Ask Dr. Halverson: COVID-19 — a look forward

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By Dr. Jim Halverson
In last week’s column, we took a look back over the past year since the World Health Organization declared COVID-19 a pandemic on March 11, 2020.
Today, let’s take a look forward, not three to six months, but the next two to five years. Will COVID-19 still be having a significant impact on our lives? Much of this information comes from an article written March 3 by F. Perry Wilson, M.D., associate professor of medicine at Yale University School of Medicine, titled “The Likely Future of COVID-19? More Than Polio, Less Than Flu.” He is a highly respected educator and has written a number of very informative articles about COVID-19. 
Let’s look at different possible levels of success in the battle against the SARS-COV-2 virus.


Can the SARS-COV-2 virus be eradicated?
This would be the ultimate victory. Eradication means the virus has ceased to exist in the world except perhaps in certain labs. 
Smallpox is the only virus that we have been able to eradicate. The WHO declared smallpox eradicated in 1980 and no cases of naturally occurring smallpox have happened since. The reason we could eradicate smallpox was twofold. First, we had an effective vaccine. Many of you born prior to 1972 may have the distinctive round, slightly depressed scar in your upper arm from when you received it. Second, there are no animal reservoirs for smallpox. (It probably jumped to humans from rodents thousands of years ago.) In modern times, humans are the only known host. That meant a global vaccination project could achieve eradication and it did. 
We do have highly effective vaccines against SARS-COV-2, but we also have the problem that the virus can circulate in other mammals and we are not able to eliminate it from them. Therefore, eradication is not possible.


Can the SARS-COV-2 virus be eliminated?
Elimination means getting the number of infections as low as possible, zero per day being the ultimate goal, and then, when an outbreak inevitably occurs, we stop it from spreading. 
The problem with SARS-COV-2 is its ability to spread asymptomatically. Up to 40% of symptomatic cases are thought to have been acquired from asymptomatic individuals. This is the fundamental difference between SARS-COV-2 and the more lethal SARS-COV, which was responsible for the SARS outbreak in 2002 that killed 30% of infected individuals. If not eradicated, SARS was eliminated. This was due in large part to the fact that people were almost universally symptomatic when they were infected and could be quarantined immediately.


Can SARS-COV-2 become like the seasonal flu?
 I most certainly hope not. There are usually millions of influenza cases annually and influenza kills, on average, 25,000 individuals in the United States each year. Imagine if we had that number of COVID-19 cases also. We would likely be in a panic each year as we would worry that we were about to have another severe COVID-19 outbreak, since it is much more deadly than influenza. We should have the goal of having significantly fewer cases of COVID-19 than of influenza annually.
There are three good reasons to believe that COVID-19 will have less impact on us than influenza within the next several years. 
First, influenza viruses mutate much more rapidly than SARS-COV-2. Though the mutation rates are not as dramatic as some of the great mutators such as HIV or Hepatitis C (for which effective vaccines have still not been able to be developed due to rapid mutations in those viruses), it is significantly higher than the coronavirus, thanks in part to a proofreading enzyme that the coronavirus carries in its genetic makeup. This helps eliminate mutations (changes in genes) before the virus replicates. Since influenza viruses mutate more rapidly, vaccines each year are generally no more than 50% effective. Current vaccines for SARS-COV-2 are up to 95% effective. Thus, we can generate better immunity and keep case rates much lower for COVID-19 as long as people continue to follow vaccination recommendations.
Second, we will have effective oral treatments that can help lessen the severity of COVID-19 infections in the future. Several of those oral medications are in phase 3 randomized clinical trials at the present time. This will lessen the death rate and the significant morbidity that COVID-19 is currently causing.
Third, we can take advantage of the spreading pattern of COVID-19. It tends to show up as a cluster of cases often due to one superspreading individual.  Flu spreads more uniformly. This means that if we are able to get rates way down, we are more likely to identify isolated outbreaks that we can quickly respond to, compared with the slow burn that we see in a typical flu season. One big superspreading event, such as a large indoor concert in a poorly ventilated arena, could set us way back, however. Hopefully, in the next several years, COVID-19 cases will become very infrequent, and generate rapid response when they occur. 


Will we have changed due to COVID-19? 
I look forward to the “new normal.” Consider these questions and opportunities that lie ahead for all of us:
• Will we cherish time with family, friends and loved ones more?
• Will we connect more frequently with those far away through Zoom, Face-Time, or other platforms?
• Will we work more from home and travel for business less frequently?
• Will we take the freedoms that living in this beautiful valley and in this country offer us as lightly?
• Will we better live one day at a time realizing that things can change dramatically at any moment?
• Will we trust medical science more, or continue to rely on social media for our fact-finding?
The only person we can change is ourselves. Knowledge and wisdom come through learning from experience. What an experience this pandemic is. Hopefully, we can all change in ways that allow us to respect ourselves and others more and accept our differences without criticism and contempt in the days, weeks and months ahead. It starts with each of us.
Stay hopeful, stay diligent, stay properly informed, stay safe and stay well.


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