Wed. Aug 10th, 2022

delta virus

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As New Zealand shifts from elimination to oppression, those who claim that COVID-19 will become endemic and part of our lives either do not understand or ignore what this would actually mean.

Elimination has always been a difficult word because it involves eradication. But we have eradicated only one human disease – smallpox – and are close with several others.

For some, the end of elimination now means we have to let the virus spread. But semantics means less than politics. If we do not eliminate, we must still aim to contain, dry up, reduce close to zero and counter this pandemic.

Because we certainly can not live with endemic SARS-CoV-2.

The Delta variant spreads ominously and out of control, each infected person would on average infect six more, then 36, 216, 1296, 7776, 46,656 – we would get to more than twice New Zealand’s five million with three cycles more.

We must continue to either eradicate the virus or keep the number of cases very low. To include case numbers, we need to keep an eye on border protection, wearing masks, spacers, bubbles, contact tracking, testing people and wastewater and vaccination.

In the current Delta outbreak, more than 95% of those infected were either unvaccinated or had only received their first dose.

Delta does not look like the flu

Our most common endemic infections include colds (caused by hundreds of different viruses that circulate freely) and influenza (caused by a group of influenza viruses).

Those who dismiss a mild case of COVID-19 as being “no worse than the flu” have forgotten how appalling a case of the flu really is. They may also have forgotten that even with effective vaccination, influenza has a mortality risk of around 0.1% – it kills around 500 people in New Zealand each year.

Still, some seem to expect that COVID-19 will learn to behave and become endemic. Some even seem to welcome this, claiming that a “disease becomes endemic when manageable.”

It’s not true. Being manageable is not part of the definition of endemic disease. A disease becomes endemic when it is more or less always present in a population. It does not matter if it is manageable.

Seasonal influenza has a basic reproductive rate (R0) of about 1.5, which means that an infected person on average spreads the disease to fewer than two other people. This is why it takes very little to break the transmission chain. The annual flu epidemic is declining because we have effective vaccines and because seasonal conditions in the summer are less favorable for the virus’ survival.

However, as we have already mentioned, the Delta variant has an R0 of at least six. This will be as low as it gets from here on out. If a new variant replaces Delta, it will do so because it is even more transferable.

There will be no season for COVID-19, no breaks in transmission, no decline in infectivity. We have been struggling worldwide with this virus for 18 months, with spikes everywhere in every season.

School and business closures are part of the new normal

If COVID-19 becomes endemic, there will not be one or two people sick at a workplace or a home. We get waves and clusters and more local eruptions. Schools and businesses close for several days, even weeks, because too many people are sick. It will cost the world trillions – consider what it has already done with global supply chains.

If COVID-19 becomes endemic, the burden on our healthcare system will be enormous. It will not imply a predictable, modest increase in hospital admissions. Waves and clusters will characterize endemic COVID-19 in the same way they have characterized pandemic COVID-19, overwhelming local health care without warning.

If COVID-19 becomes endemic, Merck’s new antiviral drug Molnupiravir will be an important addition to the toolkit because it will be much cheaper than monoclonal antibodies, easy to store, easy to transport, and people can take it at home.

The as yet unpublished trials suggest that treatment may halve hospitalizations, significantly improving outcomes for those already infected. But it will not reduce the number of cases by another.

Treatment never does – only prevention, public health measures and vaccination reduce the number of cases. Those who are less ill and treated at home can spread the virus even more.

If COVID-19 becomes endemic when the health care system does not cope with the latest wave, more people will die.

Long-term health and financial costs

Even if we managed to get COVID-19 down to the severity of the flu (for one person), endemic Delta — with an R0 about five times flu-like and those fully vaccinated — would still be able to become infected and spread — still mean thousands of hospitalizations and deaths each year.

Only four cycles of Delta infection can result in more than 250 times as many cases as four cycles of influenza.

If COVID-19 becomes endemic, many of us will know someone who dies every year.

If COVID-19 becomes endemic, more than a third of unvaccinated cases, even the asymptomatic ones, will have symptoms months later. Influenza leaves a little lasting damage. Long COVID damages the lungs, heart, brain, hearing and vision as well as the insulin-producing cells in the pancreas and causes diabetes.

The cost of COVID-19 is so much higher than the flu, not only due to higher numbers of cases, hospitalizations and deaths, but more long-term injuries and disabilities.

If COVID-19 becomes endemic, we will live with a stressed, often overwhelmed health system, where schools are exposed to unpredictable closures, with insecure jobs, with a disturbed economy, with our children threatened, with death and disability at a persistently higher level than we have known – probably for decades.

We do not care what the current strategy is called, as long as we continue with border protection and public health measures until we get close to universal vaccination. Otherwise, many thousands of New Zealanders will be hospitalized, die or experience long COVID.

Ultimately, we need a sterilizing vaccine (one that protects humans from becoming infected) because we cannot live with endemic COVID-19.


COVID is likely to shift from pandemic to endemic, but what does that mean?


Provided by The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.The conversation

Citation: Why must we not allow COVID to become endemic in New Zealand (2021, October 11) retrieved October 11, 2021 from https://medicalxpress.com/news/2021-10-covid-endemic-zealand.html

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