Vaccination drives hold out the promise of curbing Covid-19, but governments and businesses are increasingly accepting what epidemiologists have long warned: The pathogen will circulate for years, or even decades, leaving society to co-exist with Covid-19 much as it does with other endemic diseases like flu, measles, and HIV.
The ease with which the coronavirus spreads, the emergence of new strains and poor access to vaccines in large parts of the world mean Covid-19 could shift from a pandemic disease to an endemic one, implying lasting modifications to personal and societal behavior, epidemiologists say.
“Going through the five phases of grief, we need to come to the acceptance phase that our lives are not going to be the same,” said
Thomas Frieden,
former director of the U.S. Centers for Disease Control and Prevention. “I don’t think the world has really absorbed the fact that these are long-term changes.”
Endemic Covid-19 doesn’t necessarily mean continuing coronavirus restrictions, infectious-disease experts said, largely because vaccines are so effective at preventing severe disease and slashing hospitalizations and deaths. Hospitalizations have already fallen 30% in Israel after it vaccinated a third of its population. Deaths there are expected to plummet in weeks ahead.
But some organizations are planning for a long-term future in which prevention methods such as masking, good ventilation and testing continue in some form. Meanwhile, a new and potentially lucrative Covid-19 industry is emerging quickly, as businesses invest in goods and services such as air-quality monitoring, filters, diagnostic kits and new treatments.
A person slept outdoors to save a spot in line for a limited number of oxygen-tank refills during a Covid-19 outbreak in Peru last week.
Photo:
sebastian castaneda/Reuters
The number of gene-detecting PCR tests produced globally is expected to grow this year, with manufacturers like New Jersey’s
Quest Diagnostics
predicting that millions of people will need a swab before they attend concerts, basketball games or family functions.
“We assume it would last for years, or be eternal, such as the flu,” said Jiwon Lim, spokesman for South Korea’s SD Biosensor, Inc., a test maker that is ramping up production of at-home diagnostic kits. Leading drug makers—Switzerland’s Novartis International AG and
Eli Lilly
& Co.—have invested in potential Covid-19 therapies. More than 300 such products are currently in development.
Airlines like
Lufthansa
are restructuring to focus on short-haul flights within Europe, and away from Pacific countries that have said they’ll keep borders closed for at least this year. Some airports are planning new vaccine passport systems to allow inoculated passengers to travel. Restaurants are investing in more takeout and delivery offerings. Meatpacking plants from Canada to Europe are buying up robotic arms, to curb the risk of outbreaks by reducing the number of workers on assembly lines.
Diseases are considered endemic when they remain persistently present but manageable, like flu. The extent of the spread varies by disease and location, epidemiologists say. Rabies, malaria, HIV and Zika all are endemic infectious diseases, but their prevalence and human toll vary globally.
Very early on, after countries failed to contain the coronavirus and transmission raged globally, “it was evident to most virologists that the virus would become endemic,” said John Mascola, director of the National Institutes of Health’s Vaccine Research Center. “When a virus is so easily transmitted among humans, and the population [lacks immunity], it will spread any place it has the opportunity to spread. It’s like a leak in a dam.”
Immunologists now hope vaccines will prevent transmission, a finding that would drastically reduce the virus’s spread. An Oxford University study published last week found people given the
AstraZeneca
vaccine might be less likely to pass on the disease.
A woman got a Covid-19 vaccine from a member of the National Guard on Saturday at a mass vaccination site in Maryland.
Photo:
Sarah Silbiger/Getty Images
Still, there are vast pockets of the human population that will remain beyond the reach of a vaccine for the foreseeable future, giving the virus plenty of room to continue circulating.
There is currently no vaccine authorized for young children, and supply issues will leave most of the developing world without a shot until late next year at the earliest. Meanwhile, Europe has seen high rates of vaccine refusal: Less than half of French people were willing to get a shot when asked in a recent YouGov poll.
As scientists develop new treatments, Covid-19 will further “become an infection that we can live with,” said Rachel Bender Ignacio, an infectious-disease expert at the Fred Hutchinson Cancer Research Center in Seattle. As such, she said, it will be important to develop therapies for the persistent debilitating symptoms that many patients struggle with months after getting sick, like memory fog, loss of smell and digestive and heart problems.
Some countries like Australia and New Zealand have brought their average daily case counts into the low single digits, but neither ever experienced the enormous outbreaks that the Americas and Europe continue to see, and both island nations have watched the virus slip past their strict travel restrictions.
“I don’t believe we should start setting elimination or eradication of this virus as the bar for success,” said Mike Ryan, executive director of the World Health Organization’s emergencies program. “We have to reach a point where we’re in control of the virus, the virus is not in control of us.”
The Tampa, Fla., convention center on the day before Super Bowl LV; demand for Covid-19 tests is expected to explode as millions of people get swabbed before sports, cultural and family events.
Photo:
shannon stapleton/Reuters
Just one human virus has been entirely eradicated in modern history: smallpox. While that disease infected only people, the novel coronavirus can spread among small mammals like mink, then, though less effectively, back into humans, turning the world’s fur farms into potential reservoirs for the virus.
Moreover, tens of millions of Covid-19 cases have given the virus ample opportunity to improve its ability to infect other mammals, said Sean Whelan, a virologist at Washington University in St. Louis. A mutation present in the variants from South Africa and the U.K. gave the pathogen the ability to infect mice, he said.
Diseases that spread from people who don’t show symptoms—often the case with the coronavirus—are particularly hard to eradicate. Decades of multibillion-dollar global efforts haven’t eradicated another such disease, polio, which, while eliminated from the U.S. in the 1970s, was cleared from Europe only in 2002 and still exists in Afghanistan and Pakistan.
Respiratory viruses like the novel coronavirus are prone to becoming endemic because they can transmit through usually benign acts, like breathing and talking, and can be particularly good at infecting cells. They include OC43, a coronavirus that researchers now think caused the Russian Flu of the 1890s, a pandemic that killed one million. That virus—still present in the population—is responsible for many common colds, though it has become less virulent likely because people developed immunity.
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Mutations in the novel coronavirus variants appear to have made it better at infecting human cells or at evading some antibodies, raising concerns that existing vaccines might become less effective. Scientists say monitoring for new variants will be critical to vaccination programs long term. Understanding their characteristics will help determine whether the shots need to be updated periodically, as they are for flu.
Vaccinations will be just as important when the pandemic subsides and Covid-19 becomes endemic.
“People seem to think that when a virus becomes endemic, it becomes attenuated and it doesn’t become as serious,” said Angela Rasmussen, a virologist at the Center for Global Health Science and Security at Georgetown University. The misconception stems from the fact that usually viruses evolve to maximize the number of people they infect before they kill.
But most people survive Covid-19, so “there’s not a lot of pressure for this virus to become more attenuated because it’s already spreading and finding new hosts and new opportunities to replicate before its hosts are getting sick,” she said. “It’s doing just fine.”
Write to Daniela Hernandez at [email protected] and Drew Hinshaw at [email protected]
Copyright ©2020 Dow Jones & Company, Inc. All Rights Reserved. 87990cbe856818d5eddac44c7b1cdeb8
Vaccination machines promise to contain Covid-19, but governments and corporations are increasingly carrying out what epidemiologists have long warned: the pathogen will circulate for years, even decades, allowing society to coexist with Covid-19 as it does with other endemic diseases such as influenza, measles and HIV.
The ease with which the coronavirus is spreading, the emergence of new strains and poor access to vaccines in many parts of the world mean that covid-19 could evolve from a pandemic to an endemic disease, requiring long-term changes in personal and public behavior, according to epidemiologists.
“After going through the five stages of grief, we must move on to the stage where we accept that our lives will never be the same,” he said.
Thomas Frieden,
former director of the U.S. Centers for Disease Control and Prevention. “I don’t think the world has really realized that this is a long-term change.”
According to infectious disease experts, endemic covid-19 does not necessarily mean permanent control of coronaviruses, in part because vaccines are so effective in preventing serious illness and also in reducing hospitalizations and deaths. In Israel, hospitalizations have already been reduced by 30% after a third of the population was vaccinated. The death rate there is expected to fall sharply in the coming weeks.
However, some organizations envision a long-term future in which prevention methods such as taping, proper ventilation and testing will be maintained in some form. Meanwhile, the potentially lucrative new Covid 19 industry is growing rapidly, with companies investing in products and services such as air quality monitoring, filters, diagnostic kits and new treatments.
A man slept outside to get a seat in line for limited oxygen bottles during last week’s Covida 19 outbreak in Peru.
Photo:
Sebastian Castaneda/Reuters
More PCR tests for gene detection are expected worldwide this year, with manufacturers such as New Jersey’s
Quest Diagnostics
predict that millions of people will need a swab before attending concerts, basketball games or family gatherings.
“We expect it to last for years or forever, like the flu,” said Jiwon Lim, spokesman for SD Biosensor, Inc. of South Korea, a test manufacturer that is ramping up production of diagnostic home test kits. Leading drugmakers Novartis International AG of Switzerland and
Eli Lilly
& Co. have invested in potential Covid 19 therapies. More than 300 such products are currently in development.
Airlines such as
Lufthansa
A restructuring is underway to emphasize short-haul flights within Europe and from Pacific countries, which have declared that they will keep their borders closed for at least this year. Some airports are planning new vaccination passes to allow vaccinated passengers to travel. Restaurants are investing more in delivery services and takeout. Meat processors from Canada to Europe are buying robotic arms to reduce the risk of disease outbreaks by reducing the number of workers on the assembly line.
Diseases are considered endemic when they are persistent but treatable, such as influenza. According to epidemiologists, the degree of spread varies by disease and location. Rabies, malaria, HIV and Zika are endemic infectious diseases, but the prevalence and number of victims vary from country to country.
Very early on, after countries failed to contain the coronavirus and transmission spread around the world, “it became clear to most virologists that the virus would become endemic,” said John Mascola, director of the Vaccine Research Center at the National Institutes of Health. “If the virus can be transmitted so easily between people and the population [is not immune], it will spread wherever it can. It’s like a leak in a dam.”
Immunologists now hope that vaccines can prevent the transmission of the virus and thus dramatically limit its spread. A study published last week by the University of Oxford found that people who had
AstraZeneca
the vaccine is less likely to transmit the disease.
A woman received the vaccine Covid 19 from a member of the National Guard at a mass vaccination site in Maryland on Saturday.
Photo:
Sarah Silbiger/Getty Images
However, large portions of the human population will remain inaccessible to the vaccine for the foreseeable future, giving the virus ample opportunity to continue circulating.
Immunization of young children is not currently allowed and, due to supply problems, most developing countries will not be vaccinated until late next year at the earliest. Moreover, the refusal rate in Europe is high: according to a recent YouGov poll, less than half of French people were willing to be vaccinated.
As scientists develop new treatments, Covid-19 “will become an infection we can live with,” said Rachel Bender Ignacio, an infectious disease expert at the Fred Hutchinson Cancer Research Center in Seattle. That’s why, she said, it’s important to develop treatments for the persistent and debilitating symptoms that many patients struggle with for months after their illness, such as memory loss, loss of smell, and digestive and cardiac problems.
In some countries, such as Australia and New Zealand, the average number of cases per day has been low or even dropped by single digits, but neither country has ever had to deal with the massive epidemics still seen in America and Europe, and both island states have seen the virus escape their strict travel restrictions.
“I don’t think we should start looking at eliminating or eradicating this virus as an obstacle to success,” said Mike Ryan, executive director of the World Health Organization’s Emergency Response Program. “We need to get to a point where we control the virus and the virus doesn’t control us.”
Tampa, FL, convention center on the eve of the LV Super Bowl; demand for the Covid 19 survey is expected to explode as millions of people take samples for sports, cultural and family events.
Photo:
Shannon Stapleton/Reuters.
Only one human virus has been completely eradicated in modern history: smallpox. Although this disease has so far only infected humans, a new coronavirus may spread among small mammals such as mink and then return to humans, albeit less efficiently, making the world’s fur farms potential reservoirs for the virus.
Moreover, tens of millions of cases of Covida 19 disease have given the virus ample opportunity to improve its ability to infect other mammals, said Sean Whelan, a virologist at Washington University in St. Louis. A mutation found in variants from South Africa and Britain has enabled the pathogen to infect mice, Whelan said.
Diseases that spread among people who have no symptoms-as is often the case with coronaviruses-are extremely difficult to eradicate. Decades of billion-dollar global efforts have failed to eradicate another such disease, polio, which was eradicated in the United States in the 1970s but not in Europe until 2002, and which continues to occur in Afghanistan and Pakistan.
Respiratory viruses such as the new coronavirus tend to be endemic because they can be transmitted by normally harmless actions such as breathing and talking, and can be particularly effective at infecting cells. These include OC43, the coronavirus that researchers believe caused the Russian flu in the 1890s, a pandemic that killed one million people. This virus – still present among the population – causes many colds, although it has become less virulent, probably because people have developed immunity.
SHARE MY THOUGHTS
How have you adapted to the “new normal” of Covid-19 over the past year? Join the discussion below.
Mutations in new variants of the coronavirus appear to make the virus more capable of infecting human cells or bypassing certain antibodies, raising concerns that existing vaccines may become less effective. Scientists say monitoring new variants will be essential for long-term vaccine programs. Understanding their properties will help determine whether vaccines need to be updated regularly, as is the case with flu vaccines.
Vaccination will be equally important if the pandemic subsides and Covid-19 becomes endemic.
“People seem to think that when a virus becomes endemic, it becomes weaker and less severe,” said Angela Rasmussen, a virologist at the Center for Global Health and Safety Sciences at Georgetown University. This misconception stems from the fact that viruses generally evolve to maximize the number of people they infect before killing them.
But most people survive Covid-19, so “there’s not a lot of pressure to contain this virus, because it’s already spreading and finding new hosts and new opportunities to reproduce before its hosts get sick,” she said, “it’s doing well.
Email Daniela Hernandez at [email protected] and Drew Hinshaw at [email protected].
Copyright ©2020 Dow Jones & Company, Inc. All rights reserved. 87990cbe856818d5eddac44c7b1cdeb8
