A Post-Pandemic World?

ASHLEY ZLATOPOLSKY CONTRIBUTING WRITER

Two years after COVID19 was first declared a global pandemic by the World Health Organization, medical experts are now hopeful the deadly virus will become endemic.

“When something is endemic, it’s essentially part of the population on what is a small, but consistent basis,” explains Dr. Steve McGraw, EMS medical director for the Oakland County Medical Control Authority and medical director of Hatzalah of Michigan, a Jewish organization that provides rapid response to medical emergencies in the Oak Park area.

In an endemic phase, overall COVID-19 cases would become static, rather than rising or falling. The virus could eventually become similar to influenza, which has been classified as endemic for decades. Endemic diseases are also more predictable and manageable.

However, the classifications can sometimes be tricky to differentiate: to be considered an epidemic, an outbreak sees a sudden increase in cases. If that disease then spreads across several countries and affects a large number of people, then, like COVID-19, it becomes a pandemic. If the disease reaches an equilibrium, an endemic phase is likely.

Yet if COVID-19 becomes endemic as experts predict and hope, what will that mean for the general population? Doctors and health organizations still believe a robust policy response will be necessary, as will regular vaccinations, potentially on a yearly basis.

McGraw says that before COVID-19 can be considered endemic, enough evidence has to be gathered on an international scale. “They’re going to want to see other populations, not just in the United States but throughout the world, reaching this kind of smoldering, steady state,” he explains of a decision to label COVID-19 as endemic.

In his opinion, however, McGraw argues that we’ve already reached the endemic phase of the virus that has now killed more than 6 million people worldwide and more than 35,000 people in Michigan. “We have a very low frequency of transmission,” he explains. “Our positivity rate is under 5%. We are much less vulnerable than we were.”

McGraw says vaccines have done a tremendous job in reducing vulnerability to the deadly virus, while natural immunity has also done its part in potentially moving COVID-19 into an endemic phase.

“We can’t go through a surge again like we did without the virus manifesting some really dramatic mutational change,” he continues. “It would almost need to be a different virus to really put us down again.”

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If COVID-19 becomes endemic, McGraw says we may see seasonal transmissions between Thanksgiving and February, similar to influenza. “We’ll see a big surge right around Christmas and Chanukah,” he predicts. “And that’s because it’s endemic.”

McGraw estimates that COVID-19 vaccines could be combined with flu shots, which are reviewed annually to combat any changes or circulating viruses. While there’s always a possibility for COVID-19 to revert to a pandemic classification, McGraw says this doesn’t follow the “evolutionary impulse.”

“Most diseases that are contagious become more transmissible and less lethal,” he says of nature’s trends.

For now, most indoor mask wearing requirements have been dropped. “Omicron seems to spare the lungs, which is a remarkable turn of events,” McGraw explains of the latest COVID-19 variant, which has a lower severity compared to previous variants. Low hospitalization rates “make it likely that we will have no mask requirements,” he adds.

McGraw believes that unlike previous months, it’s no longer a stretch to talk without masks. However, those who are vulnerable should still consider wearing them. “People on cancer chemotherapy, anti-rejection drugs, or people who have respiratory or cardiovascular diseases put them at great risk,” he explains. “I don’t think we’ve reached a point where I would [recommend] they go without a mask indoors yet.”

However, it’s safe for those individuals who don’t fall into these categories to consider going maskless in places where masks are no longer required, such as restaurants or grocery stores. At the end of the day, though, McGraw says it’s most important to respect your own comfort level, which greatly varies from person to person.

“I respond to folks that say, ‘I’m not comfortable enough’ or ‘I’m not ready to do that,’” he explains. “I say, by all means, wear a mask all you want. I have no problem with that, and I don’t think anyone else should either if wearing a mask makes you feel more secure.” McGraw likens mask-shaming to seat belt-shaming. “It’s outrageous,” he adds.

— DR. RUSSELL FAUST

West Bloomfield-based internist Dr. James Bragman, who specializes in geriatric medicine, says vaccines, and especially boosters, are a must for older individuals. “It’s been shown repeatedly to have a favorable impact on long-term morbidity and mortality,” he explains.

Data from the CDC shows that full vaccination against COVID-19 in adults 65 and older results in a 94% reduction in risk of COVID-19 hospitalizations.

Bragman says there’s a new product on the market as well called CofixRX, a nasal spray that promises to boost one’s immune system. He’s now recommending it to senior patients. “It works anywhere from 6-8 hours with all over-the-counter ingredients,” he describes. “In addition to masks and vaccination, it has a favorable impact. If a person wants to go out to dinner, for example, a couple spritzes will help protect them.”

Like recommendations for general populations, Bragman says older individuals with chronic conditions or debilitating medical conditions should continue to exercise caution. He suggests that those visiting elderly or sick loved ones in nursing home facilities should still wear masks, since those populations tend to be more vulnerable. KN95 or K95 masks give optimal protection, though surgical masks still give some protection.

Bragman explains that a sedentary lifestyle is a major risk factor for COVID-19, so it’s important for the elderly population to continue to get exercise and move around if possible. “When people are physically active, you enhance your immune system,” he says. Sleep also matters. “When you’re well-rested, your immune system is bolstered.”

As it stands, the latest recommendations for COVID19 vaccinations include children ages 5 and older, says Dr. Russell Faust, medical director for Oakland County. Faust, who spent most of his career working in pediatric health, explains that the CDC has dropped the mask mandate; however, children living in multigenerational homes with elderly relatives or children with chronic ailments should continue to wear masks.

“When these folks do become infected, they’re at greater risk of severe side effects,” Faust says. “Do my own kids wear masks to school? Yes, they do. When I’m indoors, around a crowd, I also wear a mask.”

Luckily, the Omicron variant, like in other age groups, hasn’t hit the pediatric population hard with severe side effects, Faust continues. “I don’t think there’s really a need to steer clear of much,” he says of activities for children or families. “But anything that’s indoors or in a crowd is a greater risk. There’s no such thing as zero risk.”

As the weather warms up and Michigan has more opportunities for outdoor socialization, Faust is “cautiously optimistic” that COVID-19 will continue to improve. Whether or not the disease will become endemic, though, is too early to tell just yet.

“We all need a break,” he says. “Everybody needs a break.”