How will the coronavirus pandemic develop and how will it end

Ed Yong

Popularizer of science, author of the book "How Microbes Control Us".

Three months ago, no one knew about the existence of SARS-CoV-2. Now the virus has spread to almost all countries, infectingCOVID ‑ 19 CORONAVIRUS PANDEMIC more than 723 thousand people - and these are only those cases that are known about.

It brought down the economies of various countries and undermined the health care system, overcrowded hospitals and devastated public places. Separated people from loved ones and forced them to leave their jobs. He disrupted the usual life of modern society on a scale that almost no one living today has seen before.

Soon, everyone will know someone with the coronavirus.

A global pandemic of this magnitude was inevitable. In recent decades, hundreds of healthcare professionals have written books, reports and articles warning of this possibility. In 2015, Bill Gates saidBill Gates' TED 2015 Talk about this at a TED conference. And so it happened. The question "What if?" turned into "So what next?"

1. Coming months

To some extent, the near future is already predetermined because COVID-19 is a slow-onset disease. People who got infected a few days ago will only now start showing symptoms. Some of them will be admitted to intensive care units in early April. Now the number of cases is growing rapidlyConfirmed cases of new coronavirus infection COVID-2019 in Russia, increasing at times.

The situation in Italy and Spain is a serious warning to us. Hospitals are short of beds, equipment and staff, and the number of deaths from coronavirus per day is 700-800Coronavirus Cases in Italy man. So that this does not happen again in other countries and that the worst scenario does not come true (millions fatalities due to lack of medical equipment and human resources), four measures are needed - and fast.

1. Establishment of production of medical masks, gloves and other personal protective equipment. If health care workers are not healthy (and they are the easiest to get infected), other efforts will be undermined. a lack of masks is caused by the fact that medical devices are made to order, and their production depends on the most complex international supply chains that are currently being strained and torn.

It is imperative that industrial enterprises switch to the production of medical equipment, as in times of war they switch to the production of military equipment.

2. MBulk test release. The process is slow due to five separate factors:

• There are not enough masks to protect the people who are taking the test.
• There are not enough tampons with which to take a swab from the nasopharynx.
• There are not enough kits for the isolation of viral genetic material from the samples taken.
• There are not enough chemicals that are included in these kits.
• There is a lack of trained staff.

This shortage is also largely due to supply strains. We have already managed to cope with something, because private laboratories have connected. But even now, tests still have to be used in a limited way. According to Harvard epidemiologist Marc Lipsitch, the first thing to check is medical workers and hospitalized patients so that hospitals can "put out" the current fires. And only then, when the immediate crisis subsides, can they be spread more widely.

All of this will take time, during which the spread of the virus will either accelerate and exceed the capacity of health systems, or slow down to a manageable level. And the development of events depends on the third necessary measure.

3. Social distancing. Look at the situation from this point of view. Now the entire population is divided into two groups: group A includes all those involved in medical measures to combat epidemic (those who work with patients, conduct analyzes, produce masks and other materials), and in group B - all rest.

Group B's task is to win more time for Group A.

It is possible to do it physically isolating yourself from other people, that is, breaking the chains of transmission. Given the slow progression of COVID-19 to prevent a collapse of the healthcare system, these drastic at first glance, steps must be taken immediately, before they seem proportionate to us what is happening. And they should last for several weeks.

However, convincing entire countries not to voluntarily leave their homes is not easy. In such a situation, when the general well-being rests on the sacrifices of many people, the fourth urgent measure is very important.

4. Clear coordination. It is necessary to convey to people the importance of social distancing (but not intimidate them). Instead, however, many business leaders are willing to abandon isolation measures in an effort to protect the economy. They emphasize that it is possible to protect representatives of high-risk groups (for example, the elderly), and the rest can be allowed to go to work.

This position is very attractive, but wrong. People underestimate how badly the virus can hit low-risk groups and how overcrowded hospitals will be, even if only young.

If people follow social distancing measures, if enough tests and tools are performed personal protection, there is a chance to avoid the worst predictions about COVID-19 and at least temporarily take the epidemic under the control. Nobody knows how long it will take, but the process will not be quick.

2. Interchange

Even an ideal response will not end the epidemic. As long as the virus exists somewhere in the world, there is still a chance that one infected traveler will carry sparks of the disease into the countries that have extinguished their fires. Under such conditions, there are three possible scenarios of events: one is extremely unlikely, another is extremely dangerous, and the third is extremely long.

1. Unlikely scenario. All countries will simultaneously tame the virus, as was the case with SARS (SARS) in 2003. But given how widespread the infection is now and how poorly many countries are doing, the chances of synchronized control of the virus are steadily diminishing.

2. An extremely dangerous scenario. The new virus does what previous influenza pandemics did - travels around the world, leaving enough survivors who develop immunity so that he can no longer find suitable for life organisms. The group immunity scenario is faster and therefore more seductive. But he would have to pay a terrible price. The SARS ‑ CoV ‑ 2 strain has transmissibility abovethan normal flu.

The attempt to form group immunity is likely to result in millions of deaths and the destruction of health systems in many countries.

3. Extremely lengthy scenario. According to him, all countries will fight the virus for a long time, suppressing outbreaks of infection here and there, until they create vaccine. This is the best option, but at the same time the longest and most difficult.

First, it depends on the development of a vaccine. It would be easier if it was a flu pandemic. The world already has experience in creating flu vaccines - they are made every year. There is no vaccine for coronaviruses yet. Until now, these viruses have led to mild illness, so researchers had to start from scratch. According to preliminary data, it will takeCoronavirus vaccine: how soon will we have one? from 12 to 18 months, and then some more time to produce it in sufficient quantities, deliver it all over the world and introduce it to people.

Therefore, it is likely that the coronavirus will remain a part of our lives for at least another year, if not more. If the current round of social distancing measures works, the epidemic could wane enough for things to return to some semblance of normalcy. People will be able to visit offices, bars and universities again.

But when the usual routine of life returns, the virus will return. This does not mean that all people are required to remain in strict isolation until 2022. But, as Harvard immunologist Stephen Kissler says, we must prepare for multiple periods of social distancing.

Much of the coming years, including the frequency, duration and timing of periods of social isolation, depends on two characteristics of the virus that are still unknown.

First, the seasonality. Typically, coronaviruses turn out to be winter infections that weaken or disappear in the summer. Perhaps the same will happen with the SARS ‑ CoV ‑ 2 strain. However, it is likely that the change in weather will not slow the virus down enough, because most do not yet have immunity against it. Now the whole world is looking forward to the arrival of summer and the answer to this question.

The second unknown characteristic is duration immunity. When people become infected with milder types of human coronaviruses, which cause cold-like symptoms, immunity lasts for less than a year. But those infected with the first SARS virus (the causative agent of atypical pneumonia), which was much more serious, lasted much longer.

Provided that SARS ‑ CoV ‑ 2 is somewhere in between, people who have recovered from it can be protected for a couple of years. For confirmation, scientists need to create accurate tests that check for the presence of antibodies, which provide immunity. And also make sure that these antibodies really prevent people from contracting the virus and transmitting it. If confirmed, people with immunity will be able to return to work, care for vulnerable members of society, and support the economy during periods of social distancing.

In the intervals between these periods, scientists will be able to work on the creation of antiviral drugs and look for possible side effects. Hospitals will be able to replenish the necessary supplies. Medical professionals - to conduct massive tests to detect the return of the virus as quickly as possible. Then such harsh and widespread social distancing measures as now will no longer be needed.

In any case, either because of the emergence of a vaccine or because of the formation of group immunity, it will be more and more difficult for the virus to spread quickly. But he is unlikely to disappear completely. The vaccine may have to be modified to accommodate changes in the virus, and people may have to do regular vaccinations.

Perhaps epidemics will repeatProjecting the transmission dynamics of SARS ‑ CoV ‑ 2 through the post ‑ pandemic period every couple of years, but with less harshness and less disruption to normal life. COVID-19 could become what flu is now - the annual companion of winter. Perhaps one day it will become such a common thing that, even with the vaccine available, children born today will not get vaccinated, forgetting how much this virus has affected their world.

3. Effects

The price to pay to achieve this with a minimum of death will be enormous. As writesThis Is Not a Recession. It's an Ice Age. my colleague Annie Lowrey, the economy is now "experiencing a shock more sudden and more violent than anything seen before by those who live today." In the USA alone, about one in five 18% of U.S. workers have lost jobs or hours since coronavirus hit, poll finds will lose hours or work. Hotels are empty, airlines are canceling flights, restaurants and small outlets are closing. And economic inequality will only grow, because social distancing measures will hit the hardest on low-income people.

Disease has undermined the balance of cities and communities many times, but in developed countries this has not happened for a very long time, and not on the scale that we see now.

After the spread of the infection subsides, a second pandemic will follow - problems with mental health. Now, in a moment of fear and uncertainty, people are cut off from the comfort of human contact. Hugs, handshakes, and other social rituals are now associated with danger. People with depression and anxiety disorders have a harder time getting support.

The elderly, who already have so little participation in public life, are asked to isolate themselves even more, only increasing their loneliness. Asians are even more likely to beThe Other Problematic Outbreak racist attacks. Domestic violence is likely to increase as people are forced to stay at home, even if it is unsafe.

It will take time for healthcare professionals to recover. According to researchersLong-term psychological and occupational effects of providing hospital healthcare during SARS outbreak, two years after the SARS outbreak in Toronto, healthcare workers were still less productive and more likely to suffer from burnout and post-traumatic stress disorder. People who have survived a long quarantine will also experience long-term psychological consequences. “Colleagues from Wuhan note that some residents refuse to leave their homes, and some have developed agoraphobia"Says psychologist Steven Taylor, author of The Psychology of Pandemics.

But there is a chance that after this trauma, something in the world will change for the better.

For example, the attitude towards health. The spread of HIV and AIDS “has completely changed sexual behavior among young people growing up during the peak of the epidemic, says Elena Conis, a medical historian at the University of California Berkeley. "Condom use has become the norm and STI testing is common." Perhaps in a similar manner, washing hands for 20 seconds, which until now has been difficult to enter even in hospitals, during this infection it will become a habitual action that will stay with us forever and ever.

Moreover, a pandemic could act as a catalyst for social change. People and organizations are now surprisingly quick to adopt innovations that were previously in no hurry to transition, including remote work, video calls, normal hospital and flexible childcare environment. “This is the first time in my life I've heard someone say 'Oh, if you're sick, stay home,'” said Adia Benton, an anthropologist at Northwestern University.

Perhaps society will understand that preparedness for an epidemic is not only about masks, vaccines and tests, but also a fair work schedule and a stable healthcare system. Perhaps it recognizes that medical professionals make up its immunity, and so far it has been suppressed rather than strengthened.

Usually, society quickly forgot about the problem after the initial wave of panic. After each infectious crisis - HIV, anthrax, SARS, Zika virus, Ebola - the disease is given attention and investment is made in treatment. But soon memories are erased and budgets are cut. This was in part because these epidemics affected only limited groups of people, or occurred somewhere far away. The COVID-19 pandemic affects everyone and directly affects everyday life.

After the terrorist attack on September 11, 2001, the world focused on anti-terrorist measures. Perhaps, after COVID-19, the focus will shift to public health.

A jump can already be expected investment in virology and vaccinology, the influx of students to medical schools and the growth of domestic production of medical equipment. Such changes in themselves can protect the world from the next imminent epidemic.

The lessons we will learn from this pandemic are difficult to predict. We can go the way of distance from each other, build metaphorical and physical walls. Or learn to be united, ironically born in social isolation, and cooperation.

Imagine this future: we are moving from a policy of isolationism to international cooperation. With constant investment and new brainpower, the number of healthcare workers is growing. Children now born at school write essays about their dreams of becoming epidemiologists. Public health is becoming a central element of international politics. In 2030, the SARS ‑ CoV ‑ 3 virus appears out of nowhere and is pacified within a month.