What will the next six months of the pandemic bring?

For anyone who wants to see light at the end of the COVID-19 tunnel for the next three or six months, scientists have some bad news: get closer than we’ve ever experienced.

The outbreaks will close schools and cancel classes. Residents of vaccinated warning homes will face renewed fears of infection. Workers will weigh the danger of returning to the office as hospitals are overwhelmed, once again.

Experts agree that almost everyone will be infected or vaccinated before the pandemic ends. Maybe both. A few unfortunates will contract the virus more than once. The race between the transmission waves leading to new variants and the battle to achieve inoculation of the planet will not end until the coronavirus has touched us all.

“I see these continued rises going on around the world,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, and an adviser to U.S. President Joe Biden. “Then it will fall, potentially in a rushed way,” he said. “And then I think we could very easily see another increase in the fall and winter,” this year, he added.

With billions of people around the world waiting to be vaccinated and with little chance of eliminating the virus, we can expect more outbreaks in classrooms, public transportation and workplaces over the coming months as economies move forward. with the reopening. Although vaccination rates increase, there will always be people vulnerable to the virus: newborns, people who cannot be inoculated or not, and those who get vaccinated but suffer from advanced infections as levels of protection decline. .

The next few months will be tough. One of the main risks is that a vaccine-resistant variant will develop, although it is not the only risk we face.

“We will see hills and valleys, at least for the next few years as we get more vaccine. This will help you. But the challenge will be: to what extent will the hills and valleys be in terms of their distance? “Osterholm said.” “We do not know. But I can tell you that this is a coronavirus forest fire that will not stop until it finds all the human wood that can burn. ”

The five well-documented flu pandemics of the past 130 years offer a plan for how COVID-19 could develop, according to Lone Simonsen, an epidemiologist and professor of population health sciences at Roskilde University in Denmark. She is an expert on the ebb and flow of such events.

Although the world’s longest flu outbreak lasted five years, it consisted mainly of two or four waves of infection for an average of two to three years, he said. COVID-19 is already shaping up to be among the most serious pandemics, as its second year concludes with the world in the middle of a third wave, and with no end in sight.

The virus known as SARS-CoV-2 may not follow the path established by past pandemics. After all, it is a different pathogen, new and potentially more transmissible. And with a death toll of more than 4.6 million people so far, it is already more than twice as deadly as any outbreak since the Spanish flu of 1918.

Despite brutal initial waves and relatively high vaccination rates, countries such as the US, the UK, Russia and Israel are flirting with a record number of cases. Vaccination helps to moderate the incidence of serious cases and deaths, but growing infections mean that the virus reaches young people and other people who are not vaccinated, leading to an increase in rates of serious illness in these groups. .

Nations where vaccination has been scarce, including Malaysia, Mexico, Iran and Australia, are in the midst of their largest outbreaks to date, fueled by the contagious delta variant. With the virus still spreading out of control in vast areas of the planet, another new variant could emerge.

History shows that the common belief that viruses become softer over time (to avoid ending their host population) is wrong, according to Simonsen. While new mutations are not always more severe than their predecessors, “pandemics can become more deadly during the pandemic period as the virus adapts to its new host,” he said.

At the beginning of the COVID-19 outbreak, there was good reason to expect vaccines to provide long-term protection, similar to childhood vaccines that stop diseases such as polio.

Coronaviruses have a “test-reading” mechanism that fixes birth errors caused when the virus reproduces, reducing the likelihood that variants will appear when the virus is transmitted from one person to another.

However, the number of global cases has been so large that mutations occur anyway.

“With the pandemic, we have this enormous strength of infection,” said Kanta Subbarao, director of the WHO Collaborating Center for Influenza Reference and Research at the Peter Doherty Institute for Infection and Immunity in Melbourne. “This has offset the virus’s ability to test them.”

As a result, COVID-19 could be like the flu, which requires regular refills of vaccines to stay effective as the virus evolves.

Some researchers say that SARS-CoV-2 is about to be completely resistant to the first generation of vaccines. A study from Japan, which has not yet been published or reviewed by experts, suggests that potentially dangerous mutations in the delta variant are already being collected in a global database that is used to track these developments. Reports of current strains that broke vaccinations or caused higher mortality rates have so far not maintained strict control.

“This is a scenario we hope doesn’t happen,” Simonsen said. “My God, we should do it all over again.”

Other even more serious possibilities for the coming months include the appearance of a new flu virus or another coronavirus that makes the leap from animals to humans.

“As long as there are coronavirus animal reservoirs, there is still the possibility that another zoonotic coronavirus may emerge in the future,” Subbarao said. “There’s this at the bottom, the risk of continuing to treat it when another one comes out.”

What seems clear is that the pandemic will not end in six months. Experts generally agree that the current outbreak will be domesticated once most people (perhaps 90% to 95% of the world’s population) have a degree of immunity thanks to previous vaccination or infection.

They say the key element should be vaccination.

“Without vaccination, one is like a seated duck, because the virus will spread widely and find most people this fall and winter,” Simonsen said.

According to the Bloomberg vaccine tracker, more than 5.666 million doses of vaccine have been administered worldwide. But the success of the launches in some regions, such as the European Union, North America and China, masks the failure in others. Most countries in Africa have only given enough vaccine to cover less than 5% of their populations with a two-dose vaccine. India has managed enough to cover only 26%.

The pandemic will end at different times and in different places, as previous outbreaks had, said Erica Charters, an associate professor of medical history at Oxford University and coordinator of a project on how epidemics end. Governments will have to decide what part of the disease they feel comfortable living with, he said.

Approaches vary. Although some countries continue to shoot at zero cases, the world is unlikely to eradicate the virus completely.

Nations such as Denmark and Singapore, which have managed to keep the cases relatively contained, are already moving towards a post-pandemic future with fewer security restrictions. Others, such as the United States and the United Kingdom, open up even as the number of infections approaches records. Meanwhile, China, Hong Kong and New Zealand have vowed to continue working vigilantly to remove the virus locally. As a result, they are likely to be among the last places to leave behind the disruption caused by the pandemic.

“The final process will not be uniform,” Charters said. The pandemic “is a biological phenomenon, but it is also a political and social phenomenon.”

“Even now we have different approaches to it.”

It is likely to be messy, leaving a lasting legacy for years to come. Until then, most of us will have to prepare for many months to control the pandemic.

“We have to approach it with our eyes wide open and very humble,” Osterholm said. “Anyone who thinks we’re going to end this in the next few days or a few months is seriously wrong.”