How do we know a pandemic's over?

[TragicMonkey]

I'd rather get a shot I don't need than an illness I could have avoided. Especially when the shot is free but I'd have to burn up sick leave if I get sick!

[Roger Ramjets]

Originally Posted by dann

The reason why it appears to be mostly over and why you now see "around 200/day over the last month or two" is that most countries have stopped reporting!!!

In New Zealand we rely on self-reporting. I was worried that this might make the numbers look a lot lower than they really are, but the authorities also do wastewater testing. So far this proxy is tracking the case numbers closely.

Hospital admissions are another indicator. Sadly we are now seeing a surge in old people getting the virus and a surge in hospitalizations. But each surge is less than the one before it. When we first opened up weekly hospital admissions exploded to a peak of 1110 on the 3rd of March 2022. The next surge peaked at 859, then 590, 313 and now 179 (so far). Deaths are now running at 2 per day, compared to 25 per day at the peak in July 2022.

[dann]

The two C-19 deaths per day in a population of 5 million makes it clear that 200 reported (!) deaths per day in the world is nowhere near the real number. Denmark also does wastewater testing, and the numbers are currently rising. One problem with wastewater testing is that it only happens in major cities, so when people go to the country for their summer holidays, the levels appear to be dropping. The opposite happens when they return home, coinciding with school openings etc.

Only people who are hospitalized are tested, and it makes it impossible to track down how widespread new variants are. The recent three cases of the Pirola variant were in different parts of the country and unconnected.

Does NZ do a lot of gene-sequencing to find out about new variants?

[dann]

Originally Posted by Chanakya

... and after having already gotten a boost via the vaccines we've all already taken in, and add to that that over these many months we may well have actually built up sizeable "herd immunity" --- back then a fiction, but now maybe not so !

Still a fiction - or a fiction again - with a virus that mutates as much as this one does.

Quote:

With worrying mutations, limited vaccine rollout, vastly reduced testing and a creaking health service, experts are predicting a tough few months ahead
ew variant”, “care home outbreak”, “cases rising”: you’d be forgiven if the headlines around Pirola, or BA.2.86, the latest Covid strain to arrive in the UK, had triggered a severe case of pandemic deja vu. More than two years since the UK’s last lockdown, concerns over BA.2.86 – known to have infected dozens of people in the UK as of last weekend, including 28 at a Norfolk care home – have been rising. The worry is over what is “the most striking Sars-CoV-2 strain the world has witnessed since the emergence of Omicron”, according to Francois Balloux, professor of computational systems biology and director of the University College London Genetics Institute.
‘Lessons have been forgotten’: is the UK ready for a new Covid variant? (TheGuardian, Sep 16, 2023)

[dann]

Originally Posted by Roger Ramjets

In New Zealand we rely on self-reporting. I was worried that this might make the numbers look a lot lower than they really are, but the authorities also do wastewater testing. So far this proxy is tracking the case numbers closely.

SARS-CoV-2 in DK wastewater has been on the rise since July along with C-19 hospitalizations:
Blue line is SARS-CoV-2 in wastewater, green line is hospitalizations (notice the y-axis!).

[dann]

Excellent article about when the pandemic is not over:

Quote:

“Here’s my proposed definition: the country will not fully emerge from the Covid-19 pandemic until most people in our diverse nation accept the risk and consequences of exposure to a ubiquitous SARS-CoV-2, the virus that causes Covid-19.”

This claim—that more disease risk and contagion means the end of a disease event—runs contrary to the science. Many have claimed that widespread SARS-CoV-2 infections will lead to increasingly mild disease that poses fewer concerns for an increasingly vaccinated (or previously infected) population. In fact, more disease spread means faster evolution for SARS-CoV-2, and greater risks for public health. As we (A.C. and collaborators) and others have pointed out, rapid evolution creates the risk of novel variants with unpredictable severity. It also threatens the means that we have to prevent and treat Covid-19: monoclonal antibody treatments no longer work, Paxlovid is showing signs of viral resistance, and booster strategy is complicated by viral evolution of resistance to vaccines.
The Coronavirus Still Doesn’t Care About Your Feelings (TheNation, Oct 13, 2023)

We have known for quite some time that the virus is also impervious to optimistic predictions!

[Chanakya]

Originally Posted by dann

Excellent article about when the pandemic is not over:



We have known for quite some time that the virus is also impervious to optimistic predictions!

That was disturbing to know, that apparently Covid's starting to show resistance to Paxlovid. Even though that resistance is only "low level" so far, but still.

I suppose they're working on other, newer drugs as well, already? They must be, I suppose. Should the resistance to Paxlovid build up to more significant levels than merely this "low level" thing, hopefully there'll be other drugs available by that time.

[dann]

Paxlovid was never a wonder drug, but apparently alternatives do exist already: Paxlovid Alternative Is Similarly Effective (JAMA Network, Feb 8, 2023)
Molnupiraivir vs. Paxlovid: Which is better for COVID-19? (VeryWellHealth, June 7, 2023)
But since the virus seems to be pretty good at evading both acquired immunity and medication, I think that avoiding infection altogether is still the safest solution, i.e. #DavosStandard.

[Chanakya]

That's good to know! (I haven't really kept abreast of Covid much in recent times. And thankfully, beyond one serious Covid infection in the family, that required hosipilization, back in the very very early days, we've all of us been spared any infections ourselves, so that I ...well, don't really know what meds are already out there really, beyond the Paxlovid thing. Good to know there's already other alternatives available.)

I agree the virus will keep mutating. On the other hand, I'm hopeful that we'll be able to keep working out medication to deal with those variations. (Just a general hope, not an 'informed' hope really!)

I agree, it does make sense to keep to the barest minimum, without really going overboard about it, one's exposure to Covid. No sense in going out of your way to court trouble, when a little bit of care can make a significant difference. I myself continue to exercise care, without going overboard like I said --- per my lights, that latter, I guess many others around me might be of the opinion that I DO go overboard, but wtf, it's my life, and I live it per my lights, not theirs.

[dann]

Sorry, but the (somewhat) good news didn't last long:

Quote:

Molnupiravir, an antiviral drug used to treat COVID-19, induces numerous mutations in the SARS-CoV-2 genome that can increase the rate at which the virus evolves — yielding viral variants that might survive and be passed on.
(...)
“When considered together with the low efficacy of molnupiravir in reducing COVID-19 associated deaths or hospitalizations, and that such drugs can interact with (and therefore potentially mutate) host DNA, continued widespread administration of molnupiravir seems inadvisable.”
Anti-COVID drug accelerates viral evolution (Nature, Oct 24, 2023)

[Roger Ramjets]

Originally Posted by dann

Excellent article about when the pandemic is not over:

Quote:

Even if you haven’t heard much about the new strain of the coronavirus, being told not to panic might induce déjà vu. In late 2021, as the Omicron variant was making its way to the United States, Anthony Fauci told the public that it was “nothing to panic about” and that “we should not be freaking out.”... This is a telling claim, given what was to follow—the six weeks of the Omicron BA.1 wave led to hundreds of thousands of deaths in a matter of weeks...

Media and public health coverage have a strong hand in shaping public response and can—under the wrong circumstances—promote indifference, incaution, and even apathy. A very visible example of this was the sharp drop in the number of people masking after the CDC revised its guidelines in 2021, recommending that masking was not necessary for the vaccinated

Here in New Zealand we were panicking because our attempt to stamp out Delta by locking down didn't work like it did with the original virus. Vaccines had already been available for a while, but many people hadn't got their shots yet because the country was virus free so why panic? Delta showed them how naive that attitude was.

The scare we got from Delta was enough to goad most people into getting vaccinated. So while it was disappointing that opening up our bubble to Australia caused us to get Delta, it turned out to be a good thing. Without that we wouldn't have been prepared when Omicron arrived soon after.

When Delta was announced with its much higher infection rate, I predicted that a new variant would arise which was even more infectious. I was pooh-poohed for inciting unnecessary panic. Then when Omicron hit combined with relaxed restrictions ("because everyone's vaccinated now so don't panic") the infection rate skyrocketed to insane numbers, threatening to wipe out all the gains we had made previously. Every day was like dodging bullets.

But that's how it had to be. A state of panic can only be held for so long. We thought we could lock down for 3 weeks and squash Delta, and at first it looked like we were winning. Then the numbers kept dragging on and wouldn't go down. In all, Auckland spent 107 days in lock-down trying to eliminate Delta. It was too much. The virus continued to spread because people were tired of the restrictions and wouldn't behave. If that was bad, the next next one would be impossible.

So we let it rip because there was no other choice, hoping the vaccinations would be enough. Many of us still wore masks though, and stayed away from others whenever possible. Eventually I decided it was time to test my immunity by going maskless at the supermarket, but my brother and his partner still kept theirs on. I'm guessing I must have been exposed many times since and the immunity is working, but who really knows?

Case numbers have gone back down now and with two three boosters I feel reasonably safe, but I know new variants are out there attempting to flare up. I will never let my guard down completely because I don't want to get it (or any other virus for that matter). So yeah, we're past the panic phase, but that doesn't mean we are all apathetic. I'm still watching it like a hawk. If a new variant flares up or wastewater detection shows massive under-reporting, I'm ready to put my mask back on and limit exposure again (now that I am retired it's a lot easier).

[dann]

Quote:

Adults in their 20s, 30s and 40s are driving the trend. Researchers point to long Covid as a major cause.
(...)
Cognitive impairment is a “hallmark of long Covid,” said Dr. Ziyad Al-Aly, chief of research and development at the V.A. St. Louis Health Care System and a clinical epidemiologist at Washington University in St. Louis.
Studies estimate some 20 percent to 30 percent of people who get Covid have some cognitive impairment several months later, including people with symptoms ranging from mild to debilitating. Research has also shown clear biological changes from the virus related to cognition, including, in some long Covid patients, lower levels of serotonin.
“It’s not just fog, it’s a brain injury, basically,” said Dr. Monica Verduzco-Gutierrez, chair of rehabilitation medicine at the University of Texas Health Science Center at San Antonio. “There are neurovascular changes. There’s inflammation. There are changes on M.R.I.s.”
Can’t Think, Can’t Remember: More Americans Say They’re in a Cognitive Fog (NYT, Nov 13, 2023)

Includes interesting graphs, for instance: Percent of Americans who said they had “serious difficulty” remembering, concentrating or making decisions

[dann]

Originally Posted by Roger Ramjets

The scare we got from Delta was enough to goad most people into getting vaccinated. So while it was disappointing that opening up our bubble to Australia caused us to get Delta, it turned out to be a good thing. Without that we wouldn't have been prepared when Omicron arrived soon after.

The Delta variant was handled admirably by NZ. Cuba didn't fare as well, probably because it is more dependent on tourism and couldn't mantain strict border control at the level of NZ.
Cumulative confirmed COVID-19 deaths per million people

Originally Posted by Roger Ramjets

When Delta was announced with its much higher infection rate, I predicted that a new variant would arise which was even more infectious. I was pooh-poohed for inciting unnecessary panic. Then when Omicron hit combined with relaxed restrictions ("because everyone's vaccinated now so don't panic") the infection rate skyrocketed to insane numbers, threatening to wipe out all the gains we had made previously. Every day was like dodging bullets.

When Omicron hit Denmark in the winter and spring of 2021-22, we were told that hybrid immunity = "super immunity," i.e. the disastrous Swedish herd-immunity-by-infection strategy was adopted as herd immunity by vaccination + infection, slightly better but far from great. It's still the official pandemic ideology and the media alone with health authorities are more or less ignoring the current rise in infections and hospitalizations. The numbers have even been made impossible to find, the rate of infections is based on wastewater samples - and only from major cities.

The major 'super spreader' of the lie about 'super immunity' was awarded with a medal from the queen, other awards and the position as leader of the Danish Pandemix Center.

Originally Posted by Roger Ramjets

But that's how it had to be. A state of panic can only be held for so long. We thought we could lock down for 3 weeks and squash Delta, and at first it looked like we were winning. Then the numbers kept dragging on and wouldn't go down. In all, Auckland spent 107 days in lock-down trying to eliminate Delta. It was too much. The virus continued to spread because people were tired of the restrictions and wouldn't behave. If that was bad, the next next one would be impossible.

What state of panic? I followed the situation in NZ and didn't see any signs of a panic. And the Auckland lockdown was nowhere near what was seen in China or Italy. It looked like a pretty smooth ride.

Originally Posted by Roger Ramjets

So we let it rip because there was no other choice, hoping the vaccinations would be enough. Many of us still wore masks though, and stayed away from others whenever possible. Eventually I decided it was time to test my immunity by going maskless at the supermarket, but my brother and his partner still kept theirs on. I'm guessing I must have been exposed many times since and the immunity is working, but who really knows?

I wouldn't recommend testing one's immunity your way, and I doubt you have been exposed to the virus by going to the supermarket. Their ventilation systems are generally good, so you'd probably have to be unlucky to be at the store near a spreader who happens to be there at the same time as you.

Originally Posted by Roger Ramjets

Case numbers have gone back down now and with two three boosters I feel reasonably safe, but I know new variants are out there attempting to flare up. I will never let my guard down completely because I don't want to get it (or any other virus for that matter). So yeah, we're past the panic phase, but that doesn't mean we are all apathetic. I'm still watching it like a hawk. If a new variant flares up or wastewater detection shows massive under-reporting, I'm ready to put my mask back on and limit exposure again (now that I am retired it's a lot easier).

The number of boosters doesn't help much when they aren't geared to handle the most recent variants, and from what I've been told the booster currently in use in NZ aren't.

At least around here, I get the impression that even though some "people were tired of the restrictions," that wasn't really what caused the shift to relying solely on vaccinations. It seemed to be businesses, big and small. The small business owners were the loudest. Big Business left it to the think tanks they pay to spread the idea that "people were tired of the restrictions" and that the virus isn't any worse than the flu or the common cold even though it conspicuously is, even now, almost two years later. Of course, Big Business also has the ear of politicians.

The John Snow Project seems to share my opinion that it's pretty much the same everywhere in the Western world: 'Endemic' SARS-CoV-2 and the death of public health (Nov 6, 2023).
Singapore remains the exception. However, they appear to one of the many countries that have stopped reporting. No new numbers since June.

[Brainster]

Dann will let us know eventually, well after the rest of us have moved on (my move-on day was three weeks after my second vaccination), although I doubt he will accept that we were right to move on.

[dann]

Quote:

While navigating a sea of strangers may seem intimidating for the health-conscious, experts say there are a number of familiar precautions you can take to keep from catching an illness from fellow travelers or out-of-town visitors this year.

‘Don’t let your guard down’
Some Americans have continued to wear masks well into 2023, but many cast the practice aside as local jurisdictions eased Covid-19 guidelines. However, Chin-Hong said that wearing a mask on public transport and at the airport is still one of the best things you can do to prevent the spread of disease.

“I know we think about masking as something that people do when they don’t want to get [sick], but if you have mild symptoms, wearing a mask is actually going to prevent other people from getting what you have, even if it’s a common cold,” he said.
As holiday season gets underway, here’s how to protect yourself and your family from respiratory viruses (CNN, Nov 20, 2023)

But why worry about spreading infectious diseases to others who may be vulnerable - or who may have relatives or friends or colleagues who are?

And there's good news to Brainster:

Quote:

Chin-Hong said many Americans have become nonchalant about circulating viruses. In fact, about three-quarters of adults say they are “not too worried” or “not at all worried” about getting Covid-19 over the holidays, according to a new survey from KFF, and two-thirds say they are not worried about spreading the virus to people close to them.

So if you worry more about how precautions against the the virus may affect property prices than about how C19 affects health, 'tis the season to throw caution to the wind.

[theprestige]

One way you can tell a pandemic is over is when people start saying, "yes, but don't forget about the common cold!"

[8enotto]

Unless somehow everyone everywhere met the strictest precautions and got the vaccine early on about a few years ago, it's all futility by now. All those kids that couldn't get a vaccine early on and couldn't be distanced from caretakers are a greater number than antivax morons.

Herd immunity won the popular vote. I do agree the vulnerable should get boosters or whatever
Mexico had a campaign of sending nurses out into the streets seeking seniors to vaccinate again. We didn't even have to wait in lines at community clinics on that one.
Not sure how it went nationwide but a lot of us here don't want streetside medical care like that.

They still push flu shots here as always in addition CV and the rest. So it's available and usually free to the public.

[TragicMonkey]

Depends on what you mean by "the pandemic". The disease remains with us, and will for the foreseeable future. But the fatalities and hospitalizations are reduced in numbers to what is manageable without special precautions on the part of the general public, so people in ordinary circumstances are reasonably expected to resume their lives as before --although they probably would be wise to continue getting vaccinations as and when they are available and recommended.

[dann]

I am not sure what exactly you mean when you call the disease manageable. As I have pointed out in the Sweden thread, it is currently on the verge of unmanagable, and I notice that many countries, my own included, seem to be doing their utmost to hide the current level of infections, hospitalizations and deaths.

I wrote this on Twitter/X a few days ago about the Danish media's reporting on the pandemic:
The media rules of COVID-19:
1. Don't mention C-19!
2. If at all, mention C-19 only as ONE OF MANY!*
3. Don't mention the C-19 DEATH TOLL!
4. Don't mention that C-19 can be PREVENTED!
5. Don't mention that C-19 vaccinations protect YOUNG people and CHILDREN, too!
6. Don't mention that some countries vaccinate EVEN YOUNG CHILDREN.
7. Don't mention that the vaccination of young people and children benefits EVERYBODY!

* As for 2, e.g. this article:
Overvågning af Influenza, covid-19, RS-virus og andre luftvejssygdomme
Surveillance of influenza, COVID-19, RSV and other respiratory diseases

If you scroll down to the two graphs of the three mentioned respiratory diseases, guess which one turns out to be six times worse than the flu (and not really seasonal unlike the flu)?
Laboratoriepåviste tilfælde af covid-19, influenza og RS-virus, sæson 2023/24
(Lab-confirmed cases of COVID-19, influenza and RSV, season 2023/24)
Indlæggelser med laboratoriepåvist covid-19, influenza og RS-virus, sæson 2023/24
(Hospitalizatons wth lab-confirmed COVID-19, influenza and RSV, season 2023/24)

As for the seasonality of SARS-CoV-2, you should take a look at the countries where summer is fast approaching:
COVID cases are rising across Australia. Here's a rundown of the latest advice (ABC.net.au, Nov 1-3, 2023)
COVID cases are rising in WA, and experts warn the virus is still a force to be reckoned with (ABC.net.au, Nov 14, 2023)

That studies now indicate that the sudden surge of old infectious diseases may be due to the effect of COVID-19 on the immune system is something the media, at least in my country, doesn't want to mention. It seems to be a much more comforting idea to believe that it is due to 'immunity debt' - more than two years after the lockdowns, even in countries where the lockdowns were anything but 'draconian' and lasted only a few weeks.

And then, of course, there are all the countries that have stopped reporting their numbers to WHO - and thus to Our World in Data:
Cumulative confirmed COVID-19 deaths per million people in the last 12 months. (It's the reason why I stopped updating the US vs. Cuban numbers.)

I wasn't surprised when I saw notorious minimizers referring to the current numbers as proof that the SARS-CoV-2 pandemic is now no worse than the flu or the common cold. Minimizers gonna minimize, and misleading numbers serve the purpose.

[TragicMonkey]

"Manageable" means there is room enough and staffing in hospitals to handle the case load without extraordinary measures. It's been like that for some time now where I am, we even closed down the special respiratory clinic sites which we'd had to open in 2020.

[dann]

Enjoy it while it lasts! (Or better still: encourage people not to 'let it rip'.)

As mentioned in the previous thread, some regions in Sweden recently introduced "extraordinary measures", and the notorious anti-mask country is now masking up - at least in hospitals:
Restriktioner tillbaka på flera svenska sjukhus (SVT.se, Nov 15, 2023)
Restrictions are back in several Swedish hospitals

Flera sjukhus inför restriktioner – munskydd på patienter (SverigesRadio.se, Nov 15, 2023)
Many hospitals introduce restrictions - patients to mask up

Smittskyddsexperten: så kan företagen hantera att covid-19 ökar (Prevent.se, Nov 20, 2023)
The infection prevention expert: how companies can handle the rising level of COVID-19

... while telling people that it's OK to go to work sick!


ETA:
[quote]– Så många smittade har det aldrig varit hittills under pandemin, säger Anders Nystedt, länets smittskyddsläkare.
Värsta covidspridningen i Norrbotten någonsin (SVT.se, Nov 20, 2023)
- So far, we never had so many cases of infection during the pandemic, says Anders Nystedt
The worst outbreak of COVID-19 in Norrbotten ever

[8enotto]

Dann, just tell us when it's safe to go outside without full hazmat suit and respirator.

We're patient.

[dann]

Minimizer jokes are just so funny!
Now, can you also tell us one about the crazy people who wear condoms when they have sex?

[The Atheist]

Originally Posted by dann

Now, can you also tell us one about the crazy people who wear condoms when they have sex?

You know when someone is losing an argument when they come out with idiotic failed analogies like that.

Death rate covid to date - <0.5%
Death rate HIV to date - almost 50%

[dann]

The Atheist seems to have confused this thread, How do we know a pandemic's over?, with his two imaginary threads, COVID-19's death rate is higher than HIV's, Make any and all diseases seem irrelevant by comparing them to others that killed more people.
I'm just surprised, The Atheist didn't choose the plague, but maybe he's saving it for later.

But now that The Atheist is back, I'll remind him of the posts earlier this year he never responded to: post 290 and post 291.

[theprestige]

Originally Posted by theprestige

One way you can tell a pandemic is over is when people start saying, "yes, but don't forget about the common cold!"

Oh snap, dog! It happened to me! I traveled for the holidays, and now I have a head cold! That pandemic sure is something!