COVID-19: The Road To (Ab)normality

With the current state of the World, it’s easy to forget the ongoing threat of COVID-19. Unfortunately, viruses don’t care about war or politics, and Sars-CoV-2 continues to kill upwards of 7000 people a day globally at the time of writing (9th of March, 2022), while many more are left with long term health problems following their infection.

In just a few days, it will have been exactly two years since the World Health Organisation officially declared COVID-19 a pandemic on the 11th of March, 2020. At that moment in time, some of us remained hopeful that COVID wasn’t here to stay. Immune memory acquired from past infection and from the eventual new vaccines, it was hoped, would be sufficiently powerful and long lasting that COVID would cease to be a serious threat to global health. Unfortunately, we have known for some time that immune memory declines quite rapidly, and while vaccines are highly effective at preventing hospitalisations and deaths, their ability to prevent transmission of the virus is less than what we might desire.

Instead, as COVID-19 transitions from pandemic to endemic, living with the virus will become the ‘next normal’ – a continuing threat like influenza that needs to be managed year-on-year. Doing so successfully is going to require a change in our approach to managing the virus. A recent report in the United States, entitled ‘Getting to and Sustaining the Next Normal: A Roadmap to Living with Covid‘, aims to provide a vision for what the future of the COVID-19 crisis might look like. It was written by 12 experts including a number of advisers to the current government, and gives some insight into how the pandemic might progress from here and what we need to do to avoid the worst case scenarios.

In the report, the authors sketch out three possible future scenarios for the U.S., depending on how well immune memory against Sars-CoV-2 holds up, and whether the virus becomes any more infectious or lethal through further mutations. The experts predict that COVID-19 will cause between 15 and 30 thousand deaths per year in the country in the optimistic scenario, and up to ten times that in the most pessimistic scenario.

The authors suggest that the U.S. should begin to treat Covid as just one of a number of respiratory viruses, and to shift focus to minimising deaths from respiratory infections as a whole. This is to say that by adopting measures that are effective against multiple respiratory infections (such as improved indoor air quality and better monitoring of circulating viruses), we may still hope to achieve pre-pandemic levels of yearly deaths from respiratory infections. The authors suggest a target of 60 000 a year, which is roughly the number of deaths caused by influenza in a bad season.

That’s not to say that life will be the same as it was in 2019 – special public health precautions are still going to be needed to deal with outbreaks, though not at the scales and durations we saw at the start of the pandemic. Convincing the public to accept this as the new normal might not be easy, especially as case counts begin to fall towards the end of winter, all while the largest war in Europe since WW2 threatens to push COVID to the back of our minds.