Covid19. After two years of pandemic, the world is divided between hope and prudence

The conflict in Ukraine in recent days has virtually erased Covid-19 from our daily lives, but the virus is still there.

In early March 2020, two years after the WHO’s official announcement describing Covid-19 as a pandemic, is the world finally approaching a return to normalcy? To date, the situation is improving, but remains worrisome around the world. First of all, with the risk of the emergence of new variants.

Is the end of the epidemic near?

For months, announcements of the “end” of the pandemic have proliferated around the world, especially with the rise of the ultra-infectious but proportionately far less virulent Omicron variant.

Covid-19 will continue but the end of the pandemic is near

Global health expert Christopher Murray in The Lancet in January

These words very well sum up the mood of health authorities in many countries at the beginning of 2022: Faced with a variant that causes less severe forms, thanks in part to mass vaccination, the world is getting used to “living with the virus.” .

Between France, Denmark or the UK’s neighbors almost all health restrictions have been lifted: mandatory wearing of masks, isolation of patients, health passes…

slow decline in France

Hospital tension linked to Covid-19 is slowly but surely improving in France, according to Public Health France.

French hospitals are welcoming a total of 24,437 Covid patients (including 169 new admissions), compared to 25,079 on Monday and 27,566 a week ago.

The same downward trend in intensive care services, which treated the most serious cases and treated 2,408 Covid patients (2,456 the previous day, 2,842 last week).

The government remains cautious, but mentioned a transition below the threshold of 1,500 patients in intensive care by mid-March among the criteria for removing all or part of the vaccine pass in place for a month.

However, the mortality rate is very high: 200 people died from the disease within 24 hours, and the total number of deaths since the beginning of the epidemic reached 138,576.

In terms of contamination, 79,794 Covid positive cases were registered (97,382 seven days ago), again confirming a slow decline in the epidemic. Correcting daily discrepancies, the seven-day average rose to 54,457 cases, up from more than 74,800 last Tuesday.

Vaccination continues, but at a slow pace: 54.20 million French received at least one dose (ie 80.4% of the population), 53.22 million received the full vaccine (79% of the total population), and 39 million additional doses. According to the General Directorate of Health.

This could mark the end of the “acute phase” of the pandemic, according to WHO, which considers it “possible” by mid-2022.

Is it now an “endemic” virus?

The term is coming up more and more frequently in public discussions: the virus would become “endemic.” That is, it will continue to circulate, but on a “regular” basis, with a fixed number of cases.

However, this concept of “endemic” is often perceived to characterize a disease that is not very serious and is therefore likely to lead to extreme relaxation of populations in the face of the virus.

But experts point out: The endemic nature of a disease has nothing to do with its severity, only its spread: this means that the virus is almost constantly and ubiquitously present. It is by no means less deadly.

A disease may be endemic and remain both deadly and widespread, such as malaria or tuberculosis.

Aris Katzourakis, virologist, In Nature

What possible scenarios?

In any case, the debate is not limited to characterizing the disease as “endemic” or “pandemic”: at least three or four scenarios emerge, according to epidemiologists.

The British Science Council detailed four of these in February: at two extremes, a so-called “optimistic” version of local resurgences of Covid-19 rather than seasonal flu; and a marked pessimism, with new criminal waves accompanied by heavy restrictions.

At the center of the uncertainties: the emergence of more or less virulent variants and the persistence of immunity induced by the vaccine or a previous infection against these possible variants.

What variants in the future?

Beware of false hopes, scientists insist: we know that variants arose thanks to strong viral circulation against the background of partial immunity. This is exactly the situation the world would find itself in if it allowed the current virus to spread too easily.

Many epidemiologists fear that “living with the virus” will lead to the emergence of as yet unknown variants. For this reason, they recommend that you continue to limit the circulation of the virus as much as possible without falling into a “zero Covid”, which is now considered largely unrealistic with Omicron.

Chaos clinging to “zero Covid” in Hong Kong

Drowning hospitals, empty supermarkets, dreary quarantine camps: chaos has gripped Hong Kong, which is facing the strongest wave of coronavirus with tens of thousands of cases every day and preparing to screen all its residents.

Many Hong Kongers blame the government for failing to anticipate the current crisis, despite the two-year rest period they have experienced thanks to their health-successful “zero Covid” strategy, and the “more limited economic impact compared to countries that have chosen to live.” with the virus”.

Other countries that followed the “zero Covid” strategy, such as Australia, New Zealand, and Singapore, have now decided to live with the virus. But China is determined to eliminate all cases and has ordered Hong Kong to do the same.

The city is set to test its 7.4 million residents in March and isolate every infected person, including prefabricated camps built with China’s help.

Over the past few weeks, morgues have been full, medical staff and ambulances are understaffed, and many patients have been parked in camps and segregated from loved ones.

The quarantine hypothesis, initially rejected by CEO Carrie Lam, has come to the fore in recent days, causing a wave of panic in the city where supermarkets have been robbed.

There is no rule that a virus automatically becomes less dangerous, whether it is more contagious or not, especially for remembering. Every new variant is a new leap into the unknown:

We often hear the idyllic but wrong idea that viruses become less dangerous over time. But that is not the case: nothing can predict the evolution of a virus in this way.

Aris Katzourakis, virologist

What about vaccines?

This is the other main blind spot in the future of the pandemic: It remains particularly effective against severe forms, and rather deaths, and still makes it possible to prevent contamination. But will vaccines continue to be effective in the future? And if so, against which variants and for how long?

The rise of the Omicron has made possible a kind of lifetime testing: existing vaccines have proven far less effective against the risk of transmission – slightly less than half avoided with the original variant compared to nearly all of them.

The question therefore arises: will it be necessary to continually adapt the vaccine, necessarily a posteriori, with the logistics this implies? Or duplicating regular reminders?

If the booster dose proves to be effective, subsequent supplements will show no real immune rebound in countries that have tested them. Not to mention the lack of public support.

When it comes to the promise of adaptability of vaccines facilitated by messenger RNA technology, it faces reality: Nothing has come out of the labs yet against Omicron. Even so, it would require billions of new doses to be produced, distributed and injected worldwide in a very short time.