Wednesday, August 17th, 2022 14:47:15

In search of light through a Covid 19 tunnel: Is this the end of the beginning?

By Sarat C. Das
Updated: January 16, 2022 2:39 pm

It is a dreadful apocalyptic vision. The Covid 19 may last until 2026 as a worst-case scenario. Reason: the vaccinations and antivirals would cease to be effective against new COVID-19 variants, according to the UK Health Security Agency (UKHSA). The report says, it is too early in our understanding of Omicron to see if or how this may influence when COVID-19 ends, and we can settle into ‘the new normal’.

If this is the case, restrictions and lockdowns could be used as new waves emerge up until 2026. This would have a significant impact on economic growth, and it would cause a major surge in job losses as companies struggle to cope with on-and-off closures. The ominous span of seven years can lead us to Covid fatigue, long Covid, and our vaccines and monoclonal drugs may totter, a bunch of one-trick ponies, keeping up with mutating coronavirus as many sick and infirm shamble off down the hospital corridor.

If it had been a freak epidemic, let us say some local outbreak of meningococcal infections, we could have managed it within weeks. For example, an outbreak rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic, but now, the virus seems to have got many legs and expansive territories to lord over.

Our ‘middle’ scenario is reposing faith in the Whitehall report. This offers some optimism and hope. This case scenario predicts that COVID-19 will become steady, manageable, and endemic between 2023 and 2024.

Finally, our ‘best scenario’ is believing the words of WHO director-general Tedros Adhanom Ghebreyesus’ expressed optimism that the Covid-19 pandemic will end in 2022 only if inequity ends. But it does not seem to be a prediction. It is more about feeling despondent with downcast eyes and listening to Ghebreyesus’ earlier words, ”No one is safe, until everyone is safe”. Anyway, the best case scenario envisages an end to lockdowns but the possible continuance of extra seasonal measures – such as mask wearing – to try to control winter surges.

Most of us are always tempted to draw a parallel between Covid 19 and Spanish Flu, which in its most hostile form lasted between February 1918 and April 1920. Medical historians estimate that Spanish flu infected some 500 million people globally in four successive waves, with some 100 million people perished. After that, this strain of flu receded, likely due to changes in the virus itself and the fact that most people had already been exposed and developed immunity or died.

Unfortunately, the end of influenza in summer 1919 did not portend the end of COVID-19 in the summer of 2020. History shows the pandemic ebbed after a final, third wave in spring 1919 without the benefit of an influenza vaccine (available only in the mid-1940s) or a molecular or serologic test, or effective antiviral therapy, or even the support of mechanical ventilation.

Scientists offer several explanations for the high mortality, including a six-year climate anomaly affecting migration of disease vectors with increased likelihood of spread through bodies of water. The virus was particularly deadly because it triggered a cytokine storm, ravaging the stronger immune system of young adults, although the viral infection was apparently no more aggressive than previous influenza strains. Malnourishment, overcrowded medical camps and hospitals, and poor hygiene, exacerbated by the war, promoted bacterial superinfection, killing most of the victims after a typically prolonged death bed.

Because the waves of pandemic flu did recede, it’s tempting to imagine today’s pandemic following a similar trajectory. However, fundamental differences between the biology of SARS-CoV-2 and influenza viruses make it hard to chart the future of COVID-19 based on what happened in the early 20th century.

In some countries, COVID-19 infections would still be high and new variants may cause new waves. However, a combination of good testing, vaccination, and antivirals would keep rates of serious COVID-19 infection to manageable levels.

Post the massive surge of Delta, many of us thought we are at the beginning of the end now, but then Omicron deluged us with its more contagious ability to achieve ”immunity breakthrough”. And the new variant of concern rewrote the timeline.

McKinsey analysis suggests that in the United States, this combination of characteristics would lead to Omicron replacing Delta as the dominant variant in the next few months and to a higher peak burden of disease than the country saw in the second half of 2021 (but likely below the peak reached in the winter of 2020–21).

This base-case scenario has the potential to place a severe strain on healthcare systems. The optimistic scenario would see a peak of disease burden close to that seen over the past six months, while the pessimistic would see a very significantly higher burden of disease than in the past six months.

Before the emergence of Omicron, America’s Chief Medical Advisor to the President, Dr. Anthony Fauci said in an interview with CNN that we could start having some control over the pandemic come spring, while Moderna’s CEO, Stéphane Bancel, thought the pandemic could be over in a year. They both were proved awfully wrong as Omicron upended all mathematical models and predictions.

Historically, the timespan of the most devastating pandemic strikingly varied across geographies: Antonine Plague for fifteen years (165-180 AD), Plague of Justinian for short span of one year (541-542 AD) Japanese Smallpox lasted for two years (735-737 AD), Black Death (Bubonic Plague) raged for four years (1937-1351), the Cholera 6 outbreak for six years (1817-1923 AD), and so on. Many pandemics are reduced to endemics, but their occasional outbreaks certainly rattle us. We are still living with malaria, small pox, and yellow fever which surfaced in late 18th century.

Many epidemics or pandemics’ historicity could never be known: how and when exactly the outbreak occurred and how long it lasted and how many it killed. For example, the “Hamin Mangha”, one of the best-preserved prehistoric sites in northeastern China. About 5,000 years ago, an epidemic wiped out this prehistoric village in China. The bodies of the dead were piled inside a house that was later burned down. No age group was spared, as the skeletons of juveniles, young adults and middle-age people were found inside the house. Before the discovery of Hamin Mangha, another prehistoric mass burial that dates to roughly the same time period was found at a site called Miaozigou, in northeastern China.

In any scenario for the future of the COVID-19 pandemic, much depends on the ways in which societies respond. Three levers are likely to be especially important, starting with the extent to which countries can effectively scale and make available new oral therapeutics with the potential to reduce the chance of progression to severe disease, and which are unlikely to be blunted by Omicron. Second, evidence is accumulating that booster doses are especially important for protecting against the Omicron variant; accelerating their rollout will help protect populations. And third, given public fatigue and the lessons of the past two years, finding the right combination of public-health measures will be critical.

A series of well-documented influenza pandemics of the past 130 years provide us a blueprint for how Covid might pan out, according to Lone Simonsen, an epidemiologist and professor of population health sciences at Roskilde University in Denmark. She is an authority on the ebb and flow of such pandemic events.

While the longest global flu outbreak lasted for half a decade, they mostly consisted of two to four waves of infection over an average of two or three years, she extrapolated. Covid is already emerging to be among the more severe pandemics, as its second year concludes with no end in sight.

In all likelihood the SARS-CoV-2 would not follow the path set by the preceding pandemics. It is a novel and potentially more transmissible pathogen.

Despite the persistence of disease and pandemics throughout history, there’s one consistent trend over time – a gradual reduction in the death rate. Healthcare improvements and understanding the factors that incubate pandemics have been powerful tools in mitigating their impact. And possibly, this way together with following Covid appropriate behaviors we will be able to affect the Covid 19 timeline.

 


By Sarat C. Das

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