How will Covid-19 end? Because all pandemics do
It is safe to say that for the next year or so, life will not return to normal for the world. Even if the Indian epidemic peaks around May , as some experts are now predicting, it will take several months for the deaths to stop. And in the interim, and perhaps for months afterwards, it will still be considered dangerous to go to the cinema, to attend large weddings, to shake hands with strangers, etc.
But eventually, the epidemic will have to end. It is sometimes hard to recognise this because things look so bleak right now. The truth is that all epidemics end sometime. And this not even the worst epidemic of the last century or so.
Consider the Spanish Flu pandemic. It lasted from January 1918 to the end of 1920. Over half a billion people (yeah,billion – not million) were infected and over 50 million people died.
You can argue about the number of infections. So, the number of deaths is often a slightly more accurate way of gauging the extent of a pandemic.
In contrast, the Covid pandemic has been relatively mild. (As bizarre as this may sound.) According to official figures there have been 450 deaths in India so far. Even assuming that this an underestimate and that more will die in the weeks ahead, the total deaths will be under ten thousand (nearer 5,000 at the most, unless there is an unforeseen event).
This sounds terrible. And yet, it is nothing compared to the Spanish Flu. One estimate has it that 5 percent of India’s population died --- around 17 million people. If five percent of our population died now, that would be several crores (around six or seven crores).
When you see these figures, the havoc, death and devastation caused by Covid pales in comparison. And yet, as terrible as the Spanish Flu pandemic was, it did end.
And it ended without a cure being found or without a vaccine being developed.
In the 21st Century, we believed that pandemics could never happen because modern medicine has advanced to the level where any disease can be cured. That is why we look for miracle drugs or wait for a vaccine. But it seems unlikely that a Covid vaccine will be widely available over the next 12 months (at least). And yet, it seems probable that the scale of incidence of Covid will have reduced significantly even before scientists can find a cure.
History shows us that this is likely.
There are broadly, three ways, in which a pandemic ends.
The first is herd immunity. This is probably how the Spanish Flu ended. Herd immunity means that a virus has spread so widely through a community (in the case of Spanish Flu, the whole world) that the people who have survived it have developed immunity.
This is a risky strategy but there is no doubt that the UK government at least toyed with the idea in the early stages of the pandemic. The reasoning was that just as most Brits have immunity to measles and many strains of flu, the same immunity to Coronavirus could develop among the larger British population.
It is a difficult strategy for the layman to understand. The reason we have immunity to measles is that most of us contracted it as children. With the flu, there is reason to believe that antibodies to flu, which are in the blood of anyone who has had a mild attack, will protect them from more virulent strains.
But as Covid-19 is caused by a new virus which few of us have been exposed to, how would herd immunity develop?
A more likely consequence is that the virus would kill off large sections of the population (starting with the elderly) before such immunity developed.
Though the UK government denies this, critics argue that the reason the UK did not start on social distancing measures till it was almost too late was because it believed in herd immunity. If the government had acted promptly critics say, the UK would have not been so badly hit by the virus. Britain has had nearly 15,000 deaths, a lot more than India or even China, countries with much larger populations.
Another approach, made possible by modern medicine, is to manufacture Covid antibodies in a lab and to give them to those at risk from the virus. So far, nobody has done this successfully but there are promising reports of such antibodies being created.
Alternatively, you could invent a Covid vaccine and vaccinate the general population. Several groups of researchers are working on such a vaccine (which would make the body create its own antibodies) but the earliest we can expect one to be widely available is the second half of next year.
Yet another solution would be to find drugs that can beat the virus. This is not as easy it sounds.
Take, for instance, AIDS. We now have many drugs than can beat the symptoms and help the body fight the virus. Life expectancy after infection has increased so much that AIDS is no longer the death sentence it was in the 1980s.
But no, we still don’t have a single drug that knocks out the virus. So it is with Covid. Even if the drugs that are much hyped (such as Hydroxychloroquine) do work – and there is no hard evidence that they do —they don’t knock out the virus but at best, help with the symptoms.
In the absence of a silver bullet, most societies fall back on a simple strategy: stopping the virus from spreading.
Though we did not notice this because it was so localised, in the early part of the century, China beat SARS by using the same methods we are using to fight the Coronavirus (a cousin of the SARS virus). Flights were stopped, people wore masks, quarantine was ordered, etc.
The good news is that SARS has not been back. The bad news is that, by some estimates, Coronavirus is ten times more infectious than SARS. And they still haven’t found a vaccine for SARS.
But behavioural changes can control the spread of a deadly virus. In the 1980s, it was said that AIDS would devastate the world. In fact, the spread was controlled because people changed their behaviour: unprotected sex with a stranger is now relatively rare. Condom usage is now the norm for such encounters.
You can argue that while behavioural changes cannot fight the virus biologically, they reduce the danger posed by an epidemic as our experience with SARS and AIDS demonstrates. There is yet another view --- as yet not fully substantiated --- which says that as viruses cease to reproduce, they lose their potency. A team of British scientists claims that the HIV virus is weaker now than it was at the start of the epidemic.
The AIDS epidemic changed human behaviour forever. Will the same be true of Covid?
The short answer is: we don’t know.
If, by next June, as some scientists are predicting, a vaccine has been developed then will we still be as nervous as we are now about going to concerts or attending parties? My guess is that we won’t. Little by little we will ease the restrictions we have now placed on ourselves.
If a vaccine and antibodies are really on the way and will be here by next year, then I don’t think social distancing will become the norm. It will be seen as a way of having bought time till medicine was ready to fight the virus.
And our children will remember this as a terrible time for the world which, fortunately, passed in a year or so. Our grandchildren will not remember it at all. And when they are asked what Covid was, they will respond with the same sort of incomprehension as most of us exhibit today when we are asked about the Spanish Flu.
But if by the middle of next year, medicine has not found a cure or a vaccine, then yes the world will change.
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