When and how the COVID-19 pandemic will end: 4 scenarios

In the world, vaccination against Covid-19 is in full swing, and everyone asks the question - what's next? The publication told about four scenarios of development with the BBC.

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Will they finally open up all the borders and how much can the emergence of new variants of the coronavirus hinder this? Is it far from herd immunity and will the world be able to return to normal life before an effective cure for coronavirus is found?

This, according to European experts, will depend on three main factors: how quickly vaccination can be carried out - both in individual countries (of different levels of income) and on a global scale; how exactly the virus will mutate - in other words, how dangerous the new (not yet appeared) variants will be; How strictly will all of us - both vaccinated and unvaccinated - follow the recommendations of the authorities and comply with the necessary restrictive measures.

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Today, experts say, the state of affairs in all these areas does not look very optimistic.

According to researchers, people around the world are less and less willing to comply with antiquarian restrictions.

Only every fourth adult on the planet has received both prescribed doses of the vaccine - and this is not only due to the inaccessibility of the drugs, but also to distrust in them.

The particularly contagious viral strain “Delta” has already penetrated almost everywhere and is gradually displacing its less dangerous counterparts, and what’s most unpleasant is that it often infects those who have already recovered from or are fully vaccinated against Covid-19. At the same time, compliance with restrictive measures around the world, according to the conclusions of the authors of the article, is getting worse.

It is not surprising that the number of new infections in such conditions continues to grow rapidly: the world is at the peak of the third wave of the pandemic: since mid-July, the number of confirmed diagnoses has soared more than one and a half times (from 350 to 655 thousand daily).

The course of the pandemic will also depend on whether a cure is found for the disease and its protracted form - “long Covid”

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On the one hand, experts admit that it is unlikely that it will be possible to completely get rid of the virus: if all people are vaccinated, the infection will continue to mutate among animals.

On the other hand, a lot depends on how quickly an effective cure is found - not only for the disease itself, but also to combat the protracted form of the infection, better known as “long Covid.”

Four options

In more detail, possible scenarios for the development of a pandemic are outlined in an article in the journal of the American Medical Society JAMA at the end of July.

The large-scale vaccination campaign (and in the US it is gaining momentum quite quickly) gives hope for a relatively quick return to normal life, the authors write. “However, there are many obstacles along the way: extremely uneven availability of vaccines, persistent reluctance to get vaccinated, emerging new variants of the virus and global waves of deadly infection,” they add.

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The four possible scenarios described in the work “represent a range of potential outcomes that could resolve the Covid-19 epidemic.”

Scenario one is complete eradication. It provides that doctors will be able to finally erase Covid-19 from the face of the Earth, as it happened almost half a century ago with the variola virus.

Immunity (both after vaccination and after illness) must be strong and long-lasting - so that it protects against re-infection and at the same time prevents further transmission of infection.

In the case of Covid-19, there is little hope for that.

The authors call “a more realistic goal for the short term” elimination, that is, a temporary reduction in the number of infections in a particular country to zero due to mass vaccination and a strict system of restrictive measures - in fact, the complete closure of borders and isolation from the outside world. The most famous such example today is the situation with the measles virus. Thanks to mass vaccination in childhood, outbreaks of this disease are rare these days and can be brought under control relatively quickly.

In the case of the coronavirus, several countries have been able to achieve this state of affairs for a while: these are Australia, Vietnam, China, New Zealand and Singapore. This scenario is suitable for those countries where you can keep everything under control.

The worst is vaccination in poor countries, and until they can be vaccinated, the virus will continue to spread across the planet.

The third scenario is living with the virus (cohabitation) — assumes that the developed vaccines and their future modifications will continue to protect only from the severe course of Covid-19 and death. In such conditions, where there are many vaccinated, the virus will cease to pose a mortal danger and, in fact, Covid-19 will turn into a seasonal cold, and most of the population at any given time will be sufficiently protected so that large-scale outbreaks of a serious illness can be avoided.

Finally, The fourth scenario is a large-scale conflagration. This option is feasible, provided that the population will not be massively vaccinated.

The third option is the most acceptable, but so far the world is proceeding according to the latter scenario.

“On a global scale, there are still very few vaccinated people,” Eli Adashi, the lead author of the article in JAMA, professor at Brown University, explains to the BBC Russian Service. “And this means that the virus can easily walk around the world and mutate to its heart’s content.”

Most registered vaccines are highly effective in protecting against severe disease - but not always against infection.

Paul Hunter, a professor at Norwich Medical School at the University of East Anglia, who did not take part in the study, also does not believe in the possibility of completely eradicating the infection. He recalls that smallpox, mentioned in both works, is a virus that leaves behind a persistent - also called sterilizing - immunity. And immune protection against the new coronavirus drops by about half after just six to nine months.

In addition, currently registered vaccines with varying degrees of effectiveness prevent the severe course of Covid-19, but do not necessarily protect against infection: there are many cases when fully vaccinated people get sick. Their disease is relatively easy or completely asymptomatic, but at the same time they are quite can carry the virus, infecting others.

That is why the collective immunity, which most scientists (and after them, politicians) hoped for at the beginning of the pandemic, turns out to be unattainable in the end.

But this does not mean that the virus at some point mutates so terribly that it wants to kill all of us.

“Most likely the virus will become seasonal, and we will be periodically infected with it throughout our lives. Almost all the world’s leading virologists have already come to this conclusion,” says Paul Hunter, a professor at Norwich Medical School at the University of East Anglia.

Back in January, the journal Nature conducted a survey of scientists - immunologists, virologists and infectious disease specialists from around the world, collecting a total of more than a hundred expert opinions.

Almost 90% of respondents share the same opinion as Professor Hunter: it will not be possible to completely destroy the Sars-Cov-2 (eradication) coronavirus and it will continue to periodically infect people around the world. At the same time, children who have been ill at an early age will receive stronger immunity than adults, and at the same time partial protection against future mutations of the virus.

Perhaps we are facing a kind of “arms race” between vaccines and new mutations of the virus.

“All we have at our disposal are vaccines and restrictive measures, and everyone decides for themselves how strictly they should be followed,” says lead author of the JAMA paper, Professor Eli Adashi.

At the same time, since the immune defense weakens rather quickly, most likely, the vaccine will have to be updated periodically.

“What if new variants emerge that make existing vaccines significantly less protective? In this case, a kind of arms race could begin [between the virus and vaccine developers], continues Professor Adashi. — New drugs will catch up with the constantly mutating virus. And whether we have a chance to win this race is still unclear.”

However, the expert adds, in addition to the four options already described, there is a fifth scenario - the most optimistic. He assumes that in some foreseeable future doctors will be able to develop an effective antiviral drug or find another treatment option for Covid-19.

Mike Ryan, WHO Executive Director for Health Emergencies, says he himself would like to know when the pandemic will end. But the doctor must always tell patients the truth, and the truth is that no one knows the answer to this question yet.

“What I know for sure is that it will end faster if each of us does something about it,” he is sure. - If we give vaccines a better chance to be used around the world. If we think about how to protect ourselves and protect those around us. If our hospitals can do a better job of caring for the sick.”

“I think if all these conditions are met, we will be able to end the pandemic much earlier. I would really like to say that by the end of this year, but I don’t even count on that,” the expert admits. “There is a chance that we will be able to get the disease under control next year - if we are very lucky.”

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