In Part I of this series, we discussed a recent poll taken of over 100 scientists working on the Covid-19 coronavirus if they thought it would be entirely eradicated through the widespread dissemination of vaccines or if it would become endemic, continuing to circulate in pockets of the global population. In this poll, 89% of the scientists believed it would become endemic.

Childhood Virus

The Nature article that reported this poll went on to discuss possible future scenarios. One scenario posits that children will contract the Covid-19 coronavirus like they contract the common cold, another coronavirus, today. The symptoms will be mild, like the common cold, and will not require any significant lifestyle changes. This will come about through widespread vaccination and herd immunity.

This scenario would follow what we have already seen in four common coronaviruses known as OC43, 229E, NL63 and HKU1. At least three of these four endemic coronaviruses have been circulating in human populations for hundreds of years. Two of them are responsible for approximately 15% of respiratory infections.

Jennie Lavine, an infectious disease researcher at Emory University, Atlanta, says the virus would become a foe first encountered in early childhood, when it typically causes mild infection or none at all. Lavine and her colleagues developed a model that show how most children first come down with these viruses before the age of six and develop immunity to them. That defense wanes pretty quickly so it is not sufficient to block reinfection entirely, but it seems to protect adults from getting sick.

It is unknown if the SARS-CoV-2 (Covid-19) virus will behave in the same way. One large study of people who have been infected with Covid-19 suggests that their levels of neutralizing antibodies start to decline after 6 – 8 months. But their bodies also make memory B cells, which can manufacture antibodies if a new infection arises, and T cells that can eliminate virus-infected cells.

Daniella Weiskopf, an immunologist at La Jolla Institute for Immunology, who co-authored the study, says if most people develop life-long immunity to the virus, either through natural infection or vaccination, then the virus is unlikely to become endemic. But immunity might wane after a year of two – or the virus evolves to escape it by developing new variants. More than half the scientists in the Nature survey think waning immunity will be one of the main drivers of the virus becoming endemic.

Vaccines and Herd Immunity

We are already seeing a decline in the daily number of new infections since the vaccines have become available. The number of serious illnesses is also declining. But it will take longer to see how effectively vaccines can reduce transmission. Data from some clinical trials suggest that vaccines that prevent symptomatic infection might also stop people from passing on the virus.

If vaccines do block transmission, and remain effective against new variants, it might be possible to eliminate the virus in regions where enough people are vaccinated so that they can protect those who are not, contributing to herd immunity. It is estimated that a vaccine with 90% or greater efficacy will need to reach 55% of the population to achieve herd immunity as long as mitigating factors such as masks and social distancing remain in place. If these measures are eliminated, the vaccine would have to be given to almost 67% of the population.This will be a greater challenge in some countries than others.

What does the future of Covid-19 look like? That’s the question on the minds of many scientists, as well as ordinary people, as the world gets vaccinated. Will the vaccines end this plague or do we have to get used to living with this SARS-CoV-2 coronavirus?

This is the question discussed by Nicky Phillips in a recent issue of Nature, which polled a group of scientists. In January, they asked over 100 immunologists, infectious disease researchers, and virologists working on the coronavirus if it could be eradicated. Unfortunately, 89% of those scientists in the poll believe this coronavirus will very likely or likely become an endemic virus. “Endemic” means the disease will continue to circulate in pockets of the global population for years to come; like the flu.

“Eradicating this virus right now from the world is a lot like trying to plan the construction of a stepping-stone pathway to the Moon. It’s unrealistic,” says Michael Osterholm, an epidemiologist at the University of Minnesota in Minneapolis.

This is no reason to panic, however. We live today with other coronaviruses; the influenza virus and four other coronaviruses that make up the common cold. We live with those through annual vaccinations and acquired immunity without the need for lockdowns, masks, and social distancing. It is true, however, that these measures in 2020 drastically reduced the number of cases of influenza usually seen.

Many of these same scientists had a more optimistic view. More than one-third believed it was possible the SARS-CoV-2 virus could be eliminated in some regions of the world while it continued to circulate in others.  In zero-COVID regions there would be a continual risk of disease outbreaks, but they could be quenched quickly by herd immunity if most people had been vaccinated. “I guess COVID will be eliminated from some countries, but with a continuing (and maybe seasonal) risk of reintroduction from places where vaccine coverage and public-health measures have not been good enough,” says Christopher Dye, an epidemiologist at the University of Oxford, UK.

“The virus becoming endemic is likely, but the pattern that it will take is hard to predict,” says Angela Rasmussen, a virologist from Georgetown University, who is based in Seattle, Washington. This will determine the societal costs of SARS-CoV-2 for 5, 10 or even 50 years in the future. There is much we still have to learn about this new coronavirus.

(More on the future of the Covid-19 coronavirus in future posts.)

If you live in the U.S., here’s another reason to be thankful. We have three effective, safe, approved vaccines for Covid-19 and people are getting vaccinated.

Not so in Europe. The Wall Street Journal editorial board likens the European Union to “the gang that couldn’t shoot straight.” To date, the U.S. has administered 34 doses per 100 residents, the U.K. has given 40, and Israel has given 111 (most vaccines require two shots). In comparison, France, Germany, and Italy have given about 12 per 100 residents; this despite earlier approval of the AstraZeneca vaccine in Europe than any vaccine in the U.S.

The latest management fumble was definitely an “unforced error.” When a few isolated cases of blood clots caused concern, various European regulators and politicians demanded the halt of vaccinations using the AstraZeneca vaccine, the only one currently widely available in the EU. This stoked fears unnecessarily throughout Europe. Over 11 million have been vaccinated in the U.K. and serious blood clots were found less in that population than in the general population. There are many others reasons for developing blood clots including health conditions, medications, and even Covid-19 itself. The European Medicines Agency (EMA) stepped in to declare the vaccine was not associated with an increased rate of blood clots or overall risk.

This is the problem when many different countries try to let a single bureaucracy determine their policies. WSJ says the introduction of the AsraZeneca shot was held up even after the EMA approved it because bureaucrats in Germany claimed there was no evidence it works in patients older than 65 years. The only truth to this statement was that fewer elderly patients were included in the sample during the vaccine’s trial phase. Yet this falsehood was widely disseminated, especially by French President Emmanuel Macron.

It took a long time to undo the damage done by the spreading of this misinformation. It also skewed priority lists. Younger teachers and university professors in Italy received injections ahead of the ill and elderly under a scheme developed when officials claimed the shot wouldn’t work on the old.

The bureaucracy of the EU makes it a nightmare to make decisions. No one seems to be fully in charge. Although the EMA is the agency designated for such decision-making, the large number of EU member states makes obtaining approval a challenging task. Delays are inevitable and there is no end to second-guessing. Imagine if we had to have the approval of all 50 states every time the federal government wanted to make a decision. Fortunately, we don’t have to wait for approval by rogue governors, like New York’s Andrew Cuomo, before we can make vaccines available to our people. (Cuomo once declared he wouldn’t accept the advice of the Trump administration that the vaccines are safe without “his own investigation.”)

The delays in vaccination have also been caused by EU reluctance to commit to purchases of large vaccine volumes and haggling over the prices. WSJ says Washington and London understood that crucial to mass procurement was throwing large amounts of R&D money at many pharmaceutical companies in hopes that some would work. As a result, Europeans pay a few dollars less, but were at the back of the line when it came time for shipments of vaccines.

WSJ acknowledges the benefits of living in the U.S. They ask, “Could things have been different? The Trump Administration’s Operation Warp Speed demonstrated how a large government can use its fiscal resources to fund R&D in a crisis. The U.K. and Israel have shown that small countries can leverage regulatory nimbleness to sprint ahead. But somehow the European Union – a continent-wide political bloc composed of smaller nation-states – managed to get the worst of both worlds. It’s suffering the lumbering bureaucracy of a large government and the squabbling inefficiency of a small one. Europeans can debate at their leisure whom to blame for this and how to keep it from happening again. The rest of the world can only hope they get their vaccination act together soon.”