Note: I haven't put up any new blog posts for several weeks, and this one is the reason. I've been thinking about this piece for a while, but was reluctant to post it because I didn't want to feed the endless anger. Nevertheless, I think it's important, so here we go.
The definition of an epidemic is "An outbreak of disease that spreads quickly and affects many individuals at the same time."
A pandemic is "An outbreak of a disease that occurs over a wide geographic area . . . and typically affects a significant proportion of the population."
These two word have become excessively familiar to all of us over the past couple of years, but I'm afraid we need to get accustomed to a third term: endemic means "Characteristic of or prevalent in a particular field, area, or environment."
During the COVID-19 pandemic there has been a sense among people — both the general public and those in charge of making policies to deal with the disease — that it is temporary. That if we can just get enough people vaccinated, or lock down gatherings, or seal the borders, or get everyone masked up all the time, then it will go away and everything will return to normal.
I'm afraid that's not going to happen. The COVID-19 virus isn't going away. It will never go away, not completely. This is no brushfire pandemic that sweeps the world and then vanishes. No, this disease is now endemic to the entire world. It will be with us for decades, possibly forever.
Some diseases, like smallpox, are transmitted only from human to human, and can't reinfect people who are immune. We were able to literally drive smallpox to extinction. Polio is spread by contaminated food and water, and also only affects humans. By vaccinating and improving sanitation, we have gotten the number of cases down to just a few dozen worldwide. AIDS is spread by sharing body fluids, and even though there is no vaccine, education about safe sex practices and the development of antiviral drugs has drastically reduced the number of cases.
But COVID-19 isn't like those diseases. It isn't easy to stop and it will never be eliminated.
First of all, it has already spread throughout the entire world. It can't be confined to a "hot zone" where it will burn itself out. The Chinese government failed to do that, and denied there was a problem until it was far too late to prevent COVID-19 from breaking out of Wuhan and spanning the globe. No sub-group is more at risk of catching it than anyone else. No simple measures will prevent its spread.
Second, vaccination isn't the "firewall" for COVID-19 that it is for, say, smallpox. Even after vaccination, people can catch it. Their cases tend to be much less severe, which is very good — but by the same token that implies a large number of vaccinated people can have mild or asymptomatic cases without realizing it. This means that even if everyone is vaccinated, the virus will survive. And if it survives it can continue to mutate, brewing up new variant strains. It's likely that some of those variants will slip past the antibodies of vaccinated individuals, setting off new rounds of infection and transmission. We can't exterminate this virus.
Third, we're pretty sure the original virus came from an animal host, most likely bats. There are a lot of bats in the world. A lot of them live in and around human-occupied structures, so that people get exposed to their urine and feces. We don't know about other possible animal reservoirs. Other primates might be susceptible, too. All this means that the COVID-19 virus and its variants have a reservoir apart from the human population, where the virus can survive and mutate. We can't eradicate bats (nor would we wish to), so there's no way to get rid of COVID-19 in the wild.
It's not going away. It's never going away. We will never reach zero cases.
Am I just counseling despair, here? No. Quite the reverse, in fact. I think we should stop treating COVID-19 as a crisis. It's an ongoing, endemic problem, part of the world from now on, and we must face it on those terms.
Treatment should become the focus of medical research and public policy. If we're not going to be able to stop people from catching it, then we should be working to stop them from dying from it. Instead of tracking case numbers we should be watching the death rate. We should be working on antiviral drugs with the same fervor we developed vaccines, and investigating ways to mitigate or prevent the lingering side effects of the virus.
Another useful step would be to tone down the social division and anger. This disease isn't going away, which means that there's no point in scapegoating the unvaccinated. They'll get the shot, or get the disease, and they'll either live or die. The virus will remain. Screaming at people and moral posturing won't change that.
Finally, the crisis must end. Arbitrary and contradictory rules, economic damage and travel restrictions, censorship and scapegoating all need to stop. They're making us all insane. Nobody wants those things to go on indefinitely, they aren't going to make the disease disappear, so end them. Reduce the stress, reduce the panic, reduce the anger, reduce the fear.
I expect getting each year's COVID variant vaccine will become as routine and uninteresting as getting a flu shot. We'll probably adopt the habit of wearing masks if you think you're contagious. People will get sick from the disease and recover, just as they do with the flu, mono, walking pneumonia, shingles, and other endemic diseases. And as with those diseases, some of the infected will die. Nobody can prevent that.
The good news is that diseases mellow out over time. The strains that kill their victims don't survive as well as the milder ones. Combine that with better treatment, better medicines, and the immune response boost from vaccinations, and in a few years nobody will worry. We've gone through far more deadly epidemics. It's going to be all right.
For more on this subject, check out these articles from The Atlantic (sorry about the paywall).
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