Our Endemic COVID Future Is Probably Not What You Think--Why More Action Is Necessary Now (A long 🧵 ):

Many think we're already “post-COVID.” We're not, but it does beg the question of what the future has in store for us. If we ignore how tired everyone is of #COVID19 and instead explore the latest data and studies, we may see that we've not yet fully understood or adjusted to our COVID future. We've gone back to “old normal” when a “new normal” is necessary.

WHY WE'RE NOT POST-COVID

No, the pandemic is not over. The World Health Organization says we're still in a pandemic. WHO declared the public health emergency on 30 January 2020 and a pandemic on 11 March 2020, and it's the entity that gets to decide it's over--not you, me, or President Biden. Days ago, WHO held a meeting to discuss COVID, and it determined the pandemic remains a public health emergency of international concern.
https://www.euronews.com/next/2023/01/30/who-to-keep-highest-alert-over-covid-as-public-health-emergency-of-international-concern

Some claim COVID is endemic, but this is not true. It will be endemic, eventually, but it isn't yet. For a disease to be endemic, it must be consistently present and cause a steady, predictable number of people to get sick. This is far from the case with COVID-19 right now. In the last three months, the US has seen two variants become predominant in rapid succession, and these were variants scientists had only just discovered four months earlier. That is not predictable. https://covid.cdc.gov/covid-data-tracker/#variant-proportions

The US has also had three surges of hospitalizations in the past year. Unlike the flu, which has a predictable annual season, COVID is not yet steady.
https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions

The US has not had a significant surge in COVID death ina year, although it continues to have a troubling level of COVID fatalities, losing around 3,500 people a week. But, we may yet see another significant wave of deaths. Other nations, like Japan and Sweden, have experienced their first- or second-highest levels of #COVID19 deaths of the pandemic in the past month or so.
https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=desc&pickerMetric=new_deaths_smoothed_per_million&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=SWE~JPN~NOR~AUS~HKG~FIN

None of this suggests that we've yet reached a stable place with COVID. Experts warn new variants could soon cause yet another surge of illness and hospitalization.
https://today.tamu.edu/2023/01/30/what-you-need-to-know-about-xbb-1-5-covids-latest-variant/

BUT WHAT MIGHT OUR COVID-ENDEMIC FUTURE LOOK LIKE?

Too many folks repeat the discredited idea that COVID is “just the flu.” It's led to folks thinking that COVID will be a minor inconvenience for the vast majority of the public on some annual basis. First of all, "just another flu" would be nothing to take lightly. The flu hospitalizes between 250,000 to 600,000 people in the US most years, and it kills between 20,000 to 60,000 people.
https://en.wikipedia.org/wiki/United_States_influenza_statistics_by_flu_season

But #COVID19 is not "just the flu.” A new study suggests that our endemic future is one with risks that demand much more public, not just individual, action. It concludes that “individuals seeking to opt out of adverse outcomes upon SARS-CoV-2 infection will find it challenging to do so, as large reductions in contact rate are required to reduce the risk of infection.”
https://www.medrxiv.org/content/10.1101/2023.01.22.23284884v1.full

Some specific findings from this study include:

There's little individuals can do to protect themselves short of enormous sacrifice if we don't implement public health solutions. Vaccinated people wishing to reduce their frequency of infection by half will need to reduce their contact rate 10-fold. People who only reduce their contact rate by half will “experience infections rates only marginally less” than those who have a median level of contacts with others.

People who are vaccinated and not taking measures to reduce their contact rate can expect to spend an average of 6 days a year acutely sick with COVID-19 and be infected 1.4x annually. That's a #COVID19 infection every 8.5 months on average. Now is a good time to remind the "just the flu" folks that the average American gets the flu once every 10 years or so.

https://www.cdc.gov/flu/about/keyfacts.htm

The study estimates that 2% of vaccinated individuals who have a median contact rate will experience long COVID so severe that it impacts their employment. Sounds small, but think of 1 of every 50 people being that disabled. That is a frightening situation.

Not only isn't COVID like the flu in terms of its evolution, transmission and frequency, we're also learning #COVID19 infections are likely much more dangerous to long-term health. To focus on just three out of 150 studies demonstrating the ways COVID can damage hearts, brains, immune systems, reproductive organs, kidneys and organs:

One study found that people who had COVID have a 43% higher risk of developing auto-immune issues.
https://www.medrxiv.org/content/10.1101/2023.01.25.23285014v1

Another study found those who had #COVID19 have a 60% greater risk of myocardial infarction and 39% higher risk of stroke.
https://www.mdpi.com/2075-4418/13/3/491

And another study uncovered the much greater risk of cognitive impairment in people following a COVID infection.

https://www.sciencedirect.com/science/article/abs/pii/S0165178122005972

Doctors won't necessarily tie individual heart attacks, strokes, diabetes diagnoses and the like to past #COVID19 infections from which people have recovered. Instead, what we'd see in a population that is repeatedly infected is an increasing burden of poor health and rising excess deaths. And that is precisely what is happening. Excess deaths (which is the number of people dying above historic averages) are very high and rising in many countries.
https://ourworldindata.org/grapher/excess-mortality-p-scores-projected-baseline?country=GBR~IRL~CHE~SWE~JPN~HKG~DEU

Take Ireland as an example. Currently, the COVID risks are lower than they've ever been since I moved here in October 2021. Our hospitalizations and positive rate of testing are the lowest they've been in 15 months. So, why do we have record levels of deaths so great that mortuaries can't keep up?
https://www.breakingnews.ie/ireland/number-of-deaths-in-recent-weeks-leading-to-funeral-delays-1425557.html

The excess-death situation is so pressing that actuaries--the people who guide long-term decisions for pensions and insurance companies--are beginning to adjust their assumptions. Continuous Mortality Investigation says “mortality in 2022 may be indicative of future mortality… life expectancy assumptions at age 65 are likely to fall by around 6 months, equivalent to 2%… higher death rates seen in the latter part of 2022 may be indicative of future mortality.”
https://www.lcp.uk.com/media-centre/2023/02/life-expectancy-assumptions-could-fall-by-6-months-if-cmi-proposals-adopted/

While the typical group of COVID-minimizing, herd-immunity-hyping, mask-hating folks love to blame the vaccines for excess deaths, the evidence is substantial and in doubt among experts that vaccines do much more good than harm. No vaccine is 100% safe, but we get vaccinated because the risks are miniscule compared to the risks of getting a deadly or disabling disease.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/is-the-covid19-vaccine-safe

Our endemic future isn't a return to 2019 norms but demands a new way of thinking of public health. If your personal risk isn't enough to encourage a change in your perception and behavior, perhaps you'll care more about the threat to the economy.
https://www.bloomberg.com/opinion/articles/2022-12-07/long-covid-is-a-threat-to-the-whole-economy?leadSource=uverify%20wall

We are seeing a historic decline in lifespans. We can wait a few more years, lose more lives to disability and death, and see how much more our lifespans decline, or we can begin to understand that COVID wasn't a temporary situation for us to get past. COVID, I believe, must be recognized as a global change in the risks we face and the way we live. We need to stop pretending our 2019 normal makes sense and figure out what our 2024 normal ought to be.
https://www.forbes.com/sites/joshuacohen/2023/01/01/the-number-one-health-story-from-2022-is-the-troubling-decline-in-life-expectancy/

HOW TO RESPOND TO OUR COVID-ENDEMIC FUTURE

There is a range of things we ought to do to create the conditions for a healthier, safer future. But, none of this will work on a voluntary basis. Public health can't be left to individual choice. It's called “public” health for a reason!

If you don't believe me, let me ask you three questions:

First, are you masking on long flights? No? Then you're ignoring the guidance provided by WHO to keep you and others safe.
https://www.reuters.com/world/whoeurope-backs-travel-checks-us-given-spread-latest-omicron-variant-2023-01-10/

Second, do you mask when in crowded indoor spaces? No? Then you are disregarding the latest advice WHO offers, which is masking “for anyone in a crowded, enclosed, or poorly ventilated space.”

https://www.who.int/news/item/13-01-2023-who-updates-covid-19-guidelines-on-masks--treatments-and-patient-care

Third, after you've had a potential exposure, do you test yourself? In fact, do you test three times? No? Then you are turning a blind eye to the FDA advice you conduct serial testing across three tests each 48 hours apart. Almost no one is following the guidance from public health organizations. Social pressures, COVID exhaustion, and poor risk awareness have combined to make voluntary compliance completely useless. We need public solutions to protect public health.
https://www.fda.gov/medical-devices/safety-communications/home-covid-19-antigen-tests-take-steps-reduce-your-risk-false-negative-results-fda-safety

This is why we need governments to act and business leaders to care. We know leaders are aware of the ongoing COVID risks--just look at how they protected each other at the World Economic Forum. Shouldn't each of us expect the same level of concern and care from our leaders that they extend to each other? The protections extended to attendees show us what we must consider--filtration for safer air, testing to reduce COVID transmission, and masks where possible.
https://www.linkedin.com/pulse/equitable-protect-corporate-leaders-from-covid-19-more-augie-ray/

Governments can lead in many ways. Belgium, for example, is implementing a “ventilation plan” that requires businesses to make a CO2 monitor clearly visible. CO2 itself is not a risk, but it is a good proxy for estimating how much of the air we inhale is rebreathed air from others--the higher the CO2, the more we're breathing others' air, and the higher the risk of infection.
https://workinmind.org/2022/04/05/belgium-agrees-on-ventilation-plan-for-public-places-co2-meters-essential/