How does this pandemic end?

Recently some politicians and health experts have been predicting that COVID will soon shift from a pandemic to an “endemic” phase.  But what does that mean?  Endemic is a technical term that describes a disease that is commonly present in the population, but it doesn’t spread rapidly or cause major outbreaks.  Endemic diseases can still cause major suffering and death — malaria is a deadly disease that is endemic in parts of Africa, for example — but to describe a disease as endemic often implies that its occurrence is stable and predictable.

That certainly doesn’t describe the current situation with COVID.  The incidence of new COVID cases in California, including Plumas County, is higher now than at any other time in the pandemic.  And although the new Omicron variant of the coronavirus is less deadly than previous variants, the death rate from COVID is still high.  California registered about 50,000 COVID deaths in 2021 and is on track toward 16,000 this year at the current rate.  To put these numbers in perspective, California has less than 1,000 deaths from influenza in a typical year, and that number is still too high, given that influenza is preventable and treatable.

The rates of new COVID cases and deaths will have to come down a long way to be on the same level as influenza.  To get there, we’ll need higher levels of population immunity and better ability to treat people who get sick with COVID.  There are reasons to be optimistic on both counts: immunity has expanded significantly in the last year due to vaccination and infections by the Delta and Omicron variants, and highly effective new medicines are coming online.  We’ll also need to avoid the development of more dangerous variants of the coronavirus.  That will depend partly on increasing immunity worldwide and partly on luck, because viruses mutate largely at random.

Looking at the way we approach influenza can be helpful in thinking about how things could change if COVID enters a different phase.  We don’t try to count every case of influenza, and we don’t routinely trace contacts or issue quarantine orders. Instead, we focus on monitoring and preventing hospitalizations and deaths.  To control the spread and severity of influenza, we rely first on vaccination and second on commonsense measures like reminding people to stay home if they’re sick.  And because the flu virus is constantly evolving, we conduct campaigns to give influenza “booster” shots that are updated every year.

So far COVID has proven to be more contagious and deadlier than the flu, so the way we handle it in a post-pandemic world may look a bit different, at least in the near future. However, if we succeed in bringing the current wave of COVID under control, we’re likely to continue emphasizing vaccination to maintain high levels of immunity.  If new viral variants keep appearing, COVID vaccinations might be updated regularly, similar to flu vaccines, and people will go to a clinic or pharmacy every year for a combination flu-COVID shot.

We can also hope to turn primarily to individual responsibility, rather than requirements and restrictions, to control the spread of infection.  Expanding home testing can help here.  Being able to test themselves empowers people to take action to avoid infecting others and to get medical attention if they need it.  And although it’s always better to prevent disease than to treat it after people get sick, we have medications now that can be taken at home to prevent the worst effects of COVID and avoid a hospital stay.

In the centuries before the mechanisms of infection were understood or effective vaccines and treatments were available, pandemics died out naturally, but the consequences were often severe.  The bubonic plague killed half the population of Europe in the Middle Ages, then came back in several waves during the next 500 years.  That pattern began to change about 100 years ago.  Since the middle of the 20th Century, most pandemics have been stopped through a combination of vaccination and public health measures.

If we’re able to weather the current surge, continue building immunity through vaccination and avoid more deadly virus variants, our approach to COVID should be able to shift from emergency response to routine control.  That would mean that, for most people most of the time, it will be possible to go about daily life without the emergency measures we’ve lived with for the past two years.