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The Transitional Phase of Covid-19

The Transitional Phase of Covid-19

 

We are in the Transitional Phase of Covid-19.

I initially described this phase in my book From Killer to Common Cold: Herd Protection and the Transitional Phase of Covid-19, written in the summer of 2020.

After the initial waves, Covid-19 doesn’t go away. Rather, it settles into a transitional phase between pandemic and endemic.

Since we know that SARS-CoV-2 will become the fifth common cold coronavirus (since that is how viruses become endemic to humans, they all jump from other species), the question is: where are we now?

 

When Did the Transitional Phase of Covid-19 Start?

When does a pandemic end?

As a pandemic is a collection of local waves of infection, the pandemic will end in different locations at different times. Therefore, the input and output depend on each community.

That is, locally, there is a degree of herd protection that has multiple factors. First, herd protection is a term I coined for this pandemic that never caught on but is much more descriptive than herd immunity.

Factors include:

  • the number of at-risk individuals (those with non-normal immune systems usually due to medical interventions)
  • and the degree of immunity in the community. Immunity in the community is from BOTH prior infections and vaccination.

Then there is the virus itself. The degree of mutation has been outstanding with the virus and truly unexpected to me two years ago. Different communities have had different strains with different penetrance, and thus they have different levels of natural- and vaccine-based immunity. So let’s agree that vaccine and virus-related immunity is ok.

We never expected permanent ongoing immunity from vaccine or virus exposure; since you do not get it with the other human coronaviruses, why would we expect it from Covid?

Regardless, let’s say that the pandemic is over when 50% of people have easy access to vaccination. People can then choose to get the vaccine or the virus. So here is the message we should have been sending all along: you are going to get the vaccine or the virus. Which do you prefer?

And after you have had the vaccine or the virus and it has been a few months, you are going to get the vaccine or the virus, which do you prefer? At some point, people will pick the virus. Hopefully, your relative immunity built up by the 3-5 previous vaccine or virus exposures will protect you.

The pandemic is over. It ended when your community had easy access to vaccination.

 

How Long Will the Transitional Phase Last?

So, how long until covid becomes endemic?

In my book, I predicted it would take 2-5 years. I admit there is no science behind that prediction. I also admit that the last two years have been amazingly painful for most who have to deal with covid every day, and the world has moved on for the most part.

So, I have not written about covid for at least 18 months. Since we have been in the transitional phase for at least that long, I am now thinking about the question: how long with the transitional phase of covid-19 last?

Let’s look at some data to see where we are!

 

Where are We with Covid-19?

Since we can no longer rely on case numbers, let’s look at percent positive.

percent positive

 

Above you can see percent positive for the last two years.

To me, percent positive is a much better measure of community cases since most testing is done at home and is likely not reported. However, for those who do choose to get tested regularly at a setting that reports testing outcomes, how does the percentage of those who chose to get tested change over time?

In green is Texas. They have a high percent positivity rate compared to California, New York, and the USA. We could learn a lot about the different strains of Covid by studying these data, but I want to focus on this year’s data. You can see back in January, with the Omicron surge, there was a massive uptick in all regions. Now Omicron is a transmissible master virus that also evades prior immunity. We have moved on to a variant of variants, so the BA-5 version of Omicron is what we are dealing with now. This data is from covidactnow and is delayed, so let’s focus more on the current percent positive.

 

Percent Positive best Represents Community Cases

So, since percent positive best represents community cases, let’s dive in with NTY data.

community cases of covid

Above, you can see the percent positive data for the US. It peaked at almost 18% early in July and has been stable/downtrend since then.

This means that cases are on the way down in most communities. How does the percent positive data look in your state and region?

Again, a pandemic is a collection of regional epidemics, and my epidemic is not your epidemic. The strains that have visited my community and the number of jabs in arms are different, as are the ecology of the environment and the people (which are all the same to a virus).

 

Hospitalizations and Covid-19

The data for hospitalizations is also reliable and can be followed in your region. It is likely still going up, and it will be up for a while as a late marker of a viral surge.

Percent positive and hospitalizations are useful indicators of viral activity in the community. These will go up and down but trend down over time as they approach endemic levels.

The question is: can old people get the same life-long relative immunity to a novel coronavirus as kids when exposed like they are “supposed to be” exposed.

That is, the type of virus that covid will become will be similar to the common cold coronaviruses. They still cause infections and death each year. So will covid, likely to the same degree. But this may not happen until all those who were >5 years old in 2020 have had their way with Covid. Unfortunately, some people are more susceptible to covid and will die from it because they didn’t get the normal immunity to it when they were a kid.

Kids who are getting covid naturally now likely will have the same future response to it that they have from other human coronaviruses. That’s just the way it is going to be! Get used to it.

Meanwhile, how many more people will die from Covid?

 

How Many More Will Die from Covid?

So, how many more people will die from covid?

Let’s look at some data first.

how many will die from covid

Above, you can see weekly death totals in the US.

Some quick math: if there were 3000 weekly deaths, that makes covid the 4th leading killer in the US, with a total of more than 150k dead a year.

But that was the nasty Delta wave. Remember that? When it was done, we thought so was covid.

Currently, despite hospitalizations (and now ICU, too) going up, deaths have been stable in the last few months.

Again, there will be increased mortality until those who are currently older than seven die of other causes. So, yes, mortality will be here for a good-long time, going up and down, but going down to baseline over time.

What is the baseline? It is the number that dies every year to non-covid human coronavirus infection. I’m not sure what that number is, but it is much less than what influenza kills yearly. But remember, you gotta die sometime. (Memories of the early AIDS epidemic from Falsettos)

 

The Transitional Phase of Covid-19

In summary, welcome to the transitional phase of covid. You have been here since vaccine was widely available in your community.

How long will you stay? The transitional phase of covid-19 will last until most people have enough immunity to provide herd protection. Then, with smaller and less frequent waves over time, hospitalizations and deaths will slowly decrease as covid becomes the common cold.

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