Covid Will Soon Be Endemic, Thank Goodness

Widespread immunity, vaccinated and natural, will bring control and a full return to normal.

By Monica Gandhi. Dr. Gandhi is an infectious-disease physician and professor of medicine at the University of California, San Francisco. Excerpts:

"A disease becomes endemic when it is manageable—defined, for instance, as not causing an undue burden on hospitals or other healthcare resources—but is unlikely to be eliminated because of the pathogen’s inherent properties."

"Australia, China and New Zealand have pursued “zero Covid” policies that aim at elimination (reducing incidence in a region to zero) or even eradication (world-wide elimination). That goal is unrealistic. Smallpox is the only human disease that has ever been eradicated. The smallpox virus has had four properties that made it eradicable: the lack of an animal reservoir, clear and distinctive signs and symptoms, a short period of infectiousness, and both lifelong natural immunity after survival and a highly effective vaccine.

SARS-CoV-2, by contrast, is unlikely to be eradicated. It has animal reservoirs, a high level of transmissibility (especially of the Delta variant), and overlapping symptoms with other respiratory diseases. It has, as well, a prolonged period of infectiousness, caused by its propensity to spread from asymptomatic or presymptomatic carriers."

"Many ineradicable infections are controlled by vaccination and treatment. Measles, a highly transmissible respiratory virus, created high levels of immunity among adults who were exposed as children. But until a vaccine was developed in 1963, some nonimmune adults died every year."

"Antibodies generated by the vaccines will naturally wane, but the vaccines trigger the creation of B cells that get relegated to our memory banks, and these memory B cells produce high levels of neutralizing antibodies if they see the virus again, even in variant form. Memory B cells are long-lasting."

"T cells (also put into cell memory) generated by the vaccines protect us from severe disease and are unfazed by variants."

"As circulation of the virus decreases with increasing immunity, Covid-19 will go the way of other respiratory viruses over which we have control. We will test those who arrive at the hospital for a variety of infections—including influenza, Covid-19, respiratory syncytial virus (mainly in children) and bacterial pathogens—and tailor treatments to the infectious agent."

"Denmark dropped all restrictions at a 74% vaccination rate and low cases on Sept. 10, and Norway dropped them on Sept. 25 at a 67% vaccination rate. Many U.S. states had an undue burden of hospitalization during the Delta wave, although California is keeping restrictions in place despite low hospitalization and high vaccination rates. We will need to accept that the noneradicable disease is endemic. A low burden of disease should facilitate the transition."

"no virus in history has ever continued to evolve to higher pathogenicity."

"No vaccine-preventable or immunity-inducing infection has ever raged on as a pandemic indefinitely. An endemic virus doesn’t require continuing isolation and other restrictions; defanging SARS-CoV-2 by stripping it of its ability to cause severe disease through immunity will relegate it to the fate of the other four circulating cold-causing coronaviruses."