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.”
Epidemiologists suspect that the path taken by the UK will lie somewhere between Israel and Singapore. “My guess for endemic management in the UK is a major emphasis on high vaccine coverage, mandatory for some, with changes to vaccines and boosters as needed,” says Christopher Dye, an epidemiologist at the University of Oxford. “Then Covid surveillance embedded into national public health, hospital and care systems, with surge capacity for outbreaks.”
But one of the key questions will be the level of acceptable deaths that societies are willing to tolerate, in return for their freedoms. This coming winter is expected to test the UK government’s resolve on avoiding further lockdowns, with a potential surge in Covid-19 hospitalisations – which have been slowly rising over the past month – adding to the strain inflicted by seasonal influenza, and an existing backlog of cases.
In his interview, Farrar provocatively suggested that 30,000 Covid-related deaths in a year in the UK may have to prove an acceptable toll. While this is roughly comparable to the annual influenza mortality rate – 29,516 people died of flu in 2018 and 26,398 in 2019 – others feel that it is still far too premature in the course of the pandemic to acquiesce to such statistics.
“I think that's basically giving up isn't it?” says Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. “It is difficult now, because we've now got the Delta variant, and that is more infectious. But surely the point by public health is to drive deaths and ill health down to as low a level as possible. And of course, we don't know what else is coming along, which is another good reason for trying to do more.”
As well as the death toll, McKee points to the potential risks of Long Covid in younger people, pointing to the evidence showing that people can develop neurological complications from the virus. “There’s data showing that young people who are getting infected are having cognitive problems,” he says. “We know that after the Spanish flu in 1918, people were getting Parkinson's disease which only became apparent about 20 years later. So we still don’t know what the long term consequences of this virus are.”
Rather than reintroducing restrictions like social distancing, McKee feels that the UK needs to place a much greater emphasis on reaching remaining unvaccinated sections of the population, including children. Currently an estimated 28 per cent of the UK population have still not had a single jab. Other scientists believe that this, along with future iterations of Covid-19 vaccines which are more effective against new variants, could help reduce the impact of the virus in future.
“In a few years time, once most people have been vaccinated, it's not obvious that Covid will exert a very high burden in mortality and morbidity,” says Balloux. “Certainly not higher than influenza. I actually expect it to yield lower mortalities in the long term. In an immunised population, it’s not extraordinarily different to the other four coronaviruses we have in circulation, which kill mostly elderly people every year.”
Farrar admitted that the major risk with endemic Covid strategies is that unrestrained transmission in areas with low vaccine coverage may lead to the development of further variants which may be more effective at circumventing the protection provided by the current range of jabs.
However, other scientists say that vaccinating the entire global population is an unrealistic goal, given the lack of infrastructure needed to do so in large parts of Africa, South America, and Asia. Instead, they feel that we must accept that further variants are inevitable, and focus our energies on getting vaccines to the most vulnerable individuals in poorer nations, such as the elderly and those with underlying health conditions.
“The more realistic global objective should be to reach the most vulnerable with vaccines,” says Eyal Leshem, an associate professor in internal medicine and infectious diseases at Tel Aviv University. “Do we want to focus on attempting to prevent mutations, which are probably going to occur anyway, given how transmissible this virus is, or reducing preventable deaths?”
For many of these questions there are no easy answers. The only certainty is that the level of endemic Covid will vary both within and between countries. And just as the pandemic has exacerbated existing inequalities within our society, the ongoing legacy of it is likely to do the same.
“Endemic Covid is one more way in which socio-economic injustice could be exposed, with disadvantaged communities bearing the brunt of it, a special risk in the inequitable UK,” says Dye. “The poorest will likely suffer more, as for almost all other illnesses, especially where social protection is weak.”
- 💼 Sign-up to WIRED’s business briefing: Get Work Smarter
- The race to stop fish becoming the next factory farming nightmare
- What to do if your Facebook account is hacked
- Microsoft is heading for a new antitrust showdown
- How Out Run changed video games forever
- The draconian rise of internet shutdowns
- A radical plan to treat Covid’s mental health fallout
- The 100 hottest startups in Europe in 2021
- 🔊 Subscribe to the WIRED Podcast. New episodes every Friday
This article was originally published by WIRED UK
