If COVID-19 Becomes Endemic...

A few thoughts on what happens if COVID-19 becomes endemic....

So, first off, vaccination rates.  You may be thinking that as we live with COVID-19, people will accept the vaccines and accept that COVID-19 is a serious enough illness to take, you know, seriously.  I would argue that after a year and a half, if people aren't taking it seriously yet, it's unlikely they'll start.  So what could potentially increase our vaccination rates if people refuse to take it seriously?  Well, one option is mandates.  We're seeing more and more requirements around people being vaccinated in different settings, and these may continue to increase.  Yes, people balk at them and raise hell over their rights, but some will use it as an excuse to get vaccinated when it's not socially acceptable to do so otherwise.  Having the vaccinations be required for college settings will help too given the idea that is prevalent that with youth comes less risk, but if you need to get vaccinated to take classes in person, well, that's just what you have to do regardless of your personal risk.

And vaccinations work in multiple ways.  There's the personal, wherein the risk to yourself from severe illness is lessened (though not negated given that 1/3 of the hospitalized patients with COVID-19 right now in MA were fully vaccinated when admitted.  It's also the case that being vaccinated somewhat reduces the chance that, should you be exposed, you will pass COVID-19 on to others.  The more people that get vaccinated, the more we can reduce the spread through just that mitigation method.

There are other things we can do as a standard practice that we may need to just live with from now on.  These include wearing masks when indoors and limiting the frequency and size of social gatherings in general.  The former being something we can just do as a general rule and blanket statement without differentiating between people.  The latter becomes somewhat a question of the individual, with those who feel the need for more frequent gatherings and larger networks being a cause for greater spread.  

We can make getting tested regularly a common practice, similar to how the UK has already done.  We need to get used to the fact that this illness spreads efficiently asymptomatically and therefore we need to get better at accepting that sometimes we won't feel sick but still need to self-isolate for a little while.

If we change our normal more dramatically than we have in recent months, we can reduce spread again as we did in the spring when mask mandates were still in place.  We can reduce spread back to the less than 1 case per day per 100,000 that we briefly saw.  We can reduce the deaths back down to the 1-2 per day, getting it off the top 10 cause of deaths in MA.

But, if we're not willing to do these things in order to keep the spread super-low, akin to where we got it back in the spring, if we're not willing to change our normal to protect our community, then we need to accept a few things.  

• First, we need to accept that hospitals need to expand both in terms of numbers of beds and their staffing levels.  They've been working on/off at the limits for the last year and a half and we need those limits expanded for when the next pandemic that hits on top of this new endemic, or any emergency situation that impacts many people for that matter.  
• We also need to understand that we're condemning many many people to live with long term health impacts.  
• Then there are the deaths... thousands per year in MA alone.  In MA, it will take over the 3rd or 4th leading cause of death and be just behind cancer and heart disease and potentially be higher than accidents and almost certainly higher than chronic lower respiratory disease and stroke and more than alzheimer's disease, flu/pneumonia and diabetes combined... yes, would it surprise you to find out that flu/pneumonia is in the top 10 leading cause of death in MA?   
• Events such as weddings will either need to adapt or will become the cause of grief and family schisms where family members get sick as a result of precautions not being taken and some members not realizing that others weren't taking the potential ramifications seriously.  The commonality of the lack of knowing about others in the family may be a short term thing but the potential for spread at these events will continue to be greater than your usual small gathering.
• There's one more thing we'll need to accept... that there will be more members of society that simply cannot participate in in-person activities anymore... those with weaker immune systems for one reason or another (whether genetically or because they have cancer or what have you) or those that live with said individuals.  This saddens me but it's something we should face despite not being willing to in general right now.