When will we declare victory over COVID-19?

One year after the start of the pandemic, infection rates are falling. Hospitals are quieter; morgues are more empty. Encouraged by the vaccines, we are dropping our masks and approaching. We are slowly reopening in-house restaurants, theaters, museums and schools.

Will we declare victory over COVID-19?

No, say public health experts. But we are going to negotiate a difficult truce. Instead of completely eliminating the virus, we can create a strict containment strategy, building public health bastions to help ward off an astute, adaptable and lasting enemy.

That means accepting a certain level of risk as society returns to normal, they add.

“Here is what we can call ‘victory’: learning to live with this virus in a way that allows us to continue to enjoy life,” said Dr. John Swartzberg, from the UC Berkeley School of Public Health.

Over time – as vaccines improve, the number of deaths decreases and we adopt new behaviors, such as wearing masks when we are sick – we will accommodate this, just as we do with other deadly infectious diseases, he said.

Last year, there were unimaginable advances against the virus. With accelerated plans for vaccine manufacturing, President Joe Biden now promises to supply enough vaccine for every adult in America by the end of May. Some states, like Texas, are already racing to reopen fully.

But there is a growing consensus that COVID-19 is here to stay, causing intermittent and limited outbreaks in the United States and other countries with well-developed vaccination programs, but causing significant disease underway in parts of the world where access to vaccines is most limited.

“Unless you have completely eradicated a disease, you are always at risk of having an outbreak,” said Stanford infectious disease epidemiologist Dr. Yvonne Maldonado.

Why is eradication so difficult? It is because pathogens, once established, are unlikely to be extinguished.

We were able to eliminate just one big infectious killer: smallpox. A terrible disease that killed 30% of all victims, smallpox was last reported in 1977 in Somalia. Only two remnants of the virus, stored in tightly controlled government laboratories in the United States and Russia, survive.

Certainly, we have achieved notable victories in the conquest of disease in specific geographic areas. In the USA, there has been a declining trend in infectious diseases. For example, the country reported only 13 cases of measles and an isolated outbreak of mumps in 2020. Less than 10 Americans contract rubella each year; of these, all are infected during a trip abroad. 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 the 32nd year of what should be a 12-year effort. Scientists have been unsuccessfully looking for an HIV vaccine since the virus was identified in 1984.

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

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

Geographically limited diseases, such as onchocerciasis, can be brought to the brink of extinction by a targeted campaign. But COVID-19 is almost everywhere. It has spread to 219 countries and territories worldwide, causing 118 million confirmed infections.

Also simpler are diseases that can be subdued by a single vaccine with lifelong immunity, such as measles. We still don’t know how durable our COVID-19 vaccines will be.

With COVID-19, “it is definitely not about reaching zero risk. Because that is not feasible, ”said California surgeon general Dr. Nadine Burke Harris last week.

So, what is an acceptable number of deaths?

We are likely to contract a disease that behaves like the flu, say public health experts. Although it is deadly, especially for the elderly, the flu is not seen as a special threat that requires an exceptional response from society.

“It seems that we believe, with faith, that there will be a flu epidemic every year,” said Maldonado.

Dr. Joshua Adler, vice president of clinical affairs at UCSF, imagines the day “when the incidence of COVID will decrease to a level where we will no longer need special processes. It becomes like another infectious disease that is part of our general environment. “

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

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

Other infectious diseases are much lower: the respiratory syncytial virus, a common virus that infects the lungs and airways, kills 2.1 to 6 per 100,000 people across the country, according to an extensive study by the National Institutes of Health published in 2014. Diarrheal diseases, such as rotavirus, kill 2.4 per 100,000 people across the country; 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 must set intermediate goals, said UC San Francisco epidemiologist Dr. George Rutherford.

One of the objectives is to avoid another sudden increase in cases, so that hospitals are not overloaded. In addition, we need to offer better drugs, so that infected people rarely die. Currently, patients hospitalized with COVID-19 face nearly five times the risk of death than those with influenza, according to a large study published last December.

And when variants arise, we must be prepared to respond, said Rutherford.

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

Over time, the risk will decrease, experts predict. That’s because COVID-19 vaccines are better than flu vaccines and can be readily modified.

“I am confident that things will be a little better than they are today. Does this mean that you can live without risk? I don’t think so, ”said Adler. “But it can be a risk low enough that most of us are comfortable with it.”

Eventually, the so-called community immunity, or “herd immunity”, will protect us.

At this point – when 70% to 90% of the population is protected by vaccination or previous illness – it is much more difficult for the virus to move through the population. The risk for people who cannot be vaccinated decreases dramatically. It is when it seems safest to return to our beloved meetings. Think of big weddings. Soccer games. Music festivals.

At the moment, this is a challenging target. Why? Children make up about 22% of the population and will not be vaccinated until clinical trials are completed later this year. Reluctant adults may represent another disability. According to US Census data released at the end of January, about 14% of adults said “probably not” and 10% said “definitely not” would be vaccinated.