From Pandemic to Endemic
In the first few weeks and months of the COVID-19 pandemic, there was a real hope that with sufficient lockdowns, contact tracing, and social distancing measures we might be able to quash the virus to the point where there would only be isolated cases. There was even good reason to think we could eradicate it completely, the way we quickly eliminated the original SARS virus and MERS a few years later.
A year and a half later, with continuing waves of outbreaks despite widespread vaccination in developed countries, it’s fair to say that the window has closed for bringing COVID-19 under control. In hindsight, it now seems like we may never have had a real opportunity to keep the disease from spreading globally. The combination of asymptomatic spread and airborne transmission make this virus ideally suited to evade attempts to contain it, and our globally connected world means that even a single case has the potential to lead to hotspots all over the planet.
We now have to get used to the idea that the SARS CoV2 virus has become endemic worldwide. With near-universal vaccination it might someday be possible to eradicate the disease, but that appears to be a long way off. And in the meanwhile, enough people can’t or won’t get vaccinated that we will continue to see waves of infection for the foreseeable future.
This means we need to shift from trying to control or wipe out COVID, to learning how to create a reasonably normal world despite the presence of the disease. We need to figure out how to go to work and school, how to gather for large events, and how to travel (even internationally) in a way that balances risk with reward in some reasonably sane way.
And this means that people—mostly the unvaccinated and the vulnerable—will continue to get sick and die.
But the unfortunate truth is that people are going to continue to get sick and die no matter what we do at this point. It seems unlikely we can enforce the kinds of measures needed to truly get COVID under control with the more virulent variants well established.
What I expect will probably happen is that we will continue to see a campaign to get everyone vaccinated (even though we seem to be close to the point where we need to start persuading the unpersuadable), and we will continue to see masking encouraged or even mandated. Meanwhile schools, offices, entertainment venues, and all other risky gathering places will keep gradually bringing people back together in groups.
This continual reopening means we will keep seeing wave after wave of infection, though each wave may be a little less deadly as we adapt to life with the virus.
The places I really worry about are the ones which have succeeded in isolating themselves and staying mostly COVID-free. My sister is living in New Zealand, and while they’ve been extremely successful at locking down and keeping COVID out, at some point they will want to reopen their country and rejoin the rest of the world. When that happens, COVID is going to rapidly spread through the population—they won’t be able to keep it out—and anyone not vaccinated will be almost guaranteed to get sick. Presumably they won’t reopen until nearly everyone is vaccinated, but since the virus has proven itself able to spread through mild cases even among immune populations, I expect herd immunity may be difficult or impossible to achieve with the current generation of vaccines.
So be prepared for a world slowly inching back to “normal,” whatever that is, even as COVID continues to sicken and kill. Be prepared for masks and vaccines and social distancing to be with us indefinitely. And be prepared for the fact that COVID is never going to completely go away, just gradually fade into a normal part of life.