COVID as endemic, explained

Also: Ways to deal with the stress and uncertainty of a constantly evolving situation. [Donate ❤️]( [View in Browser](  February 18, 2022 Good Morning Boston, We restarted these coronavirus special newsletters a few weeks ago because we were back in the soup, with cases rising at an uncontrolled rate. A little more than a month later, that wave hasn't just crested, it's ebbed considerably. You can see it in the 14-day per capita case numbers: And you can see it in the [MWRA wastewater data]( which has proven itself to be one of the most reliable barometers of the pandemic. The poop data shows COVID-19 levels peaked on Jan. 3. A day later, cases reported by date peaked. About two weeks later, hospitalizations crested on Jan. 14. Four days after that, so did deaths. We are definitely on the back end of this wave. And just like the end of last year's surge, people are talking about the future. But this time, it isn't just dreams about hot vax summer. This time, the conversation is a little more serious, and to some, a little more scary. People are now talking about COVID as endemic, aka as something we're gonna have to live with, even as it remains a dangerous illness. The concept came up this week, when Gov. Charlie Baker [rolled back]( the state's masking advisory. You've also heard the word from Dr. Anthony Fauci, who lamented that [we will not eradicate COVID the way we did with smallpox]( but instead we'll see the disease transition to one we manage. “Hopefully it will be at such a low level that it doesn't disrupt our normal social, economic and other interactions," he said. So, why all this talk about endemic now? We've come through other significant surges in Massachusetts and other parts of the country. What, aside from an understandable frustration with the pandemic, has so many people talking about reframing COVID as an endemic illness? To be sure, there are people who just want to turn the page, everything else be damned. But lots of smart people — people you have gone to for thoughtful, consensus takes on where things stand — are also talking about the COVID-19 pandemic becoming an endemic. Here's why: - Vaccines - Therapeutics - At-home and PCR testing - The observed difference in outcomes in cases because of the above - Declines in hospitalizations Given that lens, Massachusetts is in a very strong place to try this transition, which, to be clear, does not mean giving up on trying to reduce the risk of COVID. But the commonwealth (and the Northeast in general) has one of the highest vaccination rates in the world. On top of that, more than half of the fully vaccinated people in the state have received a booster shot. The result, despite lots of press about breakthrough cases, has been very positive, as this chart shows: You can [click here]( to see a bigger version of the chart. [Here's the underlying data]( provided by the state. The data is clear: the COVID vaccines, delivered years faster than any previous vaccine, have worked very well, especially in curbing the severity of illness. Doctors and nurses have a better understanding of COVID-19 and have new therapeutics added to their arsenals. And researchers are providing more insights seemingly every day. And it took too long, maybe, but we're approaching a point where there's much better access to free at-home testing kits and continued PCR tests for when more accurate detection is required. In short: - We're better prepared to prevent the illness. - We're better prepared to detect the illness. - We're better prepared to treat the illness. As the Washington Post [writes]( "None of these tools are silver bullets. They can’t eliminate the coronavirus. But together, they can help turn the virus into a manageable risk, allowing people to hug relatives, go to the movies and travel without fear." (That Post [piece]( goes into great detail about all of the facets above, and is laid out in a very engaging way. It's definitely worth a bookmark.) There's another reason for scaling back on all the precautions we've been taking, and this is one many people may have a hard time accepting: The fatigue is real, and if left unrecognized, will make it harder to get people to gear back up during another surge. As [Dr. Ashish Jha wrote recently on Twitter]( "preserving people's willingness to do things is critical." Despite all of this, there are still people who are especially susceptible to severe illness from COVID, and there are people suffering long-term effects from the bug. Many of us have lost friends and loved ones to this pandemic. Endemic doesn't mean COVID is no longer dangerous. As Jacob Stern and Katherine J. Wu write in [The Atlantic]( we have plenty of very virulent endemic diseases, like measles and whooping cough. Efforts to protect the immunocompromised, to [redouble vaccination efforts among older people]( and to [better research and treat long COVID]( are a critical part of addressing endemic illness. WBUR's Gabrielle Emanuel gets into this more a little later in this newsletter. It also means staying frosty; our civic leaders must be ready to respond during any future surges. Being prepared could include setting clear metrics that would trigger specific actions, like a return to masks for short periods. Axios explores that idea more fully [here](. And CDC Director Rachelle Wallensky on Wednesday said [hospital capacity will remain a key metric moving forward]( since the ability to quickly treat the ill is a hallmark of properly managing a disease. None of this is to say we're going "back to normal," if by "normal" you mean a pre-COVID world. But, if you mean you can now go and live your life, grabbing a mask when you feel sick or if you’re not vaccinated, skipping a party when cases rise, and taking tests to make sure you're good to see nana, then yeah, "normal" may be coming back. Roberto Scalese Senior Editor, Digital [Follow](  Support the news  Q&A (Jesse Costa/WBUR) We caught up with our health reporter, [Gabrielle Emanuel]( to learn what the experts are saying. Do we have a sense of what the future of the pandemic looks like? When can we officially exhale? The news can feel dizzying. Our governor is[lifting mask statewide school mandates]( soon, but there was recently yet another[setback for our youngest kids]( accessing vaccines. The COVID-19 levels in Boston-area wastewater are dropping fast and low, but experts are confident another variant is likely to emerge. When I ask experts how to think about this current moment and what the future looks like, I consistently hear optimism about the spring — but after that, there’s a lot less certainty. Here are two things experts are saying about the pandemic’s future: - There will likely be a strong seasonal component to COVID. Ofer Levy, director of the Precision Vaccines Program at Boston Children's Hospital, painted a likely scenario: “We're going to see it come and go, and be worse in the winter and better in the summer,” Levy said. “We might end up in a pattern where there are vaccines that come out in September, October time that are matching the strains that are circulating.” Levy said he’s also holding out hope for a universal coronavirus vaccine. - Life could continue to be hard for those at high-risk. Jacob Lemieux, an infectious disease specialist at Massachusetts General Hospital, said depending on the risk COVID poses to you, you might face an entirely different reality. “This is quickly transitioning into an epidemic of the vulnerable,” Lemieux said. “The largely healthy, the immunized can likely return to pre-pandemic life with little risk to life or limb, so to speak. And the complete opposite is true for the immunocompromised, despite vaccination, despite taking all precautions.” What metrics are experts watching? Here are a few factors I hear mentioned regularly: - Hospitalization numbers. “Hospital capacity is really the key metric for when we’ll need to move back to control measures,” said Andrew Lover, an epidemiologist at the University of Massachusetts, Amherst. However, it’s a lagging indicator. So, he said, wastewater surveillance is an important tool and should be used routinely in communities across the state. The Massachusetts Water Resources Authority deserves a lot of credit for doing this monitoring in the Boston-area and making the data publicly available. Its[website]( is a good place to keep an eye on. - Vaccination rates. When it comes to jabs, Massachusetts has done a very good job compared to other states. However, there are some distinct pockets where experts are concerned. While Massachusetts has done a very good job compared to other states, there are some distinct pockets where experts are concerned. For example, [pregnant women](. About one in every three pregnant people in the U.S. are still unvaccinated. That is despite evidence the vaccines are safe and the risks of COVID are worse in pregnancy. Andrea Edlow, an obstetrician at MGH, said, “We have a lot more work to do.” - Treatment. Right now, we have a[couple medications]( to turn to, but they are in short supply. Paxlovid is a promising oral medication, but it is not yet available to children, and it has a number of drug interactions. Lemieux, of MGH, said he’s watching for when our options and our supply improve. “One key thing that is missing – that I hope won't be missing for too long – is widespread availability of easily distributable oral medications,” he told me. If that were available, it could go a long way toward making COVID a much less significant concern. - Long COVID. There is[still a lot we don’t know]( about all those lingering symptoms that can, sometimes, be debilitating for[the individual]( and challenging for[the economy](. There’s been a call for more study of long COVID, including in[kids](. It would be very helpful to understand how often people develop long COVID and whether vaccinations reduce your risk (there have been[some promising signs]( on this front). Given Massachusetts' high level of vaccinations and that we've just had a large number of people gain natural immunity with the omicron surge, are we in a different place than the rest of the country? Might it be safe and appropriate to return to something closer to normal? I put this question to Robert Horsburgh, a physician and professor of epidemiology, biostatistics and global health at Boston University. His response: “I wish that were true.” He thinks we need to focus our attention on getting all our school-aged kids vaccinated. “At present, only 51% of children 5 to 11 in Massachusetts are vaccinated,” he said. “Studies have shown that they are the ones that keep flu circulating in our communities, and I am certain that will be the case with [COVID] as well.” One [interesting study]( the New England Journal of Medicine on flu vaccinations comes from Japan. For more than a decade, Japanese schoolchildren were required to be vaccinated against the flu. But that law was relaxed and eventually repealed. What happened next is telling: vaccinations among schoolchildren dropped to a low level, while deaths among older adults increased. The researchers concluded that “the vaccination of Japanese children [had] prevented about 37,000 to 49,000 deaths per year.” Horsburgh says these findings have been confirmed by subsequent studies. But whether or not COVID vaccination will be mandated in schools is not just a scientific question but a political one – and the answer will almost certainly vary state by state. Commentary [Understanding (and taming) your angry COVID brain]( Two years into the pandemic, exhaustion, cognitive overload and perceived injustice have combined to make people very, very angry. Dr. Molly Colvin explains what’s happening in our brains. [Read more.]( [Understanding (and taming) your angry COVID brain]( Two years into the pandemic, exhaustion, cognitive overload and perceived injustice have combined to make people very, very angry. Dr. Molly Colvin explains what’s happening in our brains. [Read more.]( Suggested Reading: NPR spoke with psychologists who [explored ways for everyone to help deal with the stress and uncertainty]( of this constantly evolving situation. 😎 Forward to a friend. 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