After a tumultuous and unprecedented year that turned our lives upside down, 2021 was welcomed with open arms. There was hope that the year would bring with it a return to normalcy - and take us back to life as we knew it before the COVID-19 pandemic first struck us.
With major advancements in vaccines, falling cases and a reduced death rate in a majority of regions, this expectation, at first, didn’t appear to be far-off.
But a deeper look into the way viruses generally work, combined with what we know so far about SARS-CoV-2, reveals that the coronavirus is here to stay - perhaps for all times to come.
How realistic would it then be to imagine a post-COVID world already? Not quite, as multiple global reports are proof of. The year 2021 would need to accommodate the ‘new normal’, and life may never be the same again. But what would it be like instead?
The ‘Endemic’ Possibility
The World Health Organisation (WHO) had warned us months back in May 2020, that the novel coronavirus ‘may never go away’. Dr Michael Ryan, emergencies director, WHO, had said at a virtual press briefing,
“It is important to put this on the table: this virus may become just another endemic virus in our communities, and this virus may never go away.”Dr Michael Ryan
While over 100 vaccines are being developed in the world right now against COVID-19, it cannot be guaranteed that the virus will get eradicated. Dr Ryan also said that he doesn’t think "anyone can predict when this disease will disappear.” In fact, diseases such as measles have still not been eliminated despite vaccines.
In a survey by the science journal Nature, almost 90% of 100 immunologists were of the belief that the virus will become endemic, i.e., it will continue to circulate in some pockets of the world for years to come. Michael Osterholm, an epidemiologist at the University of Minnesota in Minneapolis, was quoted in the report as saying:
“Eradicating this virus right now from the world is a lot like trying to plan the construction of a stepping-stone pathway to the Moon. It’s unrealistic.”Michael Osterholm
But this is not to say that the situation will be as critical as it was during the initial few months of battling the COVID-19 wave. To begin with, we know more about the virus than we ever did - and our understanding only continues to expand with each passing day. Several countries are in the middle of their vaccination drives; and the antibodies acquired through natural infection and immunisation (or eventually attaining herd immunity), would help bring down the scale and transmission of the virus.
This would ensure that while the coronavirus may persist in specific regions and pockets, it will not as deadly or widespread to require a lockdown or other stringent measures to be contained.
Moreover, if the virus continues to stay but vaccines or natural infection are able to prevent disease severity by building some level of immunity, there would be much less to worry about in the long run - once a majority of the people have either been infected or vaccinated.
But here, again, there is a caveat. The virus is mutating.
Mutations, Variants & Vaccines
Mutations are a part of a virus’ life cycle and are bound to happen. But at times, they can lead to more transmissible variants which can further cause newer waves of infection - as has been seen in the United Kingdom and South Africa, among other regions.
While it has largely been believed that the current vaccines will work against these, some recent studies have stirred scepticism by indicating otherwise.
On Wednesday, 17 February, US drugmaker Pfizer said that a new study suggests their mRNA vaccine might not be as effective against the South African variant of the coronavirus. The laboratory study showed that the variant may reduce antibody protection from the vaccine by two-thirds, reported Reuters.
In another instance, the COVID-19 vaccine developed by the US firm Novavax demonstrated overall efficacy of 89.3% in a phase 3 clinical trial in the United Kingdom, but offered significantly lesser protection (60%) against the one that was originally identified in South Africa, according to interim data shared by the company.
As a result, South Africa decided to temporarily not inoculate its population with the Oxford AstraZeneca vaccine procured from India.
Part of the findings from the same trial also suggested that prior infection with COVID-19 may not completely protect against subsequent infection by the South Africa escape variant.
Apart from these variants, another grey area is the duration of protection provided by vaccines. We do not have clarity over how long the immunity generated from vaccines will last, even though some recent estimates have suggested it could remain for up to eight months. More than half the scientists who responded to Nature’s survey think waning immunity will be one of the main drivers of the virus becoming endemic.
Ensuring the Vaccine Reaches All
It must not be forgotten that inequities in vaccine distribution would make it challenging for many countries to immunize their populations, and with global travel and ease of restrictions, no region would be entirely safe - unless they have attained herd immunity (which would require vaccinating more than 60% people based on the vaccine’s efficacy), and unless the virus hasn’t mutated to an extent that the vaccine doesn’t work.
“Firstly, the risk of infection from elsewhere, and thus outbreaks, would always be imminent. Secondly, there has to be universal coverage of vaccines with consistent upgrades, as the pace of vaccine development may not match the new variants’ emergence. Thirdly, a zero-COVID-19 strategy will worsen global health inequities by creating green zones of free travel among richer countries, thus alienating poorer nations,” Giridhara R. Babu, Professor and head, Lifecourse Epidemiology, at the Indian Institute of Public Health, PHFI, Bengaluru, wrote in The Hindu.
Initiatives to take the vaccine to less developed countries are a step in the right direction - especially with the WHO granting emergency use authorisation to the AstraZeneca-Oxford vaccine, paving the way for it to be rolled out globally through COVAX. Dr Mariângela Simão, WHO Assistant-Director General for Access to Medicines and Health Products, said in a statement,
“Countries with no access to vaccines to date will finally be able to start vaccinating their health workers and populations at risk, contributing to the COVAX Facility’s goal of equitable vaccine distribution.”Dr Mariângela Simão
Where India Stands
Our dependency on vaccines must not overlook the fact that only a minuscule proportion of the world has received it so far - and even among them, many are yet to complete their dosing schedule.
In India, for instance, less than 1% of the country has been vaccinated yet. It will take months, or even years, for the vaccine to reach the entire population (or enough to reach herd immunity).
The country has managed to vaccinate merely 30% of its target group in the initial phase and intends to start vaccinating people aged above 50 and those younger with morbidities in March. Dr Anant Bhan, Adjunct Professor & Researcher in Bioethics at Mangaluru’s Yenepoya University, had told FIT in an earlier interview that we will need to increase our vaccination centres or outreach immunisation centres.
“Healthcare workers were vaccinated mostly in their facilities so reaching them and coordinating was easy, but with a larger population we need to figure out delivery points, will we be going out into communities and immunizing like for children - this may be challenging but will increase uptake. Will they have to come in? We need to train people accordingly.”Dr Anant Bhan
Further, the nature of the virus along with the multiple COVID waves in different states are proof that we can never be too cautious. Delhi has seen three COVID waves, with numbers rising to nearly 10,000 a day, while Maharashtra and Kerala, for instance, are currently dealing with a spike in their active cases after experiencing slumps in the past.
“The cause for concern never went away,” Dr Swapneil Parikh, an internal medicine specialist in Mumbai and author of ‘The Coronavirus: What You Need to Know About the Global Pandemic’ said while speaking of Maharashtra. “We’ve seen how the tightening and relaxing of restrictions has lead to multiple peaks in other countries already, and this to be expected.”
Looking at the bigger picture, however, India’s number of new cases has been on a steady decline since the middle of September. The daily numbers estimates have come down from over 98,000 to between 10,000 and 13,000 now. But there has been a stagnation in this decline because of the numbers reported in Kerala and Maharashtra, accounting for almost 70 per cent of all the cases in the country, reported The Indian Express.
In addition, the number of cases being recorded of the South African and the UK variant is also concerning. In theory, it is possible that the entry of these variants could be behind the rising numbers in specific regions, but this can only be confirmed by genome sequencing.
Living With COVID in 2021
The keyword right now among all this is ‘HOPE’ - the expectation for things to get better.
Vaccine developments are coming in as a ray of sunshine, but as previously established, expecting life to resume and get back to normal will be too far-fetched. In an earlier story, FIT had spoken to experts to provide the much-needed reality check. According to them, we may have to hold our horses before making any plans for 2021 - because we would still have to be cautious and safe next year.
Dr Arvinder Singh Soin, Chairman, Liver Transplant at Medanta said,
“Common people will have to wait long for the vaccine. They will not get the vaccine before we are at least six months into 2021. Therefore, it is obvious that we will have to follow all necessary precaution.”Dr Arvinder Singh Soin
These safety measures would include: responsibly wearing masks, maintaining physical distancing, avoiding public gatherings, and following hand and respiratory hygiene. It would also mean upgrading ventilation and air-conditioning systems in schools and enclosed spaces to prevent airborne spread.
Although this is a personal choice, we must only try and travel when absolutely necessary.
“We should restrict our travels because the state of infection in different regions is not uniform. Cases are rising in some countries but coming down in others. This is the case even within a nation - with some states or cities witnessing worse outcomes than others.”Dr Arvinder Singh Soin
He also cautioned that till at least 60-70% of the population is not vaccinated and herd immunity is not attained, there will always be the chance of more outbreaks.
Most importantly, we must not forget that vaccines are not enough to bring the virus under control. With uncertainty about mutations, new and emerging variants, questions over immunity and unequal distribution, pinning all our hopes on immunization would not be wise. As Dr Shahid Jameel, Virologist and Director, Trivedi School of Biosciences at Ashoka University, had said in conversation with FIT, “Vaccine is not the answer to all our problems. For now, we will have to be cautious. We have to live with the virus in 2021 as well. But we can hope that in a few years, vaccines can help control it to a great extent.”