The world has been in pandemic mode for a year and a half. Now the virus continues to spread, but at a slow burn; intermittent lockdowns are the new normal. The approved vaccine provides only six months of protection. An estimated 250 million people have been infected worldwide, and 1.75 million are dead.
Around the world, epidemiologists are constructing short- and long-term projections as a way to prepare for, and potentially mitigate, the spread and impact of SARS-CoV-2, the virus that causes COVID-19. Although their forecasts and timelines vary, modellers agree on two things: COVID-19 is here to stay, and the future depends on a lot of unknowns, including whether people develop lasting immunity to the virus, whether seasonality affects its spread.
Perhaps most importantly — the choices made by governments and individuals. “A lot of places are unlocking, and a lot of places aren’t. We don’t really yet know what’s going to happen,” says Rosalind Eggo, an infectious-disease modeller at the London School of Hygiene & Tropical Medicine (LSHTM). We don’t really know yet what will happen.
“The future will very much depend on how much social mixing resumes, and what kind of prevention we do,” says Joseph Wu, a disease modeller at the University of Hong Kong. Recent models and evidence from successful lockdowns suggest that behavioural changes can reduce the spread of COVID-19 if most, but not necessarily all, people comply.
Last week, the number of confirmed COVID-19 infections passed 15 million globally, with around 650,000 deaths. Lockdowns are easing in many countries, leading some people to assume that the pandemic is ending, says Yonatan Grad, an epidemiologist at the Harvard T. H. Chan School of Public Health in Boston, Massachusetts. “But that’s not the case. We’re in for a long haul.”
If immunity to the virus lasts less than a year, for example, similar to other human coronaviruses in circulation, there could be annual surges in COVID-19 infections through to 2025 and beyond.
The epidemic is not playing out in the same way from place to place. Countries such as China, New Zealand and Rwanda have reached a low level of cases — after lockdowns of varying lengths — and are easing restrictions while watching for flare-ups. Elsewhere, such as in the United States and Brazil, cases are rising fast after governments lifted lockdowns quickly or never activated them nationwide.
In South Africa, which now ranks fifth in the world for total COVID-19 cases expects a peak in August or September, with around one million active cases, and cumulatively as many as 13 million symptomatic cases. In terms of hospital resources, “we’re already breaching capacity in some areas, so I think our best-case scenario is not a good one”, says Juliet Pulliam, director of the South African Centre for Epidemiological Modelling and Analysis at Stellenbosch University.
But there is hopeful news as lockdowns ease. Early evidence suggests that personal behavioural changes, such as hand-washing and wearing masks, are persisting beyond strict lockdown, helping to stem the tide of infections. In a 3 June report, a team at the MRC Centre for Global Infectious Disease Analysis at Imperial College London found that among 53 countries beginning to open up, there hasn’t been as large a surge in infections as predicted on the basis of earlier data.
Researchers in virus hotspots have been studying just how helpful these behaviours are. At Anhembi Morumbi University in São Paulo, Brazil, computational biologist Osmar Pinto Neto and colleagues ran more than 250,000 mathematical models of social-distancing strategies described as constant, intermittent or “stepping-down” — with restrictions reduced in stages — alongside behavioural interventions such as mask-wearing and hand washing.
The team concluded that if 50–65% of people are cautious in public, then stepping down social-distancing measures every 80 days could help to prevent further infection peaks over the next two years. Overall, it’s good news that even without testing or a vaccine, behaviours can make a significant difference in disease transmission.
In regions where COVID-19 seems to be on the decline, researchers say that the best approach is careful surveillance by testing and isolating new cases and tracing their contacts. This is the situation in Hong Kong, for instance. “We are experimenting, making observations and adjusting slowly,” says Josef Wu. He expects that the strategy will prevent a huge resurgence of infections — unless increased air traffic brings a substantial number of imported cases.
As we noticed in the first and second waves of spreading the epidemic, the reaction of governments was to follow the methods of ban and partial or complete general closure in order to reduce mixing and increase distance. In those cases; huge economic damage occurs at the public and personal levels. There is no doubt that all commercial activities are affected by the closures process and impose a curfew.
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