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COVID-19 is likely to become endemic rather than be eliminated. We investigate the path of the COVID-19 pandemic to endemic mode. Using a variety of mathematical modelling approaches we explore how several factors will interplay to determine how and when endemic mode will be reached. We also compared gradual and rapid reopening and reopening at various vaccination coverage levels. 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 representative simulations; 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, and might be characterized by further waves of high incidence 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. The consequent burden on health care systems depends on the severity of infection in immunized or previously infected individuals.

Co-authors: Yexuan Song, Jessica E. Stockdale, Paul Tupper and Caroline Colijn

Elisha Are is a postdoctoral fellow in the Mathematics Department, Simon Fraser University, and a Research Associate at the South African Centre for Epidemiological Modelling and Analysis (SACEMA). He currently works with Professor Caroline Colijn on several modelling projects, focusing especially on modelling for public health policy to inform COVID-19 response plans in Canada. He does research in epidemiological modelling and analysis, rapid response modelling of emerging infectious diseases such as COVID-19. Before taking up his current position at SFU, he completed his PhD in Mathematical biology at Stellenbosch University, South Africa. His PhD thesis focused on using mathematical models to quantify and predict the impact of climate change on tsetse and trypanosomiasis in Africa. He has six years experience as a faculty member in the mathematics department, Federal University Oye-Ekiti, Nigeria.

Preprint: 'COVID-19 endgame: from pandemic to endemic? Vaccination, reopening and evolution in a well-vaccinated population' https://www.medrxiv.org/content/10.1101/2021.12.18.21268002v1