Why is COVID-19 not endemic in the US yet?

BILLIONThese are the words people have been waiting to hear — that the COVID-19 pandemic is easing from a five-alarm fire that broke out in 2020 to a slightly smaller one. On April 27, the US’s chief medical adviser, Dr Anthony Fauci, described the country as being in a “transition phase, from the deceleration of the numbers to a more controlled one. and prevalence” in a Interview with the Washington Post.

His comments come nearly two years since pharmaceutical manufacturers shipped the first batches of their COVID-19 vaccines for early testing. Fauci noted that those vaccines, as well as Drug treatments can control the virus in those infected, is largely responsible for the fact that the initial urgency of the pandemic as a public health threat has passed. But COVID-19 itself is far from complete for us. The virus continues to mutate and the latest variants reported in South Africa — new subspecies of Omicron include BA.4 and BA.5—A sobering reminder that viruses do not stand still.

“Pandemic” versus “Endemic”

While we may have come out of the pandemic emergency phase, we are not yet ready to call COVID-19 a pandemic, meaning the virus is still within us but relatively under control. similar to the flu.

And it’s not clear when that will happen. And even if that happens, medical professionals may disagree on the transition. There are no hard and fast definitions for “pandemic” and “endemic,” and there is no threshold for the number of cases or deaths that mark the transition from one disease to another. The World Health Organization considers a pandemic to be an “epidemic that occurs worldwide or over a very large area, crosses international boundaries and usually affects large numbers of people”. Experts have noted that these figures say nothing about how quickly the disease spreads, how much disease it causes, or the role of immunity in the population.

But those are important factors for public health professionals and political leaders as they manage a pandemic. There are no metrics to determine when to deny initial emergency response or withdraw drastic measures like lockdowns and mask requirements.

That’s what the world is grappling with right now — figuring out if the risk of getting SARS-CoV-2 is to the point where we can treat it more like the flu, by protecting ourselves as much as possible. as possible by vaccinations and basic hygiene such as washing. and cover coughs, or whether we still need to control SARS-CoV-2 as a threat serious enough for most people that we should maintain public health measures like wearing face masks and keep a distance from society.

Read more: Most Americans have had COVID-19. That doesn’t mean they won’t get it again

What does a ‘under control’ pandemic look like?

Fauci argues that we are somewhere in between, describing our current situation as a “controlled pandemic”—not quite the urgent threat of a pandemic, but again not quite ready for peace of mind in the midst of a pandemic. outbreak. And the numbers prove that: Since the beginning of the year, cases in the US have dropped dramatically, from an average of 700,000 to 800,000 a week to 30,000 to 50,000 a week. About 66% of the US population is now fully vaccinated against COVID-19, and deaths from the disease have been declining steadily since January. It’s clear that we’re not in the same vulnerable place we were in 2020. Vaccines have created some barriers to the virus, and that’s worth a lot. But that immunity is still not enough to declare the end of COVID-19.

Those numbers, however, have encouraged a push to relax public health restrictions that have been in place since 2021 — the federal government mandates that everyone wear a mask while indoors and on public transport. including subways, buses, trains and planes, as well as requiring proof of vaccinations for certain gatherings at sports and entertainment complexes. In April, a US District judge in Florida federal mask mission abort, claiming that it was illegal and that the Centers for Disease Control exceeded its authority in imposing it. The Biden administration is appealing the ruling, but in the meantime, airlines and most public transit systems are no longer asking. masked passenger.

That coincides with an uptick in COVID-19 cases — there’s no way to directly prove one causes the other, but coincidence is hard to ignore. After remaining at around 24,000 to 25,000 new infections per week in early April, infections began to rise again by the end of the month to an average of nearly 50,000 cases a week. Hospitalization rates are also on the rise, although those trends lag behind case rates.

Steps towards a truly endemic COVID-19 virus

Those trends suggest that it may be too early to lower our guard against COVID-19, which remains a potential threat for a number of reasons. First, no vaccine is 100% effective at protecting against infection or disease, and the COVID-19 shots are no exception. While highly effective at preventing the worst COVID-19 symptoms from the virus that originally emerged from China, these shots are less effective at protecting against infections. newer variant of SARS-CoV-2. And the virus continues to mutate, with each version appearing to improve the final strain’s ability to quickly and effectively infect. Fortunately, these changes have so far not resulted in a more virulent strain of the virus, but they could swing in that direction, and cause more serious and contagious disease. If that happens, existing vaccines and treatments may offer little, if any, protection.

That leads to the second reason that COVID-19 is not fading into the background any time soon. Despite the vaccine’s effectiveness, scientists still don’t know exactly what is needed to fully protect a person from COVID-19. That question is really broken down into two related questions: What’s to prevent infection in the first place, and what level of immunity is needed to protect from serious illness? Even in the third year of the COVID-19 pandemic, scientists still don’t have a definite answer to either.

Read more: Many Americans are celebrating the end of COVID-19. This is what you feel like when you don’t

While mRNA capture in particular is effective in curbing COVID-19 disease, reducing the rate of COVID-19 symptoms by more than 90% in vaccinated people, the vaccine was less effective at protecting people from getting infected in the first place . That’s not unusual for vaccines, because the best way to prevent infection is to use a ready-made stock of antibodies that can stick to viruses and prevent them from infecting cells — and before when immunized, most people in the world do not have any antibodies against SARS-CoV-2. And even after vaccination, antibody levels drop after a few months, which is why health officials have recommended booster doses. For this reason, those boosters are likely to slightly lower the risk of infection, but vaccines are still not designed as an effective way to prevent infection.

They are much better at preventing severe COVID-19 illness. But even there, it’s unclear exactly how much of an immune response, or what type of response, is enough to prevent severe COVID-19 symptoms that can lead to hospitalization and even death. Studies of people who have been vaccinated, as well as studies involving people who have been naturally infected with SARS-CoV-2are trying to shed light on this, but scientists have not yet been able to pinpoint the exact type of immune response required to eventually push SARS-CoV-2 back.

Such knowledge of what scientists call the correlation of immunity could go a long way toward shaping US policy on booster shots in the fall. Currently, the Food and Drug Administration and other public health experts are relying on surrogate antibody level data to assess how well a vaccine works and what type of immunity is needed. . But in one recent meeting of FDA vaccine advisory committee, experts have raised concerns about the reliability of current antibody levels as a proxy for these immunoreactivity correlations. Until further research shows that this level of immune protection is sufficient, it is unlikely that the world will ignore treating COVID-19 as a continuing pandemic threat, although, as Fauci suggested, A threat is now better controlled than when it first emerged in 2020.

That’s why the White House, with the support of the CDC, is pushing back against the lifting of the federal requirement for face masks on public transit and insisting that even though the number of people entering Hospitals and deaths are trending in the right direction, but the virus has not gone away and remains a threat to public health.

It is unlikely that consensus will be reached anytime soon as the pandemic moves from even Fauci’s so-called “controlled” phase to an endemic one. Meanwhile, instead of waiting for widespread statements on whether the pandemic will end, some health experts are urging people to start making their own informed decisions about what behaviors and situations feel safe for them. If they have youunderlying chronic conditions that could put them at higher risk for severe COVID-19, such as diabetes or asthma, or if they have compromised immune systems it makes sense for them keep wearing the mask even on the plane and training where not required. Or if people living in households with elderly people or children under the age of six are not yet eligible to be vaccinated, continuing to wear masks in certain parts of the home and avoiding crowded situations could be wise thing.

Government and global health statements about the pandemic are critical in helping countries navigate responses and allocate resources to address public health, but when tools that are already available, it is up to us individually to use them in a combination and frequency that provides us with the best protection in our particular circumstances. Even if SARS-CoV-2 becomes endemic, like the flu, it will still pose a threat to some groups of people, just like the flu. For these people, it is important to maintain all behaviors that protect them from infection. For those less vulnerable, easing some of those protections might make more sense. While the mandates serve as guidelines for how best to fight the pandemic, going forward it is likely to increasingly diminish for individuals who rely on those guidelines to forge their path. their own way forward as each of us learns to live with COVID-19, in whatever form it takes.

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