What Do The Experts Say About Covid Ending?

As the Covid-19 pandemic is heading into its third year, there finally seems to be an end in sight. At the pandemic’s start, a silver bullet vaccine was seen as the path to eliminating Covid-19 and ending the pandemic.

Still, multiple vaccines and variants later, the world might have to settle for an end to the pandemic rather than an end to Covid-19. Indeed, an article published in The Lancet titled ‘COVID-19 will continue but the end of the pandemic is near’ clearly shows that the scientific community believes this to be the best-case scenario.

For people worldwide, an end to the pandemic could mean a return to normalcy and a reduction in the risk of serious illness on the off chance one gets a future variant of Covid-19. For now, the main discussion is what experts are saying about Covid-19 ending.

The current situation

Current data from Our World In Data shows that the latest Covid-19 strain, Omicron, is causing a spike in new infections and reported deaths in almost every country.

In the United States, recorded weekly deaths are at a level last seen in February 2021, while countries like Denmark and Norway are seeing infection surges after officially lifting all mitigative measures.

Conversely, incidences of serious illness, hospitalization, and death from the Omicron variant have not been significantly more than those caused by the Delta variant. Current data suggests that the WHO tagged it as a variant of interest because of its rapid spread, especially among vaccinated and previously infected groups.

The state of vaccinations globally is another benchmark used when discussing the end of Covid-19. Currently, 62.3% of the global population has received at least one dose, most of whom are in developed countries. The current vaccine administration rate stands at 31.82 million daily doses, including booster shots.

Although vaccination and acquired immunity from a previous infection are helping slow down the pandemic, these two factors alone are not enough to end the pandemic, as discussed later in this article.

What can past pandemics teach us about the current pandemic?

Covid-19 is not the first pandemic to impact the global population. Over the history of humankind, dozens of pandemics have surged and tapered off, leaving millions dead and millions more with acquired immunity.

In the recent past, pandemics that significantly impacted the global community include:

  1. Asian Flu; 1957-1958; 1 million
  2. The Spanish Flu; 1918-1920; 50 million
  3. Flu pandemic; 1889-1890; 1 million
  4. Cocoliztli Epidemic; 1545-1548; 15 million

Although these pandemics died off after some time due to herd immunity, the massive death tolls recorded serve as a grim reminder that more must be done to end the pandemic without paying the same price as past generations.

So, what can we learn from these pandemics?

Past pandemics cannot predict the current one

The pandemics listed ended within one to three years of starting. That does not mean the current pandemic will follow a similar timeline. For example, outbreaks of Ebola still pop up now and then, infecting entire communities before disappearing. Experts believe this is a possible outcome of the current pandemic, with localized (endemic) outbreaks affecting communities well into the future.

Calling it over before it is over

In the 1918 flu pandemic, multiple restrictions slowed down infections, like most governments implemented when Covid-19 started. However, a premature return to normalcy in 1918 led to a significant rise in infections and deaths. The lesson here is that individual human behavior substantially determines whether and how soon the pandemic ends.

Viruses never really leave once they come

Over the history of humanity, diseases have come and stuck with us for good. For instance, the bubonic plague, which was responsible for three significant pandemics that killed millions, has been around for thousands of years and still causes localized outbreaks today. The Covid-19 virus might follow this path, joining a legion of pathogens that are now a permanent artifact of human existence.

The endemic endgame

If past pandemics ended when less technologically advanced mitigative measures were available, are we headed to an imminent end with the current pandemic?

Experts believe the most probable end will not be a complete end of Covid-19 but a transition from pandemic to endemic.

Pandemic vs. endemic

  • Pandemic definition: A disease outbreak that spreads to multiple countries and continents exponentially and affects many people.
  • Endemic definition: A disease that affects multiple regions but maintains a baseline of those affected instead of being widespread. For example, seasonal Flu affects multiple countries but does not spread from country to country.

Endemic Covid-19

Covid-19 fits the definition of a pandemic because it affects multiple countries and continents and is widespread. However, the current variant, Omicron, has created a watershed moment that could help the world transition from pandemic Covid-19 to endemic Covid-19.

Models from the Institute of Health Metrics and Evaluation (IHME) show that by mid-January 2022, there were around 125 million new Omicron infections per day, more than ten times the peak of Delta infections. By these estimates, a substantial portion of the global population will get Omicron by late March 2022.

Other data suggests that up to 90% of these infections could be asymptomatic, pointing to a switch in the viral mutation cycle from moderate infection rates and severe illness to high infection rates and less severe disease, much like the Flu.

Combining these data, plus a peak saturation rate of Omicron infections globally, it is possible that we are now entering the endemic phase of Covid-19, where infection outbreaks continue but remain localized and essentially asymptomatic.

This scenario could signal the end of the Covid-19 pandemic, but a lot still depends on how the subsequent Covid-19 variants behave.

New variants might continue pushing back the endemic timeline

Viruses, especially flu viruses like SARS, multiply at an extremely high rate and generate millions of copies of themselves within hours. This high rate of replication leads to genetic errors, most of which are inconsequential but some of which are significant enough to create a mutated version or a variant.

Omicron is currently the all-star variant in terms of rate of spread, which means there might be new variants on the way. How these new variants impact the endemic timeline depends on three main virus character traits.

The extent to which it can evade acquired immunity

As each Covid-19 variant has emerged, a recurring trait is the new variant’s ability to infect more people despite measures such as vaccines, testing, social distancing, and masking.

As future variants of concern (VOCs) emerge, how effectively they evade acquired immunity developed by those vaccinated or previously infected by other variants will determine whether significant portions of populations maintain immunity (herd immunity), limiting the spread of the virus.

Its inherent infectiousness

Virus infectiousness is often expressed as a higher basic reproduction number or R0 (pronounced R-naught). The numeral denotes how many people an infected person can potentially infect.

If the number is R0 or lower, the disease is dying off; if R1 it will continue but is stable; R2 and above means it will spread and cause an outbreak.

Omicron currently has a value of R7, compared to R5 for the Delta variant.

If R0 values of future variants fall from this current all-time high, this will favor the endemic outcome, while similar or higher R0 values could prolong the pandemic.

The severity of disease caused

Omicron is spreading at ten times the speed of the Delta variant. At the same time, severe illness and hospitalization incidences are not significantly higher than during the Delta wave, indicating a much lower capacity to cause severe illness.

As new variants emerge, the severity of illness caused will be crucial in determining their overall impact on society. If more people are infected, but fewer people need hospitalization, this trajectory could add Covid-19 to the dozens of flu viruses that cause endemic outbreaks each year.

Key factors that can help end the pandemic

Virus variants are beyond the control of health agencies and populations, but some measures can help bring the curtains down on the pandemic.

Here are the four most important ones that can help end the pandemic:

1. Routine testing 

Rostered routine testing (RRT) is currently conducted at healthcare facilities to control infections among healthcare personnel in contact with patients. Similar practices are conducted at non-healthcare facilities too.

Although mass testing might not be feasible in the long term, the importance of routine testing is well demonstrated in healthcare settings.

Routine testing approaches like testing before and after traveling and before visiting loved ones in a healthcare facility can offer a more sustainable approach to testing as a long-term solution against the pandemic.

2. Ongoing booster shots

The effectiveness of most vaccines wears off after two to five months, although this may change as vaccines are improved over time.

Booster shots provide extended protection against severe illness, hospitalization, and death from Covid-19 as per this and this studies by the CDC. The studies also found that booster shots are effective against current variants, Delta and Omicron.

Due to the continued mutation of the virus and waning protection, booster shots are an effective way of protecting populations while suppressing the rampant spread of the virus, which can also slow down its mutation into dangerous variants.

3. Oral therapeutics 

Oral therapeutics or oral vaccines are antiviral drugs taken orally to reduce the effects of a Covid-19 infection. Currently, the only oral vaccine granted emergency use authorization (EUA) by the FDA is Pfizer’s Paxlovid.

According to leading healthcare experts, oral therapeutics are not substitutes for vaccines and are only for use in infected individuals at risk of escalating into severe illness and hospitalization.

Nevertheless, they represent a substantial opportunity to reduce severe illness cases, especially once such treatments are approved for home use.

4. Consensus-based public healthcare management methods

One of the many challenges foiling current pandemic management measures in the United States and globally is a lack of consensus-based decision-making in public healthcare.

For instance, healthcare officials propose one set of measures, and government officials pass different measures, resulting in poor pandemic management outcomes.

As such, actively pursuing consensus-based public healthcare management methods can help create a unified approach to the long-term management of the pandemic, building systems, and structures that foster an enduring post-pandemic world.

What does a post-pandemic world look like?

If past pandemics have taught us one thing, it’s that societies are often permanently changed in the wake of a pandemic. For example, the typhoid and cholera pandemics gave rise to sewerage systems, malaria to door and window screens, measles and chickenpox to early childhood vaccination, and HIV/AIDS to protected sex.

Although the hope is to return to pre-pandemic normalcy once this pandemic is over, this might not be the case. Socio-economic changes like the work from home (WFH) movement have not slowed down, even as companies have resumed full operations. Similarly, a trend towards a work-life balance, emphasizing mental health and wellbeing, does not seem to be slowing down.

On the disease front, the most likely scenario is endemic Covid-19 managed through oral therapeutics, vaccine booster shots, masks, and social distancing for at-risk persons. Countries like Norway and Sweden have already embraced this future by lifting all Covid-19 restrictions and retaining them even as Omicron infections rise in their populations.

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The end of the Covid-19 pandemic is nearing, but the virus will most likely live on as an endemic disease. Distinguishing these two dynamics provides a clear end to the pandemic that societies can look towards.

What might not change after the pandemic dust settles is the need for individuals to protect themselves based on individual risk factors through routine testing, vaccine boosters, oral therapeutics, and social tools like masking and distancing.

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