The pandemic's last act

 

By Noralyn O. Dudt

THE OMICRON, we would like to think with a modicum of hope,  is the  pandemic's last act. As Omicron has behaved so brazenly chasing as many victims as it could, but not as potent as the Delta had been, the pandemic  ending is no longer a question of how but when.  So many cases of infections—serious and not too serious—have brought people to the hospitals that the light we thought we saw at the end of the tunnel suddenly looked dimmer. 

However, these large numbers of infections had provided a "layer of immunity" to huge swathes of the world and may be moving us closer to an endemic stage as the virus is maxing out in its ability to make such big evolutionary jumps.

For the first time since the spread of COVID-19 stunned the world in early 2020, many  epidemiologists are now willing to entertain the prospect that the virus might be making steps toward endemic status—the stage when COVID-19 is comparable to seasonal illnesses like the cold or flu.

A disease that is endemic has a constant presence in a population but does not affect an alarmingly large number of people nor does it  disrupt society as typically seen in a pandemic.  Instead, it eventually reaches a period similar to several other illnesses where most people will be infected as children, possibly multiple times.  As these infections accumulate, they build up immunity. 

The human immune system will continue to improve in recognizing "invaders"  and fighting back. Immunologists find hope in the body's amazing ability to remember germs it has seen before and create multi-layer defenses. One of those layers are memory cells that live for years in the bone marrow,  ready to swing into action to produce more antibodies when needed. However, those memory cells need to be trained first in the immune system "boot camps" called germinal centers, learning to do beyond just making copies of their original antibodies.  Research studies show that Pfizer's vaccinations rev up "T helper cells" that act as drill sergeants in those "training camps" during production of more diverse and stronger antibodies that may retain their efficacy when the virus changes again. Furthermore,  baseline population immunity has improved so much that even as breakthrough infections inevitably continues,  there will be a drop in severe illnesses, hospitalizations and deaths, regardless of the next variant. We must remember that we are not the same population as we were in 2019.

There are four  other coronaviruses that have become endemic. Though comparing the current scenario to previous ones is not an exact science, there is evidence from the past that viruses can be expected to evolve into less severe versions  and eventually disappear into the arsenal of annual colds and influenza.  The natural history of infections indicates that Covid-19 may become the 5th. The Russian flu in the late 19th century ( 1889-1890) killed around  a million people before it became just the common cold-type. The Spanish flu in 1918 gave the world a very nasty dose of the H1N1 influenza virus which was then a novel virus. It infected one-third of the world's population  and killed 50 million of them. That pandemic eventually ended but the virus is still with us today—now we get a wave of it almost every year. Scientists and health experts agree that Omicron is moving us closer to that stage. The world is fortunate that Omicron didn't share more of Delta's characteristics. Pandemics do end but  there is a significant caveat that determines how fast we'll get there—it depends not on the current strain but on the one that comes next.

A transition from pandemic to endemic is not a light switch and "there's no metrics associated with what endemic means for COVID-19" says an Infectious disease expert. Instead we should continue to focus on decreasing transmission rates and preventing hospitals from getting overwhelmed as they face critical staffing shortages.

Pandemics do not move merely with the whims of a virus. They are also directed by human behavior and political acts. In its second-year anniversary, we are seeing positive signs of an "arms race" toward endemicity. Government leaders of Germany, Spain, France, and other nations in the European Union are all seeking a unified approach to the Omicron variant trying to avoid widespread lockdowns and closed borders.

AP News reported that Dr. Anthony Fauci, the top U.S. infectious disease expert, is looking ahead to controlling the virus in a way "that does not disrupt society, that does not disrupt the economy."

The US is sending signals that it's on the path to whatever will become the new normal. The Biden administration says there are enough tools—vaccine boosters, new treatments and masking—to handle even the omicron threat without the shutdowns of the pandemic's earlier days. Additionally, the CDC just reduced the period of  isolation  to five days among those who test positive with COVID-19 to avoid  sickening others, saying it has become clear they're most contagious early on.

An assistant professor of medicine and an expert in pulmonary and critical care medicine at Johns Hopkins Medicine says emphatically that we “don't need any more scientific breakthroughs on COVID," and that  we already know how to stop severe COVID: Vaccines, face masks and testing. He adds, "the more people who are unvaccinated, the more end up in the hospital.  The more cases, the more opportunity for dangerous new variants."

We want to think positively. We all want to have a modicum of assurance that what we are seeing now is the pandemic's last act. We all want to see the day when someone who gets a coronavirus infection stays home for only two to three days, and then move on. THAT -- we all hope -- will be the endgame. And if you want to join the global celebration,  get vaccinated if you haven't. If you've had doses  of the vaccine, get the booster.  The tools are there... for the taking.

 

Noralyn Onto Dudt is one who likes to analyze,  to inquire, to observe, to measure, to find out what causes this and that and to seek the simplest explanation of complex facts.