How the coronavirus pandemic could end

https://www.axios.com/when-will-coronavirus-pandemic-end-ecef1ae7-33b5-474c-8a02-2471742dbe99.html

It’s still the early days of the coronavirus pandemic, but history, biology and the knowledge gained from our first nine months with COVID-19 point to how the pandemic might end.

The big picture: Pandemics don’t last forever. But when they end, it usually isn’t because a virus disappears or is eliminated. Instead, they can settle into a population, becoming a constant background presence that occasionally flares up in local outbreaks.

  • Many emerging viruses become part of the viral ecology. The four coronaviruses that cause the common cold are endemic, circulating in the population, and the influenza strains that cause seasonal flu predictably surge each year.
  • The SARS outbreak in 2003 didn’t go the same way due to biology and behavior: It was much less transmissible than the virus that causes COVID-19, countries contained it quickly, and it has pretty much disappeared.
  • One virus, smallpox, was eradicated through widespread vaccination, and polio may be close, after decades of effort and billions in funding.

What’s happening: The pandemic is deepening in the U.S., Europe and elsewhere in the world.

  • Experts — from the U.K.’s chief scientific adviser to pharmaceutical CEOs to the WHO — increasingly say SARS-CoV-2 is likely to circulate in the population on a permanent basis, mainly due to the foothold the virus has already established.
  • But what damage endemic COVID-19 causes will depend on different factors, including how often people are reinfected, vaccine effectiveness and adoption, and if the virus mutates in any significant way.

“If the vaccine is really effective, like the measles vaccine or the yellow fever vaccine, it’s just going to land like a ton of bricks and suffocate this. Maybe not quite eradicate it — yellow fever and measles are not eradicated — but it’ll be an utter game changer,” UC Irvine epidemiologist Andrew Noymer says.

  • But if the vaccines are less effective — as many experts expect for at least the first generation — COVID-19 may eventually behave more like the seasonal flu, Noymer says. (Still, the death rate of COVID-19 currently well eclipses that of the seasonal flu.)

Reinfection is “the big issue,” says Columbia University’s Jeffrey Shaman, who recently described how reinfection and other factors would affect the spread of SARS-CoV-2 if it became endemic.

  • So far, there are just a handful of documented reinfection cases, but evidence about whether people retain their antibodies after infection is mixed, and a lot of unknowns remain about the likelihood of reinfection.
  • The worst-case scenario would be that there isn’t a vaccine or long-lasting immunity and people get COVID-19 repeatedly and are just as likely to end up in the hospital as with initial infections, Shaman says.

“I would say COVID-19 is already endemic,” says Larry Brilliant, an epidemiologist who worked to eradicate smallpox and now chairs the nonprofit Ending Pandemics.

  • With about 59,000 new cases per day in the U.S. alone, Brilliant says “it is already everywhere.”
  • “It doesn’t really mean very much if it is endemic,” he adds. “The real question is: How does it all end?”

Eventually, COVID-19 could end up in “the retirement village of coronaviruses,” like HIV, which today can be treated to the point of elimination, or circulate at low levels and be kept in check with a vaccine, like measles, Brilliant says, laying out a handful of possible scenarios.

  • Noymer says he suspects that after its “cataclysmic emergence,” COVID-19 may eventually fade into a common cold after a decade or so.

What’s next: We have to work with it as a virus that we will be contending with for years possibly,” Shaman says. “It doesn’t mean an effective vaccine or treatment won’t be developed. What it means is that holding out hope that we’re going to just get a vaccine and not doing anything else is not the level of preparation we need.”

  • Until we have an effective vaccine and better contact tracing and testing, Johns Hopkins University epidemiologist Justin Lessler says public health measures should continue encouraging the use of face masks and social distancing.
  • If the disease does become endemic, Lessler says it’s likely to eventually become more like a childhood infection because adults will gradually build an immunity. And since children tend to have fewer complications, “it will no longer be the same sort of burden to health that it is now.”

The good news: Viruses can sometimes become milder with time, treatments are already becoming more effective and vaccines can be improved.

  • “Right now we are frightened, depressed and on our back heels. We will be able to conquer this disease,” Brilliant says. “It will be a matter of time and science.”

Experts Slam The White House’s ‘Herd Immunity’ Plan

Experts warn Trump's misinformation about coronavirus is dangerous

The White House is reportedly embracing a herd-immunity approach focused on “protecting the elderly and the vulnerable” but experts are calling the plan dangerous, “unethical”, and equivalent to “mass murder”.

The news comes following a petition titled The Great Barrington Declaration, which argued against lockdowns and school and business closures and got almost 500,000 signatures – although some of them were fake.

“Current lockdown policies are producing devastating effects on short and long-term public health,” the declaration states, adding, “The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.”

Essentially, herd immunity is when enough people are immune to a disease, like Covid-19, that the disease can’t be transmitted as easily and thus provides indirect protection.

It’s been rumoured that the government has been leaning towards this plan of action for some time now, although this is the first real admission.

In response to today’s news, experts around the world have been voicing their concerns.

And this isn’t the first time we’ve heard experts say herd immunity is not a good idea.

For example, the head of the World Health Organization said Monday that allowing the novel coronavirus to spread in an attempt to reach herd immunity was “simply unethical.”

Similarly, the National Institutes of Health (NIH) director Francis Collins also denounced herd immunity as a viable plan.

“What I worry about with this is it’s being presented as if it’s a major alternative view that’s held by large numbers of experts in the scientific community. That is not true. This is a fringe component of epidemiology. This is not mainstream science. It fits into the political views of certain parts of our confused political establishment,” he said in an interview.

Not to mention studies continue to show that Sweden’s attempts at herd immunity have failed and have resulted in a higher Covid-19 death toll than expected.

As more research comes out, scientists are starting to learn that Covid-19 immunity, even in those who were severely infected, can fade after a few weeks.

This is why we’ve seen cases of reinfection and why many experts are advising against a herd immunity plan.  

Currently less than 10% of the population in the U.S. are immune to Covid-19 but for herd immunity to be achieved most experts estimate between 40% to 80% of the population would need to be infected.

To put that into context, that means around 197 million people would need to be infected in America. And assuming that the Covid-19 fatality rate is somewhere between 0.5% and 1%, based on numbers from the World Health Organization (WHO), more than 1 million people would die – at minimum.

William Haseltine, Chair and President of ACCESS Health International, told CNN “herd immunity is another word for mass murder. We are looking at two to six million Americans dead – not just this year but every year.”  

This is an unmitigated disaster for our country – to have people at the highest levels of our government countermanding our best public health officials. We know this epidemic can be put under control. Other countries have done it. We are doing the opposite.”

Nevada man’s COVID-19 reinfection, the first in the US, is ‘yellow caution light’ about risk of coronavirus

https://www.yahoo.com/news/nevada-mans-covid-19-reinfection-223155707.html

COVID-19 reinfection: Nevada man is first confirmed American case

An otherwise healthy 25-year-old Nevada man is the first American confirmed to have caught COVID-19 twice, with the second infection worse than the first.

He has recovered, but his case raises questions about how long people are protected after being infected with the coronavirus that causes the disease, and potentially how protective a vaccine might be.

“It’s a yellow caution light,” said Dr. William Schaffner, an infectious disease expert at the Vanderbilt University School of Medicine in Nashville, Tennessee, who was not involved in the research.

Respiratory infections like COVID-19 don’t provide lifelong immunity like a measles infection. So, Dr. Paul Offit, an infectious disease expert at Children’s Hospital of Philadelphia, said he’s not at all surprised people could get infected twice with the coronavirus, SARS-CoV-2. 

It’s too soon to know whether the man from Washoe County, Nevada, who had no known health problems other than his double infection, was highly unusual or if many people could easily get infected more than once with SARS-CoV-2, Schaffner said.

“There’s hardly an infectious disease doctor in the country who hasn’t encountered a patient who thinks they’ve had a second infection,” he said. “Whether that’s true or not, we don’t know. There are lots of respiratory infections out there.”

How rare is he?

There have been at least 22 documented cases of reinfection worldwide since the start of the pandemic, but it’s unclear how many cases there have actually been, and how common it may be among people who don’t even know they’re infected.

“It could be a one in a million event, we don’t know,” said Akiko Iwasaki, an immunologist at Yale University and an investigator with the Howard Hughes Medical Institute, who wrote a commentary with the study.

With millions of people infected, it’s hard to know if case studies like the new one represent very rare events or the tip of an iceberg, she said. “It’s possible that the vast majority of people are completely protected from reinfection, but we’re not measuring them, because they’re not coming to the hospital.” 

Also, many people don’t know they are infected the first time, so it’s hard to say whether they’re getting re-infected.

In one of the recent cases, a Hong Kong man only knew he was reinfected because it was caught during a routine screening when he returned from outside the country, months after he had cleared an infection and tested negative. 

One reason there may not be more documented cases of reinfection: It’s tough to prove, said Mark Pandori, a pathologist at the University of Nevada, Reno School of Medicine, and senior author on the new study

His team coordinated early in the pandemic with members of the Washoe County Health District to look for repeat infections. They had the benefit of sequencing equipment on campus, as well as microbiologists, he said. And they got lucky finding someone who had been tested both times he was infected and cleared in between. 

Why his infection was worse the second time remains unclear, said Pandori, director of the Nevada State Public Health Laboratory. “I can’t tell you if it tells us anything in particular about the biology of this virus.”

The man caught a slightly different version of the virus the second time, according a genetic analysis of the man’s infections. It’s possible the second version was more dangerous, though there is no evidence of that, or that it was just different enough that his body didn’t recognize it, the paper said.

Implications for vaccination

Iwasaki said the study raises questions about how long immunity lasts after a natural infection. Protection with a vaccine is likely to be quite different, she said.

“Vaccines can be designed to induce much higher levels of antibody and much longer lasting immunity,” she said. Just because the natural infection doesn’t give you protection doesn’t mean the vaccines cannot. It’s a separate issue.”

Offit, also a vaccine expert at the Perelman School of Medicine at the University of Pennsylvania, said he expects protection from vaccines will likely last at least a year or two.

The protection provided by infection or vaccination isn’t 100% perfect until the day it disappears completely, he said. Instead, protection fades gradually, so someone exposed to a huge dose of the virus might get re-infected within months, while others could be protected for years, Offit said.

It’s also possible the Nevada man has an undiagnosed problem with his immune system. “He probably should be seen by an immunologist,” Offit said. 

The length of time an infection will be protective remains one of the key open questions about the virus.

Infected twice, two months apart

The Nevada man, considered an essential worker, started feeling ill in late March, with a sore throat, cough, headache, nausea and diarrhea. His workplace had been hit with an outbreak early in the pandemic, before safety measures like masks could be put in place, said Heather Kerwin, senior epidemiologist at the Washoe County Health District and a co-author on the paper. 

He went for testing on April 18 and his infection with the coronavirus was confirmed.

On April 27, he reported his symptoms had all resolved and he felt fine, but at the time, employees were required to test negative for COVID-19 twice before they would be allowed back to work, Kerwin said. So he remained isolated at home.

A month later, he began feeling poorly again. At the same time, there was an outbreak where one of his parent’s, also an essential worker, was employed, Kerwin said.

On May 31, he went to an urgent care center, reporting fever, headache, dizziness, cough, nausea and diarrhea. On June 5, he went to see a doctor who found his oxygen levels dangerously low and had him hospitalized. Again, the man tested positive for the virus, even though he still had antibodies to the virus in his bloodstream, Kerwin said.

Genetic differences between the viruses responsible for each of his infections suggested he was infected two separate times. The virus doesn’t mutate quickly enough within a single person to explain the differences between the two infections, the researchers found. 

A parent living with the man also caught COVID-19 and was diagnosed on June 5.

Mark Pandori, pathologist
Mark Pandori, pathologist

The paper reports it’s possible the man was reinfected because he was exposed to a higher dose of the virus the second time, perhaps from the family member.

His cough lingered and he suffered from shortness of breath and mental fog, and was on oxygen for six weeks after the second infection, Kerwin said. He has now fully recovered.

Reinfections imply so-called herd immunity cannot be obtained just through natural infection. If natural infection protects for only a few months, then it will be impossible for enough people to be protected simultaneously to reach herd immunity.

The moral of the case study, said co-author Pandori, is even people who already have been sick with COVID-19 need to protect themselves by wearing a mask, avoiding large gatherings, washing hands frequently and maintaining social distance.

“You’re not invulnerable to this,” Pandori said. “In fact, you could get it worse the second time.”