Opinion: How does the COVID-19 pandemic end? History and biology help provide the answer.
A frequent topic of discussion lately is how the COVID-19 pandemic ends. As is usual when trying to predict the future, the near-term is pretty much anybody's guess. The longer-term view is clearer: COVID-19 will become incorporated into our lifecycle, just like the other four coronaviruses.
Yes, you read that right. There are already four coronaviruses in the human population: 229E, NL63, OC43, HKU1. These are a few of the viruses that cause the common cold. (I’m easing back on terminology here: 229E, NL63, OC43, HKU1 = “Coronavirus 1-4.” “Coronavirus 5” = COVID-19. Just easier.) Donald Trump may have spoken clumsily, but he was right when he said that COVID-19 is just a common cold. That is what it eventually will become. The “eventually” part is the problem.
First let’s try to understand a bit about coronaviruses. They have been with humans for centuries. The 1889 flu pandemic, the so called “Russian flu,” is thought to be OC43 entering the human population. The Wikipedia article on Russian flu describes the waves of infections that swept the globe. It's a worthy read. (Interesting factoid: the 1918 flu pandemic was called influenza because that was the bacterium most frequently recovered from many people who died. Viruses weren't known for another 20 to 30 years. And this was not the Spanish flu, it was the Kansas flu, but that's not nearly as interesting a name. Revising opinions is nothing new!)
Immunity from coronavirus is temporary
So how do coronavirus infections look? Coronaviruses cause that runny, snotty nose that kids bring home from daycare. They can have a cough for a week to 10 days and be "off the feed.” Additionally, that child can bring this loving gift home to their parent, giving them a runny, snotty nose for a couple of days. (Thanks, kids!) This is key to understanding coronaviruses and their transmission: essentially everyone alive today got Coronavirus OC43 as a child. The parent (obviously) had this when a child. Then, if the parent had OC43 as a child, why does the parent get sick again? (This is Question #1.) Should the parent not be resistant? Answer #1. This is what the body does with coronavirus do. Infection does not impart absolute lifelong immunity; any immunity is temporary. (This is common; get your tetanus shot updated?) The immune system cannot maintain a permanent defense against all pathogens all the time; you wouldn't have the time or energy to do anything else! Corollary #1. This is likely the reason why COVID immunizations don't give permanent absolute immunity; that simply is what the immune system does with coronavirus.
The parent with a runny snotty nose and cough that they got from their loving child knows better than to visit their elderly sick grandma in the nursing home. They know to wash their hands. They know to cough into their elbow. They know to throw away the used Kleenex. They know not to visit people with poor immunity. We knew all of this before COVID-19. Question #2: Why are we acting all surprised at the recommendations on COVID-19? Didn't we already know this before 2019? Answer #2. Common sense is not that common; cool heads do not always prevail. There’s no money in that! Corollary #2. Pay attention to what your parents taught you. Wash your hands. Don't share your pop cans. Put your used dinnerware in the sink. And don't visit old, sick people in the nursing home when you are sick yourself. (Full disclosure: My dad is 97 and living in a nursing home.)
What makes COVID-19 different from coronaviruses we already experienced?
So now that we understand this, what about COVID vs. those other four coronaviruses? They have been with us for well over a century and seem to be nothing more than a common cold; one wonders why all the excitement about COVID-19? It does seem we're getting all excited about a common cold. The answer is combining the first two ideas, COVID-19 and the other four coronaviruses. No one, from a newborn up to my father, had antibodies to COVID-19. That's because it wasn't present when my dad was a child, when I was a child or when you were a child (unless you're too young to be able to read this.)
Thus, when anyone older than a teenager gets COVID-19, their body has no idea how to fight it off. They don't have that wonderful, active, well-controlled immune system of a youngster. This is why children receive all those immunizations; their immune system knows how to handle them. The adult immune system has to be trained and doesn’t do as well. It lacks the skills of a child's immune system in properly responding to challenges.
In the end, everybody will have COVID antibodies
Thus, many older people, myself included, are known to have less-than-ideal immune systems. We've known this for 15 to 20 years. People my age (over 65) must get four times the amount of flu shot to get our immune systems just to respond. We know that older folks get sicker and die easier. Thus, when an older person (defined as anybody older than me) gets sick, they tend to get sicker and die more easily from a sickness that would not have so affected a young person. So Question #3: How are people going to get immunity? After all, people are all going to get immunity to this coronavirus, just like the other four. Answer #3: People are going to get immunity to COVID-19 the same way they got immunity to the other coronaviruses: by getting antibodies and T-cell immunity. They're going to get an infection or an injection. Period, end of discussion. This is 100% of the population … that survives. And the ones that don't survive, who die from COVID, do so through the infection route. It will be extremely rare to be damaged via the injection route.
Those who claim they don't have the immunization and yet don't get sick have antibodies they got from somewhere; no magic allowed. They could have had a stealth infection or a stealth injection; both occur. Corollary #3: At the end of this, everybody will have antibodies. If they die of COVID-19, they may not have developed antibodies in time. If they survive COVID-19, they will have antibodies from infection. Infection or injection, everyone will have antibodies to Coronavirus #5, (COVID-19) the same as the Coronaviruses 1 through 4.
More: Here's the thing about that dire climate report: We have the tools we need to fix things
Endemic COVID stage will take decades to arrive
This final stage, when COVID is present everywhere, from childhood through the elderly, is called the endemic stage. It will take several decades to occur; the children will grow up and have children themselves. The young adults will become old adults. The old adults will have either died or had infection or injection which allows them to survive COVID. We will remain, of course, susceptible to all the usual “vicissitudes of life.” (That's a complicated way of saying that people are going to die anyway, whether they get COVID-19 or are in a car wreck or have a heart attack.)
In the meanwhile, we're all in this together. We are responsible for what happens to our neighbor. If our actions harm our neighbor, we are responsible for that harm. This is what personal responsibility is all about; adults take responsibility for their actions. So let's stop all the fighting. Let's stop letting social media companies monetize our differences. Let us study this fascinating, new phenomenon.
Never before have we been able to track a virus as it makes this way into the human population. The possibilities for new knowledge and research are incredible. I'm going to predict that we will find an answer to such things as chronic fatigue syndrome and fibromyalgia. We're going to find answers to disorders like Kawasaki disease, a cause of heart attacks in children. There's so much interesting research to be done and so many burning questions to be answered! Wasting this opportunity by fighting with each other is a sin of the gravest order.
How does end? Not with a bang, but with a whimper.
And that's my prediction for the future.
I won't be around to see if I'm right.
That’s my opinion; what’s yours?
Dr. Tom Benzoni is an emergency physician, practicing locally. He is a spokesperson for the American College of the Emergency Physicians. All opinions expressed are exactly that, his opinion.
This article originally appeared on Des Moines Register: Opinion: This is how the COVID-19 pandemic will end
