The crisis
The COVID-19 pandemic has rapidly become the most destructive infectious disease since HIV-AIDS. Since being discovered in humans in late 2019 (hence the “19” in its name), it has killed at least 2.6 million people worldwide and at least 520,000 in the US (as of March 2021). It remains out of control in most parts of the world. Recently-developed vaccines are proving effective, but gaining control of the virus will require vaccinating most of the world’s population, potentially repeatedly. This will be a historically unprecedented project. The virus may have the ability to mutate away from vaccine control, requiring a sophisticated rapid-response vaccination capability. Although 2021 may see improved conditions in the most-vaccinated countries, it is likely to take several years to gain secure control of this endemic virus.
The COVID-19 pandemic has rapidly become the most destructive infectious disease since HIV-AIDS. Since being discovered in humans in late 2019 (hence the “19” in its name), it has killed at least 2.6 million people worldwide and at least 520,000 in the US (as of March 2021). It remains out of control in most parts of the world. Recently-developed vaccines are proving effective, but gaining control of the virus will require vaccinating most of the world’s population, potentially repeatedly. This will be a historically unprecedented project. The virus may have the ability to mutate away from vaccine control, requiring a sophisticated rapid-response vaccination capability. Although 2021 may see improved conditions in the most-vaccinated countries, it is likely to take several years to gain secure control of this endemic virus.
The Virus
The SARS CoV-2 virus which causes COVID is a member of the Coronavirus family, named for its crownlike appearance. Four other coronaviruses cause about 30% of the cases of common cold. Two other coronaviruses have been responsible for much smaller, but very serious, human epidemics in recent years: SARS (Severe Acute Respiratory Syndrome), which infected humans from 2002 to 2004 and is sometimes referred to as SARS CoV-1, was much more lethal but much less infectious than SARS CoV-2. It is currently considered eradicated in humans, but could jump into humans again from another species. MERS (Middle East Respiratory Syndrome, also called MERS CoV) is also far more lethal and far less infectious than SARS CoV-2. It appeared in 2012 and remains in low circulation.
SARS CoV-2 has nine properties which make it a particularly difficult adversary:
- It is adept at airborne transmission;
2. Many infected people never show symptoms, yet can spread the disease;
3. Even people who do develop symptoms become infectious prior to the onset of symptoms, increasing their effectiveness as disease spreaders;
4. Many serious cases require extended hospitalization, burdening the healthcare system;
5. A significant number of cases turn into “Long COVID,” with a wide array of symptoms that can last for an as-yet-undetermined length of time. Some damage may be permanent.
6. The case fatality rate is high enough to ensure that uncontrolled spread will lead to many deaths, but low enough to ensure that causing death does not slow down the virus’ ability to spread.
7. It is much more lethal among certain groups, most notably older people.
8. It has shown an ability to mutate readily into variants that can make it more contagious, possibly more serious, and somewhat less susceptible to natural immunity and vaccine-induced immunity.
9. It infects a number of species besides humans. There is a risk that the virus will move back and forth between species, increasing the odds of dangerous new variants.
covid 19 in The United States
The US has paid a uniquely high price for being so unready for this crisis.
- The US leads the world in cases and deaths by a wide margin.
- Unlike countries which learned from prior epidemics (such as Singapore or Taiwan), the US lacks the infrastructure needed to manage an uncontrolled novel virus.
- Testing, tracing and monitoring systems to prevent infection spikes were only a fraction of what was needed, and were quickly overwhelmed.
- Hospital beds, staff and equipment to treat those who are infected were overwhelmed during the spring outbreak, and nearly so several times since. When the healthcare system is overloaded, death rates soar.
- Centrally managed decision systems for ensuring compliance are lacking.
- The pandemic became a highly politicized topic, with individuals making decisions such as whether to wear a mask based on political identities. Some of this polarization is now impacting the national vaccination program.
- The US leads the world in cases and deaths by a wide margin.
- Unlike countries which learned from prior epidemics (such as Singapore or Taiwan), the US lacks the infrastructure needed to manage an uncontrolled novel virus.
- Testing, tracing and monitoring systems to prevent infection spikes were only a fraction of what was needed, and were quickly overwhelmed.
- Hospital beds, staff and equipment to treat those who are infected were overwhelmed during the spring outbreak, and nearly so several times since. When the healthcare system is overloaded, death rates soar.
- Centrally managed decision systems for ensuring compliance are lacking.
- The pandemic became a highly politicized topic, with individuals making decisions such as whether to wear a mask based on political identities. Some of this polarization is now impacting the national vaccination program.
VACCINE DEVELOPMENT
The brightest spot in the entire pandemic story has been the exceptionally rapid development of remarkably effective vaccines. There is no historical precedent for this achievement. The first vaccines were in use in late 2020, barely a year after the virus was first discovered. Scaling up the manufacturing, distribution and delivery of vaccines has not been a smooth process, but has steadily improved. Most of the “first world” will have access to vaccines by mid-2021. However, some parts of the world will be years behind that. There have been over 70 vaccine candidates created, and nearly a dozen are already in use. Given the virus’ ability to mutate, vaccine development is likely to be an ongoing, long-term task.
The brightest spot in the entire pandemic story has been the exceptionally rapid development of remarkably effective vaccines. There is no historical precedent for this achievement. The first vaccines were in use in late 2020, barely a year after the virus was first discovered. Scaling up the manufacturing, distribution and delivery of vaccines has not been a smooth process, but has steadily improved. Most of the “first world” will have access to vaccines by mid-2021. However, some parts of the world will be years behind that. There have been over 70 vaccine candidates created, and nearly a dozen are already in use. Given the virus’ ability to mutate, vaccine development is likely to be an ongoing, long-term task.
Vaccination Challenges
It’s not yet known how durable immunity will be. One of the variants (P1, from Brazil) appears to ignore natural immunity which people gained by recovering from the Wuhan lineage virus. Some of the vaccines appear to be somewhat less effective against the variant from South Africa. Pharmaceutical companies are already developing new boosters to increase resistance to some of the new variants. As long as the virus remains active at a high level globally, the risk that vaccine-resistant variants will emerge is relatively high.
Vaccine hesitancy or outright resistance is also a significant challenge. People become unwilling to be vaccinated for different reasons in different places, but the net effect is worrisome, since this virus will only be stopped by high levels of immunity in the global population.
Some of the vaccines require two doses separated by 3-4 weeks, which adds a layer of logistical complexity and cost. Some also require storage and transport at extremely low temperatures, which limits where they can be given to prospective recipients.
Our vulnerability to global pandemics is increasing
It’s not yet known how durable immunity will be. One of the variants (P1, from Brazil) appears to ignore natural immunity which people gained by recovering from the Wuhan lineage virus. Some of the vaccines appear to be somewhat less effective against the variant from South Africa. Pharmaceutical companies are already developing new boosters to increase resistance to some of the new variants. As long as the virus remains active at a high level globally, the risk that vaccine-resistant variants will emerge is relatively high.
- Global travel has become pervasive. The COVID shutdown of travel was a wake-up call. As travel resumes, our vulnerability will again increase.
- A growing share of the world population is living in high-density urban areas.
- Local mobility and opportunities for individuals to socialize across many groups are growing.
- Face-to-face service industries are ubiquitous.
- Economies depend on global supply chains, which the virus is disrupting.
- Humans are coming into extended contact with many more wild species than in the past.
- Our modern information systems have intensified the spread of poor information about how we should behave in response to the pandemic.
- Global travel has become pervasive. The COVID shutdown of travel was a wake-up call. As travel resumes, our vulnerability will again increase.
- A growing share of the world population is living in high-density urban areas.
- Local mobility and opportunities for individuals to socialize across many groups are growing.
- Face-to-face service industries are ubiquitous.
- Economies depend on global supply chains, which the virus is disrupting.
- Humans are coming into extended contact with many more wild species than in the past.
- Our modern information systems have intensified the spread of poor information about how we should behave in response to the pandemic.
THE FUTURE: What will NORMAL look like?
Some countries may be able to effectively eradicate the vaccine and keep it eradicated. They will pay a price in travel difficulties, but may be able to form alliances with other countries that have achieved eradication to ease travel between safe jurisdictions.
Other countries—likely including the US—will achieve a good measure of control, but will find eradication impossible. We will learn to live with a certain number of cases (including long COVID) and deaths annually, as we do with other serious health problems. We will adopt cyclical vaccination rituals, and probably experience continuing political skirmishes about vaccination. There will be local or regional outbreaks from time to time, which will be tamped down through testing, tracing, and quarantine. This livable but imperfect state may eventually give way to eradication made possible by scientific advances at some indefinite point in the future.
Meanwhile, our economy will be functioning “normally” again, with a few exceptions. There will be extra virus control protocols that continue to affect some businesses. “Work from home” will remain a significant phenomenon. Some business sectors may remain impacted: large indoor crowds may remain risky, for example. Even with good vaccination success in 2021, fear of variants will remain for several more years at best.
Other countries—likely including the US—will achieve a good measure of control, but will find eradication impossible. We will learn to live with a certain number of cases (including long COVID) and deaths annually, as we do with other serious health problems. We will adopt cyclical vaccination rituals, and probably experience continuing political skirmishes about vaccination. There will be local or regional outbreaks from time to time, which will be tamped down through testing, tracing, and quarantine. This livable but imperfect state may eventually give way to eradication made possible by scientific advances at some indefinite point in the future.
Meanwhile, our economy will be functioning “normally” again, with a few exceptions. There will be extra virus control protocols that continue to affect some businesses. “Work from home” will remain a significant phenomenon. Some business sectors may remain impacted: large indoor crowds may remain risky, for example. Even with good vaccination success in 2021, fear of variants will remain for several more years at best.
COVID-19 will cast a long shadow cast over our lives, but we will largely gain control of it. We will undoubtedly lay the groundwork for hitherto-undreamed-of advances in life sciences. For at least some period of time, we will be better-positioned to respond rapidly and effectively to the threat of the next potential pandemic. Future generations will benefit by our efforts, and perhaps knowing this will make it easier for us to bear the burdens of the next few years.