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COVID-19 Will 'Not Become Endemic But Episodic’

A clinician offers his perspective on how the virus is behaving and the role that vaccines and therapies will play.

With news the BA.2 variant continues to be seen in a greater number of patients, new questions begin to emerge, including will we be perpetually fighting variants? And when will we transition out of the pandemic, and into another phase? The ongoing public health consensus has been COVID-19 will eventually evolve from pandemic to endemic phase.

The general public is looking for signs that we have moved into the endemic phase, and certainly with local and state restrictions being lifted or made optional in different cities and states, it seems like we are slowly moving that way.

However, we also thought things were subsiding last fall before the emergence of Omicron (BA.1), which as we now know had different plans. That variant quickly took hold and within a matter of weeks, became the predominant strain. Now, as the Omicron variant begins to see a decrease in cases, its cousin, the BA.2 variant is beginning to take hold here in the US and internationally.

As we wait to see what happens next, one clinician offers another possibility. Robert Gottlieb, MD, PhD, FACC, Baylor Heart and Vascular Hospital, foresees the possibility of it not becoming endemic but episodic. “I think it is going to be an episodic disease with episodic variants emerging,” Gottlieb said. “I really think we have no indication that this will be a seasonal virus…a lot of people are placing this in context of seasonal viruses, like influenza, which are more prominent in the winter. [However], we’ve seen throughout this pandemic that this can be in the northern and southern hemisphere at the same time.” 

Gottlieb is a transplant cardiologist and has been involved in COVID-19 therapeutic studies. He points to the data and the real-world clinical experience that has shown that countries in the southern hemisphere coming out of summer and going into the fall having high incidences rates. And in early June of 2021, the Centers for Disease Control and Prevention (CDC) was warning the public about the emerging Delta strain, which grew in incidence throughout the summer months and became the dominant strain.

In an opinion piece written by Eric Topol, MD, in the LA Times today, he pointed out, “The SARS-CoV-2 virus is still with us and is adroit at finding new ways to infect us at scale.”

So, does this mean this virus will be with us perpetually just mutating enough to reinfect the population at large every few months?

At this point, no one can truly say what the future looks like because COVID-19 and its many mutations are not behaving in ways we expected it to, specifically getting weaker or evolving into a seasonal virus.

Still, medical science has done some magnificent work in creating vaccines and therapies to help slow down the severity of the disease and help stave off untold hospitalizations and mortality. 

Contagion spoke to Gottlieb recently and he offered his perspective on the virus, what roles antivirals and monoclonal antibodies will play in the clinical care strategy, and how he remains optimistic about the future with vaccines and therapies despite the latter’s supply challenges.