The COVID-19 Pandemic: Looking to the future and the "new normal"Jan 10, 2022
As we head into year three of the SARS-CoV-2 pandemic, attention is turning to this next year and beyond. We have passed the two-year anniversary of the identification of the emergency of SARS-CoV-2, although Colorado’s anniversary dates arrive in March. Interviewed by Axios Denver about what comes next, I said, "One thing we learned from the virus is it's going to stay with us…We are going to be living with it in the foreseeable future."
The complexities of a transition from epidemic to endemic are addressed in several recent articles, which describe the interplay of factors that drive viral evolution and our efforts to control the virus. In an August 2021 paper in Nature, Amalio Telenti and colleagues provide a comprehensive picture of the driving determinants of the transition, drawing on lessons learned from influenza. Depending on the balancing of these factors, the authors offer three potential scenarios: persistence of an uncontrolled epidemic; transition to an epidemic seasonal disease, as with influenza; and persistence of SARS-CoV-2 as a cause of endemic disease. They end by emphasizing the need for national action, international cooperation, and more science to move from the first, unsustainable scenario of an ongoing pandemic to the alternatives. Rustom Antia and M. Elizabeth Halloran provide an epidemiological perspective on the transition to endemicity. Their analysis is useful for highlighting what we need to know about changes in immunity over time after infection and vaccination, and the possibility of moving on a path to “benign endemicity.”
The term the "new normal” has arrived, referring to a future with endemic or seasonal SARS-CoV-2. A quartet of commentaries (Jennifer Nuzzo and Lawrence Gostin; Ezekiel Emanuel, Michael Osterholm, and Celine Gounder; Luciana Borio, Rick Bright, and Emanuel; and David Michaels, Emanuel, and Bright) in the Journal of the American Medical Association (JAMA), addresses this new normal. Read together, they point to a path forward towards building the infrastructure to manage SARS-CoV-2 as an endemic coronavirus. The authors include six members of the Biden Administration’s transition team on COVID-19, giving weight to their view of the future and their recommendations. The most recent plan from the Administration is titled "Path Out of the Pandemic." Its six-pronged approach focuses on bringing the pandemic to a close, aiming to “put this pandemic behind us”; the authors of the JAMA commentaries suggest that this is not the goal at the moment.
They are correct in pointing to the need for acknowledging that the COVID-19 marathon is underway and that the finish line can’t yet be seen. Common “lessons learned” thread the four commentaries: inadequacies of data and surveillance systems; lack of systems for implementing the needed level of testing and for providing respiratory protection; distrust of public health institutions and measures; accounting for social vulnerabilities and inequities; and failure of global cooperation. Success for the long-run—the new normal—will only be achieved with attention to these problems, none of which have been adequately addressed at the two-year mark. As a local example, the case counts on the Colorado Department of Public Health and Environment (CDPHE) are flagged from December 27 forward as affected by reporting lags. Quoting Emanuel, Osterholm, and Gounder, “Without a strategic plan for the ‘new normal’ with endemic COVID-19, more people…will unnecessarily experience morbidity and mortality, health inequities will widen, and trillions will be lost from the U.S. economy.” An accountable entity within our government should develop that plan, but the fleeting and often misplaced pressures of politics are a barrier. Hopefully, the messages from these commentaries will be heard.
Back to public health, the pandemic, and the courts—now the Supreme Court. The two critical cases related to the Biden Administration vaccine mandates have now reached the highest court: one is the mandate through the Occupational Safety and Health Administration (OSHA) requiring vaccination for workplaces with 100+ employees and the second is the requirement for vaccination of healthcare workers at facilities receiving federal funds. News reports suggest skepticism towards the OSHA Emergency Temporary Standard and perhaps a more favorable view of the mandate for healthcare workers.
And a quick update on Colorado’s situation. We know that case counts are very high and not accurately counted at the moment, and hospitalizations are rising, but not spiking sharply. This week should give a better picture of the course of hospitalizations and insights as to when Omicron will peak in Colorado. At the CU Anschutz Medical Campus, our school’s leadership is sufficiently concerned by the Omicron wave and will open the spring semester remotely for the first two weeks.
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health