The British government recently said it hopes to transform COVID-19 into a manageable illness, like the flu.
Vaccines and new treatments, argue ministers and their scientific advisers, will reduce the death rate and allow us to live with the virus, instead of constantly fighting against it.
Wiping covid off the face of the earth would be great, of course, given the deaths and destruction it causes.
But the only problem is that eradication has only been achieved with one virus: smallpox, in 1980.
It took decades to get to this point, and scientists and governments were only able to do it thanks to a series of unique circumstances.
First, the vaccine was so stable that it did not need to be refrigerated, and when it was supplied it was immediately obvious whether it had worked or not.
It was also evident when a person had been infected. It was not necessary to do a laboratory test, which was a great advantage when it comes to containing outbreaks.
Covid, as we all know, is completely different.
Is therategia “covid cero”
Instead, the movement called “zero covid” tends to speak of elimination. This basically means reduce the number of cases to close to zero in a territory and keep it that way.
One of the highest-profile proponents of this theory is Professor Devi Sridhar, a public health expert at the University of Edinburgh in Scotland.
Sridhar believes that we should treat COVID-19 like measles, which has mostly been eliminated in rich countries.
The professor argues that the continuous restrictions to reduce the number of cases together with a more effective system of tracking and testing, more vaccination, would allow containing the virus and returning to a “sort of normal domestic life”, where the opening of restaurants, bars and the realization of sporting and musical events were possible.
But the price to pay, he says, would be restrict international travel and impose border restrictions, as well as “short and severe quarantines” when cases inevitably go up.
Deepti Gurdasani, a clinical epidemiologist at the University of London, is another proponent of this strategy. She is one of more than 4,000 signatories to the “covid zero” petition, which calls for this proposal to be debated in the British parliament.
“Life could return to something similar to normality. We could even open travel corridors with other countries that have followed that path,” he says.
The measles approach problem
It may be a tempting prospect, but one that many believe is out of reach or would require such sustained restraints that economic and social costs would be enormous.
“Covid Zero is not compatible with the individual rights and freedoms that characterize post-war democracies,” notes Professor Francois Balloux, Director of the Institute of Genetics at University College London.
Countries like New Zealand, Taiwan and Australia have achieved this because they were able to prevent the virus from taking hold, and everything seems to indicate that once the populations of these countries are vaccinated, they will begin to lift restrictions at the borders.
But no country that has seen the virus spread like the UK has managed to suppress it to the point of eliminating it.
Vaccines are in theory a new tool to achieve this, as has happened in the case of measles.
But there is a significant flaw in this argument, explains Professor Jackie Cassell, a public health expert at the University of Brighton.
Measles, he says, is an “unusually stable” virus. This means that it does not change in a way that allows you to avoid the effect of the vaccine. In fact, the same vaccine has been used essentially since the 1960s, and it also provides lifelong immunity.
It is already clear that, “sadly”, this is not the case with this coronavirus, says Cassell.
The challenge is staying ahead of the virus
Variants that have emerged in South Africa and Brazil allow the virus to switch to evade some of the immunity created by vaccines.
The virus circulating in the UK has also mutated and achieved a key change – known as E484 – that allows this to happen.
As more people get vaccinated, this is likely to increase. This is because mutations that can circumvent the immune response in some way will have a selective advantage, notes Adam Kucharski, a professor at the London School of Hygiene and Tropical Medicine, who has conducted research on global outbreaks from Zika to Ebola.
“We can’t save ourselves from this. We may need to update vaccines.”
The challenge, then, is “to stay ahead of the virus,” he explains. But this is not, he thinks, as difficult as it sounds.
The coronavirus changes less than the flu, he says, which means vaccines should remain effective to a large extent.
What’s more, the fact that the mutations being seen share some key characteristics gives us a good idea of the path they are following. “Hopefully it will be easier to update than the flu vaccine, where there are many different strains.”
Although he cautions that extreme care must be exercised at this time, as a population that is building immunity at a time when there is a lot of infection around provides an ideal breeding ground for variants to escape from those vaccines.
Kucharski says it’s too early to tell if we’ll get to the point where the coronavirus can be treated like the flu, as we haven’t yet fully seen the impact vaccines will have.
This precaution is understandable, as scientists want to first see the evidence of the deployment of the vaccination program in the real world. A study looking at this is underway in Public Health England and is expected to be published before the restrictions are lifted.
But all the indications from clinical trials and the experience of Israel, which leads the issue of vaccinating the world’s population, is that they will have a significant impact on infections, and where not, at least they will help to avoid serious cases of covid-19, complications when symptoms are prolonged, as well as deaths.
For those who are still susceptible because they refuse to get vaccinated or because the vaccine has not worked for them, advancement in treatments will be vital.
Everything indicates that we can reach a point where, as England’s top medical adviser Chris Whitty said, covid is not a risk.
This does not mean that no one will die. Whitty has spoken of reaching a “tolerable” death rate. And certainly many expect the coming winter to be challenging, with particular concern that the most disadvantaged communities will be hit the hardest, fearing that uptake of vaccination has been lower in these areas.
But it’s easy to forget that the flu can also kill on a grand scale. In 2017-18, for example, more than 20,000 people died in the UK from the flu.
It was a harsh and cold winter and deaths from other causes, such as heart disease and dementia, also rose, bringing the excess winter deaths to about 50,000. Society barely blinked.
“We have lived with viruses for millennia,” says Professor Robert Dingwall, a member of the government’s New and Emerging Respiratory Virus Threat Group. “We will do the same with the covid.”
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Eddie is an Australian news reporter with over 9 years in the industry and has published on Forbes and tech crunch.