Is it the endgame yet?

Is Covid-19 really waning away and if so, what impact will it leave in terms of health recovery? Dr Harish Pillai throws some light on the hot topic

Whether or not we will witness the beginning of the end of the current Covid-19 pandemic can be objectively analysed by both, studying the history of global pandemics like the 1918 Avian H1N1 pandemic also wrongly labelled as the ‘Spanish flu’ and by looking at the multiple waves since 2020 due to the evolving mutations of Covid-19 virus.

The Spanish flu lasted about two years and infected about 500 million people worldwide with 50 million deaths. The speed of transmission in this period was accelerated by the soldiers going to various European conflict hot spots of the first World War. There were no vaccines, antibiotics or antivirals available and the only measures widely used were public health interventions like masking, social distancing, good hand hygiene, isolation and proper rest.

In comparison to 1918, humanity is much better equipped in 2020 to fight this modern viral avatar. The quick rollout of the anti-Covid vaccine has become the biggest game-changer in reducing case morbidity, and mortality. Second in the list of effective tools, will be the wide variety of antivirals, monoclonal antibodies, anti-inflammatory agents like steroids and a choice of good antibiotics and antifungals.

Presently, the growth of the Omicron-led wave in each country will depend on the size of their respective ‘immunity walls’ which are made up of a combination of natural immunity either through previous infections or through artificial means like the double dose vaccinations followed by a booster dose, strict masking, social distancing and avoidance of large public gatherings. The two possible scenarios from here on that one can visualise is based on two different epidemiological assumptions. The first is a bullish model of a quick shift from a pandemic to an endemic by the summer of 2022. Here, the milder variants have outnumbered the more severe Delta type even though causing a greater volume of infections in the local population and thus giving them a natural immunity booster. In this model, the disease will be seasonal with a predictable and normalised spread along with a few occasional and localised flare-ups. Such predictability will accelerate the return to normal economic activities by the last two quarters of 2022 itself. The other bearish model looks at a different picture with a prolonged pandemic beyond the summer of 2022 as new mutant variants continue to emerge especially from the pockets of the unvaccinated and immune-compromised patients in several parts of the world. We cannot completely prevent the emergence of a new pandemic but can imbibe a lot from the lessons on Covid-19. The top priority is the immediate restructuring of the WHO and giving it enough teeth to quickly enter national sovereign zones and mandatorily work alongside national governments in a constructive and collaborative manner to identify the origin, localise the spread and contain the situation. There should also be a global fund created to manage pandemics that will make the delivery of essential drugs and vaccines, diagnostics more equitable.

(The author is the CEO of a Philippines-based leading chain of hospitals.)