COVID-19 endgame: from pandemic to endemic? Vaccination, reopening and evolution in a well-vaccinated population
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Abstract
COVID-19 remains a major public health concern, with large resurgences even where there has been widespread uptake of vaccines. Waning immunity and the emergence of new variants will shape the long-term burden and dynamics of COVID-19. We explore the transition to the endemic state, and the endemic incidence, using a combination of modelling approaches. We compare gradual and rapid reopening and reopening at different vaccination levels. We examine how the eventual endemic state depends on the duration of immunity, the rate of importations, the efficacy of vaccines and the transmissibility. These depend on the evolution of the virus, which continues to undergo selection. Slower reopening leads to a lower peak level of incidence and fewer overall infections: as much as a 60% lower peak and a 10% lower total in some illustrative simulations; under realistic parameters, reopening when 70% of the population is vaccinated leads to a large resurgence in cases. The long-term endemic behaviour may stabilize as late as January 2023, with further waves of high incidence occurring depending on the transmissibility of the prevalent variant, duration of immunity, and antigenic drift. We find that long term endemic levels are not necessarily lower than current pandemic levels: in a population of 100,000 with representative parameter settings (Reproduction number 5, 1-year duration of immunity, vaccine efficacy at 80% and importations at 3 cases per 100K per day) there are over 100 daily incident cases in the model. The consequent burden on health care systems depends on the severity of infection in immunized or previously infected individuals.
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SciScore for 10.1101/2021.12.18.21268002: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This occurs even under optimistic assumptions that immunity is continuously boosted, that those who have recovered are not at all susceptible to reinfection, and that VOCs for which vaccines are less effective than current estimates for the mRNA vaccines are not circulating, as are limitations in our age and contact structured model. Some of our model estimates of endemic incidence are similar to the peak incidence observed in BC …
SciScore for 10.1101/2021.12.18.21268002: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This occurs even under optimistic assumptions that immunity is continuously boosted, that those who have recovered are not at all susceptible to reinfection, and that VOCs for which vaccines are less effective than current estimates for the mRNA vaccines are not circulating, as are limitations in our age and contact structured model. Some of our model estimates of endemic incidence are similar to the peak incidence observed in BC during the pandemic so far. On the path between the current state of the pandemic and the eventual endemic state, the speed and peak of case resurgence will be modulated by how fast we reopen, vaccination coverage and vaccine efficacy, as well as the transmissibility and immune escape capacity of the dominant variant at the time of reopening. At the time of writing, many EU countries are experiencing surges in COVID-19 cases, after many of the countries reopened at 70% vaccine coverage. Large resurgences are to be expected under those circumstances, because vaccine effectiveness is not 100% and the transmission rate of the Delta variant is very high. In Austria, for instance, where only 65% [30] of the population are fully vaccinated, daily cases are at all time high with more than 15K reported cases per day. Austria has now reintroduced lockdown restrictions for unvaccinated to curb resurgence in COVID-19 cases. Currently, vaccine effectiveness (while not 100%) is high against infection and disease. However, the SARS-CoV-2 virus is only newly facing...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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