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Wednesday, January 19, 2022

When will COVID-19 shift from Pandemic to Endemic?

Dr. Gabe Mirkin

It now appears that the COVID-19 pandemic will not end with the virus disappearing, but with enough people gaining immunity from vaccination or natural infection that there will be much lower rates of hospitalization and death, even as the virus continues to circulate. Researchers from South Africa think that the Omicron variant of COVID-19 virus may help to end the pandemic to become endemic, another intermittent seasonal sickness similar to what happened to the 1918 Spanish Flu pandemic. The COVID-19 Omicron variant is more contagious, but causes fewer hospital and ICU admissions, much shorter duration of infection, and a lower death rate (Int J Infect Dis, Dec 28, 2021). The South African researchers found that with the wave of Omicron variant cases they had:
• a reduced death rate, just 4.5 percent of patients hospitalized with COVID compared to 21 percent with previous variants of COVID-19
• fewer hospital ICU admissions: dropped to one percent of patients from 4.3 percent
• fewer hospital admissions per cases of infection, which peaked at 108/day for the Omicron variant, compared with 213/day during the Delta wave
• Average length of hospital stays dropped to 4 days from 8.8 days

For comparison, in the Spanish Flu Pandemic (about 100 years ago):
• 500 million people or one-third of the world’s population became infected with this virus.
• 50 to 100 million died worldwide, including 675,000 U.S. citizens, making it one of the deadliest pandemics in human history.
• It had an unusually high death rate in younger (ages 20-40), healthy people.
• It recurred in four major waves.
Like the present COVID-19 pandemic, the 1918 H1N1 flu virus caused a cytokine storm in which a person’s own immunity attacks the human host as it is supposed to attack the invading virus. The fatality rates were among the highest ever, at about 4 percent, but there were no vaccines or effective treatments available at that time.

The COVID-19 pandemic was not caused by a more-virulent, more-lethal virus, it occurred because this virus had never before infected humans, so 100 percent of the human race could expect to become infected if they were exposed. The Omicron variant is more infectious and less damaging than the previous variants, so more people are likely to become infected without dying and thus have greater protection from future infections. People get significantly higher antibody titers from infections than from vaccinations, with infections providing 93 percent protection against a subsequent symptomatic infection and 52 percent protection against asymptomatic infection (Lancet, 2021, 397(10283):1459-1469). However, the protective antibodies do not last forever, and at this time we do not know how long they will last. When protective antibodies drop in the bloodstream, booster doses of the vaccine are likely to be needed to raise antibody titers again.

Dr. Gabe Mirkin is a Villager. Learn more at www.drmirkin.com

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