There are three ways out of the COVID pandemic
Let us admit that nothing we have tried over the past two years has worked. The SARS-CoV-2 virus keeps infecting, it keeps killing, and it keeps mutating. Given the current state of affairs, there is no scenario under which this cycle will be broken.
I shall limit the above statement to the US and Western Europe. These are two regions where I am privileged to have personal contacts and a limited degree of insider information. These are two regions where there are highly accurate health records and where the central governments are too dysfunctional to manipulate or hide any data.
For 2022 we have three options.
First, we do nothing. In fact, we may want to roll back any and all public health measures. Let people die where they fall, and by the end of 2022 everyone is either recovered from infection or dead. The fatality rate of SARS-CoV-2 is between 1 -6% and that is the price to pay for ultimate freedom. COVID 19 disease will decimate the most vulnerable, i.e., the elderly, those with other underlying medical conditions and small children whose immune system is not yet fully formed.
For many countries with no critical care infrastructure, no access to vaccines, and a leadership that is disinterested or uninformed in infectious diseases, this is indeed the only path available to them. COVID 19 disease, like any other illness before it, will decimate the poorest nations in the world.
Those countries hope that with each successive cycle, the severity of the disease is reduced as the virus mutates with transmission as the only selection pressure. The problem with this scenario, sometimes called herd immunity, is that no model can predict how many cycles of death it will take to reach the equilibrium state between virus and host.
Under some circumstances, mathematical models, governed by the Lotka–Volterra equations, predict indefinite cycling as the final equilibrium. The flu and common cold operate like this, causing around 40,000 death a year in the US, where we have the most developed (and expensive) critical care infrastructure in the world. The death rates for flu are 10–100 times higher in countries where such infrastructure does not exist.
Second, we impose draconian lock-downs. This model has been successful in countries with a mindset to put the common or group good above individual liberties. Japan, China, Korea follow this model. Their leadership operates under political circumstances that make such public health policies possible. Restricting mobility, quarantine, and social distancing are tried and true measures to contain infectious disease outbreaks. Every country uses those with impunity to contain livestock viruses. It is how we eradicated SARS-CoV-2 transmission in mink farms.
Quarantine is the only measure to contain infectious diseases of unknown origin or if there is no vaccine available. It represents the current, worldwide accepted measure to contain Ebola outbreaks.
The Omicron spread showed that in today's highly connected world, a similarly connected and rapid response surveillance system has to be running all the time. The Omicron spread also showed that we do not have such a system, today.
Third, we achieve 98% vaccination rates — globally. I was encouraged by the data from the UK (see figure above), where waves in new infections no longer result in waves of death.
Contrast that image to the data from South Africa (see figure above), which exemplifies the cyclic nature predicted by the Lotka–Volterra model and where each wave of infection is followed by a 7–21 day delayed wave of death. In South Africa, the amplitudes of each wave remain essentially constant.
The UK has a 98% vaccination rate (single dose), South Africa has 23%.
The UK famously has not opted for lock-down measures and has had high-level transmission (and death), since the Euro championship in 2021. Whereas other countries experienced cycles of cases and lock-down restrictions, the UK sustained a near-constant level of transmission until Omicron. The introduction of Omicron, lead to a new spike in infections (and hospitalizations), but thus far has not led to a spike in death.
Israel also has an above 90% vaccination rate and nevertheless experiences cycles of infection and death. I believe those represent residual, inborn immune system failures, whether due to an individual’s non-responsiveness to vaccination or incomplete responses of the immune system to infection. No vaccine will ever eradicate SARS-CoV-2 from the face of the earth.
Something else will change in 2022. We now have a robust pipeline of antiviral therapies. Merck and Pfizer are the first pills out the door that inhibit any and all variants of SARS-CoV-2. Therapeutic antibodies continue to adapt to new variants, and there is now an established pipeline for development as well as clinical experience with their use.
For the COVID pandemic to end, the world needs to achieve vaccination rates such as Israel and the UK, the world needs access to antiviral drugs, and the world needs to continue aggressive surveillance of new viral variants.
