While the World Health Organisation has marked COVID-19’s first birthday with a grim message that the globe should brace for even more severe pandemics in the future, not everyone agrees fully with this view.
Some say COVID-19 has hit a sweet spot that has made it particularly dangerous.
WHO was first alerted to this pandemic on December 31 last year, when Chinese officials reported they were investigating a cluster of viral pneumonia in Wuhan.
Since then, COVID-19 has become the deadliest disease in the world, outstripping the big three: malaria, tuberculosis and HIV.
While this trio kills between 500,000 and 1.5 million people each per year, COVID-19 has caused more than 1.7 million deaths and is now officially out of control in several countries, from the US to South Africa.
With more than 81 million COVID-19 cases diagnosed worldwide and millions remaining undiagnosed, WHO described this pandemic in an end-of-year report as a wake-up call.
“This may come as a shock to people … but this is not necessarily the big one,” said Dr Michael Ryan, executive director of WHO's health emergencies program.
While much had been learnt, he said the world needed “to get ready for something that may even be more severe in future”.
“But there are two schools of thought on this,” according to Professor Brendan Crabb, director of Melbourne’s Burnet Institute, which combines medical research in the laboratory and the field with public health.
“WHO is technically correct and there are more deadly, worse-spreading infections potentially out there," he said. "But COVID is in a beautiful sweet spot because we think we can manage it and don’t have to eliminate it.
“Even though it is 10 times more deadly than the flu and causes morbidity such as 'long COVID' with heart and lung complications we are only beginning to understand, and infects the brain, major Western governments have chosen to live with it.
“Maybe that makes it worse. If it were a more deadly infection and transmitted more readily, there would be an unambiguous need to shut it down, to go for elimination.
“I think that trying to get away with not shutting it down has made it incredibly deadly. And now it’s probably gone too far to achieve this, and will become endemic.”
Endemic means that the virus never really disappears, and is always ticking over somewhere. The return of normal international travel will mean that even countries that aimed for elimination will end up with the virus.
In the year review, Professor David Heymann, chairman of WHO's Strategic and Technical Advisory Group for Infectious Hazards, said it appeared that the destiny of this virus was to become endemic, like other human coronaviruses.
“It will continue to mutate as it reproduces in human cells, especially in areas of more intense transmission.”
Fortunately, he said, the combination of good tools and good public health measures would enable us to live with COVID-19.
Professor Crabb said this would depend to a considerable extent on how effective vaccines prove to be in interrupting transmission, and how they will be distributed.
He said only once had a vaccine eradicated a virus: “Smallpox was eradicated through a vaccine program, with the last case seen in 1977. Although polio is close, there has never been another case of eradication.”
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