‘When will it end?’: How a changing virus is reshaping scientists’ views on COVID-19

CHICAGO – Chris Murray, a Washington University disease expert whose prognosis of COVID-19 infections and deaths is closely followed around the world, changing his views on the course of the pandemic.

Murray had hoped until recently that several effective vaccines would be found in countries that could achieve herd immunity, or virtually eliminate transmission through a combination of inoculation and previous disease. But last month, data from a vaccine test in South Africa showed that not only could a rapidly spreading variant of coronavirus damage the effect of the vaccine, but it could bypass natural immunity. in previously infected people.

“I couldn’t sleep” after seeing the data, said Murray, director of the Seattle-based Institute for Health Metrics and Assessment. “When will it end?” he asked himself, referring to the pandemic. He is currently updating his model to take into account the potential for natural immune escape differences and expects to release new projections as early as this week.

A new consensus is emerging among scientists, according to interviews with 18 experts who are closely monitoring the pandemic or working to reduce its impact. Many explained how late last year ‘s outbreak of two vaccines with around 95% efficacy against COVID – 19 initially sparked hope that the virus could be largely present, similar to the way measles has spread. to be.

However, they say, data in recent weeks on new changes from South Africa and Brazil have dispelled that optimism. They now believe that not only does SARS-CoV-2 coexist with us as an endemic virus, continuing to circulate in communities, but potentially causing a burden mass of illness and death for years to come.

As a result, the scientists said, people could be expected to continue taking measures such as wearing a normal mask and avoiding crowded places during times of COVID-19 surge, especially for people at high risk.

Even after the vaccination, “I would still want to wear a mask if there was a change,” Dr. Anthony Fauci, chief medical adviser to U.S. President Joe Biden, said in an interview. “All you need is just one small kick of difference (sparking) another obedience, and then you will be predicted” about when life comes back to normal.

Some scientists, including Murray, acknowledge that the vision could improve. It seems that the new vaccines, developed at a faster pace, still prevent hospitalization and death even when new changes cause disease. Many vaccine developers are working on boosting injections and new inoculations that can maintain a high level of efficacy against the variables. And, scientists say there is still much to learn about the ability of the immune system to fight the virus.

Already, COVID-19 infection levels have declined in many countries since the beginning of 2021, with some significant reductions in serious illness and hospitals among the first groups of people who received the vaccine.

Worse than the flu

Murray said if the South African variant or similar mutants continue to spread rapidly, the number of COVID-19 cases hospitalized or deaths this winter could be four times higher than the flu large. The rough estimate assumes that 65% of the country’s population is vaccinated. In a worse case scenario, that could represent as many as 200,000 U.S. COVID-19-related deaths over the winter period, based on federal government estimates of annual flu deaths.

Its institute’s routine forecast, which runs until June 1, assumes an additional 62,000 deaths in the U.S. and 690,000 global deaths from COVID-19 by then. The model includes assumptions about vaccine levels as well as the ability to reverse the changes in South Africa and Brazil.

The shift in thinking among scientists has influenced government reports to be more cautious about when the pandemic will end. Britain said last week that it expects a slow release from one of the toughest locks in the world, despite having one of the fastest vaccination campaigns.

The U.S. government’s predictions of a return to a more normal lifestyle have been pushed back again, most recently from late summer to Christmas, and then to March 2022. Israel takes its issue “Green Pass” protection documents for people who have passed COVID-19 or been vaccinated, allowing them to return to hotels or theaters. The documents are only valid for six months as it is not clear how long immunity lasts.

“What does it mean to be past the crisis of this pandemic? ”Asked Stefan Baral, an epidemiologist at the Johns Hopkins School of Public Health. While some experts have questioned whether countries could completely eradicate any case of COVID-19 through vaccines and tight locks, Baral sees the goals as something more modest, but still meaningful. “In my mind, it seems that hospitals are not full, ICUs are not full, and people are not passing by sadly,” he said.

‘Scientific whiplash’

From the beginning, the novel coronavirus has been a mobile target.

Early in the pandemic, leading scientists warned that the virus could be endemic and “may not go away,” said Dr Michael Ryan, head of the Health Agency’s emergency program. Universe.

But they had a lot to learn, including whether it would be possible to develop a vaccine against the virus and how quickly it could be eradicated. Would it be more like measles, which can be caught almost entirely in communities with high levels of inoculation, or flu, which affects millions worldwide each year?

For much of 2020, many scientists were surprised and reassured that the coronavirus had not changed significantly to become more mobile, or lethal.

Significant progress was made in November. Pfizer Inc. said. and its German partner BioNTech SE, as well as Moderna Inc., that their vaccines were approximately 95% effective in inhibiting COVID-19 in clinical trials, a level of efficacy significantly higher than influenza bullet. any large.

At least a few of the scientists interviewed said that, despite these results, they did not expect the vaccines to eradicate the virus. But many said the data raised hopes within the scientific community that COVID-19 could be virtually eradicated, if only the world could get the vaccine fast enough.

“We all felt very optimistic before Christmas with these first vaccines,” said Azra Ghani, chair in infectious disease epidemiology at Imperial College London. “We never expected such high-efficiency vaccines to be possible in that first generation. “

The hope was not alive. In late December, the UK warned of a new, rapidly becoming more susceptible variant as the strongest form of the coronavirus in the country. Around the same time, researchers learned about the effects of the more rapidly spreading variables in South Africa and Brazil.

Phil Dormitzer, Pfizer ‘s chief vaccine scientist, said in November that the success of the US drug dealer’ s vaccine signaled that the virus was “vaccine-vulnerable” in what he called a “break-in”. expectation of humanity. In early January, it recognized the various “new chapter” changes in which companies need to look out for mutations that could reduce the impact of vaccines.

At the end of January, the effect on vaccines became even clearer. Novavax clinical trial data showed that the vaccine was 89% effective in a UK trial, but only 50% effective in preventing COVID-19 in South Africa. That was followed a week later with data showing that the AstraZeneca PLC vaccine offered only limited protection from mild disease against the South African variety.

The latest heart change was dramatic, several scientists said. Shane Crotty, a neurologist at the La Jolla Institute of Immunology in San Diego, described it as “scientific whiplash.” In December, he thought it was plausible to achieve a “eradication” of the coronavirus, similar to measles.

Now, “getting the vaccine that people can still has the same response and the same way forward as it did on 1 December or 1 January,” said Crotty, “but the result is not expect the same. ”