At this point, the pandemic is far from over.
In an attempt to understand how the COVID-19 pandemic will end, scientists look to the past to try to see the future.
We are approaching one-and-a-half years of the pandemic, and people all over the world are asking themselves the same questions: How will this end? And when?
The truth is that pandemics always end. Somehow…
Controlling the pandemic
Humans had no chance controlling the spread of SARS-2 and driving it back into nature, but vaccinating is an expensive way out of the pandemic and only a few countries will be able to do it rapidly.
To date, vaccines have never played a significant role in ending pandemics as, by the time the vaccine was ready, the worst had passed. This time, vaccines were developed, tested, and put into use within months.
Vaccines are a most powerful tool in ensuring public health and COVID-19 vaccines are playing an important role in contributing to controlling the pandemic. In the first phases of vaccination campaigns, the main objective is to slow down the pandemic, protect those who are most at risk from severe disease and reduce the burden on healthcare systems.
More time is needed until a significant proportion of the population will have been vaccinated.
More information is needed on how efficient the current vaccines are in reducing SARS-CoV-2 transmission.
Fully vaccinated people have a reduced risk of transmitting SARS-CoV-2 to unvaccinated people and should still get tested if experiencing COVID-19 symptoms.
Even with the reduced effectiveness of some COVID-19 vaccines against some of the new variants, vaccines are expected to offer some protection from severe forms of the disease. Manufacturers are exploring ways to update vaccines, to improve protection as new variants are detected.
A booster shot for COVID-19 vaccine will probably be needed, though the matter is still under study.
While vaccines have played a crucial role in past efforts to control infectious disease, their ability to bring pandemics to a rapid and definitive close is much more limited.
Experience of the past shows that pandemics abate, but identifying the precise end is almost impossible.
It is not surprising that, in historical records, there is no evidence of parties to commemorate the end of any pandemic!
How long will immunity last?
The World Health Organisation’s chief scientist said she would like to know how long immunity lasts, after infection and after vaccination.
The answers would tell us how achievable herd immunity is, and whether and when vaccine booster shots will be needed.
It is possible that protection against infection is shorter, but protection against severe disease is longer and the durability of vaccine-induced protection is different from the infection-induced protection.
In the meantime, all measures for controlling the spread of this virus, such as physical distancing, appropriate hand hygiene, respiratory etiquette and the use of face masks, remain of key importance.
COVID-19 reinfections are rare, but so far, we do not know how rare.
Even if someone contracts a second infection from a variant, the immune system would generally still be able to recognise the virus well enough to avoid severe outcomes.
The end of fear
Pandemics are a social phenomenon. A medical conclusion usually comes first, when disease incidence goes down and death rates drop, followed by the social side when fear of the infection decreases and social restrictions ease.
We also must remember that coronavirus is a global disease and that different places will have varying social and medical conclusions to their respective versions of the pandemic.
As wealthier nations continue to vaccinate themselves out of restrictions, the ending of their pandemic might come relatively quickly. But what about the rest of the world? When will developing countries see a similar conclusion?
“After the pandemic is over” must be one of the most frequently uttered phrases of 2021. I am certainly guilty of this kind of optimism, longing for the day when I can get on a plane, have dinner with my friends, and cuddle my grandchildren. We all anticipate future freedom.
Wherever you look, it is unlikely there a precise date for the ending of the pandemic. While we all might need a dose of optimism, rather than planning parties or holidays, perhaps our time now would be better spent thinking about what kind of future we want to look forward to and how we put the lessons we have learned this past year into practice.
Fauci, the well-known epidemiologist, said the first big step in ending the contagion is to get it under control. The next step would be to eliminate it from the population. The ultimate goal will be to eradicate it from the planet.
“We will likely get somewhere between control and elimination, more likely closer to control,” Fauci said. “In order to have elimination, you have got to have the whole world vaccinated.”
Pandemics in the past have stopped because human’s immune systems learned how to defend from the viruses and the viruses underwent a transition and became endemic. It is expected that SARS-2 will, at some point, follow the pattern joining other human coronaviruses that cause colds, mainly in the winter, when conditions favour their transmission.
Experience from the last four pandemics suggests that viruses change from pandemic pathogens to endemic sources of disease, within a year and a half, or two, of emerging.
But different pathogens could mean a different outcome.
History tells us that the end of pandemics is rarely, if ever, neat, uncomplicated, or even easy to date.
So far, we do not know what we would like to know.
The end of the pandemic is coming … just do not make a date for the celebration.
Best health wishes,
By Dr Maria Alice
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Dr Maria Alice is a consultant in General and Family Medicine. General Manager/Medical Director – Luzdoc International Medical Service. Medical Director – Grupo Hospital Particular do Algarve/ Hospital S. Gonçalo de Lagos