• Que veut dire « endémique », si ça ne veut pas dire bénin ? @Pr_Logos

    1/ Pourquoi, devant l’avalanche d’affirmations que nous vivons la dernière vague pandémique de la part de virologues confirmés, garder un certain doute ?
    Que veut dire « endémique », si ça ne veut pas dire bénin ?

    D’abord parce que la blague se répète et que le flou empêche d’agir.

    2/ Pour l’organisation mondiale de la santé, endémique signifie qu’on a une transmission continue du virus, pour des temps immémoriaux. On a perdu la partie, du point de vue Zero Covid : éliminer, non le virus mais le réservoir viral humain.

    3/ Ainsi, la peste est endémique à Madagascar, en République démocratique du Congo ainsi, dans une moindre mesure, que dans d’autres pays d’Europe de l’est et d’Afrique.

    4/ Le paludisme est endémique dans de nombreuses régions du globe où la population comporte un grand nombre de porteurs asymptomatiques.

    5/ Le mot endémique ne dit en aucun cas qu’il n’y a plus que des pathologies bénignes, qu’on a affaire à des rhumes de saison. Il dit qu’on n’est plus dans un état de crise mais dans une gestion permanente du virus, pour les décennies à venir.

    #covid-19 #endémie #imprédictibilité #variant #pathogénécité

  • Why Covid-19 will never become endemic | The Saturday Paper

    For most of the pandemic Australia has worked to contain the virus through evidence-based public health measures such as border closures, case finding, contact tracing, quarantine, social distancing, vaccines and, at times, lockdown. Sadly, the weaponisation of lockdown as a pointscoring issue and emotional trigger has led to a conflation of lockdown with all other public health measures, most of which do not impinge on freedoms. Denial is a major theme during the pandemic. Denial of airborne transmission, denial of science, denial of Omicron being serious and denial about what it really means to “live with Covid-19”.

    The denial of the airborne transmission of SARS-CoV-2 was started by experts on the World Health Organization infection control committee and allowed all countries to take the easy way out. If handwashing is all you need, onus can be shifted to “personal responsibility”; if ventilation needs to be fixed, that shifts responsibility to governments and private organisations. Australia only acknowledged airborne transmission after the Delta epidemic in mid-2021, almost a year after the WHO acknowledged it. Globally, 18 months was spent on hygiene theatre and actively discouraging mask use. As a result there is low awareness among the general public of the importance of ventilation and masks in reducing their personal risk.

    We had effective campaigns on handwashing, but no campaigns of similar effect have been used to empower people to control their own risk with simple measures such as opening a window. People living in apartments are largely unaware of the structural factors that make them high risk for transmission, or of the simple measures to reduce risk. The failure to focus on airborne transmission has hampered the ability to control the spread and has endangered health workers. Correcting it is critical to the long-term sustainability of health, business and the economy. How can restaurants recover without a safe indoor air plan that may prevent a lockdown cycle that disrupts and ruins their business?

    Denial of Omicron being serious suits an exhausted community who just wish life could go back to 2019. Omicron may be half as deadly as Delta, but Delta was twice as deadly as the 2020 virus. Importantly, the WHO assesses the risk of Omicron as high and reiterates that adequate data on severity in unvaccinated people is not yet available. Even if hospitalisation, admissions to intensive care and death rates are half that of Delta, daily case numbers are 20-30 times higher – and projected to get to 200 times higher. A tsunami of cases will result in large hospitalisation numbers. It is already overwhelming health systems, which common colds and seasonal flu don’t. Nor do they result in ambulance wait times of hours for life-threatening conditions. In addition, a tsunami of absenteeism in the workplace will worsen current shortages, supply chain disruptions and even critical infrastructure such as power. The ACTU has called for an urgent raft of measures to address the workforce crisis.

    As for denial of the risk in children, the majority of vaccine-preventable diseases that we vaccinate children against are mild in most children. Only a small percentage suffer serious complications. Polio and measles are examples where well over 90 per cent of children who become infected do not have severe complications, but in a small percentage there are serious and potentially fatal complications. SARS-CoV-2 is similar. Other than long Covid and multisystem inflammatory syndrome, we are only now learning about other longer-term complications of infection. For instance, there is more than double the risk of developing diabetes in children following Covid-19. A study from the United States showed the virus persisting in the brain, heart, lungs, kidneys and almost every other organ after the initial infection. A rare brain inflammation has been described in adults and children. Another study found a significant drop in cognitive function and IQ in survivors. The virus directly kills heart muscle. It is too early to know if Covid-19 will result in early onset dementia or heart failure in a decade’s time, but the evidence warrants a precautionary approach. We know some infections have very long-term complications – measles, for example, can cause a rare and fatal encephalitis about 10 years after the initial infection. We should do everything possible to prevent mass infection of children and adults.

    Denial of the science of epidemiology is widespread, even among “experts”. We are told repeatedly that SARS-CoV-2 will become “endemic”. But it will never be endemic because it is an epidemic disease and always will be. The key difference is spread. As an epidemic disease, SARS-CoV-2 will always find the unvaccinated, undervaccinated or people with waning immunity and spread rapidly in those groups. Typically, true epidemic infections are spread from person to person, the worst being airborne transmission, and display a waxing and waning pattern such as we have already seen with multiple waves of SARS-CoV-2. Cases rise rapidly over days or weeks, as we have seen with Alpha, Delta and Omicron. No truly endemic disease – malaria, for example – does this.

    This is the reason governments prepare for pandemics. The propensity for epidemics to grow rapidly can stress the health system in a very short time. Respiratory epidemic infections follow this pattern unless eliminated by vaccination or mitigated by non-pharmaceutical measures. Natural infection has never eliminated itself in recorded history. Not smallpox, which displayed the same pattern over thousands of years, and not measles, which is still epidemic in many countries.

    There is hope for better vaccines, schedules and spacing of doses, but we must be agile and pivot with the evidence and have an ambitious strategy. The current strategy is focused on vaccines only, with no attention on safe indoor air or other mitigating factors.
    Eradication occurs when a disease no longer exists in the world – the only example of this in humans is smallpox. Elimination is a technical term and means prevention of sustained community transmission. Countries that met WHO measles elimination criteria, including Australia, still see outbreaks of measles imported through travel, but when elimination is achieved, these do not become uncontrollable.

    Unlike for measles, however, current vaccines do not provide lasting protection. Masks and other public health measures are also needed to prevent the recurrent disruption of epidemic waves. There is hope for better vaccines, schedules and spacing of doses, but we must be agile and pivot with the evidence and have an ambitious strategy. The current strategy is focused on vaccines only, with no attention on safe indoor air or other mitigating factors. Instead, we have seen abandonment of test and trace because of failure to plan ahead for the expected explosion of cases. Testing and tracing are pillars of epidemic control, and the WHO has called on countries to strengthen both to deal with Omicron. Australia has done the opposite.

    Without adequate case finding (which relies on testing at scale) and contact tracing, we are on a runaway train coming off the rails. Testing allows us to find infected people and isolate them so they do not infect others. Now, during the Omicron wave, testing is a massive failure. Both the federal and New South Wales governments made a conscious decision to “let it rip”, but failed to plan for adequate TTIQ (test, trace, isolate, quarantine) capacity. Instead, when it was clear testing capacity was exceeded, they restricted testing to a small fraction of people. Very few people are now eligible for a polymerase chain reaction test (PCR), and rapid antigen tests (RATs) are in short supply. While it has improved the optics by hiding the true scale of cases, this has allowed unfettered transmission.

    Contact tracing is routinely used for many serious infections such as tuberculosis, meningococcal disease, measles or hepatitis A. It is conducted because close contacts are at highest risk of becoming infected next, and if they are not identified and quarantined they will go on to infect others and cause exponential epidemic growth. Contacts need to be traced within 24-48 hours to stop them infecting others. A range of digital contact-tracing methods such as apps, QR codes and tracking digital footprints through other means can be used when case numbers are high. Yet NSW has removed and flip-flopped on QR codes.

    Denial of the reality of “living with Covid-19” has seen us rush headlong into letting it rip in a largely unboosted population, with kids aged five to 11 unvaccinated, without any planning for increased testing, tracing or even procurement of promising new drugs to face the numbers that will come. The booster program has not been expedited, with on Friday less than 17 per cent of the population aged 18 and over having had a third dose, and two doses barely protective against symptomatic infection with Omicron. So Omicron has caused business and hospitality to suffer mass cancellations. Mass absenteeism has crippled supply chains, affecting food, diesel, postal services and almost every other industry. The first serious impacts will be in regional and remote Australia. We saw it in July, when vaccine supplies slated for remote towns were diverted to Sydney, leaving Wilcannia, in the far west of NSW, a sitting duck for the epidemic to come.

    Many do not understand “public health” and equate it with provision of acute health care in public hospitals or confuse it with primary care. Public health is the organised response by society to protect and promote health, and to prevent illness, injury and disability. It is a core responsibility of government.

    Public health comprises three components. The first is “health protection”, such as the banning of smoking in public places, seatbelt legislation or emergency powers that allow pandemic control measures such as lockdowns. “Health promotion” refers to the process by which people are enabled to improve or control their health, through the promotion of mask use, for instance. The third component – “disease prevention and early detection” – includes testing, surveillance, screening and prevention programs. Vaccination programs are an example of disease prevention.

    During the pandemic we have seen resources committed to surge capacity for clinical medicine, but there has been a lack of understanding of the need for public health surge capacity, including TTIQ. The price was paid in the Victorian second wave in 2020. Now, with the abandonment of contact tracing and restrictions on testing during the Omicron wave, we are seeing what happens when this capacity is ignored by government.

    Another outcome of these failures are the unscientific theories being pushed in many countries – such as the argument for “herd immunity by natural infection”, which has become a household narrative during the pandemic despite four pandemic waves providing little protection to date. The same people who peddled herd immunity by natural infection had no ambition to achieve herd immunity by vaccination. Instead they tell us “we have to live with Covid-19” and fall back on negative, defeatist messaging.

    The least ambitious goal of vaccination is to prevent us from dying, and that is the low bar set in Australia. This has reduced policy outcomes to a false binary of dead or alive. There is no concern in this for First Nations people, the disabled, people with chronic medical conditions, people in remote Australia or even children, who are being sent back to school at the peak of the pandemic while primary-schoolers are largely unvaccinated. The hundreds of aged-care outbreaks pass without comment in what essentially has become survival of the fittest and richest.

    The vaccine game is dynamic and ever-changing. Some countries have used ambitious, determined, organised strategies for vaccination and adapted quickly as the evidence has changed. We know the mRNA vaccines can greatly reduce transmission, but current vaccines were developed against the original Wuhan strain and, even after two doses, efficacy wanes. Omicron-matched boosters are in the wind, a seed of hope and a reason to be ambitious, but that will require agile vaccination policy.

    There is a massive vaccine and drug development effort, so it is almost certain we will have better vaccine options, including ones that are variant-proof. But what the past month has shown us is we cannot live with unmitigated Covid-19. Vaccinations will not be enough. We need a ventilation and vaccine-plus strategy to avoid the disruptive epidemic cycle, to protect health and the economy, and to regain a semblance of the life we all want.


    #covid-19 #contagion_respiratoire #airborne #déni (s) #dénégation #endémie #épidémie #immunité_collective #santé_publique

  • Faut-il un nouveau modèle de surveillance du Covid-19 ? L’Espagne veut lancer le débat

    Dans un métro à Barcelone, le 12 janvier 2022.

    Le gouvernement espagnol réfléchit à arrêter les tests systématiques, le traçage et l’isolement pour traiter le SARS-CoV-2 davantage comme une maladie endémique.

    Est-il temps d’en finir avec l’actuel système de surveillance de la pandémie, qui s’appuie sur des tests systématiques, le traçage et l’isolement des cas, y compris asymptomatiques ? En Espagne, malgré la virulence de la nouvelle vague provoquée par le variant Omicron, le débat a été lancé par le chef du gouvernement lui-même. Lundi 10 janvier, interrogé sur la radio Cadena Ser, le socialiste Pedro Sanchez a confirmé que le gouvernement « travaille depuis des mois » sur la nécessité de « répondre avec de nouveaux instruments » à « l’évolution du Covid-19, de la pandémie que nous avons connue, vers une maladie endémique ».

    Le matin même, le quotidien El Pais avait révélé que les autorités sanitaires espagnoles – le Centre de coordination des alertes et urgences sanitaires, le bureau des alertes et le Centre national d’épidémiologie – préparaient un nouveau modèle de surveillance de l’épidémie visant à traiter le Covid-19 comme une maladie respiratoire aiguë de plus, en appliquant une méthode similaire à celle utilisée pour le suivi de la grippe. Il s’agirait de ne plus compter les cas ni de faire des tests au moindre symptôme, mais de passer à un système de « sentinelles », s’appuyant sur un échantillon de médecins, de centres de santé et d’hôpitaux chargés de fournir des données statistiques extrapolables sur l’ensemble du pays, de manière à suivre l’expansion de la maladie.

    • (...)
      le gouvernement « commencera à évaluer l’adaptation à un nouveau système de surveillance et de contrôle du Covid-19 une fois passée la vague actuelle ».
      Pour la ministre de la santé, « il est évident que la situation n’est pas semblable à celle des vagues antérieures. La forte couverture vaccinale [90,5 % des Espagnols de plus de 12 ans sont vaccinés], la présence de plus en plus large du variant Omicron, qui semble présenter moins de gravité, et les taux d’incidence que nous avons connus durant la pandémie sont en train de changer l’épidémiologie du Covid-19 (…), une maladie pandémique qui prend peu à peu des caractéristiques endémiques », a-t-elle ajouté, insistant sur l’importance de « promouvoir ce débat auprès des partenaires européens. »

      Dans les faits, la très forte transmissibilité du variant Omicron a déjà très amplement débordé la capacité de suivi de l’épidémie en Espagne, et les protocoles ont été relâchés dès décembre : l’isolement des cas positifs a été abaissé de dix jours à une semaine et les contacts étroits des cas positifs ne sont plus testés s’ils n’ont pas de symptômes.

      Se concentrer sur les plus vulnérables

      Avec un taux d’incidence hebdomadaire de 1 500 cas pour 100 000 habitants, l’épidémie pourrait ainsi être particulièrement sous-évaluée. Sur les 2,1 millions de tests réalisés la première semaine de janvier en Espagne (contre 9,5 millions en France), le taux de positivité s’est ainsi élevé à 38 % (contre 20 % en France). Les hôpitaux, pour l’heure, résistent, avec 13,3 % des lits hospitaliers et 23,5 % des unités de soins intensifs occupés par des malades atteints du Covid-19. La médecine de ville, en revanche, est totalement débordée par l’afflux de cas positifs, y compris de personnes présentant des symptômes légers.

      Craignant que cette saturation n’aboutisse à une faillite du système de soins primaires, le 7 janvier, la Société espagnole des médecins de famille (Semfyc) a publié un long éditorial plaidant déjà pour « cesser de tester les personnes saines avec des symptômes mineurs », « arrêter de tracer et tester leurs contacts, abandonner les isolements » et « récupérer au plus vite l’ancienne normalité (…) : sans masque ni limite aux interactions sociales ». Rappelant que le suivi de l’épidémie a « empiété sur les soins préventifs, le diagnostic de nouvelles maladies graves ou le suivi des maladies chroniques », le texte considère que « les gouvernements [régionaux] doivent concentrer leurs efforts sur la protection des personnes les plus vulnérables au lieu de tenter de freiner, probablement avec peu de succès, la circulation du virus dans la population ».

      Si tous les experts ne partagent pas les conclusions de ce texte – les deux autres grandes associations de médecine de ville s’en sont démarquées, estimant ses conclusions prématurées –, le débat est lancé. Et le gouvernement espagnol, pressé d’avancer.

      à ce propos, il me semble que l’article donné ici par @supergeante https://seenthis.net/messages/942135
      soulignait que le passage à une endémie ne permettait pas d’affirmer que cela s’accompagnerait d’une pathogénicité atténuée.

      #covid-19 #suivi_épidémiologique #tests #endémie ou #pandémie_endémique (ou je sais pas quoi)

  • Thread by ShamanJeffrey on Thread Reader App – Thread Reader App

    Endemicity. I think we may have to re-evaluate our expectations of endemicity for #SARS-CoV-2. In temperate parts of the world, we think of seasonality as the phase-locking of incidence/transmission at one time of year, often the winter.

    This is patterned from our experience with influenza. The 4 well-documented flu pandemics emerged, produced a succession of waves over the first 2 years, then settled into a pattern of seasonal, one-outbreak-per-year endemicity.

    At population scales, partial protection conferred from prior infection (and vaccination) keeps incidence and severe disease at levels lower than seen during the pandemic waves. Influenza is not alone; other respiratory viruses are seasonal, too, including the ‘endemic’ coronaviruses (OC43, HKU1, 229E, NL63).

    But SARS-CoV-2 is different. It’s more aggressive. I don’t think we should expect it to devolve to a flu-like pattern. It has a much higher R0, evades immunity on shorter time scales, and is more virulent (jury still out on Omicron).

    Given these properties, multiple outbreaks each year, such as we’ve seen during 2021, may be the norm for the foreseeable future. We may find ourselves in a different kind of endemic equilibrium in which boosting is needed every 4-6 months and highly effective therapeutics are needed to limit severe disease. All this would need to be available globally and equitably. This is a daunting prospect. And psychologically challenging.

    #endémie #Covid-19

  • How will pandemic end ? Omicron clouds forecasts for endgame https://apnews.com/article/coronavirus-pandemic-science-health-pandemics-591db0701abcb31c2459b7a98a46e2

    Mais comment va-t-on empêcher les contaminations à partir des pays pauvres si on est prêt à déclarer la fin de la pandémie dès qu’un seuil « acceptable » d’infections est atteint dans les pays riches ?

    At some point, the World Health Organization will determine when enough countries have tamped down their #COVID-19 cases sufficiently — or at least, hospitalizations and deaths — to declare the pandemic officially over. Exactly what that threshold will be isn’t clear .

    Even when that happens, some parts of the world still will struggle — especially low-income countries that lack enough vaccines or treatments — while others more easily transition to what scientists call an “endemic” state.


  • La communication de Véran, ce week-end, affirmant qu’Omicron pourrait être la dernière vague, qu’on n’est pas à l’abri d’une bonne nouvelle, et que même que p’têt qu’il est tellement bénin que c’est une bonne chose que tout le monde l’attrape… est-ce qu’il a conscience de l’effet de ces déclarations quand, dans quelques mois, on se prendra la vague suivante ? Je trouvais déjà qu’Attal annonçant triomphalement la fin de la vague Delta juste avant les fêtes c’était pas bien malin ; là Véran l’atomise dans la connerie contre-productive. (On a déjà Blanquer qui en profite pour accélérer la contamination de tous nos enfants avant même qu’on ait une chance de les vacciner, avec les « experts » médiatiques qui assurent le service après-vente omniprésents dès ce matin…)

    Parce que comment vont réagir les gens à la prochaine vague ? À part réclamer qu’on ne prenne rigoureusement aucune mesure de protection tant qu’on n’aura pas prouvé que cette nouvelle vague n’est pas, elle aussi, une bénédiction tombée du ciel pour atteindre l’immunité collective ?

    Imaginons qu’à l’été, on a enfin un vaccin efficace y compris contre les variants, et que ce serait vraiment une très très bonne idée de se faire une dose de ça. Comment tu vas convaincre les gens d’y retourner, alors que tu leur as vendu en janvier l’idée qu’on allait laisser crever les gens avec Delta/Omicron, hospitaliser des gamins, laisser mourir les gens qui ont eu leurs soins reportés parce que l’hôpital est rempli de Covid, mais que ce « sacrifice » c’était une bonne chose maintenant on est protégés « naturellement » contre le Covid ?

    La communication précédente, entièrement orientée sur l’idée que les gestes barrières et le port du masque c’est l’horreur, mais qu’enfin grâce à la vaccination c’est terminé on n’en aura plus besoin, c’était totalement irresponsable. Mais là, vraiment, « c’est p’têt ben la dernière vague », c’est encore le niveau du dessus…

    • Oui, c’est bien à ça que je fais référence. On va le payer très cher, ça : c’est bénin, c’est immunisant, alors faites comme pour la varicelle, arrangez-vous pour l’attraper ! Et si le prochain variant est plus méchant, ayez confiance, p’têt bien que c’est comme la varicelle vous ne pourrez plus l’attraper.

    • Tant qu’on n’aura pas une vraie communication sur les séquelles, on n’en sortira pas. En deux ans, on est enfin au clair collectivement sur l’aérosolisation, à part Blanquer jusqu’à hier soir, évidemment. Même au bureau, ce matin, je constate qu’enfin, les collègues se servent en FFP2 plutôt qu’en chirurgicaux. Maintenant, il va falloir enfin faire sortir de sous le tapis les covid-longs. J’évoque à peine les immunodéprimés, tellement cette idée ne touche pas la plupart des gens perdus dans leur quotidien et tellement tout ce qui a trait à l’eugénisme ne semble plus évoquer quoi que ce soit à quiconque. Et donc, encore 3 ans, et peut-être qu’on aura fait le tour de deux ou trois alphabets latins, grecs et chinois, et qu’on pourra enfin passer à autre chose.

    • omicron c’est un vaccin gratuit profitez-en (variantes : sans les inconvénients du vaccin ; ça renforce la vaccination deux ou trois doses)
      Bon, il l’a pas inventé. certains ont essayé sur eux mêmes depuis mars 2020, et la question reste là. maintenant qu’il s’agirait de négocier (?) le tournant pandémie/#endémie, Drosten dit lui aussi des choses bizarres.
      @biggrizzly oui, mais ce sont des choses bien plus difficiles à rendre concrètes que les lits de ré et les morts pour qui a pas de cas dans ses entours. d’autant quelle ne seront pas réellement documentées sans des forces pour les rendre visibles, et pour l’imposer (//Act-up, et alliés pros potentiels).

    • "vous mettez le pied sur le frein alors que le virus galope" déclare à l’AN ce premier ministre du laisser circuler le virus puisque l’omicron ça va être un peu dur comme un tsunami mais tout compte fait ça nous aidera pour le bien de tous et de nouveau, vous verrez, tout ce qui ne nous tue pas nous rend plus forts !

      parlons frein, on entendra moins bien encore les coups d’accélérateur donnés par le gouvernement à la circulation du virus.

      #En_Marche #gouvernement

  • Covid Will Become Endemic. The World Must Decide What That Means

    The task of 2022 will be figuring out how much action we’re willing to take and how much disease and death we’ll tolerate.

    This is not the year-end we wanted, but it’s the year-end we’ve got. Inside it, like a gift basket accidentally left under the tree too long, lurks a rancid truth: The vaccines, which looked like the salvation of 2021, worked but weren’t enough to rescue us. If we’re going to save 2022, we’ll also have to embrace masking, testing, and maybe staying home sometimes, what epidemiologists broadly call nonpharmaceutical interventions, or NPIs.


    “The key question—which the world hasn’t had to deal with at this scale in living memory—is how do we move on, rationally and emotionally, from a state of acute [emergency] to a state of transition to endemicity?” says Jeremy Farrar, an infectious disease physician who is director of the global health philanthropy the Wellcome Trust. “That transition period is going to be very bumpy, and will look very, very different around the world.” (...)

    To start, let’s be clear about what endemicity is, and isn’t. Endemicity doesn’t mean that there will be no more infections, let alone illnesses and deaths. It also doesn’t mean that future infections will cause milder illness than they do now. Simply put, it indicates that immunity and infections will have reached a steady state. Not enough people will be immune to deny the virus a host. Not enough people will be vulnerable to spark widespread outbreaks.

    Colds are endemic—and since some types of colds are caused by other coronaviruses, there’s been speculation this coronavirus might eventually moderate too. (The coronavirus OC43, introduced to humans in the late 1800s, took a century to do that.) But flu is also endemic, and in the years before we all started masking, it killed anywhere from 20,000 to 50,000 Americans each year. Endemicity, in other words, isn’t a promise of safety. Instead, as epidemiologist Ellie Murray has argued, it’s a guarantee of having to be on guard all the time. (...)

    *Researchers argue that we are late in explaining to people what endemicity actually represents. “We should have been trying, from a very early stage, to teach people how to do risk calculation and harm reduction,” says Amesh Adalja, a physician and senior scholar at the Johns Hopkins University Center for Health Security. “We still should be trying, because people have gone back to their lives. They have difficulty understanding that no activity is going to have zero Covid risk—even though we’ve got great tools, and more of them coming in the new year, that are going to allow us to make Covid a much more manageable illness.”*


    But endemicity will be a daily grind, whenever we get there: a painstaking repetition of frequent testing, sometimes masking, and never quite being free of the need to think about the virus, like an annoying neighbor whom you wish would move away.

    If we resolve to do this better in the next round, we nevertheless are left with how we play out this one. “If we keep going as we are doing, it will be protracted and painful and prolonged,” Farrar says. “We need to commit to making sure everybody in the world has access to their two doses of vaccines by the end of March 2022. A level playing field isn’t just sort of a nice thing to do. It’s the only way to reduce the chance of other new variants coming.”

  • Thread by ArisKatzourakis on Thread Reader App – Thread Reader App

    [MEDIUM THREAD] On the topic of covid becoming an endemic virus. You hear this a lot; sometimes in response to critiques against strategies of elimination, sometimes just as a statement in its on right. Statements such as “Covid will inevitally become endemic.” 1/n

    The problem is, most of the time, I am not convinced people quite understand what endemic means. An endemic virus is a virus where infection levels are maintained at a baseline level without external inputs. Chickenpox is endemic; HIV is not, as it is still spreading. 2/n

    Achieving an endemic steady state requires a very particular set of conditions, namely that R(0) X the proportion of susceptible individuals in the population, is equal to 1. This would lead to a steady state, a fixed number of infections, which neither grow nor fall. 3/n

    There are reasons to think might not happen for covid, but it is not theoretically impossible under particular sets of conditions. More importantly, if an endemic state is achieved, at what level will it settle? The difference between a high and a low endemicity is vast. 4/n

    Just saying ’endemic’ is more or less information free as a statement. It says nothing about the level of prevalence of the virurs, the level of disease at the endemic steady state, or time time (could it be ten years?) taken to reach this hypothetical endpoint. 5/n

    Low endemicity is in many ways, actually akin to a policy of elimination. Keeping numbers low enough that serious disease never occurs, would be a fantastic outcome, and in some ways indistinguishable from elimination. A high endemicity? Not so much. 6/n

    Would we settle for a constant steady state of high levels of mortality and morbitity? The statement endemic is rather information free in this respect. Furthermore, would endemicity level be homogenous throughout the world? 7/n

    Very unlikely. So, if countries settle on different levels of endemicity, through global travel, we will necessarily continue to see epidemic waves. More importantly, ideas around endemicity completely fail to take into account the generation of strains. 8/n

    If we properly conceptualise the variants of concern as strains, with distinct prevalences and characteristics (mortality, spread, resistance), around the world, the prospect of some sort of endemic stable state becomes even more remote. 9/n

    Whether endemicity, and some sort of stable outcome is theoretically possible, stability is incredibly unlikely for many years to come without suppression, and will carry a tremendous cost. 10/n

    Today’s ‘endemicity endpoint’ is not dissimilar to yesterday’s ‘herd immunity as strategy’, if we include endemicity with high disease prevalence. If we can achieve stability, equivalent to attaining an R(t) of 1...11/n

    ..then we surely can achieve stability at a value just lower than that, without much additional cost, leading to elimination, or at the very least an incredibly low endemicity. 12/n

    It would be useful to understand that the two paths ahead, are either suppression on a massive scale, globally, leading to either low endemicity everywhere, or potentially elimination on the one hand, and on the other hand, a heterogenous, fluid, dynamic situation.. 13/n

    ..with generation of new strains with unpredictable characteristics, likely eventually including vaccine escape, with distinct prevalence across the globe, and waves of epidemics for many years to come. 14/n

    This is the future if we do not go for maximum suppression, not some stable endemic state, at least not in timescales that are relevant to public health outcomes. 15/n

    #covid-19 #suppression #endémie

  • #Candida_Auris: The Fungus Nobody Wants to Talk About - The New York Times

    Times Insider explains who we are and what we do, and delivers behind-the-scenes insights into how our journalism comes together.

    In 30 years, I’ve never faced so tough a reporting challenge — and one so unexpected. Who wouldn’t want to talk about a fungus?

    Last year, I began spade work on a series of articles about drug-resistant microbes: bacteria and fungi that have developed the ability to evade common medicines that we have used for decades.

    Early on, I stumbled onto a compelling example. A woman in Alaska named Sari Bailey woke up one morning with green and yellow gunk coming out of her ear. Her doctor told her it was an ear infection and prescribed antibiotics. They didn’t work. Turns out she had a drug-resistant infection that rooted on her mastoid bone, just behind the ear. It nearly killed her and required multiple surgeries to clear.

    #santé #endémie

  • Ugandans Grow Anxious Over Incidents of Deadly Viral Fever · Global Voices

    The death of nine-year-old Bridget Nalunkuuma in the central Ugandan town of Nakaseke has rattled residents who fear the girl may have suffered from Crimean-Congo Hemorrhagic Fever.

    Eight other people have reportedly died in recent months after experiencing similar symptoms.

    Present in Sub-Saharan Africa, parts of the Middle East and Asia, Crimean-Congo Hemorrhagic Fever is transmitted through insect bites or direct contact with bodily fluids of an infected person or animal. It bears symptoms similar to Ebola, the deadly viral infection that killed 11,217 people in three West African countries in 2014. But they are not in the same viral family.

    #ouganda #santé #endémie

  • Forget Ebola, Sars and Zika: ticks are the next global health threat | Science | The Guardian


    Since the beginning of our species we have been at war. It’s a continuous, neverending fight against the smallest of adversaries: armies of pathogens and parasites. As we have developed new ways to survive and stop them, they have evolved ever more complex and ingenious methods to thwart our efforts.
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    Humans have faced numerous attempts to challenge our dominance on planet Earth , and from the Black Death to the Spanish flu, we have weathered them all. However, since the start of the 21st century, with its trend towards global interconnectedness, these onslaughts are ever-increasing. In the past 17 years we have battled Sars, the Ebola virus, Mers, and more recently the mysterious mosquito-borne Zika virus. These diseases seeming to appear from nowhere and rapidly ravage our populations. One commonality is that they almost always originate in animals before jumping across to people, and few parasites are as good at jumping between animals and people as the tick.

    #santé #tics #endémies