When will the victory over COVID-19 be declared? | Health

One year after the pandemic, the infection rate is declining. The hospital is quiet. The morgue is empty. Being bold with the vaccine, we have dropped our mask and are approaching. Slowly reopen indoor dining, theaters, museums and schools.

Would you like to declare victory over COVID-19?

No, public health experts say. But we negotiate an uneasy ceasefire. Rather than completely eliminating the virus, you can create rigorous containment strategies, build public health breakwaters, and dodge witty, adaptable, and lasting enemies.

They add that this means accepting a certain level of risk when society returns to normal.

“This is what we can call a” victory. ” We will learn how to live with this virus in a way that allows us to continue to enjoy life, “said Dr. John Swartzberg, Department of Public Health, University of California, Berkeley.

Over time, vaccines will improve, deaths will decrease, and new behaviors such as wearing masks when sick will be adopted. Respond to it like any other deadly infection.

Last year, there was unimaginable progress against viruses. With accelerating vaccine production plans, President Joe Biden is now promising adequate vaccine supply to all adults in the United States by the end of May. Some states, such as Texas, are already competing for a full resumption.

However, there is growing consensus that COVID-19 is well established, causing intermittent and limited outbreaks in the United States and other countries with well-developed vaccine programs, but access to vaccines. It causes serious ongoing illness in parts of the more restricted world.

“Unless the disease is completely eradicated, there is always a risk of outbreak,” said Dr. Yvonne Maldonado, an infectious disease epidemiologist at Stanford University.

Why is eradication so difficult? Once the pathogen has settled, it is rarely extinct.

We have succeeded in eliminating only one major infectious killer, smallpox. Smallpox, a horrific disease that killed 30% of all casualties, was last reported in Somalia in 1977. Only two debris of the virus, stored in tightly controlled government laboratories in the United States and Russia, survive.

Indeed, it was a remarkable victory in overcoming the disease in a particular area. In the United States, infectious diseases are on the decline. For example, in 2020, 13 cases of measles and one mumps were reported to occur. Every year, less than 10 Americans get rubella. Of these, all are infected while traveling abroad. The original SARS disease, SARS-CoV-1, no longer bothers us.

However, attempts to eliminate historic global murderers such as hookworms, yellow fever and malaria have been frustrating failures. The Polio Eradication Program marks the 32nd year of a 12-year effort. Since the virus was identified in 1984, scientists have failed to seek HIV vaccines.

According to the American Society of Microbiology, the easiest illnesses to control are those that are readily diagnosed or recognizable. However, COVID-19 is hidden and spreads before people get sick. In addition, up to 40% of cases are done in secret and no symptoms occur. In addition, COVID-19 diagnosis requires examination by a skilled medical professional.

Disease can be easily controlled even in the absence of a persistent animal “reservoir” that lives only in humans, such as polio. This is not COVID-19, which is presumed to be derived from bats.

Geographically restricted illnesses such as onchocerciasis can be endangered by targeted campaigns. But COVID-19 is almost everywhere. It has spread to 219 countries and territories around the world, causing 118 million confirmed infections.

Also, diseases such as measles that can be suppressed with a single vaccine with lifelong immunity are easy. The durability of the COVID-19 vaccine is not yet known.

At COVID-19, “There is no doubt that the risk will be zero, because it is not feasible,” said Dr. Nadine Burke Harris, President of Surgeons in California last week.

So what is the acceptable number of deaths?

According to public health experts, you are more likely to get a disease that behaves like the flu. Although fatal, especially for the elderly, influenza is not considered a special threat that requires exceptional social response.

“We seem to believe that there will be an influenza pandemic every year,” Maldonado said.

Dr. Joshua Adler, Dean of Clinical Dean at the University of California, San Francisco, said, “I imagine a day when the incidence of COVID drops to levels that do not require a special process. That is our general environment. It looks like another infectious disease that is part of. “

“Just as there are many patients with flu or severe herpes infections, or what you have, we have many patients who may simply have COVID. Probably, “he said.

It’s still far away. California reported 137 deaths per 100,000 from COVID-19 as of March 8. According to the US Centers for Disease Control and Prevention, this is nearly 10 times the mortality rate from influenza and pneumonia in the last 2019 (15.2 per 100,000). The year those numbers were available.

Other infections are much lower: Respiratory syncytial virus, a common virus that infects the lungs and respiratory tract, is one of the 10 national health laboratories published in 2014, according to an extensive National Institute of Health study. Kill 2.1 to 6 people per million. Diarrheal diseases such as rotavirus kill 2.4 people per 100,000 people nationwide. According to HIV / AIDS, 2.4; Meningitis, 0.4; Journal of the American Medical Association, hepatitis is 0.29 and tuberculosis is 0.25.

In the meantime, we need to set intermediate goals, said Dr. George Rutherford, an epidemiologist at the University of California, San Francisco.

One goal is to prevent the proliferation of other cases so that the hospital is not overwhelmed. In addition, better medicines need to be provided so that infected people rarely die. Patients hospitalized for COVID-19 are now at almost five times the risk of death than those with influenza, according to a major study published last December.

And when varieties emerge, we must be ready to respond, Rutherford said.

Then, like the flu, “new strains disappear into the background and become part of the environment, infecting each year, but at much lower levels,” he said.

Experts predict that risk will recede over time. This is because the COVID-19 vaccine is superior to the influenza vaccine and can be changed quickly.

“I’m sure things will be much better than they are today. Does that mean you can live completely risk-free? I don’t think so,” Adler said. “But that may be a low enough risk that most of us feel happy with it.”

Ultimately, so-called community immunity, or “herd immunity,” protects us.

At that point (when 70% to 90% of the population is protected by vaccination or previous illness), it is much more difficult for the virus to move through the population. The risk to those who are not vaccinated is dramatically reduced. That’s when we feel safer to return to our important gathering. Think of a big wedding. Football game. Music festival.

For now, that’s a challenging goal. why? Children make up about 22% of the population and will not be vaccinated until clinical trials are completed later this year. Reluctant adults can represent another deficiency. Approximately 14% of adults said they were “probably not,” and 10% said they would “never be vaccinated,” according to data from the US Census released in late January.

But even when we are striving for a more complete vaccination, we slowly move towards safety. Even partial herd immunity can save lives.

However, managing the new relationship with COVID-19 requires continuous monitoring, potential re-vaccination, treatment of isolated cases, and rigorous contact tracing.

“It’s not over, but it’s definitely heading in the right direction,” Adler said.

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