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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