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After two years of pandemic, what is attainable now? |
by Dr. Rey D. Pagtakhan
The COVID-19 virus – originally referred to simply as “2019-nCoV” – short for novel CoronaVirus identified in 2019 – has been making its global journey for over two years since its start, and it isn’t over yet. What lessons have since been learned, what insights have since been gained, and what should now be our attainable goal?
Beginnings
The initial 11 unexplained cases of pneumonia with a common history of exposure to live animals in the Hunan Seafood Wet Market seen in Wuhan, China, on December 8, 2019, were clinically suspected to be caused by an unknown virus. When the number of cases increased to 59, they were gathered and admitted into one hospital where a multidisciplinary team, including public health experts, did a full investigation and reported their findings to the U.N. World Health Organization (WHO) on December 31. The offending virus was identified on January 1, 2020, and its genomic characterization achieved a few days later and shared instantaneously with the global scientific community.
Spread beyond national borders
Soon after China ordered a lockdown of the whole province of Hubei and quarantined its 60 million population, the first case was diagnosed in Thailand on January 13, followed promptly by reports of similar cases from eight more countries. In response to the increasing spread, the Johns Hopkins University’s Center for Systems Science and Engineering launched its online global coronavirus dashboard on January 22nd. This tracked the reported cases coming from all countries on the daily timescale. It has since continued to provide this valuable service. By January 30, cases had spread to 13 countries and the WHO declared a “health emergency of international concern” to help “fight further spread in China and globally (and) to protect nation-states with weaker health systems.”
Before February ended, Canada and the US had already seen their first cases and the likelihood of a full-blown pandemic was becoming more evident.
“COVID-19 is a pandemic”
On 12 March 2020, the U.N. health agency announced the sombre global moment: “COVID-19 is a pandemic” – a global public health and a socio-economic crisis that had afflicted over 100,000 patients, had claimed the lives of over 4,000 citizens, and had reached 114 countries, six continents and all regions of the WHO – all in less than 100 days from its beginning.
The new viral disease received its designation “COVID-19” (short for COronaVIrus Disease, first described in 2019) and the offending virus received its official name SARSCoV2, short for “Severe Acute Respiratory Syndrome Coronavirus 2. The number differentiates it from the first coronavirus that caused SARS in 2002-2003.
In the more than two years the COVID-19 virus has been circulating around the world, I have tried to share with the Canadian Filipino community and readers of Pilipino Express and Canadian Filipino Net the many stories of illness, suffering, stress, deaths, overwhelmed health care systems and providers. I also shared the stories of hope, altruism, courage, triumph, selfless service, and human commitment. I have tried to share the medical and scientific breakthroughs, too, and the efforts of governments to help alleviate the burden on life, livelihood, and living.
What’s next, new, and attainable?
The last two plus years have also provided lessons and given us insights about the pandemic. Dr. Anthony Fauci of the USA National Institute of Allergy and Infectious Diseases and Adviser to US President Joe Biden, and his colleagues Drs. David Morens and Gregory Folkers, recently shared their expertise on the subject and the situation, in their essay, The Concept of Classical Herd Immunity May Not Apply to COVID-19, in the Journal of Infectious Diseases. Let me share my reading.
To refresh our understanding, a classical herd immunity threshold for COVID-19 is the proportion of the population with immunity against the COVID virus (resulting from either natural infection or vaccination) above which transmission of the virus is largely prevented. That is, if someone gets infected by the COVID virus, he or she “is surrounded by enough people who are shielded against infection so that the virus has nowhere to go; it fails to spread.”
Below are the lessons that have emerged, the insights that have been gained, and their anticipation of the future (A, B, and C). I have summarized from them and have, in fact, abundantly quoted from their journal article.
A. Five lesson learned
- SARS-CoV-2 mutates continually into new variants that can escape immunity derived from infections and vaccines.
- It also can be transmitted asymptomatically and without pathognomonic signs, impeding public health control.
- SARS-CoV-2 appears not to substantially engage the systemic immune system, as do viruses that consistently have a pronounced viremic phase.
- Moreover, neither infection nor vaccination appears to induce prolonged protection against SARSCoV-2 in many or most people.
- Finally, the public health community has encountered substantial resistance to efforts to control the spread of SARSCoV-2 by vaccination, mask wearing, and other interventions.
B. Insights gained
- There are significant obstacles to achieving complete herd immunity with COVID-19.
- Eradication or elimination almost certainly is an unattainable goal.
- Controlling SARS-CoV-2 and its cycles of new variants presents a much more formidable challenge.
- Any level of herd protection against SARS-CoV-2 potentially can be overcome by:
a. ever-changing levels of immunity among countless sub-populations;
b. human movement, crowding, changes in social or prevention behaviours;
c. demographics;
d. vaccination levels,
e. variations in durability of infection or vaccine-induced immunity, and
f. evolution of viral variants, among many other variables.
5. If vaccine or infection-induced immunity to SARS-CoV-2 indeed proves to be short-lived, or if escape mutants continue to emerge, viral spread may continue indefinitely, albeit, hopefully, at a low endemic level.
6. Thus, COVID-19 is likely to be with us, even if at a very low level of endemic community spread and with lower severity, for the foreseeable future.
7. But encouragingly, after more than two years of viral circulation, and more than a year of vaccines with boosters, we now have a high degree of background population immunity to SARS-CoV-2.
C. What’s next?
- More broadly protective vaccines could play important roles in controlling SARS-CoV-2 and its inevitable variants.
- Developing “universal” coronavirus vaccines (or at least universal SARS-CoV-2 vaccines that elicit durable and broadly protective immunity against multiple SARS-CoV-2 variants) is an important goal for the immediate future.
- Optimal COVID-19 control will require both classic, nonpharmacologic public health approaches and vaccination of many more people globally with the SARS-CoV-2-specific vaccines, with booster shots and with updates to vaccine antigens, if needed.
- Living with COVID is best considered not as reaching a numerical threshold of immunity, but as optimizing population protection without prohibitive restrictions on our daily lives.
- Effective tools for the prevention and control of COVID-19 (vaccines, prevention measures) are available. If utilized, the road back to normality is achievable even without achieving classical herd immunity.
- Countermeasures such as antiviral drugs and monoclonal antibodies to prevent the progression of disease, and widely available diagnostic tests. With these interventions we can aspire to, and very likely will succeed in achieving, substantial control of community spread without the disruptions of society caused by COVID-19 over the past two years.
Indeed, COVID-19 control, not classical herd immunity, should be our aspirational goal – and that is realistically attainable.
Dr. Pagtakhan – widely published in medical journals and textbook chapters – is a retired lung specialist and professor of paediatrics and child health; former Member of Parliament, Parliamentary Secretary to the Prime Minister, and cabinet minister; and recipient of academic, governmental, professional and community awards and honours. He graduated from the University of the Philippines; trained at the Children’s Hospitals of Washington University and University of Manitoba; and spent a sabbatical as Visiting Professor at the University of Arizona. He presented as Canada’s former Secretary of State for Science, Research and Development on “The Global Threat of Infectious Diseases” at the G-8 Countries’ Science Ministers and Advisors Carnegie Group Meeting held on 13–15 June 2003 in Storkow, East Berlin, Germany.