Covid-19 pandemic: Is the end in sight?

By Dr Upul Wijayawardhana

Having had to restrict our activities severely for almost two years, all that we are dreaming of is normal times—nothing more! As 2021, another year that heaped misery on the world, ends, the best we could wish for is a normal year when reasonable health is re-established. Without that, the usual wishes for a new year of prosperity and happiness would only be a dream for many, the only exception being drugs and devices manufacturers who made a mint out of the pandemic, together with the select few benefitting by exploiting misery for profit. To find out whether we can hope for a better 2022, first we need to assess whether any lessons have been learned from this pandemic.

The only comparable event in human history is the Spanish Flu epidemic, due to the H1N1 Influenza A virus, which affected over 500 million, one third of the then world population. That pandemic which started in February 1918, began waning off around April 1920, killing around 50 million, though some estimates put the total number of deaths around 100 million. Whatever the figure, it was easily the deadliest epidemic. In fact, ‘Spanish Flu’ is a misnomer as the epicentre was not Spain, the first reported case being from Kansas, the USA. Further cases were reported subsequently from France, Germany and the UK. As the epidemic started when the ‘Great War’ was drawing to a close, censors in the opposing factions of the war, suppressed reporting this bad news in the fear that it would lower the morale of their people and troops. However, being a neutral country during that war, Spain reported accurately and paid for its honesty!

Maybe, learning from this the WHO put a stop to the name calling but that, too, took time. In fact, the record of the WHO during this epidemic is far from satisfactory, often giving contradictory messages. Although we do not know how, we know that the spread of Covid-19 was first detected in Wuhan. President Trump started calling coronavirus the Chinese Virus and when the first variant was discovered in Kent, President Macron, in his childish desire to avenge the UK for Brexit, started calling it the British Virus. When a deadlier variant was discovered in India, a successful appeal was made to the WHO, which decided to call variants by the letters of the Greek alphabet and the Indian variant was named Delta. When the next variant, more infective but less virulent, was discovered in South Africa, it was called Omicron, the WHO skipping a few letters of the Greek alphabet, perhaps, to avoid reference to the Chinese President!

Perhaps, the most important lesson that has been learned is to expect the unexpected and act quickly. As the Delta variant was being effectively controlled in most countries, there was increasing optimism that the beginning of the end is in sight. But that was not to be, as Omicron struck! As it was considered much more infectious, and probably dangerous, too, by having far more changes than any previous variant, UK took very prompt action against the spread of Omicron. the UK had no choice as it had paid heavily, with a disproportionately high death rate, during the previous waves because of delayed responses. The WHO, which initially warned against Omicron, requested countries not to overreact. It tries to warn and reassure at the same time! No sooner had it been confirmed that Omicron though highly infective was less dangerous, the UK removed travel bans from South Africa and other countries. Further, England has refrained from introducing any new Covid restrictions.

It is not only the WHO that got things wrong; most other experts also did. In fact, most experts would feel embarrassed when they reflect on their previous predictions! Perhaps, this was unavoidable because what was playing out was a guessing game, at least initially, but what is inexcusable is gross misinformation continuing to be fed to a gullible public, mostly through social media despite hard facts that were emerging. The anti-vaccination campaigns, unfortunately, have frustrated the attempts of some countries to control the epidemic.

The anti-vaxxers point out that the immunity developed following an infection is more complete which is very true as it would result in cellular immunity, in the form of T-cell immunity, in addition to the development of antibodies, which is the main form of immunity following vaccination. However, they fail to realise that if the virus was allowed to spread free, there is a sprice to pay—deaths. Reported deaths, so far, approach five and a half million and if not for mass vaccination this figure would have been much higher. Further, there is a misunderstanding regarding the purpose of vaccination; it is not to eradicate the disease but to reduce the number of serious cases so that healthcare facilities may not be overwhelmed. Coronaviruses are impossible to eradicate as they mutate fast.

A recent survey by the Intensive Care Society, in the UK, showed that around 75% of patients with Covid-19 in intensive care units are unvaccinated. It’s a pity that some refuse to see reason and continue with vigorous anti-vaccination campaigns. An anti-vaxxer in one of the WhatsApp groups circulated with glee the news of the sudden death of a physician of Indian origin in the USA, who is supposed to have said he would not grieve for those who died refusing vaccination.

Although vaccines and anti-viral drugs have been developed with lightning speed and other supportive measures, like dexamethasone were shown to be effective, the scientific community has been slow in some other aspects. When there is data suggesting that a cheap drug like Ivermectin may be effective, unlike hydroxychloroquine, which was shown to be ineffective, the delay in definitive trials to show efficacy or otherwise, helps the spread of conspiracy theories. Oxford Medical Group, which is conducting the PRINCIPLE group of trials, one of which showed the efficacy of Dexamethasone, started a trial on Ivermectin in June but announced in mid-December that the trial was on hold due to supply issues. One wonders whether the manufacturers do not want a cheap drug, out of patent, to be proved effective!

The way countries like France, Germany and USA mistreated the AstraZeneca vaccine, which was marketed without profit, together with incidents like this teach us another lesson. There is nothing the defenders of global exploitation, which is being carried out in the name of capitalism, will baulk at doing to safeguard their interests; they are thriving on the misery of others, and that has become a way of life for them! Poor countries need to learn how to look after themselves!

Unlike the beginning of the pandemic, which was explosive, the end would be a gradual process. As ‘herd immunity’ develops, due to community spread as well as vaccination, the virus would become endemic. This results in the number of severe cases decreasing and the death rate becoming very low. If preliminary data on Omicron is confirmed, it may be a blessing in disguise; the faster spread with low virulence helps endemicity. I am no expert on virology, but to me it looks as if Sri Lanka was entering this phase and do hope it is so. Perhaps, the country should be kept open to avert an economic disaster.