January 14, 2021

Endemic

When I worked on the Hopi Reservation in the mid 90’s, some interesting things about infectious diseases were reinforced to me. One was that children and adults often have very different responses to infections. For instance, many children have mild cases of chicken pox, but adults can get dangerously ill, with more lesions and complications like encephalitis. One example at Hopi was that Hepatitis A was an endemic illness, an infection that was common in that area. Hepatitis A is the food born type of hepatitis, passed hand to mouth. Most Hopi children had mild cases when they were little, most often passed at ceremonial feasts, such as weddings, kachina dances, and baby naming ceremonies. The children had mild gastroenteritis symptoms and did not develop severe jaundice. Very few adults who grew up there were susceptible to Hepatitis A. However, those of us that didn’t grow up there were occasionally exposed. We would often see a cluster of cases related to the same big ceremonial dinner. We were grateful when the Hepatitis A vaccine was approved and we could be protected from a disease that can make adults deathly ill from acute liver failure.

We have other endemic illnesses, such as Lyme disease in much of the eastern US, now spreading geographically. In tropical areas, Malaria is endemic. We know most children do well with COVID-19 and often have minimal to no symptoms. Older people do worse, increasing as age increases. Scientists have several ideas about why that is, but the mechanisms are still not completely clear. This combination of endemic disease manifesting in mild disease in children is where many scientists think we may headed with COVID-19. Read The Seattle Times article to understand it a little better.

The SARS-CoV-2 virus is expected to stick around, it is pretty much worldwide now. Immunizations will start to bring herd immunity and slow down infections so that eventually only the very young, who haven’t been immunized yet, will be exposed, in the same way they are exposed to all the cold viruses now. It may take years to get to this place, depending on how fast people get vaccinated. This is a reasonably optimistic prediction that is possible. Other expectations are that the immunizations will need to be updated regularly as the virus mutates.

The vaccine roll out is starting to pick up, challenges remain. For us, at my work, it is a matter of supply, since we are a relatively small entity, for others it is the details and logistics, for others it may vaccine hesitancy. The supply may be there but not necessarily getting to the places that need it. Each state has its own challenges. Some good news is that more people are starting to opt in to getting vaccines, as the news picks up about them and safety is demonstrated. Instead of vaccine skepticism, vaccine envy is trending. People want their vaccine ASAP, which makes the logistics of inoculating the masses challenging. The puzzles are being worked on by health officials. More support is proposed for after January 20, which is a relief for so many.

In the meantime, we need to be aware of the spread of new variants that seem more infectious, although so far do not seem to cause worse illnesses. That part is reassuring to a point, until you remember that increased infections mean more hospitalizations and more deaths. We need to remain steadfast in our safety measures, even after vaccination.

We are fortunate that we have vaccines in such an amazing timeline. Like this Seattle doctor says, we have so many people to thank for all who made them possible- the scientists, the researchers, the volunteers who received the experimental vaccines, the schedulers, and so many more.

Wash your hands, cover your nose, keep safe six, have hope and not too much envy, your vaccine will come.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.seattletimes.com/nation-world/the-future-of-the-coronavirus-an-annoying-childhood-infection/

https://www.seattletimes.com/seattle-news/northwest/oregon-reaches-daily-coronavirus-vaccine-goal/

https://civicscience.com/inoculation-gets-off-to-a-slow-start-but-covid-19-vaccine-opt-in-continues-to-rise/

https://www.seattletimes.com/seattle-news/health/huge-response-to-a-mass-covid-19-vaccination-site-in-sequim-is-likely-preview-of-whats-to-come/

https://www.seattletimes.com/seattle-news/clinics-pop-ups-and-churches-how-washington-might-double-or-triple-covid-19-vaccination-rates/

https://www.seattletimes.com/seattle-news/health/vaccines-and-masks-biden-plan-aims-to-break-pandemic-cycle/

https://www.seattletimes.com/seattle-news/health/vaccine-centers-new-stimulus-checks-included-in-biden-plan/

https://www.mdlinx.com/news/heres-what-we-know-about-the-new-covid-19-mutations-so-far/7p4OQQBNCGlvvC0d25ILBI

https://www.seattletimes.com/seattle-news/health/a-seattle-doctor-gives-thanks-to-those-who-made-the-covid-19-vaccine-possible/