Jon Meddings is dean of the Cumming School of Medicine and Jim Dewald is dean of the Haskayne School of Business, both at the University of Calgary.
Across the country, provincial governments are loosening or removing COVID-19 restrictions as case numbers drop and the strain on the health care system lessens. Many people breathe a sigh of relief and say: Society should learn to live with the virus.
We agree, but we must learn from the virus, too.
You have no doubt heard that COVID-19 will become endemic, just like the flu. But the most important thing we must remember is that endemic does not mean that it will be gone or that it will necessarily be milder. Malaria is endemic in many countries and is a cause of enormous death and suffering. COVID-19 will likely return every year, in a cyclical fashion. It has large animal reservoirs, meaning other species can catch it and pass it along. It is unlikely to be eradicated as we did for smallpox.
From what we know of the virus, it mutates frequently and new variants will emerge. There is nothing that says its evolution will always be less severe, as Omicron turned out to be. We could easily be facing a wave next year of a variant that is twice as infectious and twice as lethal. Immunity may also wane and might not last year-to-year with new variants.
That is what endemic COVID will look like. But let us be clear that this is not meant to scare people. As a society, we must understand what endemic COVID means so that we can prepare now for difficult decisions down the road – without resorting to the same tactics of restrictions and lockdowns that bring their own serious ramifications and are increasingly being ignored.
Last July, as the country started to open up again, we called for planning to address future waves. We renew that call again today from a medical and business perspective – because too often these decisions get labelled as either for the economy or for public health. Let’s plan with both in mind.
The good news is we have tools at our disposal now and the medical community has learned a lot about this virus. We have new anti-viral drugs that are helpful in treating people once infected. We know COVID is primarily spread by air, and that masks, ventilation and distancing have been shown to reduce infection. We will need to institute these early, when necessary.
We also need to monitor both the amount of virus in the community and its severity. We know it comes in waves and this will likely continue with a seasonal distribution. Since the seasons differ in the northern and southern hemisphere, we can get a sense as to what is coming if we do worldwide surveillance as we do for influenza.
Locally, we will also get an early indication of a wave by the levels of virus we find in waste water. Many Canadian cities, such as Calgary, have waste water testing that can predict outbreaks when we see virus levels rising in waste water.
Our best measure of severity currently is how many people require hospitalization. With further research we may learn to predict severity from sequencing the virus. Knowing when a wave is coming, when it is here and how severe it is likely to be allows a little time for co-ordinated vaccination on a large scale and, depending upon severity, whether we need to employ other population measures such as masking and distancing.
Before we get there, what are leaders to do now?
First, rather than be reactive, we should develop thresholds for the various health measures that trigger responses pro-actively. These would evolve and be fine-tuned as we learn more. To plan for the unknown, businesses will need to consider their supply chains, operational adaptability and overall resilience. Local supply options help strengthen innovation and reduce the cross-border travel that transmits viruses. Autonomous work arrangements, virtual meetings, home delivery and many other learnings from the past two years can provide tremendous flexibility and adaptability for most businesses. Consider also your local tourism industry – plan a staycation every third vacation. You can’t effectively respond to organic change with mechanical rigidity.
Furthermore, vaccination is a necessity. Although the virus will change and some vaccines will lose some effectiveness, it is unlikely that they will become useless. New vaccines for each year’s variant may become the norm. (We do this for influenza already.) If that is the case, we need creative ways to incentivize people to get the shot every year since the uptake on boosters has been waning. Workplaces should offer yearly flu/COVID shots to employees.
Finally, it is critically important that we vaccinate the rest of the world since mutation does not happen without replication. To the virus, there is no us and them. Leadership and resolve is needed to vaccinate the world’s most vulnerable. If we can stop the virus from infecting as many people as possible, the overall rate of change of this virus will slow and it will become more manageable and safer for all of us to live with it. We all benefit or suffer the consequences of our actions.
When the pandemic started, COVID was about 10 to 20 times more lethal than the flu. Over the past two years, the virus has not changed much. Some variants, such as Delta, show more intrinsic severity; and some, such as Omicron, might have a little less. However, the “in-the-wild” lethality of the virus has now dropped such that COVID is around two times more lethal than the flu. This is largely because of our use of vaccines and other preventive measures. It is the success of science and the willingness of people to do the right thing. We should not throw these away in our haste to return to an imagined normal.
The future of endemic COVID is one of recurring waves. It will not be gone. We need to develop personal and public strategies to minimize the impact of this virus on our lives.
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