When will we declare victory over COVID-19?

One year after the onset of the pandemic, infection rates are declining. Hospitals are quieter; the morgues are more empty. Emboldened by the vaccines, we let go of our masks and move closer. Slowly we are reopening indoor dining rooms, theaters, museums and schools.

Will we declare victory over COVID-19?

No, say public health experts. But we will negotiate a difficult truce. Rather than wiping out the virus entirely, we can create a strict containment strategy, building public health ramparts to help fend off a cunning, adaptive, and enduring enemy.

It means accepting a certain level of risk as society returns to normal, they add.

“Here’s what we can call ‘victory’: learning to live with this virus in a way that allows us to continue to enjoy life,” said Dr John Swartzberg of the School of Public Health of the UC Berkeley.

Over time – as vaccines improve, the death toll goes down and we adopt new behaviors, like wearing masks when we are sick – we will come to terms with it, just as we do with others. deadly infectious diseases, he said.

Over the past year, unimaginable progress has been made against the virus. With fast-track vaccine manufacturing plans, President Joe Biden is now promising sufficient vaccine supplies for every adult in America by the end of May. Some states, like Texas, are already in the race to fully reopen.

But there is a growing consensus that COVID-19 is here to stay, causing intermittent and limited outbreaks in the United States and other countries with well-developed vaccination programs, but causing significant persistent illness in the United States. regions of the world where access to vaccines is more limited.

“Unless you have completely eradicated a disease, you are still at risk of having an epidemic,” said Dr. Yvonne Maldonado, infectious disease epidemiologist at Stanford.

Why is eradication so difficult? This is because pathogens, once established, hardly ever go out.

We have succeeded in eliminating only one major infectious killer: smallpox. A terrible disease that killed 30% of all victims, smallpox was last reported in 1977 in Somalia. Only two remains of the virus, stored in tightly controlled government laboratories in the United States and Russia, survive.

Certainly, we have achieved notable victories in conquering the disease in specific geographic areas. In the United States, there has been a downward trend in infectious diseases. For example, the country reported only 13 measles cases and one isolated outbreak of mumps in 2020. Fewer than 10 Americans contract rubella each year; of these, everyone is infected while traveling abroad. The original SARS disease – SARS-CoV-1 – no longer haunts us.

But attempts to eliminate historic global killers – such as hookworm, yellow fever and malaria – have been frustrating failures. The polio eradication program is now in year 32 of what was to be a 12-year effort. Scientists have searched unsuccessfully for an HIV vaccine since the virus was identified in 1984.

The easiest diseases to control are those that are quickly diagnosed or recognized, according to the American Society of Microbiology. But COVID-19 is hidden and spreading before people get sick. And up to 40% of cases are clandestine, causing no symptoms. Additionally, a diagnosis of COVID-19 requires testing by qualified healthcare professionals.

A disease can also be easily controlled if, like polio, it only lives in humans and does not have an animal “reservoir” where it persists. It’s not COVID-19, which is presumed to come from bats.

Geographically limited diseases, like river blindness, can be pushed to the brink of extinction by a targeted campaign. But COVID-19 is almost everywhere. It has spread to 219 countries and territories around the world, causing 118 million confirmed infections.

Diseases that can be controlled with a single vaccine with lifelong immunity, such as measles, are also simpler. We don’t yet know how durable our COVID-19 vaccines will be.

With COVID-19, “It’s definitely not about achieving zero risk. Because it’s not doable, ”California general surgeon Dr. Nadine Burke Harris said last week.

So what is the acceptable number of deaths?

It is likely that we are accessing a disease that behaves like the flu, say public health experts. Although fatal, especially for seniors, influenza is not viewed as a particular threat that requires an exceptional societal response.

“We just seem to believe, on faith, that every year there will be an epidemic of influenza,” said Maldonado.

Dr. Joshua Adler, vice-dean of clinical affairs at UCSF, imagines one day “when the incidence of COVID is decreasing to the point where we no longer need special processes. It becomes like another infectious disease that is part of our general environment.

“We’re just going to have a number of patients who can have COVID, just like we have a number of patients who have the flu, or severe herpes infection, or whatever,” he said.

It’s still far away. California has reported 137 deaths per 100,000 people from COVID-19 as of March 8. year when these figures were available.

Other infectious diseases are much weaker: Respiratory syncytial virus, a common virus that infects the lungs and respiratory tract, kills 2.1 to 6 in 100,000 people nationwide, according to a large study by the National Institutes of Health published in 2014. Diarrheal diseases, such as rotavirus, kills 2.4 per 100,000 people nationwide; HIV / AIDS, 2.4; meningitis, 0.4; hepatitis, 0.29 and tuberculosis, 0.25, according to the Journal of the American Medical Association.

In the meantime, we should set intermediate goals, said UC San Francisco epidemiologist Dr George Rutherford.

One of the goals is to prevent another outbreak of cases so that hospitals are not overwhelmed. In addition, we must offer better medicines so that those infected rarely die. Currently, patients hospitalized with COVID-19 run nearly five times the risk of death than those with the flu, according to a major study published last December.

And when variations emerge, we have to be prepared to respond, Rutherford said.

Then, like the flu, “new strains will disappear and become part of the environment, transmitted every year but at much, much lower levels,” he said.

Over time, the risk will decrease, experts predict. This is because COVID-19 vaccines are better than flu shots and can be changed quickly.

“I am convinced that things will be a little better than today. Does this mean you can live risk free? I don’t think so, ”Adler said. “But the risk may be low enough that most of us feel comfortable.”

Ultimately, the so-called community immunity, or “collective immunity”, will protect us.

At this point – when 70% to 90% of the population is protected by vaccination or a previous disease – it is much more difficult for the virus to move through a population. The risk to people who cannot get the vaccine is drastically reduced. This is when it is safest to return to our precious gatherings. Think about big weddings. Football games. Music festivals.

Right now that’s a tough target. Why? Children make up about 22% of the population and they will not be vaccinated until clinical trials are completed later this year. Reluctant adults could represent another shortfall. According to US census data released at the end of January, about 14% of adults said they “probably won’t” and 10% said they “definitely” won’t.