When will we declare victory over COVID-19?

A year into the pandemic, infection rates drop. Hospitals are quieter; mortuaries are empty. Reinforced by vaccines, we lower our masks and step closer. We are reopening indoor dining, theaters, museums and schools.

Will we declare victory over COVID-19?

No, say public health experts. But we will negotiate a restless ceasefire. Instead of eliminating the virus altogether, we can devise a rigorous restraint strategy to build public health weapons to protect an enemy that is cunning, adaptable, and enduring.

This means that we have to accept a certain level of risk as society returns to normal.

“Here’s what we might call ‘victory’: learning how to live with this virus in a way that enables us to continue to enjoy life,” he said. John Swartzberg of UC Berkeley School of Public Health said.

Over time – as the vaccines improve, the death toll decreases and we adopt new behaviors, such as wearing masks when we are sick – we will accommodate them, just like with other deadly infectious diseases, he said.

In the past year, there have been unimaginable steps against the virus. With accelerated vaccine production plans, President Joe Biden now promises by the end of May enough vaccine supply for every adult in America. Some states, such as Texas, are already rushing to reopen.

However, there is a growing consensus that COVID-19 is here to stay, causing outbreaks in the US and other countries to be alternately limited, with well-developed vaccination programs, but causing persistent diseases in parts of the world where access to vaccines are limited.

“Unless you have completely eradicated a disease, you always run an outbreak,” said Dr. Yvonne Maldonado, dr. Yvonne Maldonado, said.

Why is extinction so difficult? This is because pathogens, once established, almost never become extinct.

We manage to eliminate only one major infectious killer: smallpox. The smallpox was last reported in 1977 in Somalia. Only two remnants of the virus, stored in tightly controlled government laboratories in the US and Russia, survive.

To be sure, we have achieved striking victories in the conquest of diseases in specific geographical areas. In the US, there has been a declining trend of infectious diseases. The country, for example, reported only 13 cases of measles and one isolated outbreak of mumps in 2020. Less than ten Americans get rubella every year; of these, all are infected while traveling overseas. The original SARS disease – SARS-CoV-1 – no longer haunts us.

But attempts to eliminate historic global killers – such as hookworm, yellow fever and malaria – have been frustrating failures. The polio eradication program is now in its 32nd year of a 12-year effort. Scientists have been unsuccessfully searching for an HIV vaccine since the virus was identified in 1984.

The easiest diseases to control are diseases that are quickly diagnosed or recognizable, according to the American Society of Microbiology. But COVID-19 is hidden and spread before people get sick. And up to 40% of cases are dormant and cause no symptoms. In addition, a COVID-19 diagnosis requires testing by knowledgeable medical professionals.

A disease can also be easily controlled if, like polio, it only lives in humans and has no animal “reservoir” where it persists. It is not COVID-19, which is thought to have originated in bats.

Diseases that are geographically limited, such as river blindness, can be pushed to the brink of extinction by the targeted campaign. But COVID-19 is almost everywhere. It has spread to 219 countries and territories around the world, causing 118 million confirmed infections.

Also simpler are diseases that can be subjected to a single vaccine with lifelong immunity, such as measles. We do not yet know how durable our COVID-19 vaccines will be.

With COVID-19, it’s definitely not about achieving zero risk. Because it is not feasible, ‘said California Surgeon General Dr. Nadine Burke Harris last week.

So what is an acceptable number of deaths?

It is likely that we are entering a disease that acts like the flu, say public health experts. Although flu is deadly, especially for older people, it is not seen as a special threat that requires extraordinary societal response.

“We just seem to believe that there is going to be a flu epidemic every year,” Maldonado said.

Dr. Joshua Adler, vice dean for clinical affairs at UCSF, imagines a ‘day’ when the incidence of COVID decreases to the level where we no longer need special processes. It becomes like another contagious disease that is part of our general environment. ”

“We will simply have a number of patients who have COVID, just as we have a number of patients who have the flu or severe herpes infection, or who you have,” he said.

It’s still a long way off. California reported 137 deaths per 100,000 people on March 8 due to COVID-19. According to the Centers for Disease Control & Prevention, the death toll – 15.2 per 100,000 people – caused by flu plus pneumonia is almost ten times higher in 2019, last year those numbers were available.

Other infectious diseases are much lower: Respiratory Syncytial Virus, a common virus that infects the lungs and respiratory tract, kills 2.1 to 6 per 100,000 people nationwide, according to an extensive National Institutes of Health study published in 2014. Diarrheal disease, such as rotavirus, kills 2.4 per 100,000 people nationwide; HIV / AIDS, 2.4; meningitis, 0.4; hepatitis, 0.29 and tuberculosis, 0.25, according to the Journal of the American Medical Association.

In the meantime, we need to set intermediate goals, said dr. George Rutherford, epidemiologist at UC San Francisco, said.

One goal is to prevent another increase in cases so that hospitals are not overwhelmed. In addition, we need to offer better medicine so that people who become infected rarely die. Currently, patients hospitalized with COVID-19 are nearly five times more likely to die than those with the flu, according to a large study published last December.

And when variants come up, we have to respond to that, Rutherford said.

Then, like flu, “new strains will disappear into the background and become part of the environment, which is transmitted every year, but at much, much lower levels,” he said.

Over time, the risk will decrease, experts predict. This is because the COVID-19 vaccines are better than flu vaccines and can be adapted immediately.

“I’m confident it’s going a little better than it is today. Does that mean you can live completely risk free? I do not think so, “said Adler. “But it can be a low risk that most of us feel comfortable with.”

Eventually, the so-called community immunity, or ‘herd immunity’, will protect us.

At that point – when 70% to 90% of the population is protected by vaccination or previous diseases – it is much more difficult for the virus to move through a population. The risk to people who cannot be vaccinated decreases dramatically. It is then that it feels safer to go back to our cherished gatherings. Think of great weddings. Soccer matches. Music festivals.

Right now, it’s a challenging target. Why? Children are responsible for about 22% of the population and will only be vaccinated before clinical trials are completed later this year. Reluctant adults can be another shortage. According to US census data released in late January, about 14% of adults said they were “probably not” and 10% said they would “definitely not” be vaccinated.