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How will pandemic end? Omicron clouds forecasts for endgame, experts say – CBC.ca

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Pandemics do eventually end, even if Omicron is complicating the question of when this one will. But it won’t be like flipping a light switch: the world will have to learn to coexist with a virus that’s not going away, experts say.

The ultra-contagious Omicron variant of the coronavirus is pushing cases to all-time highs and causing chaos as an exhausted world struggles, again, to stem the spread. But this time, we’re not starting from scratch.

Vaccines offer strong protection from serious illness, even if they don’t always prevent a mild infection. Omicron doesn’t appear to be as deadly as some earlier variants. And those who survive it will have some refreshed protection against other forms of the virus that still are circulating — and maybe the next variant to emerge, too.

The newest variant is a warning about what will continue to happen “unless we really get serious about the endgame,” said Dr. Albert Ko, an infectious disease specialist at the Yale School of Public Health.

“Certainly COVID will be with us forever. We’re never going to be able to eradicate or eliminate COVID, so we have to identify our goals.”

At some point, the World Health Organization will determine when enough countries have tamped down their COVID-19 cases sufficiently — or at least, hospitalizations and deaths — to declare the pandemic officially over. Exactly what that threshold will be isn’t clear.

Some parts will struggle

Even when that happens, some parts of the world still will struggle — especially low-income countries that lack enough vaccines or treatments — while others more easily transition to what scientists call an “endemic” state.

In this photo released by Xinhua News Agency, residents line up for COVID-19 tests at a mobile testing site in Xincheng District of Xi’an, in northwestern China’s Shaanxi Province, on Sunday. (Tao Ming/Xinhua/The Associated Press)

They’re fuzzy distinctions, said infectious disease expert Stephen Kissler of the Harvard T.H. Chan School of Public Health. He defines the endemic period as reaching “some sort of acceptable steady state” to deal with COVID-19.

The Omicron crisis shows we’re not there yet, but “I do think we will reach a point where SARS-CoV-2 is endemic much like flu is endemic,” he said.

For comparison, COVID-19 has killed more than 800,000 Americans in two years while flu typically kills between 12,000 and 52,000 a year.

Exactly how much continuing COVID-19 illness and death the world will put up with is largely a social question, not a scientific one.

“We’re not going to get to a point where it’s 2019 again,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “We’ve got to get people to think about risk tolerance.”

British Columbia Provincial Health Officer Dr. Bonnie Henry said last week that she believes the province will eventually see the end of the pandemic.

“The way the virus is changing with Omicron — that is leading us to that place sooner,” she said in a year-end interview. “The type of illness it’s causing, with most of us being protected through vaccination, means that we are going to get to that place.”

Dr. Anthony Fauci, the top U.S. infectious disease expert, is looking ahead to controlling the virus in a way “that does not disrupt society, that does not disrupt the economy.”

Already the U.S. is sending signals that it’s on the road to whatever will become the new normal. The Biden administration says there are enough tools — vaccine boosters, new treatments and masking — to handle even the Omicron threat without the shutdowns of the pandemic’s earlier days. And the Centers for Disease Control and Prevention just reduced to five days the time that people with COVID-19 must stay in isolation so they don’t sicken others, saying it’s become clear they’re most contagious early on.

Cases on the rise again

India offers a glimpse of what it’s like to get to a stable level of COVID-19. Until recently, daily reported cases had remained below 10,000 for six months but only after a cost in lives “too traumatic to calculate” caused by the earlier Delta variant, said Dr. T. Jacob John, former chief of virology at Christian Medical College in southern India.

Omicron now is fuelling a rise in cases again, and the country in January will roll out vaccine boosters for front-line workers. But John said other endemic diseases, such as flu and measles, periodically cause outbreaks and the coronavirus will continue to flare up every so often even after Omicron passes through.

Omicron is so hugely mutated that it is slipping past some of the protection of vaccinations or prior infection. But Dr. William Moss of Johns Hopkins Bloomberg School of Public Health expects “this virus will kind of max out” in its ability to make such big evolutionary jumps. “I don’t see this as kind of an endless cycle of new variants.”

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U of G to close public COVID-19 vaccine clinic due to high vaccination rates and availability – GuelphToday

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NEWS RELEASE
UNIVERSITY OF GUELPH
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The public COVID-19 vaccination clinic on the University of Guelph campus will close Jan. 21 due to high vaccination rates and greater vaccine availability within the Guelph community.

Since opening Jan. 4, about 9,000 people received vaccine doses at the campus clinic.

“I am delighted and inspired by the enthusiasm and spirit of collaboration that was displayed, once again, by our University and greater Guelph community,” said U of G president Dr. Charlotte Yates.

“People came together under tight time constraints and challenging circumstances to organize and operate our second successful campus vaccination clinic, with many of our faculty, staff and students volunteering their time and expertise. Vaccination is the best way to protect people from the most serious negative health effects of COVID-19, and I am so proud the University was able to help make a difference.”

Run in partnership with Wellington-Dufferin-Guelph Public Health and the Guelph Family Health Team, the clinic was established as part of a community-wide effort to boost vaccination rates and help stem the current pandemic wave.

Held in the W.F. Mitchell gym of the Athletics Centre, the clinic initially saw 1,200 vaccination appointments a day. That number had dwindled to fewer than 100 by late this week, said Christine Zulauf, catering manager with Hospitality Services.

She said the clinic attracted visitors from across the region.

“It’s been a really unique experience to play a role and help get all of these vaccines into the community,” said Zulauf. “Hopefully, it’s a once-in-a-lifetime opportunity and we won’t have to do it again. I’m glad the University was able to help out.”

About 55 volunteers, including staff, faculty and community members, helped direct clinic visitors into and out of the facility. They contributed almost 1,000 volunteer hours in all this month; on average, about 16 volunteers were on hand at the clinic each day.

Many of those volunteers had also helped with the first campus vaccination clinic held for almost five months in 2021. More than 80,000 vaccinations were administered during that earlier five-month clinic.

“It was really wonderful that so many volunteers came back to help us this time around,” said Zulauf.

COVID-19 vaccinations will continue to be offered to faculty, staff and students on campus through Student Health Services.

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'Very nice spring, very nice summer': Omicron will bring us closer to normal, experts say – National Post

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‘We need to lay out a strategy and a plan towards moving back toward something that is nearer normality’

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Anna Bershteyn says there are absolutely no guarantees, of course, but if asked to read the tea leaves, she sees “a very nice spring, a very nice summer, where people can let loose,” see others and not worry so much about COVID-19 .

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It’s just a hope, “but if I had to make a guess, I would say that what Omicron will probably give us is a period of respite,” said Bershteyn, an assistant professor in the department of population health at New York University Grossman School of Medicine. Immunity gained through vaccination, infection or a combination of the two, could move populations closer to controllable levels of COVID, she and other scientists said. The hope is that the virus “sort of vaccinates itself” — that a milder strain gives us immunity to a later, potentially more severe one.

While hospital and ICU numbers are rising nationally, Omicron infections may have peaked and the country could be on a downward slope, federal health officials said Friday.

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COVID is here to stay. SARS-CoV-2 will continue to live in the human population, Dr. Theresa Tam, Canada’s chief public health officer said. While we must prepare for more potential unusual variants, “we do need to lay out a strategy and a plan towards moving back toward something that is nearer normality,” Tam said . In England, mandatory masking in public spaces and vaccine passports will be dropped beginning next week, while Spain is moving toward treating SARS-CoV-2 much like seasonal flu.

Many questions linger: It’s not clear how long immunity to Omicron will last, whether we could see a second wave, or whether infection with a milder stain will indeed provide immunity against whichever Greek letter-named version of SARS-CoV-2 comes next. The virus has already proven whip smart — scientists didn’t see heavily mutated Omicron coming — and it’s still evolving.

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“The big game changer is indeed the moment when nearly everybody will have had some sort of immunity,” Dr. Peter Juni, of Ontario’s COVID-19 science table  recently told a COVID research consortium . “I can’t guarantee endemicity relatively soon, but I can guarantee we can move much closer to endemicity after the Omicron wave.”

Here’s what we know about where we are now and where we need to go.

Rapid rise, rapid descent?

“Our modelling suggests that we are at the peak around now, with some provinces (Ontario and Quebec, which experienced Omicron earliest) just past the peak and others just behind it,” said Caroline Colijn, an associate professor of mathematics at Simon Fraser University and COVID-19 modeller.

In Ontario, the rate of hospitalizations and intensive care admissions is slowing. Restaurants and gyms will reopen starting Jan. 31, with all remaining restrictions to go by mid-March, Premier Doug Ford announced Wednesday. British Columbia is seeing a slowing in transmission rate. “That’s partly the end of the holidays, but I think it partly is  a lot  of people have COVID right now,” said Colijn and that’s having a dampening effect. More people are isolating “or cancelling things if they hear five of their friends have COVID.” That, combined with a shorter course of infections, can drive a speedy decline, she said.

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Our modelling suggests that we are at the peak around now

But Canada might also have a more rounded peak, or double peaks, because of the timing with schools and universities reopening and the lifting of restrictions, Colijn said. “We may not see the very rapid decline that has been seen in South Africa, for example.”

Official case counts are almost irrelevant, with testing systems so overwhelmed. “But it’s important if the number of actual infections happening starts to go down quickly, because that’s going to decrease the burden on everybody — fewer people sick, fewer people in hospital, fewer workplace closures, fewer schools affected,” Colijn said.

Why not just get infected and get it over with?

Famed cardiologist and author Dr. Eric Topol isn’t thrilled with the “Omicron will ultimately find just about everybody,” messaging. “Let’s not invite an unpredictable virus that can cause long COVID,” or secondary attacks, where people who may not be particularly at risk of a bad infection themselves unwittingly pass the virus to someone who can wind up very sick,” Topol said, during a recent University of California, San Francisco Department of Medicine Grand Rounds Q&A. 

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In Australia, “COVID chasers” are hoping to time infections when it’s less inconvenient to isolate. Their thinking runs the lines of, “It’s going to happen anyway, I want to live my life, I’m sick of trying to avoid COVID and it’s likely to be mild in someone like me.”

It’s not a terribly brilliant idea, Topol, founder and director of Scripps Research Translational Institute, and other scientists said. Omicron can cause severe disease. It’s not uniformly mild. With hospitals grappling with shortages of staff and COVID-19 drugs, people who do end up in hospital risk ending up with less-than-optimal care, Juni said. And while it will take months before it’s known whether Omicron can cause long COVID, the phenomenon typically follows mild infections.

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  1. FILE PHOTO: A respiratory therapist and six nurses prone a coronavirus disease (COVID-19) patient inside the intensive care unit of Humber River Hospital in Toronto, Ontario, Canada April 19, 2021.

    Dr. David Jacobs: Omicron has filled up my hospital, but the panic from the Delta wave is gone

  2. Despite some claims, the numbers do indicate that among the elderly, unvaccinated people are much more apt to be made badly sick by the virus.

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  3. A new study found that vaccinated couples were no less likely to conceive than unvaccinated ones.

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Vaccines are still the best shot at making COVID manageable

The vaccines are still holding their own against severe disease with Omicron, and a third dose boosts immunity even higher. Still, demand for third doses appears to be slowing, and while Pfizer has said it should have a vaccine that targets Omicron specifically by March, Topol and others said what’s needed is a universal, “pan” coronavirus vaccine that would protect against all variants and make it harder for the virus to mutate its way around. Omicron proved that SARS-CoV-2 can take huge leaps in evolution, “and get all these mutations all in one jump,” Bershteyn said. “You really can’t place Omicron on the family tree of variants that we’ve seen before. It sort of came out of nowhere, and as far as I can tell there’s no biological rule that says that it couldn’t do this again  and  be very contagious and very deadly at the same time.”

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“The unvaccinated who do not have a boost to their immunity from vaccine are likely to become susceptible again to whatever variant comes next,” she said, and regulatory discussions should be happening now, including, would manufacturers have to do a full clinical trial of a new vaccine, or a small, short trial, looking at the antibody response? How long to monitor for safety? A vaccine against Omicron is three months away. If a more dangerous variant emerged, “we couldn’t wait three months. You’d have to completely lock down everything. It’s just not feasible.”

What’s the endgame?

“Waning immunity and the emergence of new variants will shape the long-term burden and dynamics of COVID-19,” Colijn and colleagues wrote in a pre-print.

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“If we can get another infection in a couple of months, that’s not a good thing for where this virus settles out,” Colijn said. “But if we’re well protected for a year, that’s pretty good news. And what that means is that (COVID) will decline to hopefully pretty low levels and stay at those levels.”

But endemic doesn’t mean “not a problem,” she said. “It just means that it’s stable — it’s not having this huge wave that goes through the population.”

Waning immunity and the emergence of new variants will shape the long-term burden and dynamics of COVID-19

She doesn’t think there’s pressure on the virus to get more severe. Transmission is where the virus is having “its reproductive opportunities. We have the high transmissibility without it carrying along a really high severity. So, hopefully, we don’t get the big, bad new variant,” Colijn said.

Hospitalizations will never be reduced to zero. “There are always going to be frail vulnerable people who succumb to this virus,” McMaster University infectious diseases specialist Dr. Martha Fulford said in an earlier interview. Once past this hump, and with more protection because of boosters, more immunity from infections and more effective treatments, a broader conversation will be needed about the risks posed by COVID and the risks that exist from locking down “forever and a day,” she said.

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Change to shorter isolation period part of managing COVID 19 in B.C.: top doctor – Vancouver Sun

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Dr. Bonnie Henry says unvaccinated adults who test positive are at risk of having longer-lasting and more severe illness and must isolate for 10 days but those who are vaccinated should isolate for five days.

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VANCOUVER — British Columbia’s top doctor says the current wave of COVID-19 is causing less severe illness and that calls for a shift to shorter periods of isolation in order to minimize societal disruptions.

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Dr. Bonnie Henry says unvaccinated adults who test positive are at risk of having longer-lasting and more severe illness and must isolate for 10 days but those who are vaccinated should isolate for five days.

She says children are at much lower risk of severe illness and are able to clear an infection faster, so five days’ isolation is also suitable for them, with mounting evidence showing they need to interact with others as part of their social development.

Henry says testing is not needed for most people who have symptoms and are likely to have a mild illness but those who are immunocompromised and over 70 could end up with more serious illness and likely need a test.

She says vaccination remains the best protection for everyone, especially for vulnerable groups, but anyone with symptoms should stay home until they feel better, the same as with other respiratory illnesses like the flu.

Henry says COVID-19 is far from being an endemic illness so restrictions that are in place are needed to prevent more hospitalizations, though those numbers have been declining.

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