5 ms·

> "Could SARS-CoV-2 become endemic among humans and just never go away? What then?" I really don't see how we can avoid this. I think it will take too long to

by csours 7y ago

> "Could SARS-CoV-2 become endemic among humans and just never go away? What then?" I really don't see how we can avoid this. I think it will take too long to create a vaccine, and there will be mutations and recombinations that reduce vaccine effectiveness. I'd love to be wrong though.

standardUser 7y ago
"I really don't see how we can avoid this." Some viruses just peter out, but I don't assume this one will just because it's possible. Some virus become endemic, but why would we assume that about this virus either?
- SpicyLemonZest 7y ago
  There are a handful of endemic coronaviruses, and historical respiratory disease pandemics have consistently become endemic, so it seems like a reasonable assumption.
SketchySeaBeast 7y ago
Just like the normal flu and H1N1 I imagine it may just become part of the yearly flu-shot - I imagine giving a large proportion of the population resistance changes the math considerably on how much it affects us.
- kzrdude 7y ago
  Who gets a yearly flu shot? Genuinely curious.
  - baddox 7y ago
    I'm sure it depends a lot on your location and peer group. In San Francisco, where I live, it's very common for healthy 20- and 30-somethings to get the flu shot every year. I try to remember to get it every year, and there's always friends or coworkers reminding everyone about it every year.
  - el_benhameen 7y ago
    Lots of people, I think. My extended family group chat always has a "did you get your flu shots?" thread around October of every year. Last year when I took my family for the shots, there was a line of probably 100 people on a weekday afternoon.
  - vardump 7y ago
    Most of the people I know at least? It probably varies a lot by location, subcultures and socio-economic groups.
  - gus_massa 7y ago
    It depends on the country https://en.wikipedia.org/wiki/Influenza_vaccine#Recommendations https://en.wikipedia.org/wiki/Influenza_vaccine#Recommendati... Oversimplifying, it is recommended for people with more than 65(50) years, people with chronic diseases or HIV, and pregnant women and babies from 6 month to 5(2) years. Also people that work or live with them. But each country has it's own rules and recommendations.
    - YokoZar 7y ago
      In the US, it's recommended for everyone who's not allergic or under 6 months old.
  - undersuit 7y ago
    I read about the 2017 and 2018 US vaccination rates on the CDC website recently, those years we got an estimated low 40% range vaccination on adults and in the 60% range for children vaccinated.
    - james-skemp 7y ago
      Last year I was told that we were at risk of, or no longer had, herd immunity due to that. I don't recall if it was specific to our university, city, or other geographical region. I stopped getting the flu shots in my 20s because I would always get sick despite the shot. I was convinced in my mid-30s to start getting them again. I still get sick, but it's not as bad as when I skipped the shots. (I know at least a couple times I ended up getting the shot that prevented a variant that we didn't get. There's enough of a time gap that the shot isn't causing the symptoms.)
  - asdf123wtf 7y ago
    Well, anyone who has regular visits to a doctor at all, or has prescriptions filled regularly at a pharmacies, will probably pestered about getting flu shots yearly, at least. If you are young and healthy, I don't think they are pestering you for your sake, but to build immunity and prevent its spread. Healthy people should really look at flu shots as a kind of duty to their fellow citizens, who may be more vulnerable.
    - gjs278 7y ago
      the only people that get the flu and are young are the ones who get that shot
  - Marsymars 7y ago
    Every grocery store pharmacy here gives them out for free, so it's pretty easy to do so.
  - goalieca 7y ago
    I do as I am around people with suppressed immune systems for various reasons
  - smnrchrds 7y ago
    Around a third of Canadians [1]. Although the statistics are a bit old. [1] https://www150.statcan.gc.ca/n1/pub/82-624-x/2015001/article/14218-eng.htm https://www150.statcan.gc.ca/n1/pub/82-624-x/2015001/article...
  - waterside81 7y ago
    I do. It's free in Canada, just walk into any pharmacy and you're out in 10 mins.
    - Majromax 7y ago
      Depends on the province. In Quebec, for example, the flu vaccine is (currently) only free for at-risk individuals (https://www.quebec.ca/en/health/advice-and-prevention/vaccination/flu-vaccination-program/ https://www.quebec.ca/en/health/advice-and-prevention/vaccin...). Ontario, however, has a universal program.
  - RockIslandLine 7y ago
    I and most of my siblings try to get it every year. It's recommended for anyone with frequent contact with children.
CydeWeys 7y ago
We can avoid it by developing a vaccine and vaccinating everyone. It would no longer be endemic in the population by the next generation. If there are no susceptible hosts because everyone is immune either from having it or from being vaccinated against it, it will die out like smallpox. This really hinges on whether the vaccine confers long-term immunity. If it works like the flu vaccine, then being endemic is inevitable.
- maxerickson 7y ago
  It's the rapid mutation of the flu virus that undermines the flu vaccine. People often have differing immunity to a flu based on their past exposures. People that had been exposed to the 1950s strain were not hit as hard by the H1N1 that emerged in 1977: https://mbio.asm.org/content/6/4/e01013-15 https://mbio.asm.org/content/6/4/e01013-15
- twic 7y ago
  It's worth noting that while we have eradicated smallpox, we have only eradicated smallpox. We have not managed to eradicate any other infectious disease of humans.
danieltillett 7y ago
Even if we create a vaccine how are we going to vaccinate people in conflict zones? If we can’t immunise everyone with the oral polio vaccine, then we have no chance of immunising everyone against SARS-Cov-2. There is a possible ecological solution - we drive the dangerous strains to extinction by deliberately spreading a harmless strain. Unfortunately few people seem interested in investigating this idea.
- jamiek88 7y ago
  That's like vaccinating the virus itself. Interesting idea - what's to stop the harmless one from mutating back though? Presumably it'd be engineered to be both a) harmless to humans and b) spread better than existing SARS/COV strains. If that super spreader then mutated to become harmful to humans we could end up in a worse spot, no?
  - danieltillett 7y ago
    The solution is to use a harmless strain that has gene deletion(s). These sort of mutations are very unlikely to back mutate as the information has been lost from the viral genome. The harmless strain doesn’t have to spread naturally better than the dangerous strains and it is likely any harmless strain would not spread better. We can artificially spread the harmless strain around so even if it is less contagious than the dangerous strain we tip the ecological balance in favour of harmless strain. This is really how an attenuated vaccine like the Sabin polio vaccine works from an ecological perspective. The risk of the virus mutating is there right now. It is much less likely that a harmless strain becomes very dangerous than a dangerous strain become very dangerous. This would be a bigger jump in evolutionary space. Ultimately as the immediate downvoting of my OP suggests this idea doesn’t appear popular. This doesn’t mean that it is not a scientifically valid approach that could work.
Symmetry 7y ago
We're not seeing much in the way of mutation in the SARS-CoV-2 structural proteins. And for other coroanviruses where we've developed vaccines, for dogs and pigs, we haven't had the same sort of problems with having to produce new vaccines that we do with the fast mutating flue. Now, resistance does fade and to keep your dog protected you need to give it a booster shot every year or two and it might very well be the same with humans and SARS-2. But at least we wouldn't have to play the game of guessing which strain would be dominant in an upcoming season.

by csours 7y ago

standardUser 7y ago

"I really don't see how we can avoid this." Some viruses just peter out, but I don't assume this one will just because it's possible. Some virus become endemic, but why would we assume that about this virus either?

SpicyLemonZest 7y ago
There are a handful of endemic coronaviruses, and historical respiratory disease pandemics have consistently become endemic, so it seems like a reasonable assumption.

SketchySeaBeast 7y ago

Just like the normal flu and H1N1 I imagine it may just become part of the yearly flu-shot - I imagine giving a large proportion of the population resistance changes the math considerably on how much it affects us.

kzrdude 7y ago
Who gets a yearly flu shot? Genuinely curious.
- baddox 7y ago
  I'm sure it depends a lot on your location and peer group. In San Francisco, where I live, it's very common for healthy 20- and 30-somethings to get the flu shot every year. I try to remember to get it every year, and there's always friends or coworkers reminding everyone about it every year.
- el_benhameen 7y ago
  Lots of people, I think. My extended family group chat always has a "did you get your flu shots?" thread around October of every year. Last year when I took my family for the shots, there was a line of probably 100 people on a weekday afternoon.
- vardump 7y ago
  Most of the people I know at least? It probably varies a lot by location, subcultures and socio-economic groups.
- gus_massa 7y ago
  It depends on the country https://en.wikipedia.org/wiki/Influenza_vaccine#Recommendations https://en.wikipedia.org/wiki/Influenza_vaccine#Recommendati... Oversimplifying, it is recommended for people with more than 65(50) years, people with chronic diseases or HIV, and pregnant women and babies from 6 month to 5(2) years. Also people that work or live with them. But each country has it's own rules and recommendations.
  - YokoZar 7y ago
    In the US, it's recommended for everyone who's not allergic or under 6 months old.
- undersuit 7y ago
  I read about the 2017 and 2018 US vaccination rates on the CDC website recently, those years we got an estimated low 40% range vaccination on adults and in the 60% range for children vaccinated.
  - james-skemp 7y ago
    Last year I was told that we were at risk of, or no longer had, herd immunity due to that. I don't recall if it was specific to our university, city, or other geographical region. I stopped getting the flu shots in my 20s because I would always get sick despite the shot. I was convinced in my mid-30s to start getting them again. I still get sick, but it's not as bad as when I skipped the shots. (I know at least a couple times I ended up getting the shot that prevented a variant that we didn't get. There's enough of a time gap that the shot isn't causing the symptoms.)
- asdf123wtf 7y ago
  Well, anyone who has regular visits to a doctor at all, or has prescriptions filled regularly at a pharmacies, will probably pestered about getting flu shots yearly, at least. If you are young and healthy, I don't think they are pestering you for your sake, but to build immunity and prevent its spread. Healthy people should really look at flu shots as a kind of duty to their fellow citizens, who may be more vulnerable.
  - gjs278 7y ago
    the only people that get the flu and are young are the ones who get that shot
- Marsymars 7y ago
  Every grocery store pharmacy here gives them out for free, so it's pretty easy to do so.
- goalieca 7y ago
  I do as I am around people with suppressed immune systems for various reasons
- smnrchrds 7y ago
  Around a third of Canadians [1]. Although the statistics are a bit old. [1] https://www150.statcan.gc.ca/n1/pub/82-624-x/2015001/article/14218-eng.htm https://www150.statcan.gc.ca/n1/pub/82-624-x/2015001/article...
- waterside81 7y ago
  I do. It's free in Canada, just walk into any pharmacy and you're out in 10 mins.
  - Majromax 7y ago
    Depends on the province. In Quebec, for example, the flu vaccine is (currently) only free for at-risk individuals (https://www.quebec.ca/en/health/advice-and-prevention/vaccination/flu-vaccination-program/ https://www.quebec.ca/en/health/advice-and-prevention/vaccin...). Ontario, however, has a universal program.
- RockIslandLine 7y ago
  I and most of my siblings try to get it every year. It's recommended for anyone with frequent contact with children.

CydeWeys 7y ago

We can avoid it by developing a vaccine and vaccinating everyone. It would no longer be endemic in the population by the next generation. If there are no susceptible hosts because everyone is immune either from having it or from being vaccinated against it, it will die out like smallpox. This really hinges on whether the vaccine confers long-term immunity. If it works like the flu vaccine, then being endemic is inevitable.

maxerickson 7y ago
It's the rapid mutation of the flu virus that undermines the flu vaccine. People often have differing immunity to a flu based on their past exposures. People that had been exposed to the 1950s strain were not hit as hard by the H1N1 that emerged in 1977: https://mbio.asm.org/content/6/4/e01013-15 https://mbio.asm.org/content/6/4/e01013-15
twic 7y ago
It's worth noting that while we have eradicated smallpox, we have only eradicated smallpox. We have not managed to eradicate any other infectious disease of humans.

danieltillett 7y ago

Even if we create a vaccine how are we going to vaccinate people in conflict zones? If we can’t immunise everyone with the oral polio vaccine, then we have no chance of immunising everyone against SARS-Cov-2. There is a possible ecological solution - we drive the dangerous strains to extinction by deliberately spreading a harmless strain. Unfortunately few people seem interested in investigating this idea.

jamiek88 7y ago
That's like vaccinating the virus itself. Interesting idea - what's to stop the harmless one from mutating back though? Presumably it'd be engineered to be both a) harmless to humans and b) spread better than existing SARS/COV strains. If that super spreader then mutated to become harmful to humans we could end up in a worse spot, no?
- danieltillett 7y ago
  The solution is to use a harmless strain that has gene deletion(s). These sort of mutations are very unlikely to back mutate as the information has been lost from the viral genome. The harmless strain doesn’t have to spread naturally better than the dangerous strains and it is likely any harmless strain would not spread better. We can artificially spread the harmless strain around so even if it is less contagious than the dangerous strain we tip the ecological balance in favour of harmless strain. This is really how an attenuated vaccine like the Sabin polio vaccine works from an ecological perspective. The risk of the virus mutating is there right now. It is much less likely that a harmless strain becomes very dangerous than a dangerous strain become very dangerous. This would be a bigger jump in evolutionary space. Ultimately as the immediate downvoting of my OP suggests this idea doesn’t appear popular. This doesn’t mean that it is not a scientifically valid approach that could work.

Symmetry 7y ago

We're not seeing much in the way of mutation in the SARS-CoV-2 structural proteins. And for other coroanviruses where we've developed vaccines, for dogs and pigs, we haven't had the same sort of problems with having to produce new vaccines that we do with the fast mutating flue. Now, resistance does fade and to keep your dog protected you need to give it a booster shot every year or two and it might very well be the same with humans and SARS-2. But at least we wouldn't have to play the game of guessing which strain would be dominant in an upcoming season.