Tuesday, February 8, 2022

Endgame of COVID-19

The question of how COVID-19 will end has been asked since Jan 2020.  It must be stressed that the endgame depends not only on virus properties but also on human society responses.  As a combination of those two factors, the first prediction that COVID-19 had the same trajectory as SARS was quickly squashed by late Feb 2020.  With vaccines coming out in Dec 2020 the 2nd hope was that COVID-19 would end in 2021.  Vaccines indeed work, but the relaxation of COVID-19 measures, anti-vaccination movement, the uneven distribution of vaccines globally, and the emergence of COVID-19 variants push the pandemic well into 2022.  In Feb 2022 comes the third prediction of COVID-19 endgame that new Omicron variant could immunize enough people for COVID-19 to become endemic, much like the common cold.

This 3rd prediction is plausible.  Combining vaccination of the population with the high transmission but less severity of Omicron, enough surviving people will have immunity against COVID-19 in 2022 and beyond.  Practically that is how infectious diseases have always progressed throughout human history: with time going by, there will be fewer people to infect.  Omicron might speed up the process, but COVID-19 will go downhill eventually regardless. 

But shall we bet on it for 2022, or is there anything people should do to prepare for the unpredictable future?  There remain two major unknowns.  The first is: will new, more dangerous variants arrive?  The second: how long does immunity last, and will people get infected and sick with the virus again and again?  These two issues will take months to resolve.  At this point one thing is certain: all vaccines protect severe diseases and serve as the last line of defense for humans.   

Even with these unknowns, many countries including most Western countries are phasing out or abandoning their COVID-19 restrictions.  A huge question is what will China do?  China’s COVID-19 policies have only become stricter and stricter since Jan 2020.  A consequence is that China’s COVID-19 cases and deaths are miniscule compared to most other countries.  Another is economy doesn’t run as well as it could have, for example, travels especially international travels have been severely curtailed, a big missed opportunity for China.  Tens of thousands of foreign students left China in Jan-Feb 2020 and then have been prevented from going back ever since.  Undergraduates have taken online courses and graduated, but graduate and professional students don’t have that option.  Some transferred, but inevitably many wasted a significant amount of time.  Chinese authorities might have hoped that they could come back when oversea COVID-19 situations improved, but things have only got worse, not better, since the summer of 2020, so no student or tourist entry for almost two years now.  In a sense China could have offered a safe heaven for many foreigners in 2020 and 2021, which is good for everybody including China, but that golden opportunity is gone in 2022.  To be fair, China is only one of the many countries that ban most foreign entry since 2020.  On a general note, China should welcome more foreigners in the future.  They may or may not like life in China, but they will see and find firsthand Chinese and Chinese society not much different from the rest of the world.  Their own experience will be the best weapon against WCEV.

With several major events on schedule in 2022, there won’t be any dramatic changes in China until the summer at the earliest.  But China is likely looking at other countries for clues and lessons at the same time.  Obviously for answers to the two questions above.  If there are no new variants by June, for example, there is certainly room for changes.  Also, how well other countries cope with COVID-19?  If the case numbers in, say, the US and UK, are 5K instead of >100K per day, international travel can be relaxed significantly.  Clearly it depends on the three big unknowns above and whether things go as wished.  Once China decides to loosen, it will do it in phases, so it won’t go back to a new “normal” for at least 3-6 more months.   

What will the new “normal” in China look like?  It depends on what the world learns about COVID-19 during the next several months, and don’t expect complete relaxation. On international exchanges, more flights will be allowed, fewer testings prior to departure but likely vaccination requirements, quarantine for a shorter time.  Domestically, once an infection is detected, shorter isolation time for fewer people, and no more lockdown of a whole city.  This is made possible because of a high vaccination rate in China, a good COVID-19 surveillance and response system, and a better understanding of a presumably lesser disease.  It will strike a moving balance between disease prevention and normal human life. 

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