As New Zealand moves from eradication to repression, those who argue that COVID-19 will be endemic and part of our lives either do not understand or ignore what it will really mean.
Elimination has always been a tricky word because it means elimination. But we have eradicated only one human disease – smallpox – and are close with many others.
For some, eradication now means we must allow the virus to spread. But economics matters less than policy. If we don’t eliminate it, we should still aim to stop, clean, reduce to near zero and thwart this pandemic.
Because we certainly cannot live with endemic SARS-CoV-2.
The delta variant spreads ominously and without control, each infected person would, on average, infect six more, then 36, 216, 1296, 7776, 46,656 – we would get more than double New Zealand’s five million with three more cycles.
We must either continue to stamp out the virus or keep the case numbers very low. To control the number of cases, we need to maintain border security, wearing masks, distancing, bubbling, contact tracing, testing people and waste water, and vaccination.
In the current Delta outbreak, more than 95% of those infected were either illiterate or had only received their first dose.
Read more: COVID will likely turn from pandemic to endemic – but what does that mean?
there’s nothing like delta flu
Our most common endemic infections include the common cold (hundreds of different viruses that circulate freely) and the flu (caused by a group of influenza viruses).
Those who dismiss a mild case of COVID-19 as “no worse than the flu” have forgotten how frightening a case of flu really is. They may also have forgotten that even with effective vaccination, the risk of death in the case of influenza is about 0.1% – it kills about 500 people in New Zealand each year.
Yet some seem to expect that COVID-19 will learn to behave and become endemic. Some even welcome it, claiming that “the disease tends to be endemic when it is manageable”.
it is 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 the population. It doesn’t care if it’s manageable.
Read more: NZ needs more urgent vaccination plan – almost 80% now with single-dose, most will support it
Seasonal influenza has a basic reproduction number (R0) of about 1.5, which means that one infected person spreads the disease to fewer than two people on average. That is why it takes very little time to break the chain of transmission. Annual flu epidemics decline because we have effective vaccines and because seasonal conditions are less favorable for the virus to survive during the summer.
However, as we already mentioned, the delta version has an R0 of at least six. The lower it is from here, the less it will be. If a newer version replaces the delta, it will do so because it is even more permeable.
There will be no season for COVID-19, no pause in transmission, no drop in infectivity. We have been battling this virus around the world for 18 months, with spikes everywhere in every season.
School and business closures part of the new normal
If COVID-19 becomes endemic, one or two people in the workplace or home will not get sick. We will have waves and clusters and many local outbreaks. Schools and businesses will be closed for days, even weeks, because so many people are sick. It will cost the world trillions – consider what it has already done to global supply chains.
If COVID-19 becomes endemic, our healthcare system will be heavily burdened. This would not include the projected, marginal increase in hospital admissions. Waves and clusters will characterize endemic COVID-19 in the same way they have characterized pandemic COVID-19, overwhelming the local health service without warning.
If COVID-19 becomes endemic, Merck’s new antiviral drug molnupiravir will be an important addition to the toolkit because it is a monoclonal antibody, easy to store, easy to transport, and people can take it at home.
As yet unpublished trials suggest the treatment can cut hospitalization in half, which could improve outcomes for people already infected. But this will not reduce the number of cases to less than one.
Never treats – only prevention, public health measures and vaccinations reduce the number of cases. People who are less ill and who are treated at home can spread the virus even more.
If COVID-19 becomes endemic, when health systems fail to adjust to the latest wave, more people will die.
Long term cost to health and economy
Even though we managed to reduce COVID-19 to the severity of influenza (for one person), the endemic delta—about five times that of flu with an R0 and fully vaccinated—is still able to infect and spread – Yet thousands would mean hospitalizations and deaths every year.
Just four cycles of delta infection can result in 250 times more cases of four cycles of flu.
If COVID-19 becomes endemic, every year many of us will know someone or something who dies.
If COVID-19 becomes endemic, more than a third of uninfected cases, even asymptomatic ones, will have symptoms months later. The flu leaves little permanent damage. Long-term COVID damages the insulin-producing cells of the lungs, heart, brain, hearing and vision as well as the pancreas, leading to diabetes.
The cost of COVID-19 is much higher than that of the flu, not only because of the higher number of cases, hospitalizations and deaths, but because of more long-term damage and disability.
Read more: Take-at-home COVID drug mollupiravir may be on its way – but vaccination is still our first line of defense
If COVID-19 becomes endemic, we will live with a stressed, often overwhelmed healthcare system, with schools unexpectedly closed, unsafe workplaces, a disrupted economy, with our children at risk , with death and disability at consistently higher levels than we know – perhaps for decades.
We don’t care what the current strategy is called as long as we keep up with border security and public health measures until we get closer to universal vaccination. Otherwise, thousands of New Zealanders will be hospitalized, die or experience prolonged COVID-19.
Ultimately we will need a sterilizing vaccine (which protects people from getting infected) because we cannot live with endemic COVID-19.