Two years ago we were in our first pandemic lock-down and SARS-CoV-2 was a mysterious new virus with an impact we were just beginning to unveil. In year three, we have a much better understanding of the virus and tools to lessen its impacts for patients, and yet, the pandemic drags on with peaks and valleys in the incidence of new cases. We are currently ticking upward with BA.2, and possibly other variants, and public health measures being pulled back. We are uncertain what the future will bring and where we are in the recurring cycle of surges, and yet, we are still trying to “return to normalcy.”
Immunologists, infectious diseases experts and virologists at the University of Minnesota will tell you that what we have been experiencing isn’t surprising. In fact, we are collectively experiencing the immunity cycle of viruses, especially with aggressive variants. As more immunity builds in a population, the less extreme virus impacts are on a collective level. At this point in time with the majority of people in Minnesota, the U.S. and many countries around the world vaccinated – and many millions more who have had natural infections – we are reaching or exceeding the initially targeted level of 70% of the populations with some degree of protective immunity. And yet we have learned that the virus has not gone away and that breakthrough infections do occur after vaccination and reinfection occurs after natural infection.
Since the pandemic, the university has been working on a range of high issues in academic medicine, from advancing clinical care to drug trials. What we know about COVID-19 now, from our national leading research and reporting on SARS-CoV-2 in wastewater, is that the current virus can be in a community well before it is detected in hospitalizations. Additionally, we know that vaccinations for COVID-19 lessen symptoms and transmission, which protect those most vulnerable. As immunity rises from vaccinations and natural infections, all the data points to the virus becoming endemic in human populations with future cycles of seasonal peaks and valleys in cases.
We must not let our guard down. We need to adjust our thinking not to, rather than returning to what was normal, that we become comfortable with a new normal. That will likely mean that we will constantly need to be monitoring what levels are out there and make adjustments accordingly. We will need to gear up on our levels of protection when we have a surge – face coverings, avoiding crowded places especially indoor ones – and then in between surges we can perhaps let our guards down a little. We must always remember that this is not just about our own comfort and safety, but keep in our minds that we are also providing safety for those with medical issues that not only make them more vulnerable but also less likely to build immunity from infection or vaccines.
Long-COVID has been found to have detrimental effects on the cardiovascular system and the brain. These health conditions vary from person-to-person, but highlight how serious the virus impacts the body through inflammation and high fever.
With what we know as academic scientists is that even as the virus becomes a part of our lives, there is still more we don’t know. On a community level, using wastewater as a public health informer can show us which communities are being impacted. On an individual level, vaccinations and receiving boosters are still very effective to help generate and boost immunity against the SARS-CoV-2 virus.
What we as scientists and infectious disease physicians are doing to protect ourselves and our families before COVID-19 enters an endemic phase is staying updated on our vaccinations to reduce the chance of being hospitalized, wearing a properly fitted N95 or KN95 mask in spaces where virus levels are likely to be high, and taking a test when exposed to someone positive with COVID-19.
Testing for COVID-19 when you develop symptoms of a viral respiratory infection is still important for finding cases, and people should continue to self-isolate at home when infectious to prevent spread of the infection to others. For immune compromised people, preventive monoclonal antibodies are an effective tool. Also, we now have oral and intravenous antiviral medicines and monoclonal antibodies that can be given for individuals at high risk of COVID-19 complications to help prevent hospitalization and serious outcomes.
Continue to be vaccinated and boosted. Seek medical advice if you become ill. If you have had COVID-19, consider enrolling in a university trial and talk to your healthcare provider about what you are experiencing long term.
Dr. Susan Kline is an infectious disease physician at the University of Minnesota Medical School and M Health Fairview, Dr. Jill Foster is a pediatric infectious disease physician at the University of Minnesota Medical School and M Health Fairview and Marc Jenkins is the director of the Center for Immunology at the University of Minnesota Medical School.
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