What might the end of the covid-19 pandemic look like?

(CNN) – Covid-19 is here to stay.

It is highly unlikely that the United States, much less the world, will be able to completely eliminate the coronavirus that causes covid-19.

But the day will come when it will cease to be a pandemic, when cases are no longer out of control and hospitals are not at great risk of overflowing with patients. Many experts predict that the spread of the coronavirus will look and feel more like seasonal flu.

What is less clear is how and when it will happen.

“There’s not even a measure that says something is an epidemic or a pandemic. This is all in the eye of the beholder, and that’s part of the problem,” Dr. Arnold Monto, a professor of epidemiology at the University, told CNN. of Michigan and Acting Chairman of the US Food and Drug Administration’s Advisory Committee on Vaccines and Related Biologicals.

“So all of this is not based on rules. It is typically based on what you have to do to control the outbreak,” Monto said. “What is so different here is that our vaccines are much more effective than what we usually see.”

The good news, according to Monto, is the power of vaccines.

The bad news is the power of the virus to change and evolve.

No one can predict what the future of covid-19 will look like, and the emergence of coronavirus variants, such as the delta, has changed the trajectory of the pandemic, he said.

“With the change in transmission patterns, as variants have emerged, I call it a parade of variants, now we see a much more extensive transmission and a much more uniform spread globally. This makes declaring the end of the pandemic is more difficult, “Monto said. “Because the whole pattern of propagation has changed, and it is possible that there are still outbreaks that have not really gone through the kind of waves that the rest of the world has gone through.”

We have to “wait and see and hold our breath”

Monto and other public health leaders anticipate that in the future, the world could track the spread of SARS-CoV-2, the coronavirus that causes covid-19, in a similar way to how seasonal flu is controlled.

“We have no idea if we’ll see that kind of seasonal pattern with SARS-CoV-2, but it reminds us that most of our respiratory viruses start to behave like seasonal events,” Monto said.

“There is precedent for a very seasonal pattern for some of the coronaviruses that have been infecting people,” he added. “If SARS-CoV-2 starts behaving like this, we don’t know, but at least it gives us a scenario that it could start behaving like this.”

As Monto said, we have to “wait and see and hold our breath” to find out what an endemic phase of the coronavirus could look like.

Endemic means that a disease has a constant presence in a population, but it does not affect an alarming number of people as is typically seen in a pandemic. Even in early 2020, when the pandemic was on the rise, World Health Organization officials predicted that the new coronavirus “could become another endemic virus in our communities“and never go away.

“When you think about pandemics, you are in the pandemic phase and then you have a slowdown phase, then you have a control phase, then hopefully you will have elimination and maybe eradication,” said Dr. Anthony Fauci, director. from The National Institute of Allergies and Infectious Diseases, to the Senate Health, Education, Labor and Pensions Committee of the United States in a hearing Thursday.

“What we hope to get to is at such a low level that, even if it is not completely eliminated, it does not have a major impact on public health or the way we run our lives,” Fauci said. “So if we get more people to get vaccinated globally and more people to get vaccinated now, hopefully within a reasonable amount of time we will get to that point where there may occasionally be ups and downs in the background, but it won’t get the better of us. the way he’s doing it right now. “

While last month the US Department of Health and Human Services renewed his determination Since there is still a public health emergency in the United States due to Covid-19, federal health officials are already thinking about how to measure the end of the pandemic and how to continue to track the coronavirus once it becomes endemic.

“There is still much to do” for the end of the pandemic

To transition from a pandemic to an endemic one, the nation has to develop immunity to the coronavirus, which means that many more people must be vaccinated, Dr. Philip Landrigan, a pediatrician and epidemiologist at Boston College, told CNN.

Some Americans who still refuse to receive their covid-19 vaccinations and some refuse to wear masks, the transition could take longer.

Currently, approximately 58% of the total US population is fully vaccinated against COVID-19.

“We have to get to somewhere well above 80%, possibly even well above 90% of the population with immunity, either from having an infection or having received vaccines,” said Landrigan, who worked at the CDC. for 15 years.

To control the spread of the measles virus in the United States population, for example, “we had to raise the immunity rate above 95%, and even then, we have had sporadic outbreaks. These outbreaks usually occur when there is a group of people in a particular place who are not immunized and all of a sudden the virus is introduced because a traveler has entered with the virus, and bang, you have 20 cases of measles in some city! ”said Landrigan. it is an epidemic. It is an outbreak in a context of almost no cases or scattered endemic cases. “

For now, the CDC says there is a lot of work to be done to control the current spread of the coronavirus.

“We know there is still a lot to do to stop the spread of COVID-19 and end the pandemic. We continue to see too many new cases, hospitalizations and deaths. The daily average number of cases is more than 70,000 per day with more than 1,000 deaths. That is why we are encouraging everyone over the age of 5 to get vaccinated to protect against COVID-19, “CDC spokeswoman Kristen Nordlund wrote in an email to CNN last week.

“As we look forward to fall and winter, it is important to continue applying prevention measures that we know work: getting vaccinated, wearing a mask in public places, indoors, staying home when you’re sick, and washing your hands frequently.”

Authorities insist on vaccination

Health officials are familiar with the work required to improve vaccination rates.

The CDC recommends that almost everyone over the age of 6 months should get a flu shot every year. But during the 2019-2020 flu season, only about half of those people (51.8%) did, according to the CDC. The agency estimates that the flu has caused around 12,000 to 52,000 deaths each year between 2010 and 2020.

The coronavirus has killed more than 750,000 people in the United States so far.

The battle against the coronavirus each year can be a lot like the annual fight against the flu.

“We’ve been thinking a lot about what an endemic phase looks like and the data we need to collect during that phase. Certainly, right now we are collecting data on cases, hospitalizations, deaths,” said Dr. Rochelle Walensky, director of the Centers for US Disease Control and Prevention said at the Senate committee hearing Thursday. “The question is: What will our best metrics be in the future? And probably model them based on the flu.”

From pandemic to seasonal disease

CDC collaborates with Health Departments, Laboratories, Hospitals, and Healthcare Providers to track diagnosed influenza cases, determine which influenza viruses are circulating, and measure the impact those viruses are having on hospitalizations and deaths.

One idea is that when the coronavirus becomes endemic, a similar tracking system could be used to monitor the pathogen.

“We could handle cases like we do with seasonal flu, where we can say that we know that we will see multiple cases in the winter season, and we can have the right staff, we can have the right supplies ready and we are ready to handle it, as opposed to the surges we’ve been dealing with here, “Dr. Stephen Parodi, Kaiser Permanente’s national infectious disease leader, told CNN.

“I’m still on phone calls talking about what our ICU bed capacity is? What are our supply chains that we need to provide patient care? Do we have enough drugs? Do we have enough monoclonal antibodies?” Parodi said. “We have a lot more work to do to get to where we want to be, and I think we will see this transition in 2022. But for some places, where there is less immunity, it will take longer to go.”

Even the flu is unpredictable, and doctors have seen many cases over the years.

“We know there will be cases,” Monto said. “With influenza, we have had experience with influenza pandemics before. Therefore, we typically know how they behave. This has been an evolving situation with a totally new pathogen.”