Gillian Roddie on how living with Covid means give up on the need for definitive answers
[restrict]
A year ago this month I wrote in Rogue about how we were feeling as we faced the lifting of restrictions in the lead up to Christmas (spoiler: not great). As the country prepared to move to Level 3 in early December, the government appealed to the public to reduce in-person contacts, to wash their hands regularly, to keep fresh air circulating in homes, to avoid crowds while shopping and to wear face coverings.
Last week, as Covid-19 cases rose to their highest since the second wave in January (caused by those same “reckless” easing of rules for Christmas) Dr. Tony Holohan must surely have had déjà vu when he implored the public to keep practicing “basic public health interventions – washing our hands, opening windows, wearing masks and most importantly, staying home when we have symptoms.”.
This time last year we were facing a great deal of uncertainty, tempered by the news of our first viable vaccine candidate from Pfizer. The details were scant, but it was enough to give us hope – the vaccines were, after all, our way out of this whole mess, such was the message that we kept hearing. And yet here were are 12 months on, still facing rising cases and uncertainty, and threats of new restrictions on the cards. It’s not just us either, the transmission rates of Covid-19 in 53 European countries are of “grave concern” right now according to the WHO’s Hans Kluge, with a 6% increase in new cases across the region and a 12% rise in deaths. We’d be forgiven for wondering if we’ve made any progress at all.
Before I lose you completely thinking that this is an essay exercise in doom and gloom, please let me reassure you that that isn’t the goal here at all, rather to set the scene for delivering a practical truth that might not sit well initially, but accepting it will make the way forward slightly more palatable: for as long as Covid-19 exists, so too will the uncertainty it brings.
Experts are unsure how long the pandemic will last, but there is optimism around the end of 2022, which is when the WHO is aiming for 70% of the world’s population to be vaccinated. But while this may herald the end of the pandemic, the virus itself will not be going away. What remains to be seen is how it moves from its current identity as a pandemic-level infection, into its longer term persona: will it be a seasonal virus, like influenza, that we jab up for each year? An endemic virus, like measles, that arises in clusters among the unvaccinated or those with waned immunity? Or will it mutate further to elude natural and vaccine-induced immunity entirely, plunging us into pandemic 2.0? (Unlikely, but not impossible, and I’m genuinely sorry for even mentioning it.)
As things stand, there’s really no way of knowing exactly how things will go next, but such is the nature of pandemics. We can look to previous events for guidance, but the novel SARS-CoV-2 is as novel SARS-CoV-2 does: unlike the O.G. SARS outbreak in 2003, this coronavirus can be transmitted before symptoms appear, whereas SARS would only transmit once the infected person showed symptoms, making it much easier to contain (only a global total of 8098 people were recorded as having it). The 1918 Pandemic saw three waves of infection which began in March 1918 and ended in spring of 1919, the culprit the H1N1 virus, and most deaths were seen in the 2nd wave of autumn 1918, outside the traditional seasonal peak of flu.
There are still some significant gaps in the information we need in order to make any kind of reasonable predictions about how Covid-19 will exist alongside us in the long term:
- What effect does variations in vaccine coverage have on how we move from pandemic to endemic disease?
- What role do the unvaccinated or immunosuppressed play in the evolution of the virus?
- What’s causing the variety of responses to infection?
- How long does immunity really last?
And many others yet to be articulated, never mind answered, and that is entirely normal in terms of our scientific understanding of the virus – we acknowledge that there is still so much that we don’t know, and will unreservedly hold our hands up to it.
But the end of a pandemic is influenced by far more than just science, otherwise the answer would be simple: deny the virus the bodies to thrive in and it goes away. But keeping people in indefinite lockdowns avoiding circulation of Covid-19 is, very obviously, not a realistic option. The question of how the pandemic plays out is only about 50% science, the other 50% is social and political, so while science might offer answers, normal human behaviours prevent those answers from being straightforward to implement. The world cannot come to a standstill playing chicken with a virus.
We’ve seen other ways that human behaviour has stymied science too, particularly in terms of the basics of personal hygiene management. Minimising contacts, washing our hands, maintaining social distancing and wearing masks are all effective defences – none work perfectly in isolation, but the swiss cheese model of protection tells us that many layers of imperfect measures together are effective, and we saw this to be the case in early lockdown times.
But then vaccines entered the chat, and those other measures started getting left abandoned. How many of us are diligently washing our hands and humming happy birthday under our breath? When we were once trying to stockpile hand sanitiser, it sits on shelves and can’t be given away. And masks indoors in a hospitality venue? Who is she?
There is no blame here, rather a gentle reminder that this is the reality of “living with Covid”. Since March 2020 we have been surrounded by uncertainty at every step, but demanding binary answers to every problem – most often “do vaccines/ masks/ lockdowns work or not?” – when the reality is, like the Swiss cheese model, layered and nuanced and complex.
We find ourselves now in big Covid-case territory, with warnings that cases will soon rise over 4000 pinging onto my Twitter feed. It makes for a juicy headline, and no doubt provokes a significant fight-or-flight response in many. But we are not in the same position as we were last year, with vaccination rates topping 75% for the whole population, and boosters available for those eligible. This is the beginning of what it truly means to live with Covid – an endemic disease that will stay with us, cases rising and falling with seasonality or available bodies. The demand for vaccination on a rolling basis remains to be seen, we have to wait to see in real time how the efficacy of the vaccine wanes (although to date it seems that the vaccines are holding up well in the longer term against serious disease).
At the start of this month the FDA approved the Pfizer vaccine for use in children between the ages of 5-11 and a drug called Molnupiravir has been approved for treating Covid in the UK. We have reached a point of pandemic protection that we would likely have felt impossible last year, not only because of how extensive the progress we’ve made has been, but also how non-linear and truncated that same journey of progression has been. There will be an end to the pandemic, just as the history books tell us there was with all others before it, but there will also be an endemic epilogue – and that’s the part we’re just not sure about yet. But, just as we’ve done to date, we’ll figure it out.
[/restrict]
