The contours of endemic coronaviral disease in humans and other animals are shaped by the tendency of coronaviruses to generate new variants superimposed upon non-sterilizing immunity. Consequently, patterns of coronaviral reinfection in animals can inform the emerging endemic state of the SARS-CoV-2 pandemic. We generated controlled reinfection data after high and low risk natural exposure or heterologous vaccination to sialodacryoadenitis (SDAV) in rats. Using deterministic compartmental models, we utilized in vivo estimates from these experiments to model the combined effects of variable transmission rates, variable duration of immunity, successive waves of variants and vaccination on patterns of viral transmission. Using rat experiment-derived estimates, an endemic state achieved by natural infection alone occurred after a median of 724 days with approximately 41.3% of the population susceptible to reinfection. After accounting for translationally altered parameters between rat-derived data and human SARS-CoV-2 transmission, and after introducing vaccination, we arrived at a median time to endemic stability of 1437 (IQR = 749.25) days with a median 15.4% of the population remaining susceptible. We extended the models to introduce successive variants with increasing transmissibility and included the effect of varying duration of immunity. As seen with endemic coronaviral infections in other animals, transmission states are altered by introduction of new variants, even with vaccination. However, vaccination combined with natural immunity maintains a lower prevalence of infection than natural infection alone and provides greater resilience against the effects of transmissible variants.
Significance Statement
The pandemic to endemic trajectory of SARS-CoV-2 transmission will be shaped by the tendency of coronaviruses to elicit non-sterilizing immunity and generate new variants. We utilized estimates from controlled rat coronaviral infection in deterministic compartmental models to inform routes to endemic stability in SARS-CoV-2. We introduced translationally altered parameters to explore the effects of waning immunity, exposure to increasingly transmissible variants and successive vaccination. We arrived at an endemic state in which 15% of the population remains susceptible to reinfection. Similar to endemic coronaviral infections in other animals, transmission states are altered by introduction of new variants, even with vaccination. Accumulating and maintaining evolving immunity through vaccination and inevitable natural exposure is essential to achieving a stable endemic state.