Picking ourselves up from a pandemic
After millions of deaths worldwide, a pandemic gradually draws to a close; leaps in technological capability and economic change contribute towards a social surge as the world begins to put itself back together...
That was the situation a century ago in the "Roaring 20s" that followed in the wake of the Spanish flu pandemic (caused by the H1N1 subtype of the influenza A virus). History does tend to repeat itself, so could we be heading towards a similar period of social and cultural revolution? Or will we emerge cautiously into our newfound freedom, with the persistent threat of COVID-19 hanging over our heads?
For the UK, at least, things seem to be looking up. The so-called ‘Freedom Day’ set for 19th July will see the easing of restrictions, some of which we have been living under for over a year. Of course, this does not mean that COVID-19 is no longer a concern: predictions for daily estimated infections are in the range of 100,000 by the end of the summer. A significant increase in daily deaths is also expected, but with an ever-increasing proportion of the country receiving vaccinations, it is hoped that these figures will be a mere fraction of what occurred earlier this year.
What we’re about to experience is most likely the social end of this disease. Experts typically agree that a pandemic can end in one of two ways: a medical ending, in which immunity due to vaccination or prior infection controls the spread of the disease, or a social ending, in which restricted living eventually becomes unsustainable for individuals and communities. Life begins to return to normality, leading to increased potential spread of the pathogen in question, which can subsequently delay the medical ending.
So, if we consider the controlled, social ending of this pandemic to be a careful compromise, when will COVID-19 really be gone? In reality, we have only ever managed to achieve the complete eradication of two diseases – smallpox and rinderpest – and only the former actually affects humans. In other words, many of the diseases that have caused devastating pandemics in the past are by no means completely gone, and indeed many remain rampant in some parts of the world. Especially as new variants of the SARS-CoV-2 virus keep arising – latest examples include the lambda variant, believed to originate in Peru and designated a variant of interest by the World Health Organisation in June 2021 – it is highly unlikely that the SARS-CoV-2 will ever be eradicated. However, this is nowhere near as bleak as it may sound. With the combined effects of natural immunity due to previous infection and vaccination, eventually, humanity and the virus will reach something of a stalemate. The virus will likely still be present, and rates of infection will likely increase every winter when colder temperatures force people closer together in indoor spaces, but the virus will join other four common human coronavirus strains responsible for seasonal cold-like symptoms. It is hoped that COVID-19 will shift from causing a pandemic to becoming just as endemic as seasonal flu.
There are of course other complications to consider – namely, "long COVID". The term long COVID was initially coined by a patient and has since become a topic of much discussion, at least in part because we don’t know that much about it. Long COVID can affect a range of systems in the body, from the heart and blood vessels to metabolic and neurological. The symptoms described include "brain fog", chest pain, muscular weakness and a loss of smell that can last for many months after the COVID-19 infection resolves. It remains largely a mystery as to who is in danger of developing long COVID, but a study published by King’s College London suggests increased age, excess weight and asthma may be risk factors. Long COVID can be hugely debilitating for its sufferers, and many fear that, as infection rates rise in the coming months, it will rear its head to become an even more serious concern.
Once again, however, the idea of some symptoms that persist for a long time after a viral infection is nothing new. The term ‘post viral fatigue syndrome’ refers to a range of symptoms similar to chronic fatigue syndrome, such as mental or physical exhaustion and sleep disturbances, which persist long after a viral infection. Many cases of long COVID come under this umbrella. The exact cause is unclear – scientists speculate it may arise due to the immune response to the virus, or due to the virus remaining latent in the human body. Post viral fatigue has most commonly been associated with Epstein-Barr virus – the virus responsible for causing glandular fever or ‘mono’- but significant cases were also seen after the SARS epidemic of 2003, the Ebola outbreak, and the Spanish flu pandemic. Post viral fatigue is not only seriously debilitating for individuals, but, if present in many people, poses challenges for society: how can we ensure that we meet the needs of those with chronic symptoms whilst optimising working efficiency?
As the UK looks to withdraw mandatory public health measures and focus on its vaccination programmes, it appears as though we are on the road back to recovery. It's possible that, if the vaccines continue to work as well as they have, protecting 95% of recipients from severe disease, life will become the closest to normality it has been in nearly a year and half. But, as policymakers keep reminding us, we are not quite out of the woods yet, and the long-lasting effects of the pandemic on the population’s mental and physical health remain to be seen.