Coronavirus: the last wave?

For last couple of months Covid-19 cases plummeted around the world raising the hopes for the end of the pandemic. Vaccination is happening at a good pace in some countries but nonexistent in many poor countries. Rich countries have now more than half of their populations fully vaccinated. Around the world, curbs have been easing up. Schools are open and dinning in restaurants has become common again. Markets are full and hardly anyone is wearing a mask or keeping social distance. Travel is picking up though still cumbersome due to multiple testing required by airlines. So, the big question is: will there be a winter wave? If yes, then how big or devastating it could be? And the final question is: when will it all end and world could go back to normal?

However, SARS-COV-2 (the virus which causes Covid-19) is not that straight. Even when cases were coming down around the world there was another surge in the US. Since early June when Covid cases and deaths were lowest, more than 150,000 people have died in the US alone due to a disease which is now somewhat preventable to a large extent by availability of multiple effective vaccines and tested health measures. The cases in the US declined until end of October from its peak in early September but then plateaued. Now the US is edging toward another winter surge with seven days rolling average of 80,000 daily reported cases and 2,000 deaths. But the US is not alone in this predicament, as most of Europe is dangerously moving upward again even with very high vaccination rates. Germany is now witnessing historic daily reported cases. The UK never went back to anywhere normal after the second wave and now its numbers are also moving up.

The big question is: why with even close to 70% of population fully vaccinated, Europe has now become an epicentre of the pandemic with nearly half of all new infections and reported deaths? Answer is simple as written in these pages back in January 2021. “Vaccines are part of our arsenal but never think that you can ride out of this pandemic just on them.” When I wrote these lines, as a public health professional I was aware of huge financial, logistic, administrative and community engagement processes which will be required to vaccinate enough people to achieve the ‘herd immunity’. Even in best case scenarios that meant years of hard work by our health workers. Another early assessment was that all of us are in this boat together so pandemic will be over only when it will be over everywhere. Rich countries cannot build a wall of vaccinations around their borders as if transmission is happening somewhere else, eventually a new variant will breach these walls and make these populations vulnerable again.

Now even with reported waning immunity by vaccines, we still have an expanding menu of different and effective vaccines. New medicines are upcoming and clinical protocols have improved significantly. That is evident by lower death rates. But there are wild cards too, including reduced population level benefits of vaccines due to unequitable vaccination coverage. Ventilation has been shown a major protective factor but still ignored at most places. I am not aware of any major transmission which started in a purely outdoor setting. That means we need to redesign our buildings the way they were 50 years back. That may mean huge cost but that will be much less than a cost of pandemics. Bringing in these lifestyle changes also means that we will minimise threat of any future respiratory disease pandemic.

So yes, I do expect another wave in winter, but we could minimise the damage by wearing masks in public, improving ventilation in the buildings, and getting vaccinated. It may take some time for vaccines and medicines to get to perfection but until then we could minimise the damage by just following the above. Winter is coming but keep your windows open as we still have a distance to cover.

Published in The Express Tribune, November 14^th, 2021.

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