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Dec. 3, 2022

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Pandemic’s end ‘in sight,’ but COVID isn’t going away. What’s that mean for the future?

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Tacoma — A recent news conference with global health officials on the world’s outlook for COVID-19 seemed like the news we’ve all been waiting for — that the end is “in sight” for the pandemic.

The Sept. 14 briefing from the World Health Organization offered optimism over signs the pandemic is winding down globally. WHO Director-General Tedros Adhanom Ghebreyesus announced a milestone reached in the pandemic’s global numbers.

“Last week, the number of weekly reported deaths from COVID-19 was the lowest since March 2020,” he said. “We have never been in a better position to end the pandemic. We are not there yet, but the end is in sight.”

Comparing the progress to running a marathon, he added, “We can see the finish line.”

The United States had the highest number of weekly deaths for any country reported worldwide with 2,306, according to WHO’s Sept. 14 report, but that was down 21 percent from the previous week. New U.S. cases also were down 26 percent.

Closer to home, Washington’s state of emergency and final pandemic emergency orders are set to end by Halloween.

“The end,” though, won’t be a definitive cessation of cases and health care problems tied to the pandemic. Indications point to ongoing illness and vaccination boosters as a matter of course for a long time to come.

The CDC shows low numbers of cases now requiring hospitalization, but it also shows infections still very much active nationwide.

Welcome to a new era where COVID is not completely over but is not as life threatening as it once was, at least for now.

PIERCE COUNTY

In Pierce County, weekly reported COVID-19 numbers have been steadily declining since a small spike in May. At the start of the year, weekly cases fueled by the Omicron variant peaked at 21,665 on Jan. 2.

The latest report from the Tacoma-Pierce County Health Department listed 533 cases and six deaths for Sept. 4-10.

In the months since the January peak, health officials have noted that home testing and unreported positive cases have contributed to lower case numbers. Many cases that are circulating are milder, thanks to vaccines and boosters.

The level of deaths and hospitalizations, two factors that have consistently demonstrated the pandemic’s peaks and valleys, are both low and staying there for now.

TPCHD said in its Sept. 13 update that the seven-day hospitalization rate per 100,000 was 2.1 for Aug. 26-Sept. 1. That’s 19.2 percent lower than the previous week. The rate of deaths per 100,000 per week could not be calculated, it noted on its COVID-19 data dashboard, because fewer than 10 deaths had been reported.

Wastewater monitoring, another way to track COVID community levels, is something the health department is still working to add context to as part of local reporting, according to Kenny Via, department media representative. TPCHD first announced that program in May.

Readings are posted on the CDC website. They indicated lower levels detected at two Pierce County sewersheds representing a population of 338,855.

For now, COVID-19 has retreated from the spotlight at the health department’s twice-a-month meetings.

“We are no longer doing regular COVID-19 updates at every BOH meeting,” Via told The News Tribune in response to questions. “But we’ve gone to doing Communicable Disease updates once a month at the study sessions that include info on our response to both COVID and monkeypox.”

Those updates, he added, are expected to continue once a month “for a while.”

“Occasionally we will also include updates about monkeypox or COVID in the director comments at regular meetings as well, if needed,” he noted.

The paradox of COVID tracking can be seen in the two national maps the CDC provides and the data behind them. Its community level map, based on hospital admissions and percent of staffed inpatient beds occupied by COVID-19 patients, showed low levels for most Washington counties as well as more than half of counties nationwide as of Sept. 15.

Its community transmission level map, which measures of the presence and spread of SARS-CoV-2, the virus that causes COVID-19, still showed high levels in 83 percent of counties nationwide, including most of Washington.

“High” is defined as more than 100 new cases per 100,000 persons in the past seven days, along with more than 10 percent of positive NAATs (nucleic acid amplification tests) during the past 7 days. If the two indicators reflect different transmission levels, the higher level is chosen, according to CDC.

For example, Pierce County was at a substantial level with its cases, one level below high. That contrasts with its low level reading at the community level.

So while the WHO might see a light at the end of the COVID tunnel, most parts of the United States still see cases circulating, they just aren’t rising to hospital-level serious, thanks to vaccinations and previous illness.

That gets us to what could be the next era: endemic.

Dr. Jeremy Luban, virologist with UMass Chan Medical School of the University of Massachusetts, was asked in an August interview whether the nation is now living with endemic COVID, evolving into a general widespread population-infecting illness like influenza.

That moment, envisioned by the WHO’s anticipated finish line, seems close, given the data.

“If we get to the point where the virus continues to spread and infect us, but it rarely causes severe disease because most of us have some immunity against it, we would say that SARS-CoV-2 has become endemic,” he said.

He compared the difference between the coming fall and last fall, when the world saw the Delta variant fade and Omicron kick in with an explosion of new cases and deaths.

“It’s possible that this coming fall is going to be the first relatively normal period for us since the beginning of the pandemic,” he said. “It may be the beginning of the real endemic phase for us, where most people who get infection have a common cold. But we don’t know that with any certainty, and with SARS-CoV-2 we have to be prepared for the worst.”

BOOSTERS

Going forward, COVID-19 boosters are expected to be offered much like the flu shot each year, updated depending on the variant. Recently, the new “bivalent” booster was introduced, targeting both the original COVID-19 strain and the now-circulating BA.4 and BA.5 Omicron variants.

In Pierce County, 53 percent of eligible residents have received at least one booster, according to state Department of Health dashboard.

Tacoma-Pierce County Health Department noted in a Sept. 8 update that 25.8 percent of residents are up to date with all COVID-19 vaccines, meaning the two shots in the primary series and all recommended boosters, including the new version.

Federal health officials are encouraging people to get the new booster by Halloween to offer protection in time for holiday gatherings. CDC booster guidance is posted online.

Nigel Turner is division director of communicable disease with TPCHD. Turner noted in an online update about the new boosters earlier this month, “During the peak six months of the Omicron wave, compared to those who completed their initial vaccine series, unvaccinated people in Pierce County were six times more likely to be hospitalized with COVID-19 and seven times more likely to die from COVID-19.”

LONG COVID

For those who’ve been infected, the threat of long COVID looms, with an estimated 1 in 13 adults in the U.S. currently experiencing illness long after COVID-19 has passed.

Dr. Janna Friedly is treating long-COVID patients at the UW Medicine Post COVID Rehabilitation and Recovery Clinic at Harborview Medical Center. Friedly told The state Department of Health in an interview published Friday that research now suggests more than 200 different symptoms.

“The way I think of COVID-19 is that it’s like gasoline, it sets everything on fire,” Friedly said. “If you had underlying conditions and you get COVID-19, the disease will light everything on fire and make things worse.”

Friedly noted that “A lot of people who have chronic medical conditions or are older may not necessarily associate the worsening of their symptoms or their condition with their COVID-19 infection, when in fact it may actually be related to long COVID.

“Then there are people who were considered healthy before their infection and now are experiencing debilitating symptoms. We’re not quite sure if it’s that it’s more prevalent in those populations, or that they’re recognizing it as long COVID and seeking out care more,” Friedly said.

She speaks from experience and offers optimism for those still struggling.

“We see many, many patients who recover completely. I consider myself in that category. I had symptoms for about nine months after my initial COVID-19 infection and feel fully recovered now.”

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