Are we moving to the endemic phase of COVID infections? Three NC experts weigh in on what that would look like.

Before the first snowflakes began to fall last week, meteorologists were advising North Carolinians when the wintry mix would arrive, how severe conditions would be, and how to best prepare for the impeding storm.

Dr. Jonathan Quick, an adjunct professor at the Duke Global Health Institute, envisions a future in which we have a similar system for forecasting the spread of COVID-19 and future variants.

Quick and two of his colleagues at Duke University fielded questions Monday about what it would mean for the COVID-19 pandemic to become endemic.

“If we think back to where we were last June, the virus is still around, we’re cautious but we were able to live more normally. That’s the level that we’re aiming for,” said Quick.

Quick believes an early public health warning system, coupled with diagnostics, vaccines and therapeutics will help the country approach a sense of normalcy moving forward.

Dr. Christopher Woods, co-director of the Hubert-Yeargan Center for Global Health at Duke, agrees that the key to moving forward is an ongoing investment in public health infrastructure.

“We don’t want to lose vigilance as we continue to progress into an endemic phase,” said Woods. “What we are liable to see is intermittent surges of infection.”

Dr. Woods said it’s critically important to make sure vaccinations are widely available to those in and outside the U.S.

“That’s important because that retained immunity lessons the likelihood of new strains pushing those surges,” he explained. “If it’s omicron that comes back as immunity wanes, we’re much more likely to be able to handle that as a population as opposed to if we have a newer variant that potentially has greater severity associated with it.”

Lavanya Vasudevan, an assistant professor in the Department of Family Medicine and Community Health at Duke, has been reflecting on vaccination campaigns and messaging in hopes of reaching those who remain hesitant to get a COVID shot.

“There is really no one size fits all strategy when it comes to vaccination promotion,” explained Vasudevan.

Because people perceive the risk of COVID differently, some will be willing to get vaccinated and boosters while others may require some incentive. For those who stubbornly refuse the shot, she says that may require multiple conversations.

“Again, there is no magic word or phrase we have identified in the past year that providers can use, rather it’s a conversation or multiple conversations to respond to individual concerns.”

“We need to stay on the alert”

Even as cases of omicron appear to have peaked in parts of the country, Dr. Quick says the reality is that what we know about the durability of the existing vaccines is still evolving.

He credits South Africa for being the first to warn of the contagious variant omicron. But Quick would like to see much more global genomic surveillance.

“The other thing is we have to have public health officials with a clear idea of how to respond. You can’t catch up. We’ve seen over and over again states or countries say ‘We’ll see how it goes.’ No. You don’t get a do over.”

Accurately forecasting the future spread of variants could be just as valuable as forecasting the weather, according to Quick.

“We have reduced weather-related deaths by 95% over the last five decades by being able to pick-up the warnings.”

Surge-capacity necessary

Even in an endemic phase, the coronavirus can still put a strain on hospital systems.

“With regard to our workforce, we’ve seen burnout at tremendous frequency. The ICU docs, nurses and first responders have been our true heroes,” said Dr. Woods. “The capacity for them to continue to respond to surges is going to diminish and so we need to replete that workforce.”

Woods believes that means requiring vaccines in our healthcare systems and masking at a minimum when these surges arrive.

“I suspect this will become much more the norm in hospitals at least, if not all health care situations.”

An endemic backlash

Another concern is that a certain carelessness may set in once the public thinks the coronavirus has reached an endemic stage.

“At this time, 80 percent of our population, 5 years and older, have been vaccinated. That’s a tremendous achievement for a vaccination campaign,” said Vasudevan.

“But as we move toward more endemic infections, we start to see some complacency set in. The flu vaccination rates, for example, are much, much lower than the COVID vaccination rates we are seeing right now.”

Vasudevan said the way we overcome that complacency is to streamline the messaging and resources to occur with the timing of when a surge might happen.

She says vaccines remain the best tool the world has to protect lives and prevent disruption to our economy.

That said, she would like to see better vaccines in the future.

“Combination vaccines are often helpful when thinking about rolling out vaccination campaigns.  If we have a flu plus COVID vaccine that’s something that could be particularly helpful when messaging and increasing demand. Things like a pan-influenza vaccines, we need to invest additional resources in developing those.”

Vasudevan says a viable COVID vaccine for those under the age of five is yet another area that needs further investment.

‘Vaxxed & Done’

As for those who have been vaccinated and are ready to drop their guard for a pre-pandemic lifestyle, the experts offered a word of caution.

“We learned a hundred years ago with the 1918 flu. Those places that relaxed their protections too early were the ones that were hit the hardest.”

Dr. Quick cautioned that their research is an evolving science, just as the virus is evolving.

“Not keeping up with the latest public health advice will only prolong the pandemic for everyone.”