What is an ‘endemic’ and will we ever get there with COVID-19?

Texas Politics

AUSTIN (Nexstar) — After a weekend of Texas-sized events and the summer COVID-19 surge appearing to be turning, many are wondering if the worst is truly behind us.

Most epidemiologists will say it’s hard to predict.

Dr. Jennifer Shuford, Texas’ chief epidemiologist, said at least for now, the current trends are promising for the Lone Star State.

“One thing that was expected is that we would have steep increases in cases and hospitalizations just because this last variant was so contagious — the Delta variant,” she said. “So we expected it to burn through the population quickly, which is just what happened. But we’re happy that we are seeing declines now in cases, in hospitalizations kind of earlier than we did during the last wave that we had.”

About 59% of Americans are fully vaccinated, with many states still under 50%, making the concept of herd immunity less within close reach. For comparison, President Joe Biden’s original vaccination goal was to get shots in the arms of at least 75% of Americans by July 4. Herd immunity is estimated to be anywhere from 75% to 85% of a community.

Dr. John Carlo is a Dallas-area physician who is also a member of the Texas Medical Association COVID-19 Task Force. He said the problem with the herd immunity benchmark is it has to be a global goal, since this is a pandemic, not an epidemic.

“Unfortunately, we’re not where we need to be in many places throughout the world, which gives us an ever-present risk of having not only new transmissions coming back into our communities, but new variants and new mutations, because the virus is freely circulating in other areas,” Carlo said.

Worldwide, only 35.5% of the population is fully vaccinated. Spain, for example, has one of the highest rates with nearly 78% of its citizens vaccinated. Compare that with Bangladesh, where just about 11% of its citizens are fully vaccinated.

It’s leading many to ask: “will this pandemic become an endemic?” An endemic is a disease that does not go away, one that is regularly found in particular areas or populations.

Again, most epidemiologists will tell you: it’s hard to predict.

Carlo does not like using the term “endemic” to describe the possibility of where this virus could go, because it implies our society could be okay living with this forever. He said the biggest difference between COVID-19 and the seasonal influenza virus is its mortality rate.

“The percentage of people who have really severe illness from a coronavirus infection is much, much higher than even the most severe flu season,” he said. “So we would not want to rely on sort of the current seasonal flu pattern to sort of say that’s something we can deal with, with this virus.”

The second biggest difference is that influenza strains have been around for centuries and SARS-CoV-2 is still novel. Shuford, however, doesn’t rule out the possibility of COVID-19 becoming a seasonal disease.

“What we’ve seen with previous flu pandemics is that the pandemic will come, and it’ll affect most of the globe. And then the population will get some sort of immunity to it. And it continues to circulate as a seasonal flu virus, but it doesn’t have that same case fatality rate, or it doesn’t kill as many people during subsequent seasonal circulation of that virus,” she said.

Shuford and Carlo disagree slightly on what the future of this virus looks like but agree on the tools at our disposal now, and it’s nothing new: vaccinations.

“As long as there are pockets of people who haven’t been infected or haven’t been vaccinated, we can still see small outbreaks or big outbreaks across our state,” Shuford said. “Resulting in hospitalizations and deaths, all those really bad things that we’re hoping to avoid.”

They are hoping vaccine approval for children could be a game changer, given that schools are one of the most densely-populated social settings in society.

“If we can start making sure that our kids can be in the school safely, that really is the stabilizing effect,” Carlo said.

Neither of them recommend antibody treatments in place of the vaccine but say antiviral treatments like such will also be key tools in defeating this pandemic.

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