Pandemic reality check

A recent Lancet article about the launch of a COVID-19 Scenarios Project said that the pandemic will not be over anytime soon. In the medium and long terms, or about 3-5 years, a range of different scenarios will play out, and most of them are not necessarily the ones we want.

The best-case scenario is that the next-generation vaccines will be effective against all known COVID-19 variants, and all countries will stamp out the pandemic because of effective control measures—largely through global cooperation.

The worst-case scenario, on the other hand, is that new variants will emerge and the vaccines available will not afford protection. Only high-income countries will be able to put up a good fight and the majority of countries will be on their own, strapped for resources and unable to get vaccines and other countermeasures because of intense vaccine nationalism.

What will pan out, though, as scenarios closest to reality are those that are in the middle of these divergent expectations. In these scenarios, the glaring problem will be continuing infections or repeated outbreaks. Wherever we look, the economy can’t be reset and normalcy can’t be attained.

So the reality is that, even when the vaccines have been rolled out to attain our target herd immunity, the pandemic will be far from over. We have to acknowledge this.

We have to look at five things that will determine how fast we can get out of the pandemic.

First, viral evolution and distribution. We know how new SARS-CoV 2 variants are making control efforts very challenging. Increasing transmissibility, increasing virulence possibly affecting the effectiveness of current vaccines, more variants—all these complications can emerge as a result of the natural mutation of the virus. Also, the virus has a high likelihood of being endemic because of its distribution not only in humans but also in common animals like dogs and cats.

Second, citizen behavior. Nonpharmacologic interventions (use of masks, face shields, physical distancing, avoiding crowds, sanitation) have been proven to be effective measures to curb transmission. Sustained efforts to religiously practice the minimum public health standards should be the rule, despite the relaxation of quarantine measures as economic and social activities resume.

Third, government response. With health system capacities significantly improved and whole-of-society efforts put forward to decrease cases and deaths, countries have to build on and fortify their gains in responding to the pandemic. From mobilizing resources and shifting tactics to rallying the support of all citizens, a country’s leadership should be strategic in being able to sustain the journey up to the last mile.

Fourth, scientific progress. This is the real-world miracle that is the reason we have survived this far. The unprecedented speed of scientific breakthroughs has given us effective diagnostics and vaccines and promising therapeutics, and validated the importance of simple measures (nonpharmacologic interventions) that really save lives.

Lastly, global cooperation. As the pandemic will not be over everywhere if it’s not over anywhere, diplomacy for global solidarity in terms of access to vaccines and treatment should be of paramount concern. Low-income countries must not be left behind in this protracted journey. It should not be a race for well-off countries to reach the destination first before others, but more like a solidarity walk down the long, uncertain road that is COVID-19. At the end of the line, victory is announced only when every nation comes out of the pandemic healthy and well.

We need to watch how the virus evolves, sustain our healthy and protective behaviors as citizens, enable our government to do its job well and even better, promote and support science to counter COVID-19 misinformation (and fake news in general), and echo calls for concrete global cooperation so that countries can really work together to end the pandemic soon.

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Ronald Law is a physician, public health emergency practitioner, and academic examining the COVID-19 pandemic from a global health security perspective.