Many believed that once vaccinated, this nightmare would end. But recent weeks have shown that the virus has not yet said its last word. No surprise for biostatistician Geert Molenberghs (UHasselt and KU Leuven) who, along with other experts, has always said that although the vaccine is one of the most useful weapons, it is not the panacea for this difficult virus, he said in “De Morgen” . It is too contagious, it is transmitted through asymptomatic people and even with vaccinated people. That is, as many “talents” that allow it to spread easily and move.
Today, smallpox remains the only deadly disease (with a mortality rate of 30%) which was effectively eradicated from the world after 3,000 years thanks to a global vaccination campaign launched in 1967 by the WHO. But the reproduction of this miracle with Covid seems unrealistic, because, unlike smallpox, people infected with Covid can transmit the virus to others without showing symptoms. The virus can also be transmitted by some animals, which makes it possible for it to reappear suddenly.
In reality, scientists have no doubt that the Covid virus is becoming endemic (a survey conducted by Nature magazine earlier this year among more than 100 top epidemiologists shows that 89% of them believe we are heading for this scenario) . Or to put it more concretely, that he will return every year as the flu (or like the other four coronaviruses in circulation). At best, it will follow its example by returning to predictable and controllable waves.
COVID could return like seasonal flu
Some experts believe it will be added to the seasonal flu. Like the flu virus that mutates and partially escapes the immunity that humans gained in previous flu seasons, Covid does seem to be taking a similar path as it tries to adapt. If this scenario is confirmed, the virus will never be completely eliminated and will cause an increase in hospital admissions and deaths each winter, but not to the point where hospitals are overwhelmed every time and have to postpone. “non-urgent” treatments. It is said that vaccination against Covid, as for the flu, is limited to vulnerable groups and does not aim to obtain group immunity, but to reduce the risk of serious illness.
French virologist François Balloux (University College London) recently estimated that an endemic Covid in a population of 11 million people would kill just under 1,200 a year. Another study by microbiologist Jan Kluytmans (University of Utrecht) suggests that in the near future, about 10,000 Dutch people could be hospitalized each year because of Covid. If we extrapolate to Belgium, this would be equivalent to 7,000 patients a year, according to the newspaper “De Morgen”.
As a comparison, in 2019, according to Sciensano figures, 307,000 people contracted the flu in Belgium. Of these hundreds of thousands of people, 2 to 3% were hospitalized and 6% of them died during their hospital stay. In Belgium, according to Yves Van Laethem, a “normal” flu epidemic kills between 800 and 2,000 people.
“Permanent global epidemic”
It is also possible that the new coronavirus (Covid-19) will turn like AIDS into a “permanent global epidemic„. In our country, HIV-positive patients have access to drugs that prevent AIDS and make patients no longer contagious, but this is not yet the case everywhere in the world. Every year, hundreds of thousands of people still die from this disease. And for Covid, it will be difficult to get vaccines everywhere.
It is estimated that it will probably take years before everyone has a chance at vaccines. This gives the virus plenty of time to move. Proof: several variants appeared in the first year of publication. Nothing excludes, therefore, that a variant of Covid manages to bypass all the accumulated immunity and send us to the starting point.
Something that has already happened during other pandemics, such as the Mexican flu or the great flu pandemic of 1918. The good news is that we would not have to start from scratch again, because mRNA vaccines allow us to react quickly to new variants.
In any case, the virus is likely to circulate for many years to come and cause new clusters, including in Belgium. This risk is all the more real as, once the situation is under control in rich countries, their interest in vaccinating the rest of the world may diminish.
Once the most vulnerable people in Western countries are protected from the vaccine, the presence of the virus will become viable, as the disease will be fatal to only a small part of the population. Therefore, eliminating the virus will no longer be a priority, as it will no longer be the most important disease to be eradicated worldwide. Therefore, it is likely to recur occasionally. So everything will depend on the mutations and the immunity acquired by the population against the virus.
However, today, including in Belgium, too much of the population is not immunized against the virus (a person who has been vaccinated or has already been infected). But this situation will change since more and more people will be vaccinated (even three times as many) or contract the virus. So there is nothing to prevent the virus from returning or doing so in a much more moderate way from next autumn. Ideally, repeated exposure to the virus, supplemented or not by a booster injection from time to time, should lead, without viral mutations, to increasingly weaker waves. And, in a perfect world, Covid should become what is called a cold virus like the one that causes colds.
Why the virus returns in the fall
Every winter, and sometimes since autumn, there is an increase in the number of patients. However, contrary to popular belief, the famous arrival of the cold has nothing to do with it. Most of these diseases are not caused by the cold, but by one of the 200 viruses that can make us sick. Viruses that are present throughout the year, but which become more virulent not because of lower temperatures, but because of promiscuity. Poorly ventilated rooms provide a way for viruses such as Covid. It should be noted that the cold even plays an indirect role, because the cold air is often dry.
This dries the mucous membranes and facilitates the penetration of respiratory viruses into our body. The cold will also make our extremities (hands, nose, mouth) less vascularized and less fast in providing an immune response. Thus, according to the work of Mélanie Prague, biostatistician at Inria in Bordeaux, the circulation of the virus increases by 40% in winter.
In this context of contact limitations, Corona Safe Ticket and the wearing of the mask could be reintroduced for short periods, for example autumn and winter. Which, all in all, would be just a lesser evil.
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