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Dr. Halverson: 'Is COVID-19 now endemic in Ventura County?'

Halverson

By Dr. Jim Halverson, Special to the Ojai Valley News

Gov. Gavin Newsom announced Feb. 17 that California would become the first state in the nation to treat the SARS-CoV2 virus as a manageable, endemic risk.

California’s plan shifts from a “crisis mentality” to one of prevention and adaptability. 

Newsom’s “SMARTER” plan (standing for shots, masks, awareness, readiness, testing, education, and Rx) includes maintaining a store of 75 million masks, increasing vaccination and daily testing numbers, monitoring wastewater for virus remnants, and responding to surges in cases by quickly bringing in extra medical workers via contracts with national staffing companies.

A handful of countries have also begun to shift their COVID-19 responses to treat the SARS-CoV2 virus as endemic, meaning to accept that it will exist at manageable levels for many years. The Centers for Disease Control and Prevention defines “endemic” as the constant presence and /or usual prevalence of a disease or infectious agent in a population within a geographic region. For example, malaria is an endemic disease in many regions of Africa. COVID-19 would remain deadly as an endemic disease with periodic outbreaks, largely among the unvaccinated and immune suppressed, and a continuing threat of new variants as the virus continues to mutate. How deadly the outbreaks would be will depend upon how contagious and potentially deadly the new variant is and how governments, scientists, and individuals act in response.

To better understand what endemic means, I find it helpful to understand the meanings of two other related words, epidemic and pandemic.

EPIDEMIC

An epidemic describes an occurrence of disease, in a particular community or place, that is new or higher than normal. A recent example is the Zika virus outbreak in Brazil in 2015. Measles and polio are also examples of epidemics that have occurred throughout history. Several years ago there was an epidemic of measles in Southern California that was quickly brought under control by public health measures and vaccination.

PANDEMIC

A pandemic is an epidemic whose growth rate skyrockets and spreads to many areas around the globe. Disease severity has nothing to do with whether a virus is declared a pandemic. The World Health Organization declared COVID-19 a pandemic on March 11, 2020.

A pandemic is brought to an end in one of three ways. 

ERADICATION

Eradication is the permanent reduction of cases of the disease to zero by stopping all transmission by aggressive surveillance and containment. This has only happened once, with smallpox in 1980.  The polio virus will soon join smallpox on that list.  Prior to the introduction of the polio vaccine in the 1950s, polio caused tens of thousands of cases of paralytic polio or death in U.S. children and hundreds of thousands of cases worldwide until the mid-1980s. 

It has taken nearly 40 years of unwavering dedication by Rotary International, the Centers for Disease Control, the World Health Organization, UNICEF, the Bill and Melinda Gates Foundation and GAVI, the Vaccine Alliance, to bring the number of cases worldwide to fewer than 100 per year and have only two endemic countries, Afghanistan and Pakistan, remaining. 

ELIMINATION

Elimination is the reduction of cases to an identified target with occasional outbreaks. Measles was on the verge of elimination in the United States and Europe at the end of the 20th century, until vaccination levels dropped, and the disease sprang back. Elimination is possible only with highly effective vaccines that provide lasting immunity, large-scale vaccination programs in EVERY country, intensive global disease monitoring and vigorous response to local outbreaks.

BEING DECLARED AN ENDEMIC 

The third way a pandemic ends is by the disease becoming endemic, with cases at a relatively constant level that allows society to function. It took 20 years for AIDS to turn from a pandemic to an epidemic, largely through the development of treatments. A newly diagnosed HIV positive person can now expect to live nearly as long as the population of people without HIV if they have access to those treatments.

 Substantial progress has been made in understanding, preventing, and treating SARS-CoV-2 in the past two years. There is still more to be done. We need lower rates of hospitalization and death, especially in the unvaccinated and the immune-suppressed. Better treatments for those higher-risk individuals need to be much more available and continue to be affordable. Vaccinated people need to continue to get boosters when indicated and we need more unvaccinated people, especially adults with risk factors for more severe disease, to become vaccinated. Our adult population has had access to highly effective vaccines, which greatly reduce the risk of serious disease and death, for almost a year and more recently, all children ages 5 and older became eligible for vaccination. 

Despite easy availability and no cost of those vaccines, the United States currently ranks 69th in the world in the percentage of people vaccinated. Use of N95, KN95, KF94, or even double surgical masks should be encouraged among select high-risk populations. Broad testing availability in the workplace and in schools needs to continue to improve, with return to work or school occurring as soon as a rapid antigen test is negative. Length of isolation and quarantine for COVID-19 will shorten with better access to affordable tests for everyone.

Is COVID-19 now endemic in our county? Yes. Can the endemic get significantly better? ABSOLUTELY!  Let us all continue to do our best to keep ourselves, and our community, as safe as possible. We are ALL in this together. 

Stay optimistic, stay well informed, stay safe and stay well.

— Dr. Jim Halverson is a longtime Ojai physician, who has written articles on COVID-19 for the Ojai Valley News since the pandemic began.

 

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