Excellent Read: On (Gradually) Evolving From ‘Pandemic’ to ‘Endemic’

Posted on | by Anne Laurie

An essential step will be deplatforming the most egregious spreaders of misinformation, especially those with ‘official’ credentials — so, good move, Twitter.


Seriously — read the whole thing:

… This is not the year-end we wanted, but it’s the year-end we’ve got. Inside it, like a gift basket accidentally left under the tree too long, lurks a rancid truth: The vaccines, which looked like the salvation of 2021, worked but weren’t enough to rescue us. If we’re going to save 2022, we’ll also have to embrace masking, testing, and maybe staying home sometimes, what epidemiologists broadly call nonpharmaceutical interventions, or NPIs.

Acknowledging that complexity will let us practice for the day Covid settles into a circulating, endemic virus. That day hasn’t arrived yet; enough people remain vulnerable that we have to prepare for variants and surges. But at some point, we’ll achieve a balance that represents how much work we’re willing to do to control Covid, and how much illness and death we’ll tolerate to stay there.

“The key question—which the world hasn’t had to deal with at this scale in living memory—is how do we move on, rationally and emotionally, from a state of acute [emergency] to a state of transition to endemicity?” says Jeremy Farrar, an infectious disease physician who is director of the global health philanthropy the Wellcome Trust. “That transition period is going to be very bumpy, and will look very, very different around the world.”

To start, let’s be clear about what endemicity is, and isn’t. Endemicity doesn’t mean that there will be no more infections, let alone illnesses and deaths. It also doesn’t mean that future infections will cause milder illness than they do now. Simply put, it indicates that immunity and infections will have reached a steady state. Not enough people will be immune to deny the virus a host. Not enough people will be vulnerable to spark widespread outbreaks…

Endemicity may always have been the best we could hope for. We can’t eradicate SARS-CoV-2, the virus behind Covid, because it has other hiding places in the world: not only the bat species that it likely leapt from, but more than a dozen other animal species in which it has found safe harbor. Only two diseases have ever been eradicated: smallpox and rinderpest. (Not polio, yet, despite decades of trying.) The successful efforts relied on each of those diseases having only a single host, humans for smallpox and cattle for rinderpest. As long as another host for Covid exists, there is no hope of being safe from it forever. As Jonathan Yewdell, a physician and immunologist at the National Institute of Allergy and Infectious Diseases, bluntly wrote last spring: “Covid-19 herd immunity is a pipe dream.”…

As the pandemic has ground on, we’ve told ourselves different stories about why we do all the things we do to reduce transmission: to protect the elderly and immunocompromised, to prevent hospitals from being crushed, to keep kids safe before child-sized vaccines were tested. We might now have to confront the reality that we need to keep doing all these things just to live in a world that continues to have Covid in it, because vaccination by itself has not made the virus go away. This forces us to learn yet another story about the virus: that while we may individually be protected from the worst outcomes, a transmissible new variant creates a fresh societal risk.

Researchers argue that we are late in explaining to people what endemicity actually represents. “We should have been trying, from a very early stage, to teach people how to do risk calculation and harm reduction,” says Amesh Adalja, a physician and senior scholar at the Johns Hopkins University Center for Health Security. “We still should be trying, because people have gone back to their lives. They have difficulty understanding that no activity is going to have zero Covid risk—even though we’ve got great tools, and more of them coming in the new year, that are going to allow us to make Covid a much more manageable illness.”…

Variations on Wishcasting vs Reality…

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