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Coronavirus

Endemic Times, Get Ready For Our Forever COVID Future

As the 5 million death toll has been passed, signs abound that the virus is not going away any time soon. We need to accept that we can return to normalcy even without eradicating COVID — though we must do it right and keep re-learning the right lessons.

Photo of people walking in the streets of Plovdiv, Bulgaria, some wearing a facemask

Walking in Plovdiv, Bulgaria

Carl-Johan Karlsson

-Analysis-

Heading toward Year 2, the stream of COVID headlines continues to flow: vaccine hesitancy and breakthrough infections, lurking new variants, overrun hospitals and, yes, yet another lockdown somewhere in the world. The grim milestone this week of five million deaths adds to the creeping feeling that, unprecedented scientific breakthroughs aside, we are simply outmatched in our collective battle against the pandemic.

There is a growing consensus among experts that the virus, the whole of humanity's microscopic nemesis, is here to stay.


Already a year ago, herd-immunity skeptics suggested that the COVID-19 endgame might in fact not be eradication but endemicity — where the virus lives among us like the common flu.


A return to normalcy? 

And today, those still betting on a clean break with the virus in the near future have become a minority of wishful thinking. So with the end station receding into the future, should we expect several more years of the cumulative angst of illness, death, masks and curfews that has hovered over our lives in the last 18 months?

While part of the answer remains shrouded by the same questions (Will future mutations bypass the vaccine? How enduring is immunity after infection?), the prevailing belief is that the combination of acquired immunity and annual vaccines will allow a return to normality, with infections remaining fairly constant across years with occasional smaller outbreaks.

This is what happens with common cold coronaviruses.

"With time, scientists predict COVID will become more prevalent among unvaccinated youths or those without prior exposure to the virus," writes research leader in virology and infectious disease at Griffith University Lara Herrero in a recent article for the World Economic Forum. "This is what happens with common cold coronaviruses. Despite periodical spikes in caseloads each season or immediately after relaxation of economic, social, and travel restrictions, COVID will eventually become more manageable."

Handwashing in Kampala

A photo of students lining up to wash their hands from a green water tank

Students line up to wash their hands in Kampala, Uganda

Nicholas Kajoba/Xinhua via ZUMA

Bulgaria, unvaccinated chaos

As such, the time of lockdowns, masks and social distancing will most likely come to an end; the question today is rather how fast we will get to restoring a sense of public health normality, and how it will play out in different countries.

With billions still unvaccinated, the pandemic continues unabated in many places around the world. In Bulgaria, where more than 75% of the population is refusing the jab, the government is negotiating with Greece to send coronavirus patients for treatment as a fourth wave overwhelms its healthcare system. But the real policy question in Sofia is whether another lockdown will be imposed, which initially will only apply to the unvaccinated — an unprecedented move that would likely fuel the ongoing anti-restriction protests in the country.

Flatten the curve to buy time.

Another place where vaccine-hesitancy is halting the return to normal is Uganda, where unvaccinated lawmakers will be denied access to the country's parliament building starting Monday. The move is meant to sway the Ugandans still refusing the jab, with President Yoweri Museveni expressing hopes last week that some 12 million people will be vaccinated by the end of December — a big leap from the three million doses administered so far.

Keep flattening the curves

Indeed, the coming months will look very different for countries that are currently suffering their highest rates of hospitalization and death, and those that are merely filling the gaps in their vaccination program. The latter category includes the UK, where the NHS has started to roll out the COVID-19 jab to school children aged 12 to 15, with almost three million children expected to receive one dose of the Pfizer vaccine during the fall.

Still, with the transition from pandemic to endemic increasingly becoming our new global goal, the overarching strategy remains: Flatten the curve to buy time. Even in countries with high vaccination rates, we know by now that new variants can still overload the healthcare system, and researchers and public health officials need to play catch up.

The more time we buy to ramp up immunity, the lower the death rate will be once we finally reach that end station. If we must continue to count COVID deaths in the millions, we must do all we can to spread that out over years, not months.

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