When Will it End?

If your patients are anything like mine, at some time during the day, the topic of COVID-19 is going to come up. How it has affected their children or elderly parents, their jobs, school or almost every aspect of their lives. Granted, things are much better now than they were this time last year, and certainly better than the early days of the pandemic. But what would it take to return to a pre-pandemic life?

In the early days of the outbreak, the Centers for Disease Control advocated for a national goal of achieving herdimmunity, the farmyard phrase that postulated if up to 85% of the population were vaccinated, the virus would run out of hosts and fall into the background of the seasonal flu. Unfortunately, the virus didn’t get the message and it mutated, and the population has been slow to achieve the necessary vaccination level (less than 60% of adult Americans are fully vaccinated). Dr Jefferson Jones, a medical officer on the CDC’s COVID-19 Epidemiology Task Force has also stated, “Thinking that we’ll be able to achieve some kind of threshold were there’ll be no more transmissions of infections may not be possible.” So where does this leave us? In an article published in JAMA, the authors addressed the possible scenarios of how the pandemic could play out.

ERADICATION – a global reduction of the disease to zero. To accomplish this both the vaccine and the derived immunity would have to be long lasting or repeatedly boosted to prevent secondary transmission against all manner of present or future variants. This would require a world-wide effort over an unknown timeline.

ELIMINATION – the regional, rather than global reduction of the disease prevalence to zero,

A more realistic approach until vaccines and boosters are available globally. Elimination would require strict border management to ensure incoming individuals are SARS CoV2 free, and full compliance of the population within the borders.

CONFLAGRATION – a steady state of moderate level of SARS-CoV2

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