Case Update, August 19th, 2021, Is COVID Endemic?, Mandatory Vaccination.

This is a case update. I’ll also briefly discuss the future of the pandemic.

Numbers continue to rise in the US, but are definitely slowing in their increase. New cases are most prominent in the West and Southeast. New deaths are rising, but much more slowly than for other waves.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Endcoronavirus County Level Map, August 19th, 2021
Endcoronavirus State Level Map, August 19th, 2021

For California and San Diego, it looks like we have crested the wave and new cases are starting to head down. In both of these regions, new deaths are not really increasing at all. This supports the pattern that in vaccinated areas, large numbers of new cases due to the Delta Variant are not followed by large numbers new deaths. I mentioned a few weeks ago that deaths can trail new cases by as much as 4 weeks, but we are now 6 weeks into the Delta Wave in California and San Diego without seeing a significant rise in new deaths.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County.
Graph is by me, from data collected from San Diego County Public Health. See also regularly updated slides from SD County.

Internationally, new cases appear to perhaps have peaked world wide, but it will take some time to see if cases start to go down. As stated above, countries with vaccination programs are experiencing almost no new deaths due to Delta Variant. Numbers for the Netherlands are striking, and other countries like the UK, Sweden, Japan, and South Korea show a similar pattern.

Graph is by me, from data collected from Johns Hopkins University COVID site. Graph is presented in a linear format.
New daily confirmed cases in the Netherlands, from Worldometers.
New daily deaths in the Netherlands, from Worldometers.

Several sources I listen to are now saying that SARS-2 is now or will be endemic. For some background, an epidemic is an outbreak of a disease in a small area or region. Avian influenza and the first SARS outbreaks were epidemics, since they didn’t leave Asia. A Pandemic is an outbreak in a large area including several continents. A disease becomes endemic when it becomes a constant feature of life in an area. I would include malaria, seasonal flu, and HIV in the list of endemic diseases. Interestingly, Wikipedia still considers HIV to be a pandemic.

I have resisted calling COVID endemic. I don’t think it fits the criteria at this point. While there have been several new variants that have caused additional waves of cases, they are all at least partially impacted by the available vaccines, and presumably by natural immunity as well. While this is the case, I still think it is possible that we can eradicate the virus from the world at some point.When might SARS-2 become endemic? For me, that would happen if either new variants arose that were not mitigated by natural or vaccine driven immunity, or if immunity in vaccinated or naturally immune people ceased to be effective in preventing new infection. Both of these would allow SARS-2 to continue to circulate indefinitely.

Some have argued that vaccine mediated immunity is not as long lived as hoped. This may be why there have been many “breakthrough” cases in the last few weeks. However, Youtuber Dr. Zubin Damania suggests that while protected from new infection wanes over months, vaccine protection against severe disease is persistent, at least against the Delta Variant. This may explain our current pattern of low deaths despite high cases in vaccinated regions.

So is COVID endemic? I still say no, and hope it can be eradicated. However, some municipalities, including Norway and the state of Iowa, have declared that is endemic and will be a permanent feature of the world. If I decide that the data shows that SARS-2 is endemic, then that is the day that I will get vaccinated. ‘Cuz I do want to go back to normal life someday, but I don’t want to actually get COVID. Obviously, many vaccinated and unvaccinated folks have decided to go back to living normally, despite official calls to maintain vigilance.

Vaccination mandates: I have not been in favor of requiring vaccination in order to return to work, fly on commercial aircraft, or other activities. While I am all for precautions and continue to wear a KN95 indoors while in public, healthcare is a personal choice and should not be coerced. Some have even claimed that it is illegal to coerce a measure that does not have FDA clearance. While vaccination is a good choice for many, it does have liabilities that have made many resistant to vaccination. This should be honored.

I know several people in the healthcare industry who have not wanted to be vaccinated, and have quit or been fired from technical or nursing jobs. While an argument could be made that those working with patients should be vaccinated, it seems misguided to be letting go of nursing staff when there has been a long standing nursing shortage.

Don’t fear, but be smart,
Erik

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