Endemic Covid

Now They’re Redefining ‘Endemic’ to Keep the Pandemic Going On and On

Uh-oh, now they’re trying to redefine the word ‘endemic’ in a way that moves the end of the emergency even further away.

Paul Nuki, of the Telegraph‘s Gates-funded Global Health Security team, has written a piece pushing this agenda (though to be fair to Bill Gates himself, last week he said Covid is now becoming like flu, an endemic disease). Here are some excerpts, with my comments interpolated in boldface.

Christina Pagel, a Professor of Operational Research at University College London, notes that “a virus isn’t endemic just because a Government minister says it is and just because people want it to be”. [Note that Prof. Pagel is a mathematician with no medical training.]

“The current pattern of waning vaccination, new immune evasive variants, and minimal public health response seem set to doom us to massive surges once or twice a year”, she tweeted last week. [A seasonal respiratory virus then.]

Dr Helen Salisbury, a senior GP and Oxford academic, added that people may regret talking about Covid becoming endemic as a good thing. “TB and smallpox were once endemic in the UK – it doesn’t mean mild, it just means widespread”, she warned. [But Covid, and particularly Omicron, is mild.]

So what does it really mean for a disease to become endemic and where do we stand as regards SARS-CoV-2?

Francois Balloux, a professor of computational biology at University College London, was one of the first to talk about Covid becoming an endemic disease and says, “in retrospect, we epidemiologists should have come up with a tighter definition”.

He says the common dictionary definition of the word – a disease regularly found among people in a particular area – is misleading. For epidemiologists, the term is more technical and relates to a virus’s reproduction value settling at around one.

“Essentially it means that things are kept in check up to a point by the immunity in the population”, says Prof Balloux. “There is a stability and a predictability to an endemic pathogen but the complication is that they can still go up and down”. [So is it stable and predictable or not?]

Influenza is a good example. Its seasonal waves are largely predictable and kept in check through a mixture of natural immunity, vaccines and behaviour change. [Flu being endemic and ‘kept in check’ has nothing to do with vaccines or behaviour change. Vaccines probably reduce the death toll but it was endemic and ‘kept in check’ before vaccines came along. And what has behaviour change got to do with anything – when did anyone change their behaviour during a winter flu wave, besides possibly staying at home when unwell?]. There are good years in which it kills very few and bad years where it can dangerously stretch health services. …

Adam Kucharski, an Associate Professor at the London School of Hygiene and Tropical Medicine, thinks it may take longer for things to become predictable.

He notes the evolution of SARS-CoV-2 may not yet have settled into a gentle foreseeable drift, where each new variant comes from a known lineage. Omicron didn’t emerge from the Delta lineage and Delta didn’t emerge from the Alpha, Beta or Gamma lines, he says.

“I suspect we’ve still got a period of uncertainty before we can predict the coming years with any confidence”, he told the Telegraph. “Covid evolution might pause in an Omicron-shaped corner for a while, or Omicron might give rise to another variant, much like we’d see for seasonal coronaviruses and flu, or we could see another evolutionary surprise”. [When did evolutionary predictability become a condition of being endemic? Flu is not predictable, which is one reason the vaccines are hit and miss. Indeed, Dr. Kucharski admits the endemic coronaviruses and flu virus themselves give rise to new variants, so why should this exclude SARS-CoV-2 from being endemic?]

For now, Omicron cases appear to be plateauing in parts of the U.K. On Saturday, Dr Susan Hopkins, the UK Health Security Agency chief medical adviser, said the number of infections were flat in London and the South East and rising only slowly now in the North. [Plateauing? Rising? Plummeting more like, including in the North. This is a flat-out inaccurate description of the current state of the outbreak.]

“All of that means we are seeing a slowdown in the number of admissions to hospital but they are slowing down rather than reversing”, she said. [The number of Covid patients in hospital and ICU has been declining for some days now – anyone can see this on the Government Covid dashboard.]

With hospitalisations still running at over 2,000 a day and most regular NHS business still on hold, Dr Hopkins will be hoping SARS-CoV-2 becomes endemic in the UK at a somewhat lower level than it is today. [We’re at the peak of the winter wave of a seasonal respiratory virus, what a ridiculous thing to say; of course it will not remain endemic at this level.]

Otherwise, as the US Centers for Disease Control suggests, we may be needing yet another new word. “Hyperendemic refers to persistent, high levels of disease occurrence”, it notes. [Well yes, if a virus was to persist at its winter peak level throughout the year that could be a problem. But it doesn’t, so we don’t need a new scary-sounding term to refer to it, thank you very much.]

There’s no need to over-complicate this. Flu is endemic. By endemic we mean like flu, so we can go back to normal. Covid is now like flu. Next topic.

Not worth reading in full.

Treat Covid Like the Common Cold, Says the Wellcome Trust – As Leading Israeli Immunologist Blasts Lockdown Consensus: “It’s Time to Admit Failure”

The Wellcome Trust – Britain’s biggest independent funder of medical research, set up by the man whose pharmaceutical firm became GlaxoSmithKline – has called for coronavirus to be “treated like the common cold”. The Telegraph has the story.

Nick Moakes, the charity’s Chief Investment Officer, said restrictions were no longer economically justified and it was time to “live with” coronavirus. 

“I don’t think it can mean going back into regular lockdowns because it is just not economically viable. We don’t do that for the flu, we don’t do that for the common cold,” he said.

“The best case end game is where it is treated like the common cold, like flu. And on an annual basis, those that are vulnerable get a jab against it – and the rest of us have built up a degree of immunity that protects us sufficiently. And we do live with it.”

His comments are at odds with those of the WHO Senior Emergency Officer Dr. Catherine Smallwood, who said on Tuesday that we are “nowhere near” treating Covid as an endemic virus.

However, they are in line with those of Professor David Heymann of the London School of Hygiene and Tropical Medicine (LSHTM), who has suggested in a Chatham House online briefing that the U.K. is seeing the virus become endemic. According to the Telegraph:

Coronavirus is Nowhere Near Endemic, Says WHO

The coronavirus is “nowhere near” endemic, the World Health Organisation has said, and will not reach this point until it is “stable” and stops triggering unpredictable waves of infection that don’t “rely on external forces being placed in order to maintain that stability”. The Telegraph has the story.

Speaking at a press conference on Tuesday Dr. Catherine Smallwood, a senior emergency officer at WHO Europe, said it’s still too soon to suggest the world is moving into an endemic phase of COVID-19 – in spite of assertions from politicians in countries including the U.K. and Spain. …

“In terms of endemicity, we’re still a way off,” Dr. Smallwood told journalists. “Endemicity assumes that there’s stable circulation of the virus, at predictable levels with predictable waves of transmission… that doesn’t rely on external forces being placed in order to maintain that stability. But what we’re seeing at the moment, coming into 2022, is nowhere near that… we can’t just sit back and see a stable rate of transmission,” she said. 

“We still have a huge amount of uncertainty, we still have a virus that’s evolving quite quickly and posing quite new challenges. So we’re certainly not at the point of being able to call it endemic. It may become endemic in due course, but pinning that down to 2022 is a little bit difficult at this stage.”

At the weekend the Cabinet Minister Nadhim Zahawi said he believes the country is “witnessing the transition of the virus from pandemic to endemic”, while Spain’s Prime Minister this week urged Europe to consider the possibility of treating COVID-19 as an endemic illness, such as flu. 

But Dr. Smallwood warned governments “to hold back on behaving as if it’s endemic before the virus is actually behaving as if it’s endemic”.  She added that widespread vaccination uptake on an equitable basis will be “very very key in moving toward this scenario”. 

Worth reading in full.

Note the multiple fantasies in this alarmist statement. “Widespread vaccination uptake on an equitable basis will be ‘very very key in moving toward this scenario'” – even though we already have very widespread vaccine take-up and infection rates are as high as ever.

Endemicity requires stability that “doesn’t rely on external forces being placed in order to maintain that stability” – even though there is no evidence “external forces” (i.e., interventions) have done anything to limit the spread of the virus.

Endemicity “assumes that there’s stable circulation of the virus, at predictable levels with predictable waves of transmission” – even though there’s nothing predictable about existing endemic viruses like those which cause colds and flu.

So what’s the idea now? Vaccines don’t stop the spread, restrictions don’t stop the spread, hardly anyone is getting very sick and health services can cope, but for some reason we still have to stay on an emergency footing and not move on from the pandemic?

Meanwhile, Pfizer CEO Albert Bourla has said that a vaccine for Omicron will be ready in March and the company has begun manufacturing the doses. He also admitted that two doses are no longer any good against severe disease – though he may have had other motives for implying more doses of his product are necessary for protection. The Independent has the story.

Denmark Chief Epidemiologist says Omicron is Bringing about the End of the Pandemic and “We Will Have Our Normal Lives Back in Two Months”

Tyra Grove Krause – the Chief Epidemiologist at Denmark’s State Serum Institute – has said the Omicron variant is bringing about the end of the pandemic, saying “we will have our normal lives back in two months”. Speaking to Danish TV 2, the scientist said a new Government study has found that the risk of hospitalisation from Omicron is half of that from Delta. MailOnline has more.

“I think we will have that in the next two months, and then I hope the infection will start to subside and we get our normal lives back,” [Ms Krause] said on Monday.

Despite early fears that Omicron could prolong the pandemic due to its increased level of infection, Ms Krause said it actually could spell the end of the pandemic.

According to the study: “Omicron is here to stay, and it will provide some massive spread of infection in the coming month. When it’s over, we’re in a better place than we were before.”

But while infection numbers in countries with the variant are soaring, the expert said that the highly infectious Omicron appears milder than the Delta variant, and therefore more people will be infected without having serious symptoms.

As a result, she said, this will provide a good level of immunity in the population.

Denmark has seen a spike in new cases in recent weeks, and on Sunday recorded its highest ever seven-day average infections, recording an average of 20,886 across the previous week, or 3,592.74 per million people – one of Europe’s highest rates.

It reported its highest ever new infections on December 27th (41,035).

By comparison, the UK’s seven-day average daily new confirmed COVID-19 cases per million people sits at 2,823.31 as on Monday, while in the United States, that number is 1,215.76 – lower than many countries in Europe.  

Ms Krause stressed that there was still work to be done to beat the pandemic in the coming months, however.

“Omicron will peak at the end of January, and in February we will see declining infection pressure and a decreasing pressure on the health care system,” she said. 

“But we have to make an effort in January, because it will be hard to get through.”

Encouraging stuff – though I’d be amazed if reported infections in Denmark continue rising until the end of January and don’t peak well before then, given reported infections in Gauteng in South Africa peaked weeks ago and infections appear to have stopped rising in London as well.

Worth reading in full.

The NHS Covid Pass Doesn’t Make Any Sense

Last Thursday, the Prime Minster announced that the NHS Covid Pass would become mandatory for entry into nightclubs and other venues “where large crowds gather”. While the timing of this announcement seems to be motivated more by politics than anything else, does the measure itself actually make sense? I would argue: no.

The NHS Covid Pass is available to those who meet any of the following three conditions. One, you’ve received two or more vaccine doses. Two, you’ve tested positive in the past six months and have finished self-isolating. And three, you’ve tested negative in the past 48 hours.

So, the passes do at least recognise natural immunity, which is condition number two. But will requiring them have any impact on serious illness and death (which is after all what really matters)? It seems unlikely.

Requiring passes certainly can’t guarantee zero transmission at large events, since we know that both vaccinated and previously infected people can transmit the virus.

The only measure that would come close to achieving zero transmission is requiring everyone – regardless of vaccination or natural immunity – to present a negative test upon entry. However, this measure would still be vulnerable to false negatives, or persons who became infected shortly after testing negative.  

If you’re a vulnerable person deciding whether or not to attend a large event, the fact that Covid passes are mandatory is no guarantee whatsoever that you won’t catch Covid. (As I’ve argued before, vaccine passports could have the unintended consequence of leading vulnerable people to engage in more risky behaviour.)   

In principle, requiring passes could lower the level of transmission at large events. But any effect is likely to be extremely small.

That’s because most people were vaccinated several months ago, so at this point won’t be much less likely to transmit the virus than those who aren’t unvaccinated. (They might even be more likely to transmit it.) Among the vaccinated, only those who’ve had three doses will have somewhat more protection against infection.

On top of that, the number of people who’d be turned away without a negative test – i.e., unvaccinated people who haven’t been infected in the last six months – must be pretty small, especially when you consider how many young people caught the virus over the summer. Which raises the question: what’s the point?

Finally, there’s the issue of why we should even care about the total number of infections. Covid isn’t going anywhere, which means most of us are going to catch it sooner or later – regardless of whether we’re vaccinated. (I am, in case you’re interested.)

Our goal should be protecting vulnerable people as the virus becomes endemic. It’s unclear how slowing transmission in nightclubs makes any real contribution to that goal.

People are Still Pushing ‘Zero Covid’

If there was ever a time that ‘Zero Covid’ – the goal of eliminating Covid altogether – made sense, it was when the virus first appeared in Wuhan. Had the Chinese authorities raised the alarm sooner, and scrambled to contain the virus, perhaps there never would have been a pandemic.

But there was one. Covid has now been with us for two full years (perhaps longer). Hundreds of millions have been infected, and even greater numbers have received the vaccine. At this point, you might say, ‘Zero Covid’ is a non-starter.

Yet people are still pushing the idea. A recent article in the Daily Kos – a left-wing news site in the U.S. – argues that “COVID-19 must be eliminated, not become endemic, if America is to survive”.

Is this just a case where the headline is much more radical than the article itself? No – the one thing of which the author can’t be accused is attempting to downplay his position. “We cannot live with endemic COVID-19,” he writes, “Hang on, let me say that again: We. Cannot. Live. With. Endemic. COVID-19.”

Let’s consider his arguments, one by one. The author begins by comparing Covid to the flu, noting that the former is much more contagious. Whereas seasonal influenza has a basic reproduction number of 1.4, he notes, “COVID-19 has a R0 that is over five. Maybe as high as 10.”

I don’t know where he got the figure of ‘10’ from, but even if you take the higher estimates of Covid’s R0 at face value, they correspond to circumstances in which the population was immunologically naïve.

Once enough people have caught the virus at least once, the number still susceptible to infection will be substantially reduced. Not to zero, of course, as even natural immunity wanes – but enough to forestall the kind of transmission levels we saw in the spring of 2020.

Note: this is evident not just from the protective effect of natural immunity, but also from the declining transmission advantage of new variants. As immunity to each new variant rises (particularly among the subset of individuals who’re most likely to infect others), the effective reproductive number correspondingly declines.

The author then claims that a world with endemic Covid will be one where health care is much more expensive, due to demands placed on the system by constant surges of new Covid patients. Here again, however, he ignores the impact of natural and vaccine-induced immunity.

“Endemic COVID-19,” he writes, “would behave exactly the same as epidemic COVID-19: in surges, waves, or spikes.” Would it? What seems far more likely is that endemic Covid would not behave in this way. At the very least, any “surges, waves, or spikes” will be smaller and less deadly than those observed during the epidemic phase of the disease.

The author’s next argument is that, even once Covid becomes endemic, we’ll still see a lot of deaths. But as before, he fails to take account of immunity. “If the level of COVID-19 fatalities could be dropped to just 0.5%,” he writes, “then the rate of deaths would be “just” 160,000 people a year.”

Yet ‘0.5%’ is an implausibly high estimate of the IFR for a world where Covid is endemic. In a recent Twitter thread, Professor Francois Balloux used the figure of 0.1%, adding that even this was “probably far too pessimistic”.

The author then invokes the spectre of long Covid, noting that persistent symptoms “are not rare”. However, if he’d referred to the latest estimates from the ONS, he’d know that only 2–3% of patients still report symptoms after 12 weeks, and this is before you factor in widespread immunity.

Even if ‘Zero Covid’ were achievable, which it almost certainly is not, the costs of getting there would be enormous. We’d not only need a massive annual re-vaccination program, but also constant vigilance at the border, as well as large-scale testing in perpetuity.

“Whatever the price of defeating COVID-19 may be,” the Daily Kos article concludes, “it must be paid.” And that more or less sums up the case for, and against, ‘Zero Covid’. For you can’t take a proposal seriously if there’s no estimate of costs.