Nearly two years into the Covid-19 pandemic, many are wondering when the restrictions will end and life will return to “normal” once again.
By Dr. Vasileios Margaritis
We are all tired of the pandemic and the COVID-19 restrictions. We desperately want to return to our pre-pandemic lives, and most of the governments globally promise that.
But our strong desire to predict the end of the pandemic affects our judgement to accept reality and adjust our lives to the new normal.
We either overestimate or underestimate the risk of COVID-19 depending on bias (intentional or unintentional) in scientific results and on our level of health literacy, our mindset, and personality traits (the degree of being open, conscientious, extroverted, agreeable, or neurotic).
So let’s sum up our current knowledge — and ignorance — on the pandemic.
What we know about the Covid-19 pandemic:
Although this virus is not the worst in terms of morbidity and mortality rates in human history, COVID-19 can be a severe illness that can cause not only pneumonia but also multi-organ failure that can threaten everyone’s wellbeing, even our lives.
However, COVID-19 does not affect the general population in the same way; thankfully, children have been less likely than adults to die or become hospitalized because of the virus.
On the other hand, elderly adults, and persons with underlying conditions — such as obesity, hypertension, diabetes, heart disease, and cancer — and immunocompromised individuals of any age, remain more vulnerable to the disease; therefore authorities should continue to find ways to keep them safe and healthy.
COVID-19 is an airborne disease, and this makes the control of transmission, especially indoors, much harder.
Public health officials should not forget that and should reconsider their applied policies about the type of masks that we should wear indoors, the spatial separation between persons indoors, and the effective ventilation of enclosed spaces.
And yes, these restrictions should follow us at least until the summer of 2022.
Vaccination remains the only effective and safe measure to prevent COVID-19. Acquiring immunity (antibodies, memory B and T cells) to any degree is the only way to end this nightmare.
Anyone can transmit the virus, even though the vaccinated do so far more less than the unvaccinated. The potential of breakthrough infections in vaccinated people and the large number of persons with weakened immune systems force us to use masks indoors in any public place.
This is the minimum measure that we can take to protect ourselves and others and continue participating in the activities we love. Regular testing (using for example rapid at home tests before going to a wedding or a crowded event) can also significantly help us to reduce transmission and protect the vulnerable populations, such as children and the elderly.
COVID-19 is very difficult to eradicate, not only because of the nature and transmissibility of the virus (only smallpox has been practically eradicated), but also because there are globally significant animal reservoirs of the novel coronavirus and infections from animals can make their way into humans.
Researchers highlight that we must be aware of new variants emerging from animals that live in our ecosystem.
There is the “Long COVID” syndrome, which consists of long-lasting and sometimes devastating symptoms after even mild cases of COVID-19. This seems to be a serious problem that can affect both adults and children, with a prevalence ranging from 1-10%, and more research and better treatments are needed.
All pandemics end, however. Influenza and coronavirus strains that regularly circulate nowadays caused pandemics in the past. For example, the coronavirus OC43, which now causes a common cold, was probably responsible for a pandemic in 1889-1890.
What we don’t know about the pandemic
When the COVID-19 will stop being a significant public health issue is what we don’t know. Hospitalizations and deaths remain high globally, and extremely high in the Americas and Europe, which are gradually entering the winter, and thus there will be a significant increase of indoor activities.
Further, in several parts of the world, many cases and deaths are underreported (e.g. in Africa, six out of seven COVID cases are going undetected). We need to highlight that lifting restrictions in several countries, such as UK, US and Greece, for political and socioeconomic reasons does not mean that the COVID crisis is over.
If we will have a new more dangerous variant in the near future is also an unknown. Although the delta variant is currently the dominant strain circulating worldwide, the low share (about 35%) of the global population that is fully vaccinated gives the virus considerable space to evolve into new variants.
What COVID-19 endemicity means is another area among the unknowns. Many experts worldwide try to describe the “acceptable” level of hospitalizations and deaths at least for the foreseeable future.
COVID’s current public health burden cannot be considered acceptable when we see it as one of top leading causes of death (e.g. the second cause of death in the US in September 2021, higher than cancer and accidents).
Some researchers estimate that the collective immunity from vaccines/ infection and the effect of promising therapeutics can limit COVID-19 hospitalizations and deaths to a number nearly double the figure of severe cases of seasonal flu, but this remains to be verified and most importantly to be accepted by societies.
In addition, endemicity probably will be achieved at different times throughout the world due to the unequal vaccine distribution worldwide and it will take time to have a similar level of endemicity globally, significantly affecting traveling restrictions and policies for an unknown period of time.
How long the acquired immunity from infection or vaccination lasts is another unknown. Seasonal coronaviruses seem to cause reinfections about every 1-3 years, so does this also apply to SARS-COV-2?
Also, regarding vaccination, so far vaccine effectiveness is extremely high for hospitalizations and deaths, but we also see waning of immunity to infection; therefore in the next months we need to confirm that vaccines’ effectiveness remains strong against severe cases.
So, data and our 19 months of experience show that we cannot predict the near future accurately and there is not going to be a moment when we switch from pandemic to endemic. However, there will be a gradual transition to a situation that COVID-19 will unfortunately co-exist with other diseases that can make us severely ill –just not to the degree that it is doing this now.
And we must not forget the quote of most public health historians and epidemiologists, that the coronavirus pandemic could end socially before it ends medically, similarly to all previous pandemics.
Dr. Vasileios Margaritis is a member of the core faculty in Public Health at Walden University.