As vaccines raise hope, the cold reality dawns: Covid-19 is probably here to stay

“Going through the five phases of mourning, we need to reach the stage of acceptance that our lives will no longer be the same,” said Thomas Frieden, a former director of the US Centers for Disease Control and Prevention. “I don’t think the world has really absorbed the fact that these changes are long-term.”

Endemic Covid-19 does not necessarily mean continuing restrictions on coronavirus, infectious disease experts said, mainly because vaccines are very effective in preventing serious illnesses and reducing hospitalizations and deaths. Hospitalizations have already dropped by 30% in Israel after a third of its population was vaccinated. Deaths there are expected to plummet in the coming weeks.

But some organizations are planning a long-term future in which prevention methods, such as masking, good ventilation and testing, will continue in some way. Meanwhile, a new and potentially profitable industry from Covid-19 is rapidly emerging as companies invest in goods and services like air quality monitoring, filters, diagnostic kits and new treatments.

The number of PCR tests for genes produced globally is expected to grow this year, with manufacturers like New Jersey’s Quest Diagnostics predicting that millions of people will need a cotton swab before attending concerts, basketball games or family events.

“We assumed it would last for years, or be eternal, like the flu,” said Jiwon Lim, a spokesman for SD Biosensor, Inc. of South Korea, a test maker that is increasing the production of home diagnostic kits. The leading drug manufacturers – Novartis International AG and Switzerland’s Eli Lilly & Co. – have invested in potential Covid-19 therapies. More than 300 of these products are currently in development.

Airlines like Lufthansa are restructuring to focus on short-haul flights within Europe and outside the Pacific countries that have said they will keep borders closed at least this year. Some airports are planning new vaccine passport systems to allow inoculated passengers to travel. Restaurants are investing in more delivery and delivery offers. Refrigerators from Canada to Europe are buying robotic arms to contain the risk of outbreaks, reducing the number of workers on the assembly lines.

Diseases are considered endemic when they remain persistently present, but controllable, like the flu. The extent of the spread varies according to the disease and the location, say epidemiologists. Rabies, malaria, HIV and Zika are endemic infectious diseases, but their prevalence and human mortality vary globally.

Very early, after countries failed to contain the coronavirus and transmission increased globally, “it became apparent to most virologists that the virus would become endemic,” said John Mascola, director of the National Institutes of Health’s Vaccine Research Center. “When a virus is so easily transmitted between humans and the population [lacks immunity], it will spread anywhere it has the opportunity to spread. It’s like a leak in a dam. “

Immunologists now hope that vaccines will prevent transmission, a finding that would dramatically reduce the spread of the virus. A study by the University of Oxford published last week found that people who received the AstraZeneca vaccine may be less likely to transmit the disease.

Still, there are vast pockets of the human population that will remain out of reach of a vaccine for the foreseeable future, giving the virus plenty of room to keep circulating.

There is currently no vaccine authorized for young children, and supply problems will leave most of the developing world unvaccinated by the end of next year, at the very least. Meanwhile, Europe has seen high rates of vaccine refusal: less than half of the French were willing to have an injection when asked in a recent YouGov survey.

As scientists develop new treatments, Covid-19 will “become an infection that we can live with,” said Rachel Bender Ignacio, an infectious disease specialist at Fred Hutchinson Cancer Research Center in Seattle. As such, she said, it will be important to develop therapies for the persistent debilitating symptoms that many patients struggle with months after falling ill, such as memory fog, loss of smell and digestive and cardiac problems.

Some countries like Australia and New Zealand have reduced their average daily case count to a low digit, but neither has ever experienced the huge outbreaks that the Americas and Europe continue to see, and the two island nations have seen the virus escape its rigidities. travel restrictions.

“I don’t believe that we should start to define the elimination or eradication of this virus as the bar for success,” said Mike Ryan, executive director of the World Health Organization’s emergency program. “We have to get to a point where we are in control of the virus, the virus is not controlling us ”.

Only one human virus has been completely eradicated in modern history: smallpox. Although this disease only infects people, the new coronavirus can spread among small mammals like mink and then, albeit less effectively, back to humans, turning the world’s fur farms into potential reservoirs for the virus.

In addition, tens of millions of cases of Covid-19 have given the virus ample opportunity to improve its ability to infect other mammals, said Sean Whelan, a virologist at the University of Washington in St. Louis. A mutation present in the South African and UK variants gave the pathogen the ability to infect mice, he said.

Diseases that spread to people who have no symptoms – usually the case of the coronavirus – are particularly difficult to eradicate. Decades of global multibillion dollar efforts have not eradicated another similar disease, polio, which, although eliminated from the United States in the 1970s, was eliminated from Europe only in 2002 and still exists in Afghanistan and Pakistan.

Respiratory viruses, like the new coronavirus, tend to become endemic because they can be transmitted through generally benign acts, such as breathing and talking, and can be particularly good for infecting cells. They include OC43, a coronavirus that researchers now believe to have caused the Russian flu of the 1890s, a pandemic that killed one million. This virus – still present in the population – is responsible for many common colds, although it has become less virulent probably because people have developed immunity.

Mutations in the new coronavirus variants appear to have made it better at infecting human cells or evading some antibodies, raising concerns that existing vaccines may become less effective. Scientists say that monitoring for new variants will be critical for long-term vaccination programs. Understanding their characteristics will help determine whether vaccines need to be updated periodically as they are for influenza.

Vaccinations will be equally important when the pandemic subsides and Covid-19 becomes endemic.

“People seem to think that when a virus becomes endemic, it becomes attenuated and not so serious,” said Angela Rasmussen, a virologist at the Center for Global Health and Security at Georgetown University. The misconception stems from the fact that viruses generally evolve to maximize the number of people they infect before killing.

But most people survive Covid-19, so “there is not much pressure for this virus to become more mitigated because it is already spreading and finding new hosts and new opportunities to replicate before its hosts get sick,” she said. “It’s going really well.”

Write to Daniela Hernandez at [email protected] and Drew Hinshaw at [email protected]