Is the pandemic over?

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Can I be the bearer of bad news? 

You’re not here to answer and the news won’t surprise you anyway, so I’ll just go ahead: The World Health Organization tells us that the pandemic’s not over. 

How do I know? Because Tedros Adhanom Ghebreyesus, WHO’s director general said, “This pandemic is nowhere near over.”

That’s a subtle way of putting it, but if you pay close attention you can tease out the message.

He also said, “Omicron may be less severe, on average, but the narrative that it is a mild disease is misleading. Make no mistake: Omicron is causing hospitalisations and deaths, and even the less severe cases are inundating health facilities.”

And if that’s not enough, “While Omicron causes less severe disease than Delta, it remains a dangerous virus—particularly for those who are unvaccinated. We mustn’t allow this virus a free ride or wave the white flag, especially when so many people around the world remain unvaccinated.”

The “overwhelming majority” of people admitted to hospitals are unvaccinated, he said.

 

Irrelevant photo: The first daffodils are out.

Has Covid gone endemic?

But what about the idea that Covid’s changing from a pandemic to an endemic disease and that we need to stop whining and learn to live with it? 

Let’s start by figuring out what that means: An endemic disease is “consistently present but limited to a particular region. This makes the disease spread and rates predictable.” 

Sorry, but I need to step in here. That last sentence doesn’t mean that being consistently present and limited to one region makes the disease spread. It means those things make the disease’s spread predictable.

Which was probably already clear, but I couldn’t help myself. I used to misunderstand people for a living, and old habits are hard to break.

So how do we measure up to that definition? We’ve blown it on the “limited to a particular region” part, but let’s not be fussy. Are the spread and rate predictable? 

Nope. Not only do we have sharp spikes, we have no idea when a new variant will come along or how dangerous or benign it’ll be. We do know that the climate’s right for creating new variants.

Another defines an endemic disease as constantly present but not causing the upheaval or massive number of infections that an epidemic does. Covid hasn’t become endemic by that definition either.

But again, let’s not be fussy. Even if Covid doesn’t fit either definition, couldn’t we pretend it does, get over our fear, and learn to live with it?

Well, it depends on how we want to live. Or die. Being endemic doesn’t mean it’s no threat. Before penicillin, tuberculosis was endemic. [Late correction: Penicillin has nothing to do with tuberculosis. See the comments below. It’s the things you think you know that trip you up.] So was syphilis. They wrecked a lot of lives. They killed a lot of people. People learned to live with them because they had no choice, but I wouldn’t make a virtue of it. 

It would be interesting to look at how much resistance measures to control their spread met. But that’s another post.

Learning to live with Covid is one of those phrases that, when you look at it, means nothing. Does it mean we tear off our masks, join a germ exchange, and relearn the lyrics to that Country Joe and the Fish song with the line “Whoopee, we’re all going to die”? Or does it mean we wear masks religiously, invest in some serious ventilation, and pass vaccine mandates? They’re both ways of living with a virus.

Does it mean learning to live with a constant threat, not just of death but of disability from long Covid–a threat that no one’s been able to quantify yet? If so, how will we decide to live with it?

Michael Ryan, the head of emergencies at WHO, said, “Endemic malaria kills hundreds of thousands of people; endemic HIV; endemic violence in our inner cities. Endemic in itself does not mean good. Endemic just means it’s here forever.”

Okay, he skipped the predictable part, but we did say we weren’t going to be fussy.

“What we need to do is get to low levels of disease incidence with maximum vaccination of our populations, so nobody has to die,” Ryan said. “The issue is: It’s the death. It’s the hospitalizations. It’s the disruption of our social, economic, political systems that’s caused the tragedy—not the virus.”

And in case you’re betting on the next variant being milder than Omicron, mutation isn’t a one-way street. The direction of travel is random. 

 

Could you scrape up some good news, please?

Possibly, but let’s whisper so we don’t spook it: Some experts say that once the Omicron wave recedes we may get a period of quiet. The theory is that we’ve built up widespread immunity that could keep future waves from hitting as hard as they have in the past. 

Do waves hit? Is that a mixed metaphor? Do we care?

Probably, but let’s focus on the important stuff.

That’s not a unanimous opinion and other experts are more cautious, reminding us that it’s not clear how long Omicron immunity will last or whether a new variant will evade it. Omicron has demonstrated that even a relatively mild version of Covid can put a huge strain on health systems–and on the people who work in them. 

And as Boghuma Titanji, a virologist at Emory University School of Medicine, put it, “Wealthy countries moving on, I fear, will push the issues of access to vaccines and therapeutics access down the global priority list.” Which would mean not only more deaths in poor countries but (self-interest alert here) more variants loose in the world.

On the other hand, data suggests that the human immune response becomes better and broader every time it’s exposed to Covid’s spike protein. 

On the third hand, however, Leif Erik Sander, an immunologist at the Charité University Hospital, says that Omicron’s spike is so different from the spike in earlier variants that it’s not clear just how much immunity the Omicron wave will leave us with.

At which point we’re out of hands and it’s time to talk about what the next variant might look like. One possibility is that Delta could stage a comeback tour. Omicron was able to spread so quickly in part because the earlier versions hadn’t left us immune to it. Once that advantage fades, it may die back, leaving Delta room to work. Or they could work out their disagreements, move in together, and have babies, which could easily be uglier than either parent.

And, since a handful of antibodies does not an immune system make, what happens if a new variant evades not just our antibodies but our T cell response? (Reminder: T cells are an essential part of your immune system. Don’t leave home without them.) Well, if that happens “we’re dealing with another pandemic,” Shabir Madhi, a vaccinologist at the University of the Witwatersrand, said. But “the likelihood of that happening, I believe, is quite slim.”

 

Let’s try that good news thing again . . .

. . . because my last try didn’t go well.

Researchers in Finland are working on something they call a biological mask–a spray that could (assuming the tests go well) protect a person against Covid for 8 hours. 

It’s not meant to replace vaccines but to supplement them. If a person’s immune system doesn’t respond well to the vaccines, this spray is their friend. Or if they’re faced with a combination of a vaccine-evading variant and too many human beings in a risky setting, then ditto. 

The active molecule in the spray is called TriSb92, a name I forgot as soon as I got past the comma. Never mind. It’s a clever little beast that targets a part of Covid’s spike protein that’s common to all variants–at least so far–and once it makes contact it keeps the virus from going to work. You know what that’s like. It calls in sick and loses its job because spike proteins have no union and therefore no sick leave and no job security. 

If it was anything other than the Covid virus I’d feel bad about that, but it’s got it in for us. Have no mercy.

The developers think the spray might also be effective against new coronaviruses that emerge. Keep your fingers crossed. This sounds promising.

46 thoughts on “Is the pandemic over?”

  1. You write “Before penicillin, tuberculosis was endemic. So was syphilis.”
    Penicillin cures syphilis, but not tuberculosis.
    The steep decline of tuberculosis at the start of the twentieth century was caused by improvement in living standards, better hygiene, less overcrowding, etc and happened before we had drugs to treat tuberculosis and BCG vaccination.

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  3. Timely piece (as ever) Ellen. I felt bad when speaking to my mother earlier this week to have to give her this same warning about Omicron. She was listening to the news reports that it was mild and believing it completely. She wasn’t alone in this as, in her building (where you have to be a minimum of 60 years of age to live) they’d just gathered for a tea party to celebrate the 97th birthday of one of the residents. No-one was masked, it was held indoors without any ventilation arrangements, and no-one maintained social distancing – hell, a lot of them have trouble hearing at the best of times, so that was inevitable. It was a hard decision as to whether to keep this knowledge to myself and just hope that the vaccine(s) will keep her safe, or to warn her. I came down on the side of caution, but suspect it will add to her low mood.

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    • Frozen? C’mon, my friend, I get reports from Minnesota, where they celebrate if the temperature goes above 0 Fahrenheit.

      Oops. Sorry. You were being so nice, I shouldn’t get grumpy on you, should I? Endless thanks. A double dose of my writing is guaranteed to last you through one large cup of tea, possibly with biscuits, but does not, sadly, protect against Covid.

      Stay well up there, okay?

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  5. I am in the increasingly small number of people that has not had covid, possibly due to general antisocial tendencies…

    One thing I know is I would like to keep it that way and am not stopping wearing my mask in shops and on trains no matter what Boris et al say!

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    • Presumably, at some point, it will settle into a more predictable pattern and be endemic. But I hope our friends the medical geniuses will come up with something more protective than that, whether its along the lines of the chemical mask or a universal coronavirus vaccine. I’m not fussy. But even as an endemic disease, I really hope we don’t have to live with this as a constant threat in our lives.

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  7. Given human nature, I hope, if this virus is not going to go away, that we don’t get a break from it. If we do, the cry from the masses will change from “no masks” to “not going back to those days.”

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    • I expect you’re right. There was a time when I wasn’t convinced there was such a thing as human nature (don’t ask–I was young), but I have a hunch you’ve read it right.

      Or maybe that’s not exactly human nature but what human nature has become in the societies we live in. I expect it could turn into something very different given half a chance. At least I like to think so.

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  8. I really had to process a lot of bad news here before I thankfully heard a ray of hope.
    Thank goodness I held my newborn second granddaughter yesterday for a few minutes and promised her I would do my best to work for a better place for her – so please excuse Pretty and me for doing our Happy Dance – Covid be damned today.
    I wasn’t prepared for this rush of emotion a second time. Watching our 2 year old Ella hold her little sister caused both her Nanas to weep tears of joy.

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  9. Haven’t figured out how to get toat UV light to work in my car when I make the weekly grocery/cat food run. Maybe stuck in a head band ?
    The daffodil blooming RIGHT NOW was a very positive part of your post, not to be underestimated ! Today the high was 20 F which was 20 degrees higher than yesterday, and we still have more than a foot of snow hanging around from 10 days ago.
    We especially thank you for sorting out all this news so we can get right to the point.

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  10. I like the idea of this nasal spray. It would be nice if it was over the counter, but that’s not likely to happen. This whole thing has been pretty crazy. I can’t get over the human behavior I’ve seen because of it and the consequences of that. But I’ve still got my guard up and my mask on whenever I go to shops or public indoor spaces. We’ll see.

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    • People, I swear, can convince themselves of anything. Almost. At least for a while. So in the name of We Have to Live with This, they’re taking risks that damn well aren’t necessary, as if the one follows inevitably from the other.

      Oh, hell, I think I need to find some really good trashy reading. Good trash is hard to find.

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  12. I think that regarding the pandemic we have to make our own decisions about face masks and social distancing and not rely on anybody else. It all comes down to common sense. At the moment the Government doesn’t seem to have any common sense, and so we have to rely on our own judgements.

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  13. Well, it’s not as if coronavirus were new. Only a mutation that 1 out of 20 people actually noticed having was new. It would be surprising if it didn’t go back to being an endemic virus that humans can easily live with, by ignoring it as “bird flu.”

    Here in Virginia there’s a solid consensus that it’s there already. Also that government should not be trying to manage medical concerns, because human health is so not “one size fits all.” This is not, however, new. We went along with the “panic” narrative because the 1 out of 20 people might be missed, but now the 1 out of 20 is gone–probably not missed, as most of them were very ill and not expected ever to get better.

    And of course up north, where people seem to be still in real danger, they’re doing large-scale demonstrations. Can they be blamed? Their supply of panic was used up before the original virus got close to them. Now they’re out in the weather, spreading…and some e-friends from the northern plains say whatever variants they’ve had have actually made them ill.

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    • We’re going to have to disagree on this, but I’m tired of arguing about it. A friend who died of Covid was not already ill, or unhealthy. A surprising number of people around me have long Covid, which ranges from annoying to life changing. Because it’s still so poorly understood there’s no clear definition of it yet, so any count of the people struggling with it is inherently guesswork, but Hawley’s Small and Unscientific Survey says it’s a substantial number. Governments and health systems have not yet reckoned with the impact, but I predict it’ll be substantial.

      As for governments intervening in health issues, they have from as far back as the Black Death–our word quarantine comes from the response of one of the Italian city-states. Some health issues are definitely individual and some are public health issues, when there’s no effective way to address them except as a society. As for the Canadian truckers and their allies, some of them have been harassing mask wearers on the street and they raise the question of whether their individual right to not wear one trumps someone else’s individual right not to be infected by them.

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