A Transition?

In July 2021, a post noted the potential for SARS-CoV-2 to transition from pandemic to endemic status. See How Does the Story End (July 2021). There, I noted that 
"The science from past pandemics suggests to the Statnews writer that 'viruses morph from pandemic pathogens to endemic sources of disease within a year and a half or two of emerging.' That is not to say this must be the same, because this is not an influenza we are dealing with, and its pattern and timing could be different. This is, after all, a "novel" coronavirus. There is some value to prior experiences, but not a true roadmap."
At least in Florida, the first documentation of SARS-CoV-2 was in March 2020. However, according to the Centers for Disease Control, there was a "cluster of patients in Wuhan, Hubei Providence, China" by December 12, 2019, thus the name for our reaction has not been "COVID-20." There are those who believe the virus "was likely circulating undetected for at most two months before" the first cases were diagnosed in December. 2019. Thus, by any estimation, we are 24 to perhaps 27 months into our relationship with the SARS-CoV-2.
The "morphing" has been persistent, and sometimes newsworthy. According to Johns-Hopkins, variants "are neither new nor unexpected." As these appear, they are labelled "of interest," "of concern," or "of high consequence." They are "of interest" if "characteristics . . . predict greater transmissibility, evasion of immunity or diagnostic testing or more severe disease." To be "of concern," it must be "more infectious, more likely to cause breakthrough or re-infections in those who are vaccinated or previously infected." And, to be of "high consequence" it must be "a variant for which current vaccines do not offer protection." 
Omicron is the latest of the variants. The New York Times reports that "There are now seven “variants of interest” or “variants of concern.” They have each been given a Greek letter designation because of the somewhat woke conclusion that "describing variants by the places they were detected 'stigmatizing and discriminatory.'" Those "of concern" include Alpha, Beta, Gamma, Delta, and Omicron. Those "of interest" are Lambda and Mu, according to the World Health Organization (WHO). There are no known current "high consequence" variants to worry us. 
I am reminded, in that context, of Winston Churchill's
"Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."
And, it is possible that this latest mutation signals the beginning of the end of the pandemic state. It may be that Omicron is a more infectious form of COVID-19 that is nonetheless perhaps less symptomatic and deadly. That, of course, remains to be seen. But, it would admittedly be somewhat consistent with the "year and a half or two of emerging" prognostication of Stat News cited last July.
One physician suggests that this variant being "four times more contagious than a delta variant," it is possible that it "will crowd out the delta variant eventually.” This article suggests again that COVID could become "nothing more than a recurring endemic cold." That is, something we would have to live with, but which would be less deadly and threatening.
The discussion of endemic status has been in the news on various platforms recently. See El Paso doctor believes COVID-19 will go from pandemic to endemic, and The coronavirus may be here ‘for the rest of our lives,’ doctor says. There is suggestion of the potential for annual inoculations and discussion of the promise of newly-developed anti-viral drugs. Though there is ample debate, I had a conversation this week at the WCI conference with a doctor that advocates Remdesivir and chloroquine. Perhaps these anti-viral treatments, rather than vaccines, will play a large role as the disease morphs to an endemic state.
The endemic view is not unanimous. The British Broadcasting Corporation (BBC) contends we can learn lessons from South Africa's experience with Omicron. It concedes that hospital stays are shorter, fewer patients require oxygen or ventilators, and reported symptoms are less severe in a general sense. However, these do not persuade some that the variant is "milder." Instead, some contend that this demonstrates only that the "rate of vaccination and natural immunity in the population" is more predominant.  Thus, the vaccine is seen in this analysis or hypothesis as not preventing infection but markedly militating severe symptoms. 
In the end, there is not proof. But, perhaps the increased infection rates with Omicron will produce increased populations with viral resistance. In a society that has perhaps reached peak vaccination willingness and lacks dictatorial authority to force 100% inoculation compliance (whatever that may mean as the definition of "fully vaccinated" shifts), perhaps natural infection-immunity increases population (herd) immunity and may deter further spread? Possibly, we are either entering the endemic stage of this viral onslaught, or nearing that entrance? Whether one believes the StatNews prediction on timing or not, it nonetheless seems reasonable regarding the endemic phase to say "its about time."
At the WCI this week, I repeatedly heard the expressions of relief to be back in person. The programming was outstanding and the crowds were notable. There were folks wearing masks, and a fair amount of hand sanitizer was utilized. A few folks even turned down a handshake. Those people are looking out for their health, and one never knows what circumstances they may face (one friend explained to me this week about an immune issue with a child at home; another recently had surgery and is under significant ongoing care; yet another suffers an immuno-depressive malady I can neither recall or pronounce). 
It is imperative as this pandemic creeps on that we remember people are different, face different needs and concerns, and their decision to mask, distance, or eschew physical contact is something we must all respect and understand. Similarly, if someone elects not to vaccinate, that is a personal choice. Our understanding of peoples' personal circumstances (known to us or not) and choices is an imperative part of our moving forward through this challenge as a community. 
By Judge David Langham
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    About The Author

    • Judge David Langham

      David Langham is the Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims at the Division of Administrative Hearings. He has been involved in workers’ compensation for over 25 years as an attorney, an adjudicator, and administrator. He has delivered hundreds of professional lectures, published numerous articles on workers’ compensation in a variety of publications, and is a frequent blogger on Florida Workers’ Compensation Adjudication. David is a founding director of the National Association of Workers’ Compensation Judiciary and the Professional Mediation Institute, and is involved in the Southern Association of Workers’ Compensation Administrators (SAWCA) and the International Association of Industrial Accident Boards and Commissions (IAIABC). He is a vocal advocate of leveraging technology and modernizing the dispute resolution processes of workers’ compensation.

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