What in the World Is Going on with the COVID-19 Pandemic?

What in the World Is Going on with the COVID-19 Pandemic?

“Western governments . . . were too slow and too indecisive. They displayed erratic leadership. And they lost the trust of their publics.”

- Dr. Richard Horton, editor-in-chief of The Lancet

“We’re all learning and trying to understand this. And this is important: This isn’t indecision or incomplete information. We’re learning. It’s an evolving science. The thing I’m learning is to have an even bigger dose of humility about this virus.”

- Michael T. Osterholm, PhD, director, Center for Infectious Disease Research and Policy, University of Minnesota

On November 1, 2021 the COVID-19 global death toll surpassed 5 million. Sadly, since July 2020, the U.S. has led the world in cases and fatalities. According to the Centers for Disease Control and Prevention, just last week the average number of new COVID-19 cases in the U.S. increased to nearly 75,000 or about 10,000 more cases than the week before. Cases are also soaring again in Europe. Yet the death toll has been relatively low across much of Africa and Asia.

Frankly, I’m baffled by the course this pandemic has taken, and I am not alone. Other health care professionals and public-health experts tracking the number of cases, hospitalizations, and deaths around the world have published numerous articles expressing the same degree of confusion. What is happening? In this Germ Gem post I will give you my assessment.

Differing strategies for dealing with the COVID-19 pandemic. While approaches to how a country deals with this pandemic are constantly evolving, most countries adopted one of the following strategies: (1) COVID-Zero; (2) Laissez Faire; or (3) Intermediate.

Australia, China, Hong Kong, New Zealand and Singapore took a COVID-Zero (“zero tolerance” of new SARS-CoV-2 cases) approach from the outset of the pandemic and stuck with it. This strategy, which seems draconian to some, calls for strict border closing, lockdowns, and quarantining. It appears to work. With the possible exception of China, the other COVID-Zero countries are slowly transitioning to accepting some low level of SARS-CoV-2 infections while they await endemicity (a state where the virus is stably maintained in a population). Living in a COVID-Zero country is not easy and, in my opinion, would not be tolerated by Americans. For a glimpse of what living in COVID-Zero China is like, I recommend the November 5 New York Times article, “Near-Daily Covid Tests, Sleeping in Classrooms: Life in Covid-Zero China.”

A Laissez Faire approach to the pandemic is one that tolerates little or no government regulation. The goals of this approach are to keep the economy rolling while waiting for natural or herd immunity to develop. It has been shown not to work or last long. Brazil is the best example of a country taking this approach. Recently, a major inquiry of Brazilian president, Jair Bolsonaro, accused him of crimes against humanity and failing to control SARS-CoV-2 resulting in the death of more than 600,000 Brazilians.

A large majority of countries has adopted some form of the third or Intermediate Strategy. This approach attempts to strike a balance between the number of COVID-19 cases and a country’s economy and way of life. No one is totally satisfied with the results of this strategy. As is often seen in the process of negotiating, nobody “wins.” The U.K. provides a notable example of this approach. Due to a current and unacceptable surge of COVID-19 cases in the U.K., it is now is being accused of a “shambolic” or “light touch” response to the pandemic.

The course of the pandemic in the U.S. has baffled many experts. The U.S. seems to waver from one end to the other of an Intermediate Strategy. For a good summary of where our leaders failed us, I recommend Mark Johnson’s January 21, 2021 article in the Milwaukee Journal Sentinel, “The U.S. was the world’s best prepared nation to confront a pandemic. How did it spiral to almost inconceivable failure?”

Stay calm and carry on. As I’ve already confessed, it’s often difficult for me to make heads or tails of the epidemiology of COVID-19. That said, I believe three factors are key determinants of the fate of the pandemic—globally, nationally, and locally:

• Vaccination status;

• Non-pharmacological interventions (these measures include social distancing, washing hands with soap and water, proper use of face masks, and when deemed necessary by public health authorities, quarantining, closing schools, and banning crowds); and

• Prevalence of SARS-CoV-2 variants (most recently, the highly contagious Delta variant is driving the pandemic throughout much of the world).

Obviously, many other biological, social, and political determinants of health also play a role in the course of the pandemic. In particular, the political determinants can profoundly shape the public health approach that a country or region takes to the pandemic.

Over the past few days, COVID-19 statistics began improving. The Delta wave appears to be quieting down. A Gallop poll shows that as this occurs, Americans’ outlook on the pandemic is becoming more upbeat. This positive trend coupled with some bright economic news makes me wonder, “Is there light at the end of the tunnel (or, is it a light from an oncoming locomotive carrying yet another SARS-CoV-2 variant?) The last time I felt this cautiously optimistic was on June 9 of this year (see the Germ Gems post, “Is the COVID-19 Pandemic Ending in America?”).

In fighting this pandemic, we have learned an enormous amount. While nobody’s solved, to my satisfaction, the “great epidemiological mystery” of COVID-19, the triumphs of Science are stunning. Among them are understanding the nature of the virus and of our immune system’s response to it, and above all, development and implementation of highly effective and safe vaccines in record time. According to the Johns Hopkins University COVID-19 tracking website, by November 5, 2021 a total of 7,189,147,330 doses of COVID-19 vaccine had been given globally. The world population is approximately, 7,753,000,000 people. If these were single dose vaccines, this shows that it would be possible to have enough vaccine available to vaccinate the world in record time!

Another promising development in the war against SARS-CoV-2 is the recent arrival of effective antiviral drugs to treat outpatients with mild to moderate COVID-19. As pointed out by Byprikanka Runwal in a November 5 article in National Geographic, “How the rise of antivirals may change the course of the pandemic,” oral antivirals are set to be the most promising tools to work alongside vaccines at combatting the pandemic.

One of these drugs is Merck and Ridgeback’s Molnupiravir that was approved on November 4 by the U.K. (A U.S. Food and Drug Administration [FDA] Emergency Use Authorization [EUA] is in process.) Even more encouraging, I believe, is a new antiviral pill from Pfizer with the brand name Paxlovid. On November 4, it was reported by the company to reduce the risk of severe COVID-19 by almost 90%. If the application for U.S. FDA EUA is approved, the pill should be available by the end of the year.

Finally, as was discussed in a special Germ Gems post on October 29, 2021, fluvoxamine (trade name Luvox), an oral drug that is FDA-approved for depression and obsessive compulsive disorder, recently was shown to be effective, safe, and cheap. It’s already available to treat outpatients with mild to moderate COVID-19, and given its astonishingly low cost ($4 for a 10-day course), it should prove invaluable in low-income countries.

In closing, even though SARS-CoV-2 is a challenging adversary that’s leaving many unsolved mysteries in its wake, human ingenuity is up to the challenge. We just need to be patient and to get lucky.