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Thursday, February 27, 2025

Are we nearing the end of the COVID-19 pandemic?

by

1122 days ago
20220201
An illustration shows one person on top of a steep hill while another man helps a friend ascend it. The hill symbolises the COVID-19 pandemic with people climbing it to see what lies ahead. There are clouds floating around and some smaller hills can be seen in the background.  [Jawahir Al-Naimi/Al Jazeera]

An illustration shows one person on top of a steep hill while another man helps a friend ascend it. The hill symbolises the COVID-19 pandemic with people climbing it to see what lies ahead. There are clouds floating around and some smaller hills can be seen in the background. [Jawahir Al-Naimi/Al Jazeera]

DOC­TOR’S NOTE with Dr Amir Khan | AL JAZEERA

 

■ The virus may now be less dead­ly as vac­cines con­tin­ue to pro­vide vi­tal pro­tec­tion, but new vari­ants can still emerge. Plus, how an ‘im­mu­ni­ty debt’ may have led to an in­crease in menin­gi­tis B cas­es and the symp­toms to look out for ■

 

(AL JAZEERA) — Peo­ple are suf­fer­ing from “pan­dem­ic fa­tigue”. It has been a long two years and most of us have had to en­dure harsh and of­ten un­pre­dictable re­stric­tions on our dai­ly lives. Mil­lions of peo­ple have died, liveli­hoods have been lost and economies have suf­fered. So, it is un­der­stand­able that many would cling to any hope that the COVID-19 pan­dem­ic is com­ing to an end. In some coun­tries, the eas­ing or com­plete re­moval of re­stric­tions has giv­en them that hope.

This sen­ti­ment has, in some ways, been fu­elled by the Omi­cron vari­ant, which has been shown to cause less se­vere dis­ease, in adults at least, with one study from Im­pe­r­i­al Col­lege Lon­don re­port­ing that peo­ple in­fect­ed with it were 40-45 per­cent less like­ly to be ad­mit­ted for an overnight hos­pi­tal stay than those in­fect­ed with the Delta vari­ant.

But the ar­rival of the Omi­cron vari­ant, with its in­creased trans­mis­si­bil­i­ty and abil­i­ty to evade at least some of the pro­tec­tion con­ferred by vac­cines and pre­vi­ous in­fec­tions, should re­mind us of how volatile the course of this pan­dem­ic can be.

The head of the World Health Or­ga­ni­za­tion (WHO), Tedros Ad­hanom Ghe­breye­sus, is­sued a stark warn­ing this month when he said, “It’s dan­ger­ous to as­sume that Omi­cron will be the last vari­ant and that we are in the end game.”

While Omi­cron may be milder than Delta, al­though not mild, cas­es are con­tin­u­ing to soar, par­tic­u­lar­ly across Eu­rope. This sug­gests any hope that COVID-19 may soon be­come en­dem­ic, is mis­placed.

In its most sci­en­tif­ic terms, a dis­ease is con­sid­ered en­dem­ic once the num­ber of cas­es be­comes sta­ble or sta­t­ic, not when the ill­ness be­comes less dead­ly. By this de­f­i­n­i­tion, COVID-19 is not yet en­dem­ic as cas­es are still on the rise. On the oth­er hand, dis­eases such as malar­ia, which can kill 600,000 peo­ple a year, and dengue fever, which kills up to 25,000 peo­ple each year, are en­dem­ic in cer­tain parts of the world.

So, when peo­ple, like the UK’s health sec­re­tary, Sajid Javid, talk about “learn­ing to live with” COVID, the ques­tion to ask is: What would be con­sid­ered an ac­cept­able num­ber of COVID-19 deaths in or­der for the world to car­ry on as nor­mal? It is, of course, im­por­tant to note that this ap­proach would put the clin­i­cal­ly vul­ner­a­ble and the el­der­ly, who have a much high­er chance of dy­ing from the virus, at a ma­jor dis­ad­van­tage.

Some may ar­gue that flu, which we have all come to terms with, kills up to 650,000 peo­ple each year world­wide, so sure­ly, we can live with COVID-19. But flu isn’t an en­dem­ic ill­ness; rather we see waves of it dur­ing the win­ter months. And, al­though the flu virus and the SARS-CoV-2 virus are fre­quent­ly com­pared, I am not con­vinced they should be. They cause two very dif­fer­ent ill­ness­es.

COVID-19 is a mul­ti-sys­tem in­flam­ma­to­ry virus that is not on­ly po­ten­tial­ly dead­ly but can al­so lead to long-term health prob­lems for peo­ple of all age groups. Flu, by con­trast, typ­i­cal­ly af­fects on­ly the res­pi­ra­to­ry sys­tem. This means mil­lions of peo­ple world­wide may end up liv­ing with long COVID which in it­self will have dev­as­tat­ing ef­fects on their liveli­hoods and the wider econ­o­my. In ad­di­tion to this, COVID-19 deaths so far have sig­nif­i­cant­ly out­num­bered flu deaths (al­though this in­cludes deaths dur­ing the time be­fore vac­cines were wide­ly avail­able in wealthy coun­tries and when we were still learn­ing about the virus).

There is al­so some be­lief that any new vari­ants that may arise in the fu­ture are like­ly to cause an even milder ill­ness than Omi­cron. But there is noth­ing to sub­stan­ti­ate this be­lief. It would on­ly be true if the virus had any­thing to gain by caus­ing a milder ill­ness and keep­ing its host alive.

Much of the SARS-Cov-2 trans­mis­sion oc­curs in the days be­fore a per­son de­vel­ops symp­toms and the first few days fol­low­ing the on­set of symp­toms. It is usu­al­ly the host’s own im­mune re­sponse to the virus that caus­es much of the ill­ness we have seen in those hos­pi­talised with it. This is be­cause the virus can cause an over­stim­u­la­tion of cer­tain im­mune cells, which then be­come dif­fi­cult to “turn off” as they start to at­tack healthy cells as well as in­fect­ed ones. By the time the host be­comes se­ri­ous­ly ill, the virus has moved on to an­oth­er per­son. This means there is no evo­lu­tion­ary pres­sure for the virus to be­come milder; we sim­ply got lucky with Omi­cron.

So, as un­palat­able as this may sound to many peo­ple, we are not yet in a po­si­tion to start liv­ing with this virus. We must con­tin­ue to adopt meth­ods to sup­press its spread un­til we are. This means putting mea­sures in place to pro­tect the most vul­ner­a­ble by re­duc­ing their chances of get­ting the virus.

As COVID’s mode of trans­mis­sion is air­borne, we should equip schools and oth­er build­ings with air fil­ters and look for in­no­v­a­tive ways to im­prove air­flow in ar­eas where peo­ple might con­gre­gate for long pe­ri­ods of time. We must al­so ac­cept that mask-wear­ing may be­come a part of our dai­ly lives, much as it did in parts of Asia af­ter MERS, a type of coro­n­avirus first iden­ti­fied in 2012. But it has to be the right type of mask, with N95 or FFP2 masks be­ing the most ef­fec­tive.

Al­so, vac­cines are key, and get­ting them in­to the arms of peo­ple across the world re­mains para­mount. Vari­ants are more like­ly to arise where peo­ple re­main un­vac­ci­nat­ed. Those who are vac­ci­nat­ed are more like­ly to rid them­selves of the virus more quick­ly com­pared with un­vac­ci­nat­ed peo­ple. This means the virus has less time to mul­ti­ply and less chance to mu­tate in those who are ful­ly vac­ci­nat­ed.

Push­ing for glob­al vac­cine eq­ui­ty is in every­one’s best in­ter­ests. We need to have at least 70-80 per­cent of the world’s pop­u­la­tion vac­ci­nat­ed to achieve glob­al pro­tec­tion and sig­nif­i­cant­ly re­duce the risk of ill­ness. This sounds am­bi­tious but it has been done be­fore with the vac­cine for po­lio, a dis­ease that has been more or less erad­i­cat­ed world­wide. In ad­di­tion, sec­ond-gen­er­a­tion vac­cines are be­ing de­vel­oped to tack­le emerg­ing vari­ants more ef­fec­tive­ly and will be key to safe­guard­ing us in the fu­ture.

It is not on­ly the vac­cines that need to be shared across the world. An­tivi­ral treat­ments like mol­nupi­ravir and paxlovid, which have been shown to re­duce the risk of hos­pi­tal ad­mis­sion for those in the high-risk cat­e­go­ry who test pos­i­tive for COVID-19, must al­so be made avail­able. These drugs help stop vi­ral repli­ca­tion which, in turn, can re­duce the length of time some­one is ill with COVID. A short­er ill­ness means there is less time for mu­ta­tions and vari­ants to emerge. That is some­thing we would all ben­e­fit from.

Con­tin­u­ing re­search in­to long COVID and a bet­ter un­der­stand­ing of the dif­fer­ent ways this virus can af­fect our bod­ies may al­so lead to a time when we can con­sid­er liv­ing with this virus.

I have hope that a time will come when we are bet­ter pro­tect­ed from the ef­fects of COVID-19 and equipped to deal with any emerg­ing vari­ants, but sad­ly that time is not quite now. We are in a much bet­ter po­si­tion than we were two years ago and that is large­ly down to sci­ence, but we can­not yet claim that we are near­ing the end of this pan­dem­ic.

An illustration shows a patient in hospital being tended to by a nurse.  [Muaz Kory/Al Jazeera]

An illustration shows a patient in hospital being tended to by a nurse. [Muaz Kory/Al Jazeera]

 

Menin­gi­tis B: The signs and symp­toms to look out for

 

Re­cent da­ta and analy­sis from the UK Health Se­cu­ri­ty Agency (UKHSA) shows that in mid-late 2021 there was an in­crease in the num­ber of cas­es of meningo­coc­cal dis­ease in teenagers and young adults, main­ly caused by group B meningo­coc­cal dis­ease (MenB) – with the ma­jor­i­ty of these cas­es de­tect­ed in uni­ver­si­ty stu­dents.

Menin­gi­tis B is caused by the bac­te­ria Neis­se­ria menin­gi­tidis. Menin­gi­tis can at­tack the brain and spinal cord and cause swelling in those ar­eas as well as a se­ri­ous in­fec­tion of the blood­stream, called sep­ti­caemia. Ap­prox­i­mate­ly 10-15 per­cent of peo­ple in­fect­ed with meningo­coc­cal dis­ease will die, some­times as quick­ly as with­in 24 hours af­ter symp­toms first ap­pear. For those who sur­vive, about one in five may ex­pe­ri­ence a va­ri­ety of long-term dis­abil­i­ties in­clud­ing hear­ing loss, brain dam­age, ner­vous sys­tem prob­lems, kid­ney dam­age, loss of limbs, and scar­ring of the skin.

Com­mons signs and symp­toms of menin­gi­tis and sep­ti­caemia are:

■   Fever with cold hands and feet  

■   Drowsy or dif­fi­cult to wake  

■   Con­fu­sion and ir­ri­tabil­i­ty  

■   Se­vere mus­cle pain  

■   Pale blotchy skin, spots or rash

■   Se­vere headache

■   Stiff neck

■   Dis­like bright lights

■   Con­vul­sions or seizures

Ear­ly COVID-19 re­stric­tions across the UK saw menin­gi­tis B cas­es fall to an all-time low in Sep­tem­ber 2021. But as re­stric­tions eased and peo­ple were able to mix again, cas­es in teenagers, in par­tic­u­lar, have be­gun to rise to lev­els high­er than be­fore the pan­dem­ic.

In the UK, teenagers are of­fered the meningo­coc­cal ACWY vac­cine in an ef­fort to pro­tect them from some of the dif­fer­ent bugs that can cause menin­gi­tis and the MenB vac­cine is of­fered to in­fants. It is un­clear ex­act­ly what is caus­ing the rise in cas­es in these young peo­ple. One the­o­ry put for­ward by the au­thors of the re­port is that few­er peo­ple were ex­posed to the bac­te­ria as a re­sult of re­duced mix­ing at the height of the pan­dem­ic. This meant that few­er peo­ple be­came im­mune, so when uni­ver­si­ty cam­pus­es opened up there was an “im­mu­ni­ty debt” which put them at risk of get­ting the ill­ness.

The best thing stu­dents and young peo­ple can do to pro­tect them­selves from this se­ri­ous ill­ness is to take up the ACWY vac­cine and to be alert to the symp­toms of menin­gi­tis B so that they can seek med­ical help soon­er rather than lat­er.

COVID-19HealthUnited Nations


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