Juan Signs Off

 Well, that was a long, interesting Spring.  But everything's done:

• Three months working for a local school district as a school psychologist; theirs went off to have a baby.  I just finished the last report Friday.
• Over two months in rehearsal, learning lines, and performance of "The Diary of Anne Frank" for Bigger Dreams Productions, in Oneonta, performing in Foothills Performing Arts & Civic Center.  The last two of our eight performances had to be cancelled because a cast member tested positive for COVID-19.  I played Otto Frank, Anne's father; it was a really gut-wrenching emotional experience to relive the Holocaust every night.
• Manage the installation of windows in the Cape Cod house - five huge picture-and-casement combos, and two normal sized windows.  We had to move all the furniture in all but two rooms to the center, and then it stayed there for over a month because of delays on the part of the company that assembled and installed the windows.  Also required us to sand, wipe, pre-stain, sand, wipe, stain, sand, wipe and polyurethane (2 coats) 40 pieces of trim and casing...
• ...all while trying to get the house ready for renters in mid-June.  We made it by the skin of our teeth, because we worked day and night right up to the deadline.

Back home in NY, working occasionally as a tour guide at Hyde Hall.  But I finally have time to think about, and write, the final New World post.

The most recent post hiatus was certainly the result of the sudden activity that, among other things, took up most of every day.  But it was also the result of... something more fundamental.

The New World is, first and foremost, a writing exercise for me.  I like to write, but I need some structure to keep me at it on a regular basis.  Many years ago I had a weekly column in a local newspaper.  More recently, I've written blogs on a variety of topics.  This was just the latest exercise designed to sharpen my skills and to do something I enjoyed.

But two years is enough.  When this post is done, I'll be three shy of 250 posts.  Enough.

But mostly I'm giving up because I'm giving up.  There is no New World.  Look up at the top, at Peter Baker's optimistic take on "disasters and emergencies."  I wanted to live in the "possibility of other worlds."  I wanted the massive pandemic's disruption to wake us all up and move us forward into a new set of possibilities, where we were more able to see each other, treat each other kindly and fairly, help each other, and all benefit from "working together for the common good."  I had hoped we would come out the other side of the pandemic and say, "Wow!  We don't want to go through that again!  Let's see how we can use the world's massive resources to make life safer and more enriching for everyone."

Or something like that.  But it didn't happen, not even something vaguely like that.  Oh, things changed all right.  We're now more divided and bitter, entrenched and intractable, and as a society, we're less likely to work for the common good than we were two and a half years ago.  You've been there.  You've watched it happen.  You know it's true.

So there is, I guess, a new world.  It's a world in which those who were able to benefit and profit by the "disasters and emergencies" have consolidated those gains and become even wealthier, while those who have felt the power of those calamities are left in ruins, or, at best, left without a single lesson learned.

In America, the pandemic is not over, but it might as well be.  We have learned nothing, and are in the process of setting our clocks back 50 years.  Living in America continues to mean tolerating child murder, living without adequate healthcare, aiding and abetting historic income inequality, and elevating those who live by hypocrisy.  Here's the new world:  An America where over one million Americans died, and nothing changed.

So, welcome to the new world, same as the old world, but worse.  

This is Juan Quintero, third mate of the Pinta, adrift in some ocean, somewhere, signing off.

Data (Sigh...)

As we have seen, there is disagreement regarding whether the pandemic is over, or whether it matters whether it is over or not (open at all costs!).  I thought that, since everyone seems to be weighing in on this, that you and I should be able to, as well.

So - here's a CDC site that will provide you with the actual data (if that's how you roll), and you can use it to conclude anything you want.  The site is a little buggy, but it provides granular detail regarding testing, positivity, cases, deaths, etc.  Now you can be an expert, as well!

Here's Barnstable County, MA (Cape Cod), where we own a rental house in Cape's most rural town.  We've been hiding out from COVID here in the pines for as much time as possible (click to embiggen):

Interestingly, here's the data for Otsego County, where we actually live:

Lots wrong with this one.  In August/September of 2020, the students returned to the two colleges in our small city (SUNY Oneonta and Hartwick College) and, since SUNY O didn't require student testing, there were over 700 cases within two weeks.  There's a little blip on the screen for that time, but not 700+.  Also, according to the NY Times COVID tracker, there have been 88 COVID deaths in Otsego County; according to the county Health Department, there have been 111 "COVID-related deaths."  None show up on the CDC tracker.

Anyway, in both cases, we're practically at zero.  It' over!  But wait - it's trending upward.  Oh no, a surge!

So - how do we know when the pandemic is over if we can't rely on anyone's data, or what it means?  Frustrating, to say the least.  The answer, I suppose, is to use the data you like the best, depending on what you want it to mean.  That's what everyone else is doing!

Blacks and Long COVID

It seems that in some states,  COVID   is   over, even though it  clearly  is   not.  The new world has yet to appear, although we're beginning to see some outlines.  Here's one piece of the puzzle:

It has long been clear that Black Americans have experienced high rates of coronavirus infection, hospitalization and death throughout the pandemic.

But those factors are now leading experts to sound the alarm about what will most likely be the next crisis: a prevalence of long COVID-19 in the Black community and a lack of access to treatment.

Note that this statement has two parts:  Blacks have a disproportionately higher rate of infection, and therefore long COVID, and Blacks have disproportionately fewer options and resources when it comes to necessary healthcare.  Just the way we set it up; no surprise here.  When we "go back to normal," that's what it will look like.

It's worth the time to read the whole article, for a little clearer view of what the new world will look like.  It'll look like this:

“We expect there are going to be greater barriers to access the resources and services available for long COVID,” said one of the authors, Dr. Marcella Nunez-Smith, director of Yale University’s health equity office and former chair of President Joe Biden’s health equity task force.

“The pandemic isn’t over, it isn’t over for anyone,” Nunez-Smith said. “But the reality is, it’s certainly not over in Black America.”

Are We There Yet?

 

No, we are not.

One Way to End the Pandemic

 Just change how you measure stuff.

Not Over

And So We Wait

Of course, as soon as I wrapped up the previous post, I came upon more interesting stuff about the medical conditions that persist after recovering from COVID-19.

I'm focusing on this article because it describes, first of all, a really good reason not to get it, and secondly, it is a little scary and sound like a big deal.  And, thirdly, it makes it clear that, as I noted in that previous post, we need more time to really know for sure.

It's not a surprise that people who recover from COVID have been shown to suffer from blood clots and strokes at a greater rate than those who never had COVID.  It is the great prevalence of those conditions that is new and disturbing.  In an op-ed piece for CNN, Dr. Kent Sepkowitz, a physician and infection disease expert at Memorial Sloan Kettering Cancer Center in New York, notes 

The results are clear and very significant: Compared with similar people who had not been infected with SARS-CoV-2, those who recovered from infection had many more blood clots, heart problems and strokes. The extent of the differences across the 20 different cardiovascular conditions is among the greatest of any clinical study I have read. It is jaw-dropping.*

So there's that.  Whether this is included in the concept "long COVID," or in the wider category the CDC calls "Post COVID Conditions," it is, apparently, real, and frightening.  

But is is permanent?  How long will it persist? What else don't we know about the parameters of these findings?

The study has important limitations. It involves people infected in 2020 who are at least a year post-infection; these people likely had the initial "wild" strain of SARS-CoV-2 or perhaps the Alpha variant, which dominated in late 2020. Not enough time has passed to know if similar long-term dysfunctions of the blood vessels and heart also will occur among survivors of Delta or Omicron variant infections. And the study cannot predict the health impact of Covid-19 two and three and 10 years after recovery.

"Not enough time has passed."  And so we wait. 

 * - A more detailed look at the study results can be found here and here.

Too Short a Time for Long COVID

I want to write a post - or posts - about long COVID, because it will surely be a significant factor in the new world, a legacy of the pandemic that helps define "the new normal."  But we just don't know enough about it at this point.  It's been two years since WHO* declared the pandemic, and although research is being done with patients who contracted COVID early, and then showed symptoms of long COVID, no one has had it for long enough for us to learn much.  We can describe broad categories of symptoms** that characterize long COVID, but that's about it.

So no long COVID post yet - it could, actually, take years before we think we know enough.  But there are two related topics worth mentioning at this point:

• "Post-COVID Conditions" - the CDC has a whole page devoted to this topic.  Interestingly, it does not use the term "long COVID" but describes a wide variety of symptoms and conditions (and evidence of damage) that seems to include what we know about long COVID but goes well beyond it.  Included are MIS and post-intensive care syndrome (PICS), as well as exacerbation of pre-existing conditions, organ damage and auto-immune issues.  Obviously, more needs to be done before we can sort out what is going to be happening to who, when, and as a result of what level of illness.***
• It seems that insurance companies and worker's comp are not up to speed here; many of those suffering from long COVID are suffering even more because their claims for reimbursement for medical expenses, and/or workers' comp benefits, are being denied.  Interestingly, the impacts of long COVID do not seem to fit neatly into the categories and descriptions used to qualify claims.  Interesting article and worth a read.

I can promise you that this blog will not still be going strong five years from now, but that may be what it takes to get a sense of how all this will affect the new world.

 * - WHO.  Not "the WHO," unless it's Peter Townsend and Roger Daltry and it's 1969.

 ** - From the study's findings:  "breathing difficulties/breathlessness, fatigue/malaise, chest/throat pain, headache, abdominal symptoms, myalgia, other pain, cognitive symptoms, and anxiety/depression."

 *** - UPDATE:  I found the CDC's definition of "Post COVID Conditions: 

The term “Post-COVID Conditions” is an umbrella term for the wide range of physical and mental health consequences experienced by some patients that are present four or more weeks after SARS-CoV-2 infection, including by patients who had initial mild or asymptomatic acute infection.

This kind of vague categorization is what has to change as the years go by. 

A Roadmap - If We'll Follow It

A report published by a group which, as far as I can determine (and I looked), doesn't have a name, set out a roadmap for the new world.  The formal title of the report is "Getting to and Sustaining the Next Normal: A Roadmap to Living with Covid" and it's written by (according to the report) "more than two dozen of the world’s best epidemiologists, pharmacologists, virologists, immunologists, and policy experts."  The full report can be found here.

The Washington Post Magazine summarized the report, and here's the crucial paragraph:

The report plots a course to what its authors call the “next normal” — living with the SARS-CoV-2 virus as a continuing threat that needs to be managed. Doing so will require improvements on a number of fronts, from better surveillance for Covid and other pathogens to keeping tabs on how taxed hospitals are; and from efforts to address the air quality in buildings to continued investment in antiviral drugs and better vaccines. The authors also call for offering people sick with respiratory symptoms easy access to testing and, if they are positive for Covid or influenza, a quick prescription for the relevant antiviral drug.

The report goes on to propose three possible scenarios:  optimistic, pessimistic, and one midway between.  I think when you have these kinds of prognostications, it means that nobody really knows.  However, parameters are provided for annual deaths, with 15,000-30,000 a year in the optimistic scenario, and up to ten times that if we're being pessimistic.

The group suggests the country should aim to keep the annual death toll from respiratory infections like Covid, flu, and respiratory syncytial virus to about 60,000 a year — roughly the number of deaths that influenza causes in a bad flu season.

It sounds like, post-pandemic, we will be able to fold COVID deaths into the "normal" flu deaths and not increase the total.  But remember - this is a "go-for," not a prediction:

"...improvements the group is calling for — things like better indoor air quality — will help to reduce the toll of influenza and other flu-like illnesses as well as Covid."

It turns out - unsurprisingly - that the improvements noted above will result in better treatment and outcomes for most respiratory diseases, and lives will actually be saved as a result of our pandemic wake-up call.  

If we actually do them.  Once the pandemic becomes the endemic, we will be strongly tempted to put the terrible years behind us and move on to the new crisis.  History is clear about this - it's our preferred process, for all sorts of reasons.  

We'll see. 

A Bit of a Silver Lining

It's been a bad couple of years for mosquito-borne diseases.  First malaria, and now dengue fever.

Dengue fever , a tropical disease, is carried by the Aedes mosquito, who bites during the day.  Once you get the fever, you can't transmit it to anyone; only the mosquito can do that.  You're not likely to die - although young children are much more likely to die than older children and adults - and chances are you'll have a mild dose.  Wikipedia tells us "Dengue is common in more than 120 countries. In 2013 it caused about 60 million symptomatic infections worldwide, with 18% admitted to hospital and about 13,600 deaths. The worldwide cost of dengue case is estimated US$9 billion."  Some cases progress to dengue hemorrhagic fever and dengue shock syndrome, which you can look up because it sounds worse than I want to deal with at the moment. Among other things, internal bleeding and dangerously low blood pressure are involved.

A recent study of dengue cases in 23 countries found - apparently, to everyone's surprise - that during the pandemic, when people weren't able to move about or congregate as much as normal, there was a significant decrease in the occurrence of the disease.  Previous to this, the conventional wisdom was that most infected mosquito bites took place in the home, but that seems not to be true.

These results will move prevention efforts in a different direction.  Places where people congregate - especially schools - will be treated with insecticide, and contact tracing - to determine where infected children and adults were during the probable time of infection - will be done.  This should be good news.

And not just for the tropics:

"The World Health Organization says the global incidence of dengue is growing dramatically and estimates around half of the world's population is at risk of contracting dengue. Philip McCall, a professor at Liverpool School of Tropical Medicine... said the findings were important and required further investigation, 'because dengue is the disease of the 21st century' as it spreads further north as a result of climate change."

Half of us.  But maybe not, if the results of this study bear fruit in the next few years.  Perhaps the new world, as a result of the pandemic, will be just a little bit better world to live in.

Dozing in the Crow's Nest

Nearly every sailor on the ship has sighted land recently.  "Tierra!"  "Tierra!"  And then somehow it slips away.  Or someone else say, "Nah, that's not land.  You're seeing things."  Or we sail and sail and don't get any closer.  Pretty frustrating.

Countries like Denmark, Thailand, England, Japan, Spain and, in many places, the United States* have pretty much declared the pandemic over, even though countries like Mexico, New Zealand, South Korea, and especially Hong Kong (OK, not a country) are getting clobbered.  

What's the holdup?  Once everyone gets over Omicron, aren't we home free?  Why don't we declare victory and go home?  The answer:  variants.

Well, at least according to a whole string of articles and papers like this one and this one, all of which boil down to "we don't really know what the next variant, or the one after that, will come at us with."  Omicron features a massively improved ability to transmit itself, but it's less dangerous.  If you're vaxxed and boosted, you probably won't get really sick.**  But who knows what the next one will bring?

Omicron has also spawned over 50 mutations so far, that we know of.  The pandemic still rages around the world, regardless of our insistence on "moving on to normal," so there a vast and fertile field in which the virus will mutate.  

So - we are declaring our intention to "live with the virus."  The pandemic isn't over, and the new world is not in sight.  We wait for the end of Omicron, and we wait for the next variant of concern.  The lookouts doze in the crow's nest.  Does anyone believe in the new world any more?

 * - Over 90% of Americans live in a municipality which does not require masks.

** - Long COVID, however, is another story; any variant would probably come with this feature.

The new world which emerged in Europe after the Black Death in the fourteenth century was very different from the world at the beginning of that century.  Among other things, the death of much of the laboring class left the survivors with a great deal of bargaining power, for a while, at least.  Income inequality diminished markedly.  Generally, some silver linings emerged, at least for a while.

I bring this up only as an excuse for posting this cool graph from Kevin Drum, which suggests that these silver linings will not be part of the post-COVID new world, even for a little while:

And, as Kevin notes, COVID's death toll is much higher among the much older, resulting in a smaller effect on the labor pool.  But that hardly matters; the new world will probably not be built on a new relationship between labor and management, as was true seven hundred years ago.

The Next Variant

The popular media is beginning to send a very annoying type of headline/article our way.  The headline says something like "What comes after the omicron wave?" and, after you've read the whole article, you realize that the answer is:  "We don't know."  Couldn't put that in the headline, could you?

It seems that it mostly depends on what tools the upcoming variants come equipped with and, of course, we don't know.  Some (very) preliminary research is suggesting that the BA.2 omicron variant* may have some very effective tools indeed:

The BA.2 virus -- a subvariant of the Omicron coronavirus variant -- isn't just spreading faster than its distant cousin, it may also cause more severe disease and appears capable of thwarting some of the key weapons we have against Covid-19, new research suggests... New lab experiments from Japan show that BA.2 may have features that make it as capable of causing serious illness as older variants of Covid-19, including Delta... And like Omicron, it appears to largely escape the immunity created by vaccines. A booster shot restores protection, making illness after infection about 74% less likely... BA.2 is also resistant to some treatments, including sotrovimab, the monoclonal antibody that's currently being used against Omicron.

If even one or two of these findings is accurate, we won't be reading as much about the new world soon.  What comes after this "final wave" is - the next variant.  Stay tuned.

 * - Now variants have variants.  Are we having fun yet?

COVID is Surging - Time to Open Up!

Here at The New World, we are concerned, among many things, with how long the pandemic will be with us.  Therefore, I submit for your approval a chart (science!  math!) which should help explain how to determine the pandemic's arc through the future:

                                                                                             - Cheryl Rofer via Balloon Juice

Perhaps the most common, most frequently-heard trope during the last two excruciating years has been:  "Positive test results and serious cases are surging, so let's open up and get back to normal!"  There is no reason to think this will change, which is why predicting the end of the pandemic is just about impossible.

Oh - and also, new variants, of course.  But that's a different topic.

Normal is How We Got Here

Something different today.  I'm just going to leave you with a Twitter thread I came across the other day, about our current favorite subject:

The new meaning of endemic that’s arisen during the COVID pandemic isn’t based in disease dynamics. Public health professionals, medical providers, journalists, and government officials are increasingly using the word endemic to mean some version of “getting back to normal”.

When people ask, “When will we get to endemic?”, what they really mean is, “When can we reopen?”, “When can the masks come off?”, “When will COVID be less disruptive?”, and maybe, “What amount of disease and death is acceptable to us?”

If we get to a point where COVID continues to devastate elders, immunocompromised people, and chronically ill and disabled people, will that mean it’s “endemic”?

If we get to a point where COVID is like HIV, where your privilege determines whether you get to ignore it, will that mean the pandemic is over?

What if we find a way to keep our healthcare system teetering just on the edge of collapse without quite falling over so that everyone who isn’t a healthcare worker can pretend the system is working fine, will that mean we entered the "endemic phase"?

What we need to be asking is, what is the “normal” that we’re trying to get back to? Whose deaths are acceptable to us? What level of disease are we willing to accept as normal or inevitable?

If we get to a point where we don't have an exponential increase in cases, that's great, but that doesn't mean exponential growth can't return - R-numbers are not fixed properties of infections. It doesn't mean people won't stop dying or that COVID is mild.

If individual cities like San Francisco think they're "getting to endemic", they should also remember that cities are connected to the rest of the world - this crisis won't be over until it's over everywhere.

And endemic does not mean we get to go back to normal. Normal is how we got here, and normal will continue to bring us new crises until we collectively decide to stop accepting it.

        Berkeley Free Clinic Outreach @BFCoutreach  Jan 31

For Some, the Pandemic Will Never End

As I'm sure you've noticed, there is, lately, a certain level of hopefulness regarding the end of the pandemic - the new world.  Even though everyone is getting the omicron variant, hospitalizations and deaths are, as a proportion of cases, a good deal lower.  Never mind that huge number of cases means that even a smaller percentage of serious illness still translates into a larger absolute number of hospitalizations and deaths.  Never mind that in the anti-vax-plagued US, deaths are higher than any point except last winter's surge, and a great deal higher than any other advanced nation.  As we've seen in the last few posts, nations are making plans for putting the pandemic behind them.

The pandemic, dear reader, will never be behind us.  Unless, of course, long COVID turns out to be temporary, which it has shown little sign of being.  I'd like to do some math that I've done before:  when we're comfortably settled in the new world, how many of us will not be comfortable?

As of right now, 384 million people worldwide have tested positive for COVID-19.  Estimates of the prevalence of long COVID range from one third to 42%.  Here's the math:  let's use, oh, 35% as the proportion of those positive for COVID-19 who will have long COVID.  Thirty five percent of 384 million people is *Googles math problem* one hundred thirty four million people.  Oh, wait - of those 384 million who contracted COVID, 5,700,000 died.  They won't get long COVID.  That makes about 378,300,000 who survived, leaving around 132,405,000, worldwide, who will need long-term, substantial medical care indefinitely.  In the US, the math brings us to around twenty six million who will need long-term treatment for long COVID.

That's a lot of medical care.  Are we ready for it?  

Sorry for the rambling post.  When I hear about how we're about to emerge and get back to normal, I always think about the millions for whom the pandemic will never end.

A Socially Critical Disease

Denmark has taken half a step into the new world, but a very different half than Thailand has taken:

Denmark took the European Union lead Tuesday by scrapping most pandemic restrictions as the Scandinavian country no longer considers COVID-19 “a socially critical disease.”

"No longer... a socially critical disease."  Is this the new criteria for the end of the pandemic?  If so, I suppose it would work better if we knew what it meant.  It strikes me that none of us would predict that Denmark would be vague, while Thailand would be precise.

At any rate, the media, at least, is starting to talk about lifting mitigating restrictions as the signal that the end is near.  The article about Denmark lists half a dozen European countries which have eliminated, or will shortly eliminate, all restrictions, without suggesting that they have announced the coming of the new world.  And all this in the midst of a surge, although:

Officials say the reason for the Danish move is that while the omicron variant is surging in the country, it’s not placing a heavy burden on the health system and Denmark has a high vaccination rate... The head of the Danish Health Authority, Søren Brostrøm, told Danish broadcaster TV2 that his attention was on the number of people in ICUs rather than on the number of infections. He said that number had “fallen and fallen and is incredibly low.”

Once again, one of the foundations of the new world is "a high vaccination rate," which means that many (most?) countries - oh, take the US as an example - are far from the sight of land.   

The (Thai) New World

Remember a million years ago when we were comparing the pandemic to Columbus's voyage to the new world?  When we were complaining because it wasn't over after two months, even though Columbus took half that time to get across the Atlantic?

Remember looking for signs of land:  birds, branches in the water, a change in the sea?  And then realizing that we had so much longer to go?

Well, a hypothetical stick just floated by, and there goes a hypothetical bird:

Barely 2 months after it began, the Omicron wave is already ebbing in some countries. And although it has sickened huge numbers of people, caused massive disruption, and left many health care workers exhausted, it is also leaving something unusual in its wake: a sense of optimism about the pandemic’s trajectory. In countries where many people have been vaccinated or were infected, scientists say, the worst may finally be over.

“We anticipate that there will be a period of quiet before COVID-19 may come back towards the end of the year, but not necessarily the pandemic coming back,” Hans Kluge, director of the European Region of the World Health Organization (WHO), recently said in an interview...

The optimism is shared—although couched in caveats—even by some scientists and public health experts who have stressed the risks of the pandemic from the start and implored politicians to take stricter action. “We have reached a bit of a turning point,” says Devi Sridhar, a global health expert at the University of Edinburgh... Not only has the Omicron wave crested in several countries, but its toll has been smaller than feared. And the wave of infections has likely boosted immunity at the population level, which means future waves may wreak even less havoc.

Still, researchers urge caution. 

Yeah, I'll bet they do. 

The bird and the stick are hypothetical because they are signs of land only if the folks that are doing the predicting are accurate.  It's just a guess, but an informed guess.  Nevertheless, this kind of thing is new and refreshing.

Speaking of caution, Thailand has approved the protocols for declaring COVID-19 endemic, which would, at least for them, end the pandemic and usher in the new (Thai) world.  They set out three criteria*, and asserted that they already meet all three criteria - but they're going to wait six months to a year before declaring the pandemic endemic.  Caution, indeed.  This kind of range sounds kind of made up, suggesting that Thailand is not engaged in an ordered sequence that will end on a particular day, but is just testing the winds, like Spain did not too long ago.

So, keep a lookout.  Don't believe everything you see.  And if you live in the US, good luck.  Our vaccination rate isn't anywhere near what it takes to move into endemicity.  80% vaccination rate?  Ha!  Set the sails, get another hot meal, settle in, check the maps and charts.  Lots of patience.

 * - fewer than 10,000 new cases per day; the fatality rate is no higher than 0.1% of those who are admitted to the hospital with an infection; and more than 80% of at-risk people have had at least two vaccinations.

Sufficient Control

Anthony Fauci and White House Covid-19 response coordinator Jeff Zients, laying out their maps of the new world, says much the same as Aris Katzourakis did yesterday, but somehow making it sound like a hazy, bureaucratic place that could be benign if you only squinted your eyes just right.  Of course, when Fauci and Zients speak, it is US policy, and, therefore, inherently political.  But enough of that; decide for yourself:

• "We continue to move toward a time when Covid won't disrupt our daily lives. A time when Covid is no longer a crisis, but rather something we protect against and treat,"
• Fauci said there is still a "way to go" before cases and hospitalizations decline to what he described as an "acceptable situation."
• Fauci did not offer specific metrics on what that would look like.
• Fauci said the aim is to get to a place "sufficient control," which he explained was not "eradication" like with smallpox or "elimination" like with the polio epidemic and measles, but rather, "a level of control that does not disrupt us in society, does not dominate our lives, not prevent us to do the things that we generally do under normal existence."
• "That would be a level of infection, but more importantly, concentrating on the severity of disease, hospitalizations, and deaths that fall within the category of what we generally accept. We don't like it, but we accept it with other respiratory viruses: RSV, paraflu, and even influenza," Fauci said.
• Fauci said vaccines, boosters and infection will "hopefully, get us to the point where we have antivirals to be able to treat people who are at high risk that we no longer are in a situation of threat -- threat to our equanimity, threat to our economy, the threat to allow us to live a normal life."

To me, it sounds a lot like what we here at The New World have been talking about for some time.  This vision of the future, laid out by Administration spokesmen, in a political setting, at a time when people are dying and hospitals are full, must surely downplay the deaths and hospitalizations that we can see in the subtexts. But make no mistake:  there will be deaths and hospitalizations, and they will be in addition to, not somehow subsumed into, the deaths and hospitalizations caused by "RSV, paraflu, and even influenza," that we endure on an annual basis.  So thousands more will die, every year, than have ever died before.  That's the new world.

The endemic diseases that kill millions of us each year have never really broken the surface, and come to our attention, in any meaningful or consistent manner.  Perhaps, after years of a pandemic that has reached every corner of the world, and every nook and cranny of our attention, we might decide it's time to do something about this war - The Endemic War - and maybe even start with adequate health care for all Americans, including proactive engagement and preventive medicine.

Is it being hyperbolic to call it a "War"?  You can look up the numbers.  Flu and pneumonia kill more Americans each year than died in the Vietnam War.  Diabetes, a largely preventable disease, kills even more of us.  And so forth.  Haven't we gotten to the point where we have the resources to address this kind of thing?  

Well.  This post sure got out of hand.  Sorry.  See you next time.

Lazy Optimism

Aris Katzourakis, writing in Nature, reminds us that the new world will not see COVID-19 fade away.  There will be no return to normal.  To an epidemiologist, "an endemic infection is one in which overall rates are static — not rising, not falling."  For instance, malaria and tuberculosis.  In 2020, when all eyes were fixed on the pandemic, these endemic diseases killed 600,000 and 1.1 million people, respectively.  The "normal" flu, of course, kills around 35,000 a year, just in the US.

So the new world will include a significant number of deaths from COVID-19, year after year.  How many?  Interestingly, it will depend a lot on how we manage it:

First, we must set aside lazy optimism. Second, we must be realistic about the likely levels of death, disability and sickness. Targets set for reduction should consider that circulating virus risks giving rise to new variants. Third, we must use — globally — the formidable weapons available: effective vaccines, antiviral medications, diagnostic tests and a better understanding of how to stop an airborne virus through mask wearing, distancing, and air ventilation and filtration. Fourth, we must invest in vaccines that protect against a broader range of variants.

So we must set aside "lazy optimism."  Will we?  How are you betting? 

One View

One view of the way forward.

Can you see the new world, way in the distance?   Neither can I.

Further Along the Path to Endemic

More talk about "pandemic" transitioning into "endemic."  The other day we looked at Spain's cautious call for more detailed planning in that direction, a position not yet shared with Spain's European colleagues.  But we have a little more detail regarding what endemic might look like:

Spanish officials would no longer need to record every COVID-19 infection and that people with symptoms would not necessarily be tested, but they would continue to be treated if they are sick. 

It's still a ways away.  But there will, eventually, be a situation of dynamic equilibrium:  no real surges, plateaus or declines in different parts of the world at different times, just seasonal waxing and waning, just like the normal flu.  

The article ends with some delightful news:

Even after the pandemic ends, “COVID will still be with us,” said Dr. Chris Woods, an infectious disease expert at Duke University. “The difference is people won’t be dying indiscriminately because of it, and it will be so routine that we will have much better and fairer access to vaccines, therapeutics and diagnostics for all.”

Do ya think?  Sounds good, but the first part of this prediction absolutely depends on the second part.

And what about long COVID?  Those of us who have been taking extraordinary measures to not get it for over two years - do we continue to live in caves and have everything delivered?  Or do we wash and store our masks and take our chances?  The answer may depend on learning more about long COVID, and the preliminary returns are encouraging.  We'll get into detail when there's a more comprehensive, useful body of research.  Stay tuned. 

Defining the New Endemic World

This is a few days late, but... plumbers, hot water...  Anyway:

It seems that there has been some high-level thinking regarding the end of the pandemic.  "High level" meaning government officials, not sterling quality thought.  AP reports that Spanish Prime Minister Pedro Sanchez is calling for European authorities to begin shifting to a COVID maintenance process that would treat the disease as endemic rather than continuing to approach it as a pandemic:

The change would mean treating COVID-19 as an “endemic illness” rather than a pandemic, Sánchez said Monday, adding that deaths as a proportion of recorded cases have fallen dramatically since the initial onset of the pandemic.

“I believe that we have the conditions for, with precaution, slowly, opening the debate at the technical level and at the level of health professionals, but also at the European level, to start evaluating the evolution of this disease with different parameters than we have until now,” Sánchez told Cadena SER radio.

This is the kind of bureaucra-speak we'll be hearing more and more of, especially when/if the incidence of Omicron plateaus and begins to recede.  Whereas the clean end of the pandemic, which we lost the opportunity to experience when so many of us decided to opt out of the process for political reasons, would be obvious - just a few manageable pockets of infection remaining, worldwide - the move to an endemic relationship with COVID will require only a little less monitoring and regulation than we have now - forever.

So, the new world:  just like the old world, but more complicated - and more "hard work, illness and death"?

Protocols of the New World

I've spent the last few days trying to organize some hot water at the house here in Truro.  The hot water heater started leaking on New Year's Day.  We didn't know any plumbers.  So started the quest.  Nearly two weeks later, still no hot water, but we're closer.  I learned two things:  It's possible to be in contact with many professionals in the same area, regarding a relatively simple project, and not learn a single thing.  Because - the second thing - half of those professionals directly contradict the information the other half has provided.

Sound familiar?

Anyway, I've had some time to do a little reading, and here's something that struck me this morning while I was poking around the blogosphere:

So, in the new world, will both COVID-19 and climate change become endemic?  Remember the "Wired" article which suggested this definition of "endemic":

...at some point, we’ll achieve a balance that represents how much work we’re willing to do to control Covid, and how much illness and death we’ll tolerate to stay there. 

Substitute "climate change" for "Covid," and you have the protocols for the new world.  And guess who gets to do the "hard work... illness and death"? 

The Beginnings of a Map of the New World

After two years of the pandemic, Kevin Drum is thinking about the new world.  Good for him!  He's got a list of "things we'd pretty much make permanent":

• Get vaxxed and then get boosted every year or so. (Details would depend on our evolving understanding of vaccine effectiveness.)
• Mask up at indoor public places. But not routinely at work. (Or should we bow to reality and give up on masks entirely?)
• Require proof of vaccination for large indoor events.
• Close schools only briefly and only on rare occasions when prevalence is high locally and 2-3% of students have tested positive.*

All good-natured kidding of one of my favorite bloggers aside, this is one of the first examples of post-pandemic thinking that I've read, not counting the endless numbers of definitions of "endemic."  He also includes what he doesn't think will be part of the new world.  It's a list that, in summary, suggests that we will not shut down our society as we know it.

One quibble:  He suggests schools will be closed "when prevalence is high locally and 2-3% of students have tested positive."  Yet routine testing is not on the list, in fact, one of the things he doesn't think will survive the end of the pandemic is "Routine testing requirements in general (instead rely more on proof of vaccination)."  How do we know when to shut a school - test only when it feels like there may be a lot of COVID around?

Anyway, here's the beginnings of a map of the new world.  Something to chew on; it's a start.

Hard Work, Illness and Death

You probably don't want to read another post, here at The New World, about how COVID-19 will become endemic.  I don't want to write one.  I don't even want to look up all my other 'endemic' posts so I can link you to them.  Just type "endemic" in the search bar at the top left and enjoy.

So I won't comment or expand on what is really a pretty interesting article in "Wired," a periodical in which interesting articles about endemic flus are not always expected.  There are some pretty clear definitions of endemic, which are rarer than you might think:

Endemicity doesn’t mean that there will be no more infections, let alone illnesses and deaths. It also doesn’t mean that future infections will cause milder illness than they do now. Simply put, it indicates that immunity and infections will have reached a steady state. Not enough people will be immune to deny the virus a host. Not enough people will be vulnerable to spark widespread outbreaks.

Ah, that happy medium between immunity and vulnerability.  Forever.

Also:

Endemicity, in other words, isn’t a promise of safety. Instead, as epidemiologist Ellie Murray has argued, it’s a guarantee of having to be on guard all the time.

And finally - how we know when we get there:

...at some point, we’ll achieve a balance that represents how much work we’re willing to do to control Covid, and how much illness and death we’ll tolerate to stay there. 

So the new world will, it seems, include a constant conversation regarding hard work, illness and death.

Question:  If everyone - and I mean everyone - had gotten vaccinated by, say, the summer of 2021, would we be having this conversation right now?

No. 

No, It's Not

Over two years after the pandemic began, articles about its end are still featuring the world "endemic," and are full of phrases like "wait and see" and "No one can predict" and "We have no idea" and my personal favorite, "There's not even a measurement to say that something is an epidemic or pandemic. All of this is in the eye of the beholder."  All of these bold statements appeared in the same article, titled, a little dishonestly, "It won't be a pandemic forever. Here's what could be next."

What's next is "endemic."  We've already talked about what "endemic" means:  COVID-19 will be around forever, killing us in smaller numbers and mostly in the winter, just like regular flu.   Mostly because of variants and their origins:  large numbers of people who are not vaccinated, who serve as the breeding grounds for Delta, Omicron and whatever comes next.

Anyway, it turns out that, if you believe Dr. Arnold Monto - a professor of epidemiology at the University of Michigan and acting chair of the US FDA's Vaccines and Related Biological Products Advisory Committee, who gave us the "eye of the beholder" quote above - I get to decide when it's over.  I've been beholding this pandemic, right here at this blog, since April of 2020.  

Great!

Guess what.  It's not over.

Again

We've been down this road before:

Happy New Year!