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How do pandemics end? The future of COVID-19

Abstract:

COVID-19 is not the first pandemic that humanity has suffered, nor will it be the last. The natural history of each pandemic, including how it starts, how it evolves over time, and how it ends, depends on the specific infectious agent. We can learn a lot from studying these epidemics of the past. Herd immunity, both that induced by natural infection and that induced by vaccination, is expected to determine in part the future of the present pandemic. However, it must be accepted that the future behavior of the COVID-19 pandemic will depend on both the behavior of the virus and the behavior of society. Smallpox is the only human disease that has been eradicated and COVID-19 does not meet the conditions required for eradication, including the genetic variability of the virus SARS-CoV-2 and the high frequency of asymptomatic cases. However, it is possible that COVID-19 could be eliminated in certain countries or certain geographic areas, but not globally. One scenario to consider is that the pandemic undergoes a transition to an endemo-epidemic, probably with reduced severity, concentrating on specific non-immune population groups. Among those groups could be children belonging to the new cohorts, who may require routine vaccination as we do today to prevent other childhood diseases. Another possibility to consider is a possible "social end" of the pandemic, which, although the virus continues to circulate, the population accepts the new disease and adopts social changes to mitigate its consequences.