Covid-19 may stay with us forever

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In mid-September the director of the Wellcome Trust, Jeremy Farrar, suggested that Covid-19 was here to stay. “I think that politicians across the world are sort of pretending you can have your cake and eat it,” Farrar told the German podcast Pandemia . “(They’re claiming that) You can have zero deaths, no control measures, vaccinate if you want to or not vaccinate, and it will all end. I just don’t think that’s realistic.”

Farrar was implying that Covid-19 is now endemic: a virus which will continue to circulate, perhaps forever, despite our efforts to contain it. Both governments and societies must decide whether to accept an inevitable number of annual deaths, or a certain degree of restrictions. This line of thinking is echoed by many other scientists, both in the UK and around the world, who now believe that even countries, such as New Zealand, which have pursued strict ‘zero Covid’ approaches, will eventually have to make a choice between endless restrictions, or a certain number of annual mortalities. Is it time for us to accept that Covid-19 is never going away?

The major problem is that the rise of more infectious strains of Sars-CoV-2 have quashed hopes of herd immunity, even in countries with high vaccine uptake. Scientists such as Francois Balloux, who directs the UCL Genetics Institute, say that this outcome was inevitable as soon as Covid-19 became a truly global pandemic.

“I believe the opportunity for global eradication was gone very, very early in the pandemic,” says Balloux. “You can eliminate it locally, but as long as there’s a focus somewhere in the world, whether that’s Iran, Afghanistan, Somalia, it will eventually come back. As of February 2020, it was clear that elimination would not be possible.”

Others compare Covid-19 to the Spanish flu of 1918, and the 2009 H1N1 outbreak, which both ultimately became endemic diseases. “There are several reasons why the Covid-19 pandemic cannot be eliminated like smallpox or even the original SARS,” says Paul Tambyah, president of the Asia-Pacific Society of Clinical Microbiology and Infection. “First, it has spread too widely across the globe. Second, there are animal reservoirs which make it very difficult to totally eliminate the virus, and thirdly, unlike SARS, we do not know the intermediate animal host. We probably have no alternative to living with the virus, protecting the vulnerable, and ensuring the smooth running of the healthcare system.”

The precise picture of what endemic Covid will look like, and how countries attempt to manage the virus over the coming months and years, is likely to vary from society to society, depending on their vaccination coverage, and ability to access vaccine supplies. Some nations such as Denmark, which has fully vaccinated 84 per cent of its population, have removed all restrictions in a similar manner to the UK, and are relying on a high level of testing. Israel, which had the world’s highest per capita infection rate in the week of September 4 – something attributed to ongoing transmission among minority groups who have refused the vaccine – is attempting to protect the vulnerable in society by administering third and fourth rounds of booster shots.

Other countries such as Singapore – which publicly abandoned its  zero Covid policy and unveiled a roadmap to a ‘new normal’ in June – are looking to open up their societies while keeping Covid-19 under control using existing measures for suppressing tuberculosis and influenza. “We do targeted screening, surveillance of symptomatic individuals, careful contact tracing for tuberculosis and targeted tracing for influenza in schools or nursing homes,” says Tambyah. “We also promote influenza vaccination and have directly observed therapy for tuberculosis. These efforts have been quite effective in bringing down the numbers and impact of both of these endemic respiratory diseases.”

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