Could COVID-19 end up being worse than the flu year after year? – The San Diego Union-Tribune

There is a growing consensus among experts that the coronavirus will likely be with us for many years to come, popping up in pockets even when most people across the globe have immunity through vaccination or natural infection.

Healers, then, should expect to be dealing with some level of ongoing COVID-19 burden once the virus enters what epidemiologists call an endemic state, one in which a pathogen simmers and smolders, producing new cases year after year, but not reaching the heights seen when the level of community immunity was low.

Just how heavy will that burden be?

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In the short term, with global vaccinations still far from universal, most are predicting that another surge this winter is likely. Vaccination, though, is expected to keep things from getting as out of control as they did in late 2020 and early 2021. A new variant capable of dislodging the Delta variant from its current dominance could change that outlook.

This being the first winter without a stay-at-home order, it is already plain to see in weekly reports that San Diego County will have a flu season this year after seeing very little influenza activity in late 2020 and early 2021.

To date, there have been 287 confirmed flu cases reported since July 1, nearly 16 times the 18 reported last season. And this years rate is slightly ahead of the prior five-year average, which includes nearly 12,000 cases per season, and 123 deaths, throughout the county.

Winter, then, will be the first year that the region and the nation feel the full force of the flu and coronavirus simultaneously, and experts fear that its not likely to be the last.

Some highly-educated guesses are already broaching the possibility that the coronavirus could end up producing as many or more cases than the flu.

Its one of three scenarios contemplated by a team of UC San Francisco researchers in a paper published in the journal Nature in July.

One possibility is that the virus will not come under relative control as global immunity builds, leading to a future with ongoing manifestations of severe disease combined with high levels of infection.

Deemed more likely, a second option is that SARS-CoV-2 will enter an endemic state that looks like the flu, which the U.S. Centers for Disease Control and Prevention estimates kills between 12,000 and 52,000 Americans per year.

The virus, researchers noted, could also behave more like other coronaviruses, which tend to have a significantly lower impact than influenza, in an endemic state.

When they published four months ago, the research team was reluctant to pick a scenario among the three, stating that more information was needed.

But, as cases surged, some have begun to feel more comfortable calling their shots.

Much attention has piled up around a series of 17 tweets by Trevor Bedford, the Seattle-based computational virologist recently named a MacArthur Fellow for his work modeling the introduction and spread of novel coronavirus and his advocacy of real-time genetic sequencing as an essential method of helping predict how the pathogen is likely to evolve.

Noting that the novel coronavirus has shown an uncharacteristic ability to mutate, and that there is plenty of evidence of waning immunity among the vaccinated and unvaccinated, Bedford says his best guess is that endemic coronavirus infects between 20 percent and 30 percent of the population each year. Influenza, by comparison, is estimated to infect about 10 percent of the world population per year.

Such a high attack rate, Bedford notes, would produce a larger death rate that could range from 40,000 to 100,000 per year in the U.S.

Most infections would be relatively mild (just like the flu), but theres enough of them that even a small fraction of severe outcomes adds up, Bedford said.

Its a prediction that terrifies public health officials.

Some years, noted Dr. Seema Shah, medical director of San Diego Countys epidemiology division, the flu by itself is capable of swamping emergency departments in the winter. The idea of layering a like number of coronavirus cases on top of that is particularly daunting.

There are some predictions that coronavirus could cause double the number of yearly flu deaths, Shah said. How do we allow that level of risk for that many Americans to die every year?

I find that hard to stomach.

San Diego County is home to plenty of experts in viral evolution, and, while all say that Bedfords scenario is certainly possible, this virus has proven itself enough of a wildcard that certainty is scarce.

I would not be surprised to see SARS-CoV-2 variants continuing to arise, said Joel Wertheim, an evolutionary biologist at UC San Diego whose work traced has traced the early appearance of the the virus in China. That said, every variant, every vaccine, every re-infection, changes the dynamics.

The sands will be constantly shifting, but this virus has no reason to stop trying to evolve more efficient ways to infect and re-infect us.

Kristian Andersen, a microbiologist and immunologist at Scripps Research in La Jolla whose lab has been at the forefront of the worldwide effort to map the mutations appearing in coronavirus as it spreads across the globe, agreed that the flu outcome is very possible but not certain. The focus, he has said repeatedly in recent months, should be on reducing the overall number of new infections. Every time a virus replicates is a chance of a beneficial mutation.

For too long, he said in a recent email, the mark of public health success in the coronavirus fight has been driving down the number of people who get sick enough to need a hospital stay. But driving down infections requires greater levels of vaccination in the meantime and more-rigorous masking and social distancing practices in the short term.

Unfortunately, theres no appetite for that which Im pretty convinced (although not certain) will be a decision well come to regret further down the line, Andersen said. In fact, had we taken this virus seriously from day one, as most experts urged, I dont think wed be talking about alpha, mu, delta, and the rest of them.

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Could COVID-19 end up being worse than the flu year after year? - The San Diego Union-Tribune