Is it over? Will it ever be over?
After an August and September surge of COVID-19 caused record-high hospitalizations and was blamed for the deaths of more than 150 county residents, October is a different world.
Hospitalization rates have not only dropped, they’re below the level of hospitalizations seen on an average day during the pandemic. There have been fewer than 2,000 active cases in the county since July, and the number of active cases in the county has decreased every day for more than a month
Those good signs lead to the natural question: Are we at the point where the pandemic has passed? The answer: We might be getting closer, but we’re not there yet, health experts say.
COVID-19 still is considered a pandemic, according to the World Health Organization. A pandemic means that a disease is found around the globe and there’s no protections against it.
Eventually, maybe inevitably, COVID-19 will reach a stage when it’s not considered a pandemic, but becomes something that’s more predictable: a seasonal epidemic, said Dr. Pedro Piedra, a professor of molecular virology and microbiology and of pediatrics at Baylor College of Medicine.
“Eventually, a pandemic will become seasonal, because the population has an immunity to it,” Piedra said. “It’s no longer that we don’t have any immunity. It’s not like the world is naive to the virus. The world’s been exposed, and either through vaccines or natural infection, we achieve population immunity.”
One of the things that will determine whether the world is at that point is when and how the next wave of COVID-19 presents itself, Piedra said.
“If you see the next wave present itself during the fall and winter months, then you know you’re getting a wave where this virus is becoming more seasonal,” Piedra said. “If you see the next wave occur during the spring or summer months, then you’ll know we’re not there yet.”
A fall-winter surge would mean COVID is acting more like other coronaviruses, and therefore more predictably; a spring-summer surge would mean the virus is still moving unpredictably, Piedra said.
PANDEMIC TO PREDICTABLE
Epidemics still can be serious, but people are used to them.
Almost every flu season in the past 10 years has been considered an epidemic — but the rate of infection and the deadliness of that seasonal virus has varied.
From 2010 to 2019, the seasonal flu infected between 9.3 million and 41 million each year, according to the U.S. Centers for Disease Control and Prevention. Between 12,000 and 52,000 people died each year in that time period.
The flu killed from 0.05 percent and 0.17 percent of infected people a year, according to the CDC. By comparison, COVID’s mortality rate in the United States has been about 1.6 percent of people infected, according to Johns Hopkins University. The CDC has attributed more than 731,000 deaths to COVID-19 over 20 months. Between 2010 and 2019, about 342,000 deaths were attributed to flu.
But with COVID vaccines, the game changes, said Ross McKinney, the chief scientific officer for the Association of American Medical Colleges. Among vaccinated people, COVID’s mortality rate became about equal to flu, McKinney said.
That reduction to the threat of the virus could go a long way to making it seem more normal, he said.
“I think we’re going to be to where it’s like flu fairly soon,” McKinney said. “For vaccinated people, the impact is very much like flu. When we have a very large percentage of people vaccinated, which we hope eventually we do, it will feel like a flu epidemic. It will feel familiar.”
Familiar means that communities won’t go into “shutdown mode” amid outbreak and masks might be around when needed, but won’t be prescribed all the time.
As COVID moves into a new annual form, there could be some years where it’s more dangerous than others.
But a predictable epidemic would mean predictable actions, like annual vaccinations and other precautions.
“Variants, like the delta variant, could cause a bit of damage,” Piedra said. “I would expect as time evolves we would have vaccines and antivirals that will be given at a regular time period to ensure that our population becomes immune.”
As with the flu, some years there could be more urgency in the messaging about getting vaccinated, particularly in vulnerable groups. Annual severity will depend on what kind of variant develops.
A THIRD STAGE: ENDEMIC
There could come a day where the virus becomes endemic, appearing in very small numbers and responded to like other uncommon, but present diseases such as typhoid or tuberculosis, said Dr. Philip Keiser, Galveston County’s local health authority.
With those diseases, the wider public usually isn’t asked to take precautions to prevent their spread, Keiser said. Organizations such as the health district can identify infected people and the people they’ve been around and order mandatory quarantines and other precautions. While contact tracing has been attempted during the COVID pandemic, the fast and wide spread of the virus hasn’t made it particularly effective, Keiser said.
People mostly have been asked — not ordered — to quarantine themselves during the COVID pandemic.
Endemic diseases are something we live with, consider an acceptable risk and don’t draw extreme precautions, Keiser said.
“It’s something that’s always there and we’ll never be rid of it,” Keiser said. “But it’s not so much that it overruns the health care system or has a huge impact. It’s always there, at a stable level.”
Put another way: A person might be aware typhus is present in the county and it can cause them to become sick, but it doesn’t become a huge worry until you have a typhus-carrying possum living under your house and its fleas become your cat’s fleas, Keiser said. That’s an endemic worry.
With as many as 95,000 Galveston County residents still vulnerable to COVID because they haven’t been vaccinated or previously infected, it’s still too soon to regard COVID as a threat underneath the back porch, Keiser said.
The county is moving closer to being thoroughly protected. As of this week, more than 70 percent of Galveston County residents who are eligible to be vaccinated have received at least one dose of the vaccine, a mark the health district celebrated with a pizza party on Friday.
The county’s overall vaccination rate, including people who aren’t eligible to receive a vaccine, is about 52 percent. About 53,000 residents have been diagnosed with the virus since March of last year. When considered with the number of people who have been vaccinated, about 67 percent of the county’s population has some degree of protection against the virus.
That number is expected to take a big jump in November, when vaccines likely will be approved for children ages 5 to 11.
Still, it could be well into 2022 until there’s agreement about whether the pandemic has moved into the more predictable stage.
“What we’re going to have to see is what happens over the next months — it may be up to six months before we can say it confidently,” Keiser said. “In the past, we’ve gone through three or four months before we started to see cases rise again. It may be a while before we really know.”