COVID in 2022: Key Components of Moving to an Endemic State

By Dr. Seleem R. Choudhury, February 3, 2022

During this current winter wave, many countries outside the U.S. continue to use blunt COVID mitigation measures that they relied on early in the pandemic. These measures, such as transitioning kids to at-home learning and closing businesses, resulted in significant social and economic costs. Yet more people died globally in 2021 than in 2020 as the virus slashed its way through older and unvaccinated individuals, raising the death toll at an alarming rate.

Nearly 800,000 Americans have died so far during the pandemic, with more than half of those deaths occurring during 2021 (New York Times, 2022). Comparatively, the Spanish influenza of 1918 infected an estimated one-third of the world’s population, resulting in at least 50 million deaths worldwide (Choudhury, 2021). The Institute for Health Metrics and Evaluation (IHME) provides COVID-19 projections bi-weekly. Based upon their current projection, by April 1, 2022, the U.S. will reach 970,243 reported COVID-19 deaths (Institute for Health Metrics and Evaluation, 2022).

There can be no doubt that the coronavirus pandemic is ongoing, serious, and unpredictable. But based on current data and past patterns, we can forecast what Spring 2022 might bring and how to best respond.

2022: Beyond winter, into spring 

The number of deaths worldwide from COVID-19 is horrific, especially when you consider that around seven in 10 U.S. adults (72%) report that they personally know someone who has been hospitalized or died from COVID-19 (Tyson, Funk, Kenney, & Johnson, 2021). Though devastating, the “silver lining” is that in terms of pandemics, what is happening now is not unusual. As Charumilind, et al., explains: “Epidemics end in one of two ways—either we close off all chains of transmission and drive cases to zero, as with all Ebola epidemics to date, or the disease becomes an ongoing part of the infectious-disease landscape, or endemic, as tuberculosis is today” (2021).

Societal impact

Now, on what is hopefully the verge of moving from a pandemic to an endemic, is the time for governments and countries to create a vision for what the new normal will look like and build consensus around it.

In the last two years, the COVID-19 pandemic has had a profound impact on lives and livelihoods, but response and action beyond vaccination and testing is different from nation to nation. Some countries close their borders, while some remain open. Some introduce a fourth vaccination shot, and others a “circuit breaker.” Some have closed shops and businesses, and some have not introduced anything different at all.

If you examine the past data of the various COVID-19 management tactics, a common thread among strategies that have had the most success appears to be the presence of a philosophy that the COVID response is “a shared responsibility” and “everyone’s business.” While pandemic management differs widely from country to country, greater success in lessening its impacts can be achieved with a unified response (Organisation for Economic Co-operation and Development, 2020; World Health Organization, 2021).

Masking

Masks are an important intervention for mitigating the transmission of COVID, and are an essential piece of the puzzle for moving from a pandemic to endemic status (Brooks, Butler, & Redfield, 2020; Van Dyke, M., Rogers, T., Pevzner, E., Satterwhite, C., Shah, H., et al., 2020). A 2020 study of counties in the state of Kansas concluded that there is a “significant amount of clinical evidence that countywide mask mandates appear to have contributed to the mitigation of COVID-19 transmission in mandated counties” (Van Dyke, M., Rogers, T., Pevzner, E., Satterwhite, C., Shah, H., et al., 2020). Other studies have found that face masks “decrease the daily growth rate of reported COVID-19 cases by more than 40%” (Peeples, 2021).

However, masks remain a symbol of a divided society (Powdthavee, Riyanto, Wong, Yeo, & Chan, 2021). People in the same community but with “different moral concerns react differently to the recommended guidelines” (Chan, 2021). With such differing reactions to the same set of mask-related data, an important part of the work of governments and public health agencies is to implement rational mandates on appropriate face mask utilization based upon a defined “trigger system” that reacts to outbreaks on a community-by-community basis (Feng, Shen, Xia, Song, Fan, & Cowling, 2020).

Vaccination

With unprecedented global resources focused on developing a COVID-19 vaccine, a safe, effective vaccine was created in record time. A year on from the initial release of the vaccine, the scientific and medical communities are looking toward “more potent immunity, easier transport, and mutation-proofing” (Cox, 2021). A potential game-changer would be the development of a pill or a nasal spray which would make administration much easier and cheaper, especially in places where distribution is challenging, or for people with an aversion to needles (Steenhuysen, 2021).

Testing

In past public health crises, such as HIV outbreaks, widespread tobacco usage, or childhood obesity, public health agencies engaged in campaigns to increase access to testing. Historically, testing has improved health outcomes in the spread of sexually transmitted diseases, teenage pregnancies, tobacco cessation programs, health disparities in cancer, and childhood obesity, to name just a few. Building on lessons learned from access to testing—or the lack thereof—during the COVID-19 pandemic, there are significant opportunities to expand access to testing, whether in the hospital, clinic work, school, or at home.

Access to testing is a must when trying to isolate a fresh wave or outbreak of COVID (Pletcher, Olgin, Peyser, et al., 2021). A lack of access to testing results in people spreading the virus without knowing they are positive and also further overburdens a healthcare system that is already overwhelmed (Raphael, 2021; Grimm, 2021; Centers for Disease Control and Prevention, 2021).

In the U.S., the government subsidized the more-expensive PCR lab tests for uninsured people and has required insurers to cover them with no co-pay since the start of the pandemic. However, it didn’t put a similar system in place for at-home rapid tests (Schuetze, & Eddy, 2021). In contrast, many countries have already made the takeaway tests free. For example, parents in many European countries were provided with home kits to test their children prior to going to school (Bonislawski, 2021; King, Schmidt, & Perehinets, 2021). Additionally, British citizens can order packs of rapid tests from a government website to be sent to their homes at no charge (Gov.UK, 2022).

In the U.S., it is virtually impossible to purchase at-home testing kits in a pharmacy or online, even after the federal government promised to provide home kits to households (DePillis, & Umansky, 2021). If one is lucky enough to locate a kit, many shops and big chain stores significantly raised their prices for rapid test kits, making at-home testing a financial impossibility for many citizens.

Data

Data has become “indispensable as clinicians and policymakers suit up for the fight against the pandemic” (Amazon Web Services, 2021). It will be an essential tool for forecasting the impacts of the Omicron variant in the coming months, as well as helping to determine management strategies for a future endemic (Baillie, Berger, & Brockmeier, 2020; American Medical Association, 2020; Open Data Watch, 2021). The development of “a robust system to gather and analyze data” and then “use the data to act” is necessary (Nzyoka, & Dwivedi, 2020). Data can help providers isolate people and give appropriate treatment. It can also help government and public health agencies identify vulnerable or elderly populations and send customized, targeted messaging to these groups more rapidly (Nzyoka, & Dwivedi, 2020).

Conclusion

Experts say that COVID will likely lose its pandemic status sometime in 2022 and shift to an endemic (Stieg, 2021). We will once again settle into a “new normal.” Bill Gates, president of the Gates Foundation, which has been overwhelmingly successful in their mission of creating a world free of malaria through partnership, collaboration and unity, recently commented on his blog that he hoped that soon the “only time you will really have to think about the virus is when you get your joint COVID and flu vaccine every fall” (Gates, 2021).

COVID-19 has had a significant impact in accelerating transformation of practices within healthcare and private industry, from pharmaceuticals to digital capabilities to private and healthcare businesses. This transition from a pandemic to endemic requires continued agility and a robust public health program that uses data to forecast what the coming months might hold, and to address when to wear a mask, expand access to timely testing, vaccination boosters, and public health education that promotes unity, avoids politics, and fosters individual and community compliance.

Read more from Dr. Seleem Choudhury at seleemchoudhury.com

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