The world is wondering whether the COVID-19 pandemic has reached a turning point after which it could change from a pandemic to an endemic illness.
If you are a born optimist, you take a positive view about everything, even when the situation is not completely clear. Alternatively, you might feel suffocated after two years of the pandemic and yearn to see the light of day even when gazing into the dark of night.
In either case, do not worry — you will have no trouble finding confirmation from the words of experts who believe the pandemic is about to cool down and it is time to sing “hallelujah.”
If, on the other hand, you still have serious concerns about the pandemic, or if you cannot bear the frustration that follows when false hopes are dashed, you will agree with me that it is not yet time to break out the champagne. You and I can find many people who share our views.
As US National Institute of Allergy and Infectious Diseases Director Anthony Fauci said on Jan. 17: “It is an open question whether [the Omicron variant of SARS-CoV-2] will be the live virus vaccination that everyone is hoping for.”
The WHO also said that the idea that the pandemic has become endemic is premature.
Britain’s Royal Society is the world’s oldest association devoted to conducting research into natural sciences. Its Latin motto Nullius in verba means “Don’t take anyone’s word for it” — in other words, do not blindly accept what anyone says.
I was taught this phrase by a primary care physician when I first arrived in the US as an intern, and it has been my motto for practicing and teaching medicine ever since. I have never believed that experts have a monopoly on knowledge.
My attitude to the idea that the pandemic has become endemic, or that SARS-CoV-2 has turned into something akin to seasonal influenza, is that although I would like it to be so, I cannot yet accept it with peace of mind.
Those who hold this view think that Omicron is a godsend because, although it is highly transmissible, it causes less serious illness and fewer deaths than previous strains, and it can fill in the vaccine gap to achieve “herd immunity” at a relatively low cost in sickness and death.
While I agree with that, herd immunity depends on the basic reproduction number, or R value, of a virus, which is a measure of its transmissibility. The R value is not constant and immutable, but varies according to mutations in the virus and the community’s ability to resist the disease.
We have no idea how potent a variant strain could be. Can the new strain evade the human immune system? Could it be a monster that is both transmissible and lethal? This is the greatest unknown about the pandemic’s future course.
Calculations about herd immunity are based on the assumption that human interactions within a community are evenly distributed, which is not the case in practice.
Even if the number of people with immunity in a particular area has reached the threshold for herd immunity, there will always be small groups of people who are not well integrated into society and do not get vaccinated or pay attention to preventive measures. The disease can continue to circulate among these small groups and occasionally spill over to other people whose immunity is beginning to weaken.
Although locally endemic diseases are more stable and easy to control than pandemics, COVID-19 will not become endemic in all parts of the world at the same time. Some people think that countries such as Portugal, where more than 80 percent of the population have immunity, have already entered the endemic stage. The question is, in today’s global village, where transport is quick and convenient, how many parts of the world must reach the endemic stage before we can say the pandemic is over?
In many places where vaccination rates are low, viruses are constantly mutating, which enables them to reinfect people who have had the virus before. The pandemic has lasted much longer than the “shelf life” of vaccines. Under such circumstances, can the road from pandemic to endemic really be a one-way street?
An epidemic is a war between people and a virus, and some patients could retest positive for the virus after being given the all-clear. Will Omicron be the last wave of the pandemic before it becomes endemic, or will there be several more waves in the to-and-fro warfare between humans and virus? Who can answer this question?
Based on past experience, SARS-CoV-2 will likely mutate into something like seasonal influenza or become endemic, but we cannot be sure when and how this will happen.
Some epidemiologists believe that the worse an epidemic gets, the more unpredictable the subsequent course of events could be.
With the Omicron wave still emerging, and before we see it decline from its peak, can we declare that the pandemic has ended? Or should we be more cautious and say: “It ain’t over till it’s over”?
Hsieh Ann-ming is a retired cardiologist and former director of coronary care units and the refractory heart failure clinic at Edward Hines Jr VA Hospital in Illinois, US.
Translated by Julian Clegg
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