Signs at Richmond Elementary in southeast Portland require masks to enter the school.
Elizabeth Miller / OPB
The omicron surge seems to have crested and case rates are decreasing in Oregon, though hospitalizations are at their peak. Many people are asking: What comes next?
How long will we need to keep wearing masks? What will vaccinating kids under 5 mean for everyone? What have we learned from the omicron and delta surges that could help prepare us for the next variant? And what does it mean for a disease to move from pandemic to endemic? There are no easy answers to these questions. In fact, each one seems to bring up 10 more.
OPB’s “Think Out Loud®” recently tried to get some clarity on our COVID futures with three guests: Bill Messer, a physician and scientist specializing in viral, infectious diseases at Oregon Health & Science University (OHSU); Fikadu Tafesse, an assistant professor of molecular microbiology and immunology at OHSU; and Katherine Wu, who covers science as a staff writer for “The Atlantic” and also holds a Ph.D in microbiology and immunobiology from Harvard University. To listen to the entire conversation, use the audio player at the top of this story.
Does “endemic” really mean the end?
“Endemic is this relatively simple seeming word ... It seems like a logical way to say: ‘oh, an end to a pandemic!’ But it really is actually a coincidence that it has the word ‘end’ in it,” said Wu, who recently co-authored an Atlantic story about the very squishy nature of the word.
Wu points out that, while endemic describes a relationship between disease and host, there are many different iterations of what that relationship could look like.
“Human behavior is one of the largest factors dictating what sort of cast endemicity takes on,” said Wu. “It’s so easy to say, a virus can go endemic. Where are we in that equation? Really, it’s about what endemic future could we be shaping for this virus?”
She uses the flu as an example.
“We managed to really stamp that out during our first full pandemic winter, and that was remarkable. Flu levels plummeted to pretty much zero across the board. It was totally unprecedented,” Wu explained. “Imagine what we could do if we put in place even a fraction of those same measures going forward. We could really change the picture of a lot of these diseases we assumed to just be a normal part of life, a burden that we have to shoulder for decades on end.”
COVID-19 vaccine preparation at a drive-thru vaccination clinic at Portland International Airport, April 9, 2021. The clinic is a joint operation hosted by Oregon Health & Science University, the Port of Portland and the American Red Cross.
Kristyna Wentz-Graff/ OPB
Vaccines + infection could lead to superimmunity
Tafesse was part of a team that conducted a recent study on immune responses in vaccinated individuals who also got infected with COVID-19.
“The finding was quite profound,” he said.
When compared to people who had been vaccinated but never infected, those who had both received a COVID-19 vaccine and been infected with the virus, either before or after being vaccinated, had higher antibody levels. According to Tafesse, the potency of the antibodies was also higher in people who had experienced both a vaccine and an infection, meaning they were better protected against a wider array of variants.
“The improvement of immunity that we found was significant ... We called it ‘superimmunity,’” Tafesse explained. “The vaccines are based on one element of the virus, that is the spike protein, but when you’re exposed to the live virus … the body is exposed to not only the spike proteins but other components of the virus, which are critical in terms of adjusting and training your immunity.”
Wu points out that this makes vaccine equity even more of a pressing issue.
“Distributing high-quality durable immunity equitably, that has I think really profound implications,” she said.
People who are immuno-compromised will remain more vulnerable
Messer, who also works as a clinician, said he recognizes that people with compromised immune systems are facing a different level of risk when it comes to COVID-19. These are people who may have weak immune systems for a number of reasons or be immune-suppressed because of an organ or bone marrow transplant.
“In the patients that I’ve interacted with who are in that population, there is an incredible amount of anxiety, probably for some of them it borders on severe clinical anxiety, with the emergence of yet another pathogen that they have to be wary of that is demonstrably dangerous for those people, and at the same time, acknowledging that they’ve been living with these sorts of risks already and adapting to them,” said Messer.
“Each patient has their own experience, and so I don’t want to generalize too much,” he continued. “I have encountered exhaustion, fatalism, desire for vaccination and other interventions that could protect them from getting sick, like monoclonal antibody therapy on top of vaccination … In many cases, the vaccines don’t work really well in these immune-compromised people because they have to have an immune system to react ... There are a suite of different reactions, but I think they’re all predicated on the fact that a lot of them have already been living with that risk to a certain degree.”
Messer called it a “unique experience and a unique perspective” and encouraged people with intact immune systems to consider this population with empathy moving forward.
Restaurants shut down at the start of the pandemic in March of 2020.
Tim Mossholder/Unsplash
Figuring out the new normal is complicated for everyone
We all remember the sudden change that came in March of 2020 with the first lockdown, school closures and subsequent mask mandates. Coming out of the pandemic won’t be so abrupt, and it will look different for different people.
“I think the only thing that is probably safe to say is that everyone has already been embarking on their own behavioral trajectory for a very long time now, and I expect those fates to sort of continue splintering,” Wu said. “I think some people have already accepted that they are probably never going to go back to the full slate of 2019 behaviors, and that’s just kind of going to be it from now on. Maybe the degree to which they follow pandemic behaviors will toggle up and down, maybe it’s with local case rates or what have you, whatever they’re doing to sort of gauge their level of safety. But yeah, it may just fundamentally affect the way they live their lives for the rest of this. Others have effectively gone back to 2019, with varying results. This is very complicated and I think for people who are trying to decide which lane they want to be in for the foreseeable future, or anything beyond that, it is really difficult.”
Wu says individual choices about risk don’t always have to be at odds with the greater good, and she used the decision to get vaccinated as an example of something that helps individuals and communities at the same time.
“I think it all just has to come together in a really complicated decision matrix,” she said. “I don’t want people to feel like they’re being extremely selfish by giving themselves bits of happiness. All of these things can be compatible with each other. I think we just all need to reset our risk thresholds and reset our thresholds for what sorts of behaviors are safe for us and the people around us.”
Jemma Skarphol, 8, prepares to receive a pediatric COVID-19 vaccine during a clinic held at Clackamas Town Center, Nov. 10, 2021 in Happy Valley, OR. The clinic was offered by the Clackamas County’s Department of Public Health and offered Pfizer-BioNTech vaccines for children ages 5 through 11 years old.
Kristyna Wentz-Graff / OPB
Getting young children vaccinated is an important next step
News broke last week that COVID-19 vaccines could soon be available for kids younger than 5 years old. Wu said she’s concerned that some parents may feel like it’s already too late to get their young children vaccinated.
“I’m sorry the wait has been so long, but it absolutely is still worth getting kids vaccinated,” she said. “It is never too late to get your kids protection because … COVID is going to be with us for a very long time. Getting vaccinated now is not just an investment in the omicron surge, but an investment in our future and that will really impact where this pandemic goes. I hope it makes an enormous difference.”