A second flu

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Whatever living with the virus looks like, Delta-level surges aren't considered to be sustainable for the public or the hospitals that will treat the seriously infected.

Why it matters: A major determinant of how seriously we'll take the coronavirus in the future is how many hospitalizations and deaths it's causing — and whether our health system can handle the load.

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What they're saying: "There is one scenario in which we have a double respiratory virus season each year," said former CDC Director Tom Frieden.

  • "The striking thing is that certain things work really well for both of them, especially masks, but possibly ventilation and other measures," he added.

The big picture: More than 100,000 people are still being infected daily, and hospitals in hot spots have been swamped with COVID patients over the last few months. Most of the people being hospitalized are unvaccinated.

  • Experts say this is a sign that we're not yet living with the virus in a stable way.

  • "If you see enough cases and hospitalizations and deaths that are overwhelming health systems, that cannot be endemicity," said Nahid Bhadelia, founding director of Boston University's Center for Emerging Infectious Diseases, Policy and Research.

Even if the coronavirus continues to kill as many people as the flu does in any given year — which would be a drastic reduction in today's death rate — that would be bad news for the health care system.

  • “We know that hospitals get busy during respiratory viral season ... and I think this will be added to that. You can imagine it getting more busy," said Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.

  • Some hospitals would struggle to handle the burden, particularly rural and safety net hospitals.

Yes, but: An unsustainable level of disease on a regular basis is far from being a given.

  • “I think there will be enough people vaccinated and enough people who are infected ... that you are not going to have hospital overruns," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Be smart: Longer-term COVID hospitalization rates will depend on how long vaccine- or infection-acquired immunity to the virus lasts, and how many people remain susceptible to severe disease.

  • We've learned to live with tens of thousands of flu deaths a year without any major disruptions to our lives. But if vaccination rates don't get high enough, and if immunity isn't long-lasting, COVID death rates could meet or exceed annual flu deaths.

  • "I think we would similarly tolerate that if that's all we got out of COVID. But I don't think that's all we're going to get out of COVID, even with vaccinations," said Zeke Emanuel, vice provost for global initiatives at the University of Pennsylvania.

If hospitalizations remain high over time, we have two basic options: to keep changing our behavior based on risk level, like we have been for the last year and a half, or to bolster hospital capacity.

  • The latter is "a mark of tragedy, not a mark of victory," Emanuel said.

The bottom line: Tens of thousands of deaths a year from both COVID and the flu isn't exactly an optimistic goal, regardless of the health system's ability to handle it.

  • "Does living with COVID mean we accept that as our best case scenario?" said Leana Wen, a health policy professor at George Washington University. "That seems really harsh. Let's do better than that."

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