As vaccines increase hope, the cold reality emerges: Covid-19 is likely to stay

“Going through the five phases of mourning, we need to get to the acceptance phase that our lives will not 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 does not necessarily mean that coronaviruses continue to be restricted, infectious disease experts said, primarily because vaccines are so effective in preventing serious illness and reducing hospitalizations and deaths. Hospitalizations have already dropped 30% in Israel after vaccinating a third of its population. Deaths are expected to fall in the coming weeks.

But some organizations anticipate a long-term future in which prevention methods such as masking, good ventilation, and testing continue in some way. Meanwhile, a new and potentially lucrative Covid-19 industry is emerging rapidly as companies invest in goods and services such as air quality control, filters, diagnostic kits and new treatments.

The number of PCR tests to detect genes produced worldwide is expected to grow this year, as manufacturers such as Quest Diagnostics of New Jersey predict that millions of people will need a swab before attending concerts, basketball or family functions.

“We assume it would last for years, or it would be eternal, like the flu,” said Jiwon Lim, a spokesman for SD Biosensor, Inc. of South Korea, a testing manufacturer that increases the production of diagnostic kits at home. The leading drug manufacturers, the Swiss Novartis International AG and Eli Lilly & Co., have invested in possible Covid-19 therapies. More than 300 such products are currently being developed.

Airlines such as Lufthansa are restructuring to focus on short-haul flights within Europe and outside the Pacific countries that have said they will keep borders closed at least this year. Some airports are planning new vaccine passport systems to allow inoculated passengers to travel. Restaurants invest in more takeaway and delivery offerings. Meat packaging plants from Canada to Europe buy robotic weapons 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 controllable, such as the flu. The extent of the spread varies by disease and location, epidemiologists say. Rabies, malaria, HIV, and Zika are endemic infectious diseases, but their prevalence and human weight vary globally.

Very soon, after countries could no longer contain the coronavirus and furious transmission worldwide, “it was clear to most virologists that the virus would become endemic,” said John Mascola, director of the Vaccine Research Center. the National Institutes of Health. “When a virus is transmitted so easily between humans and the population [lacks immunity], will broadcast any site that has the opportunity to broadcast. It’s like a leak in a dam. “

Immunologists now expect vaccines to prevent transmission, a finding that would drastically reduce the spread of the virus. A study from Oxford University published last week found that people receiving the AstraZeneca vaccine are likely to transmit the disease.

However, there are numerous pockets of the human population that will remain out of reach of a vaccine in the foreseeable future, which will give the virus plenty of room to continue circulating.

There is currently no authorized vaccine for young children, and supply problems will leave most of the developing world without a shot until the end of next year. Meanwhile, Europe has seen high rates of vaccine denial – less than half of French people were willing to receive a shot when asked in a recent YouGov poll.

As scientists develop new treatments, Covid-19 “will become an infection we can live with,” said Rachel Bender Ignacio, an infectious disease expert at Seattle’s Fred Hutchinson Cancer Research Center. As such, he said, it will be important to develop therapies for the persistent debilitating symptoms with which many patients have difficulty for months after falling ill, such as memory fog, loss of smell and digestive and heart problems.

Some countries such as Australia and New Zealand have reduced the average number of daily cases to low digits, but neither has ever experienced the huge outbreaks that continue to see the Americas and Europe, and both island nations have seen the virus go above and beyond. its strict travel restrictions. .

“I don’t think we need to start establishing the elimination or eradication of this virus as an obstacle to success,” said Mike Ryan, executive director of the World Health Organization’s emergency program. . “We have to get to a point where we’re controlling the virus, the virus doesn’t control us.”

Only one human virus has been completely eradicated in modern history: smallpox. Although this disease only infected humans, the new coronavirus can spread to small mammals such as the mink and, although less effectively, become human again, turning the world’s fur farms into potential reservoirs for the virus. .

In addition, tens of millions of cases of Covid-19 have given the virus ample opportunity to improve its ability to infect other mammals, said Sean Whelan, a virologist at the University of Washington in St. Louis. Louis. A mutation present in variants in South Africa and the UK gave the pathogen the ability to infect mice, he said.

Diseases that are transmitted by asymptomatic people (often the case of coronavirus) are particularly difficult to eradicate. Decades of multimillion-dollar global efforts have not eradicated another such disease, polio, which, although it was eliminated from the U.S. in the 1970s, was eliminated from Europe only in 2002 and still exists in the United States. Afghanistan and Pakistan.

Respiratory viruses, such as the new coronavirus, are prone to become endemic because they can be transmitted through generally benign acts, such as breathing and speaking, and can be especially good for infecting cells. They include OC43, a coronavirus now believed by researchers to have caused the Russian flu of the 1890s, a pandemic that killed a million. This virus, still present in the population, is responsible for many common colds, although it is less likely to be virulent because people have developed immunity.

Mutations in new variants of the coronavirus appear to have improved human cell infection or the evasion of some antibodies, which raises concerns that existing vaccines are less effective. Scientists say controlling new variants will be key to long-term vaccination programs. Understanding their characteristics will help determine whether prey needs to be updated periodically, as they are against the flu.

Vaccines will be just as important as the pandemic subsides and Covid-19 becomes endemic.

“People seem to think that when a virus becomes endemic, it attenuates and doesn’t become as severe,” said Angela Rasmussen, a virologist at the Center for Global Health Science and Security at Georgetown University. The misunderstanding stems from the fact that viruses typically evolve to maximize the number of people they infect before they kill.

But most people survive on Covid-19, so “there’s not much pressure for this virus to attenuate because it’s already spreading and finding new hosts and new opportunities to reproduce before their hosts are gone. put the sick, ”he said. “It’s very good”.

Write to Daniela Hernandez at [email protected] and Drew Hinshaw at [email protected]