

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.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00100-3/fulltext
 
Pandemic or endemic? Should we stop worrying about Omicron?
...
By Liam Mannix
JANUARY 23, 2022
...
“Endemic in itself does not mean good,” the World Health Organisation’s emergencies director, Dr Michael Ryan, said on Thursday. “Endemic just means it’s here forever.”

So, is COVID-19 moving from epidemic to endemic?

We put that question to the Australasian Society for Infectious Diseases president, Professor Allen Cheng. He says COVID-19 is at once pandemic, endemic and epidemic. The virus will be constantly present with us from now on, circling the world (an endemic pandemic). But we will also see sudden, sharp increases when a new variant arises, when the seasons change, or when public health measures are too relaxed (an epidemic). COVID-19 will continue to be a disease of waves.
...
Is Omicron the final variant? If there are more, will they be even milder?

The rise of Omicron has many people pointing to a popular notion of viral evolution: over time, viruses evolve to become more contagious and less deadly.
...
The problem: this idea, known as the “law of declining virulence”, coined by a long-dead cattle scientist, was debunked in the 1980s. Virus experts are quite baffled as to why so many people still seem to believe it.

“Sadly, it’s wrong,” says a world-leading expert on coronavirus evolution, the University of Sydney’s Professor Edward Holmes. “It is not the case that virulence always goes down. It is absolutely not true. It depends on how virulence impacts transmission.”

A virus’ virulence – how lethal it is – will evolve up or down depending on how it affects how contagious the virus is. If a mutation makes the virus both more lethal and more contagious, it’s got a good chance of sticking.
...
“We’re lucky that Omicron appears to be milder – but I think that’s primarily luck,” Cromer says.

The narrative of a weakening virus has a second problem: Omicron did not evolve from Delta.

Rather than evolving from the dominant variant, genetic evidence suggests Omicron evolved from a much earlier lineage of the virus that diverged in 2020. Delta swept the world, but somewhere – likely in Africa – was a residual pool of people infected with this older lineage. Omicron emerged there and took over the world.

That knowledge means we cannot be confident the next variant will be an evolution of Omicron – or even of Delta. It could come from anywhere, with attributes we cannot predict. Based on the evidence, and the fact that many countries still have low vaccination levels, it is simply impossible to predict whether the next variant will be more or less lethal, Holmes says.

The best bet in this pandemic remains the same: expect the unexpected.

“I don’t know I feel confident saying we’re close to saying Omicron is going to be the end of it,” Juno says. “We’ve learnt from the pandemic so far that there continue to be surprises coming around the corners.”
...

https://www.smh.com.au/national/pan...p-worrying-about-omicron-20220119-p59pdr.html
 
if something like COVID or especially omicron had happened some centuries ago,
would they have decribed it as influenza ?
Remembering all the old books that we had studied here in 2006-2008
and their desciptions of the history of influenza.

It looks somehow unlikely that Corona epidemics had never been observed before.
 
OC43 came from cattle and molecular clock data makes it probable it entered humans in the late 1800s leading to the speculation that the 1889 flu pandemic was in fact its arrival.

SARS, SARS-Cov-2, MERS and OC43 show that CoV zoonotic events can have very different pathologies in humans. SARS-Cov-2 is now, and will remain, an endemic human respiratory pathogen and I expect it to continue to throw up new variants as it adapts to the changing human immune landscape. These could be milder, or more severe, as from the virus' view point the only thing that matters is its viral fitness relative to its competitor variants. As the vast majority of viral spread will be linked to the period of highest viral load, and this occurs around symptom onset, what happens to the host after that is largely irrelevant. In common with other respiratory viruses it does not cause long lasting immunity to infection but probably will greatly reduce severity, at least for a few years. So the key is to get vaccinated, much safer than getting infected, for your first encounter with its antigens and then get a periodic refresher course by being re-challenged each time you encounter the virus in the future.
It is how we deal with flu and OC43 and the other common respiratory pathogens. Herd immunity to infection is a pipe dream but herd immunity to high levels of death and severe disease is already beginning to occur. We have 350 million confirmed cases, which only accounts for about 4% of the population, the reality is this will be far higher once the vaccinated and unconfirmed cases are added in but it still leaves plenty of immunologically naive individuals for the virus to burn through before equilibrium is achieved.
 
The Pandemic of Unknowns
Reaching a New Normal in an Age of Uncertainty
By Michael T. Osterholm and Mark Olshaker
January 22, 2022

In just two years, the COVID-19 pandemic has transformed how societies understand public health and disease. It has made previously esoteric epidemiological terms such as “flattening the curve,” “mRNA vaccines,” “rapid antigen tests,” and “variants of concern” the stuff of everyday conversation. But it has also drawn attention to the limits of epidemiological expertise and precision. The Delta variant, which swept through the United States last summer, confounded the hope that mass vaccination would bring the pandemic to an end—and made U.S. President Joe Biden’s declaration of imminent victory over the virus in July 2021 seem hubristically premature. The emergence of the substantially more infectious Omicron variant has led to the deaths of upward of 1,800 Americans each day and underlined the great uncertainty of this pandemic: it is challenging to know what will come next.

The pandemic has revealed the messiness of how science evolves in real time. The last two years have witnessed a grand experiment of leadership practices, public health policies, and medical countermeasures. Despite the herculean efforts of the public health and medical communities, Omicron has now reached all parts of the globe. Although the percentage of serious and fatal cases among those infected will be relatively low compared with Delta, the far greater overall number of cases is overwhelming health-care systems, which are suffering the loss of ten to 30 percent or more of already overburdened and burned-out staffs. Breakthrough infections among vaccinated people are occurring at least five times as frequently as they did with Delta, and Omicron appears to infect children more than previous strains. The crush of patients has been so severe that in a number of U.S. states and countries around the world, health-care workers with mild cases of the disease have had to continue working through their illness.

But the long-term view of how societies return to a version of normalcy remains murkier...

Read more: https://www.foreignaffairs.com/articles/world/2022-01-22/pandemic-unknowns
 
I'm not convinced that vaccines designed for the Wuhan strain are safer than natural Omicron infection for everyone. I don't think anyone knows that at this point.
 
yes, I read about the OC43-1889 speculation.
But the description of the 1889-disease was pretty detailed in the old books and it
seemed to match Influenza not corona.
Also considering the recent discovery of flu-B , flu-D like viruses in frog,salamander,eel,toads...
and the genetics i was wondering whether there was flu-A before
Colmbus 1492 and whether passenger pigeons had flu and why there is
no flu-B,flu-C,flu-D like in birds. no alpha,beta,delta Corona in birds.
And Holmes saying it didn't come from mallards.
And how it traveled to/from America in frogs,toads,salamanders,Mexican walking fish
 
I can not agree with this. What he is saying just does not agree with either the consensus view taught in immunology or the Sars-Cov-2 data. As their mission statement makes clear this is a single issue anti-vax site.

"Our mission is to unveil and widely share the scientific truths concerning the detrimental health and social consequences of the ongoing COVID-19 mass vaccination campaigns."

Antibodies do not wain dramatically in a couple of weeks after vaccination, they contract with a half-life of about 20 days starting after the antigen has been degraded.

Omicron, months after two shots, largely evades neutralising antibodies, although CD4+ and CD8+ protection remains largely intact, the booster shot increases antibodies in both quantity and breadth to a point where secondary attack rates are significantly reduced.

After 5 minutes of this video it was obvious that this was not accurate and was made to cloud the understanding of the vaccination program so I did not watch to the end but went looking for the site's raison d'etre which the mission statement quickly clarified.
 
Emily - The data is fairly clear the risk from vaccination is very low compared to natural infection. This holds true regardless of the variant, the vaccine and previous vaccination or infection status.

gs - Given the variability in human pathology caused by different CoVs there is no way of knowing how OC43 may have presented when it entered the human population. All we have to go on is how it presents now, as a cold, in a population who have almost universally got some level of immunity. As severe cold, as you may expect in a naive population, and flu are hard to tell apart now and would have been indistinguishable in 1890. The only hope of resolving this is a Brevig Mission type discovery of RNA.
Alpha and Beta are mammalian and Delta and Gamma avian while CoVs differentiated somewhere between 10,000 and millions of years ago, depending on whose analysis you believe (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676139/)
What was Eddie referring to, re. the Mallards, I had not seen his comment. I have no idea how it got into the Americas as have not searched for that data.
 
Please see:


PLoS Med. Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform]


"Patients discharged from a COVID-19 hospitalisation and surviving at least a week had more than double the risk of subsequent hospitalisation or death and a 4.8-fold higher risk of all-cause mortality than controls from the general population, after adjusting for baseline personal and clinical characteristics.

Risks were higher for all categories of disease-specific hospital admissions/deaths after a COVID-19 hospitalisation than in general population controls, with excess risks more pronounced earlier in follow-up for several outcomes. Risks for most outcomes were similar or lower for people discharged from a COVID-19 hospitalisation, compared with people discharged from an influenza hospitalisation in 2017 to 2019, but the COVID-19 group had higher subsequent all-cause mortality, higher rates of respiratory infection admissions and deaths (predominantly COVID-19), and more adverse mental health and cognitive outcomes (particularly deaths attributed to dementia among people with preexisting dementia) compared with the influenza group.

Our findings are consistent with emerging evidence from early studies suggesting that a subset of people infected with SARS-CoV-2 can experience health problems for at least several months after the acute phase of their infection, with fatigue, pain, respiratory and cardiovascular symptoms, and mental health and cognitive disturbances being among the problems that have been frequently described under the term “post-acute COVID-19 syndrome” [19]; however, epidemiological characterisation of such sequelae has been limited. Small descriptive studies of COVID-19 survivors have been suggestive of high incidence of a range of outcomes including respiratory, cardiovascular, and mental health related [20,21]; the present study helps to contextualise these observations by adding explicit comparison with risks experienced by the general population and by people with a recent influenza hospitalisation."
 
I think you put some blinders on if you are calling this an anti-vax site. The authors merely disagree with the mass vaccination policy into a pandemic. I agree with that position. It is a shame that what could have been a blessing to those that need and desire it has become the victim of authoritarians' fetishistic obsession with breaching the bodily autonomy of every person on the planet.
 
JJackson, what data proves that everyone, (and when I say 'everyone', I mean every last person on the planet), is better off getting the Wuhan vaccines rather than an Omicron infection?
 
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