COVID isn’t going away. Here are 3 things “chronic COVID” could mean.

In newly released information, it appears that if you get sick with the current “wildtype” COVID virus, it will offer no immunity benefit to the new South African variant.

There’s a lot baked into that statement. Let me explain what it means and what some implications might be for health care.

First, the “wildtype” variant of the coronavirus that causes COVID is the name of the virus that is the most commonly spread throughout the world. Think of this as, essentially, the base virus version that has caused the disease we call COVID.

There are some mutations in the base “wildtype” virus, but many of those mutations have been without practical consequence.

Some mutated virus strains develop significant mutations, which do create practical consequences. We refer to these new strains based on where they first take hold. The British strain we now label as B.1.1.7. The South African strain is called B.1.351.

When we get sick, our body develops antibodies in response. It retains the memory of those antibodies for a lifetime, even if the level of antibodies in the human body diminish over time.

When mutated viruses contact or enter the human body, if the similarities of the virus are close enough to the previous version of the virus that had infected the body, then the body will create new antibodies based on the previous virus and response. This allows the body to knock down the spread of the new infection. This is our immune response.

If enough of our community have this immune response, then the virus has a harder time finding a host to reproduce and spread. Ultimately, this difficulty in spreading becomes known as herd immunity, or when enough members of the community have an immune response from having been sick or been vaccinated that the disease can’t spread.

Sometimes, however, the virus mutates with practical implications and our body doesn’t recognize the new virus in spite of our body having antibodies from a previous infection.

This lack of “cross-variant” response or immunity means if you get sick once, you can get sick again with a new variant of the virus.

We see this with other coronaviruses, like the cold or the flu. You’ll have lots of colds in your lifetime. The version of the virus that gives you one sniffle is often different enough from another version that you will get another sniffle at another time. They both come from a coronavirus, but they are different enough that your body is not immune to the second in spite of the first.

It turns out the virus that causes COVID could be the same. Without cross-variant immunity, in this case from the “wildtype” virus to the South African virus, herd immunity won’t be possible. We’ll keep getting COVID just like we keep getting the flu.

As more strains become endemic, with what appears in the data to be a seasonal nature to the disease, COVID might spike in the fall every year just as we see occur with the flu.

If that is the case, if COVID is as permanent, re-occurring and as endemic as the flu due to this lack of cross-variant immune response, then that creates a number of implications for us. Here are three that stand out as this picture emerges.

 

1.  We will need to get vaccinated every year, just like the flu. 

It appears the current vaccines provide some level of efficacy across variant types, even when antibody response from previous infection is absent.

You can see from the chart provided by IHME that the range of vaccines being studied appear to have some level of utility in limiting disease and infection. We can anticipate that this will improve over time as vaccines are designed with additional new variants in mind.

So, just like the flu shot is a guess about the prominent strains of virus in the community in a flu season ahead, we are likely to have estimates about the viruses in community spread as vaccines get developed each year.

 

2.  Hospitals will need to reconfigure their surge capacity, bed allocation, and maybe their financing model.

Hospitals already worry each year about their capacity to manage surges in patients with the flu. That disease kills between 10,000-60,000 each year in the US.

Chris Murray is the Director of IHME, and has led the most accurate forecasting of COVID of any US entity tracking the disease.

In a conversation I had with him last week, he said that we can assume that society will mobilize to better respond to “chronic COVID” over time than society currently does to address the flu.

Even if we are sort of on the generous side, COVID should be four times worse than the flu in terms of hospitalizations and deaths. It could be much more. Or it could be less if we see behavioral change in the long run… All this is to say that this notion of no herd immunity and this prospect of chronic COVID is really a game changer.

Murray notes that even in this hopeful scenario, that hospitals will still likely face a seasonal surge of a converged COVID and flu. At four times the flu, that means we could see approximately 40,000 to 240,000 deaths each year.

How do you even finance the health system under those circumstances if, for example, elective surgeries in the months of December and January have to be reduced or put aside because of the combination of the flu and COVID surge on hospitals?

So, if COVID surges crowd out elective surgeries every year, we can imagine a one or two month period each year where hospital finances crater. This creates tremendous financial uncertainty resulting from chronic COVID.

Hospitals will need to jack up prices even higher for these elective services in order to offset losses from COVID/flu surges.

Or, hospitals can move to a pre-paid care model. This could look something like the models in Hawaii or in Maryland where providers are paid in a forward-looking way regardless of bed volume. This keeps hospitals stable and ready for when communities need them most, like a COVID/flu surge.

 

3.  You’re going to need to stay on those Zoom calls, indefinitely.

I know theoretically we’re all ready to get back to in person events. But, in practice, our sense of when is widely variable. As Axios reports, there is a partisan alignment to how eager we are to get into a room with a few of our closest friends. But, generally speaking, Americans are hesitant to get back into an in-person setting.

But, at least some of this data pre-supposes that at some point America will return to a pre-COVID world where the disease isn’t a threat.

As folks start to see that COVID deaths will not entirely go away, how will current practices of social distancing and mask wearing prove resilient? In other words, if we move to a state of “chronic COVID” where 100,000 to 200,000 deaths are reported annually, some folks are likely to retain the practices of social distancing.

It’s unclear how that will play out. But what is clear is that if Murray’s view of a “chronic COVID” holds, it may be a long while before we return to a pre-COVID world, if ever.