From pandemic to endemic, the light at the end of the tunnel is growing

As the nation moves through the Delta variant surge, the number of prior COVID-19 infections coupled with the number of people vaccinated suggests that the light at the end of the pandemic tunnel is growing. The virus becoming endemic.  

A virus that becomes endemic remains present, but due to widespread population exposure and vaccination, is more manageable. The current surge of infections is showing such signs in some areas of the country.  

Over the past two months, the preponderance of hospitalizations are in rural areas that have low vaccination rates and limited prior exposure, hence low immune protection.  Cases continue to be high across the country, but those cases are not leading to hospitalizations and deaths in previously high infection areas or areas with high vaccination rates.   

States with large rural areas or those with dense clusters of vaccine resistant residents have seen surges in COVID-19 hospitalizations. Florida, West Virginia and Tennessee recently reached their all-time high number of COVID-19 hospitalizations, while Texas, Georgia and North Carolina nearly matched their January 2021 peaks.  Smaller states like Arkansas and Alabama have also been hard hit.    

The good news is that as vaccination rates continue to rise and more people acquire immunity, the virus will have fewer people available to infect. The virus will transition to being endemic in such an environment.  

The bad news is that new variants resistant to vaccines or prior infections can reignite the pandemic with surges of new infections.  The unknown is whether these infections will lead to hospitalizations and deaths.   

The recent vaccination mandate by President Biden has received both compliments and criticism. The challenge has been moving the fraction of the population that is protected via vaccination higher. Although a vaccination mandate is not ideal, circumstances forced Biden’s hand to take such actions.   

The Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) recommendation of booster shots for those over 65-years-old, those at risk of poor outcomes as well as those with high exposure risk will provide more protection for such targeted populations. Pfizer’s recent announcement on the safety of their vaccine for those 5 to 11-years-old opens up the opportunity for around 28 million additional children to be eligible for vaccination.         

Once the virus becomes endemic, pockets of infections will continue to flare up, though surges in hospitalizations would be expected to be more moderate and manageable.  

With the virus becoming endemic, the need for effective treatments becomes paramount. Merck’s recent announcement of its experimental antiviral Molnupiravir shows great promise to fill this void. Positive results with a two monoclonal antibody cocktail are encouraging but such products must be the first of several products. As people become infected, treatments that facilitate rapid recoveries and prevent hospitals and deaths are key to permit everyone in the population to feel safe. This will be particularly true for those over 50 years old and those with underlying health conditions that can lead to poor outcomes when infected.  

Reaching zero-COVID, as Australia had hoped, and recently abandoned, is unrealistic until every person in the world gains full immunity. The risk of gaining natural immunity via infection is the risk of poor outcomes with the virus. We now know some indicators for such poor outcomes, like age and underlying health conditions. However, the virus continues to surprise young and healthy people with its unpredictable virulence. In addition, studies are needed to better understand, manage and treat Long COVID.      

The path to the virus becoming endemic lies before the nation. Slow uptake of the vaccines guaranteed that the light at the end of the tunnel for the pandemic is for it becoming endemic, not eradicated. Vaccination continues to provide the most reliable path forward to gaining immunity with minimal risk.  Effective treatments must be the necessary “icing on the cake” for the new normal.   

Sheldon H. Jacobson, Ph.D., is a founder professor of Computer Science and the Carle Illinois College of Medicine at the University of Illinois at Urbana-Champaign. He applies his expertise in data-driven risk-based decision-making to evaluate and inform public health policy.