What it really means to live with an endemic virus and why optimism is an obstacle to making Covid so

• Direct Coronavirus, last minute

According to some scientists,

.

The data coming from the United Kingdom are encouraging and infections and hospitalizations are decreasing thanks to the vaccine but also due to the high circulation of the virus.

Even in Italy, infections and hospitalizations are growing more gently in recent days and this bodes well for the future.

But... What will happen next? No, the virus is not going to go away with just a snap of the fingers, it is here to stay. As Dr. Anthony Fauci, medical consultant to US President Joe Biden, has assured, we are still in the first of the "five pandemic phases", with a still very negative impact worldwide. This phase will be followed by a

, presumably in the summer period, as we have already seen in the last two years; and then the control phase will come, defined as endemic.

The virus becoming an endemic disease means that it will

for years, but its prevalence and impact will drop to relatively manageable levels, making it more like the

.

To classify that an infectious disease is already in the endemic phase, the rate of infections must stabilize over the years and not present peaks that are difficult to manage, as is currently the case with Covid.

"A disease is endemic if the base reproduction number R0 is stable at

," explains epidemiologist Eleanor Murray of Boston University.

"This means that an infected person, on average,

if there are no barriers to contain the virus," he adds.

Omicron, a transition

It is clear that we are still far from this moment.

However, many scientists consider that ómicron represents a

to reach endemicity since, when such a large number of people become infected with the virus, an important layer of natural immunity will be created.

Also, omicron appears to be

Existing studies indicate that this variant thrives more in the upper airways than in the lungs and, as a result, hospital admissions are shorter and the number of patients needing to be admitted to intensive care units has decreased.

For this reason, it is believed that over time Sars-CoV-2 will be like other coronaviruses that cause colds.

The feeling of the imminent end of the pandemic is reinforced by society's image that omicron is a "mild" variant (something that occurs largely thanks to vaccines) and by the references that many politicians make to the need for "Learn to live with the virus".

But omicron, with its high rate of contagion, continues to stress the world's health systems and the reality is that the new variant seems to have significant potential to delay the long-awaited endemicity.

What does it mean to deal with an endemic virus?

The term "endemic" refers to a disease that is

, regardless of its severity.

Malaria, for example, is an endemic disease in tropical and subtropical areas and in 2020 alone it killed 600,000 people.

It is true that people live with it, but not without pain and suffering.

"Endemicity does not imply that a disease is mild, and mild disease does not imply endemicity," Elizabeth Halloran, director of the Center for Infectious Disease Inference and Dynamics in Seattle, told the Financial Times.

In addition, he believes that "there is not much that we humans can do intentionally to move towards endemicity."

For her part, Angela Rasmussen, a virologist at the University of Saskatchewan, in Canada, recalls that "endemicity does not only consist of reducing the reproductive number of the virus to one, other factors also come into play, such as

... if the health system is overloaded to the point of running the risk of staff shortages or if there are treatments available to limit as much as possible the number of people who will become seriously ill, "he says.

The biggest unknown on this journey to endemicity is the very real possibility of new variants emerging. There is no 'law' that requires a virus to get milder over time. "It's very hard to predict the evolution of virulence," says Eddie Holmes, an evolutionary biologist who helped publish the genome sequence of Sars-CoV-2 in January 2020. "It could go up, it could go down, or it could stay the same. Certainly, it still is." It is possible that a more virulent variant will emerge in the future," he clarifies. And it is that this virus circulates throughout the world, and it is known that it

that favors the appearance of new variants. With the real risk of having to start from scratch again in October, when the cold season will begin.

The idea that Sars-CoV-2 could stay with us forever may sound

.

We could never return to our pre-pandemic life without having to wear masks, without having to show the health passport or without giving up travel or handshakes.

Perhaps understanding (and accepting) that the pandemic is a long-term emergency could help governments (and psychologically citizens) to organize themselves more effectively, introducing

in their daily lives or choosing the right investments.

Rather than thinking about when the pandemic will end, perhaps it should be discussed how to manage to live with Covid, without being surprised by the arrival of each new wave.

Last fall, when the delta variant seemed to be under control, just before the explosive omicron invasion, Jeremy Farrar, director of Wellcome, a global health foundation based in London, told the 'New York Times': "We have to start thinking about planning and understanding that we are facing an infection that will never go away".

For this reason, optimism could be one of the biggest obstacles to implementing "coexistence" plans since, thinking that Covid is going away, the population tends to lower its guard and necessary investments are stopped.

Necessary investments

Among the necessary steps to be taken to achieve this endemicity is to

to arrive at a single dose universal vaccine that applies to all variants (it is a bold challenge, but the work is in progress).

It would also be advisable to continue developing effective, safe and low-cost antiviral drugs and to develop a real pandemic plan.

Because after more than two years of pandemic, doctors and health workers cannot work continuously, just like patients with other diseases, mainly oncological and heart diseases, they cannot see their tests or interventions being canceled every time. that Covid enters an emergency phase.

Another of the great challenges is to ensure the vaccine for all the countries of the world, because only in this way can the circulation of the virus be truly reduced.

In addition, engineering can help reduce the risk of contagion with controlled mechanical ventilation systems inside buildings.

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