Despair to hope: Despite China-driven Covid surge, WHO says we’re in a better place

Aditi Tandon

A few days from now, the world will bid farewell to the third year of the Covid-19 pandemic. As another painful year draws to a close, a ray of hope is surfacing at the end of a very dark tunnel, a hope articulated this week by the World Health Organisation (WHO), which said in its year-end review that 2023 could signal a fresh start with the pandemic declining significantly, the global mpox outbreak waning and there being no cases of Ebola in Uganda, the current location of the outbreak, for more than three weeks.

Experts warn against any premature complacency, reminding us of how no one is safe until everyone is safe

The mightiest statement of hope in the future came from WHO director-general Tedros Adhanom Ghebreyesus on December 21 when he said, “We are hopeful that each of these emergencies — Covid-19, mpox and Ebola — will be declared over at different points next year.”

That is not to say the enemy has retreated. For six straight weeks now, the world has witnessed a consistent rise in the global daily average cases of Covid-19, which spiralled from 3.86 lakh in the week ending November 16 to 5.76 lakh in the week ending December 21.

Much of this surge is being driven by China, which continues to suppress information, prompting the WHO to state clearly that gaps in data would compromise the world’s ability to deal better with the future pandemics.

With China’s Covid cases and mortality statistics consistently absent from the WHO pandemic dashboards, the world is left to believe that 81.2 per cent of the global cases as of today are being contributed by 10 countries — Japan, South Korea, USA, France, Brazil, Germany, Italy, Australia, Hong Kong and Taiwan.

Where Japan’s average daily cases during the week ending December 21 were 1.54 lakh, Taiwan reported 15,500 cases in the corresponding period while India reported a miniscule 153 — another cause for hope at home where 97 per cent of the people above 12 years have received the first Covid shot, 90 per cent have received both and 27 per cent people have already been boosted, significantly enhancing the population-level protection in the midst of the Omicron-driven Chinese surge.

Experts, however, warn against any premature complacency, reminding us of how no one is safe until everyone is safe. As long as it is the current Omicron BF.7 sub-variant — known to be highly infectious but less severe disease causing than Delta — the world can hope for a better tomorrow.

However, there is no guarantee that a newer, more lethal variant of Sars-Cov2 won’t emerge. High levels of replication of the virus in China, which is getting loads of cases, mean increased opportunity for new variants to surface — something other countries have to watch out for through sustained surveillance and genome sequencing of positive cases, which India has already begun, by mandating random 2 per cent sampling of all international arrivals. So the pathogen has not and cannot completely overwhelm human enterprise.

Since the peak at the end of January this year, the number of weekly reported Covid-19 deaths has dropped to 90 per cent, with even the WHO chief noting, “Certainly, we are in a much better place with the pandemic than we were a year ago, when we were in the early stages of the Omicron wave, with rapidly increasing cases and deaths.”

But what he says next is what will determine our future. “However, there are still too many uncertainties and gaps for us to say the pandemic is over: gaps in surveillance, testing and sequencing mean we do not understand well enough how the virus is changing. Gaps in our understanding of the post-Covid-19 condition mean we don’t understand how best to treat people suffering with the long-term consequences of infection; gaps in our understanding of how this pandemic began compromise our ability to prevent future pandemics.”

That brings us back to the unanswered question on the origins of Sars-Cov2, which continues to baffle the scientific world, with China determined to suppress key data. No wonder Ghebreyesus this week said all hypotheses are on the table. That said, lessons have been learned.

For the first time in world history, a pandemic fund has been created and nations have committed to negotiating a legally binding Pandemic Accord to prevent countries from hiding information in the future. As we enter 2023, the world is also better prepared for future pandemics, having created the tools needed to track pathogens and beat them back better.

Top of all, vaccines have been acknowledged the world over as a critical tool for public health and as life-savers.

As the experts say — pandemics won’t end, nor will the human capacity to inactivate them.

‘Worst case scenario is people getting infected, some having mild disease, and a very very tiny proportion having severe disease’

Aditi Tandon talks to leading vaccinologist Gagandeep Kang, former executive director of the Translational Health Science and Technology Institute and the first woman working in India to be elected to The Royal Society. Excerpts:

Is the virus from China going to encounter the same population in India as it does in China? No. Because 90 per cent of the Indian population has hybrid immunity, we have been vaccinated to a very high level, infected to a very high level

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Boosters might be needed every five years. Those above 60 years would likely need an annual booster shot

Covid is back in many countries just when we thought it was over.

It depends on what you call the end of the pandemic. If we say the end means we need no special efforts for Covid, that’s not true. We need to continue doing things. But can we dial down effort? That has already been done. I am a little concerned. It is very important to maintain structured surveillance infrastructure and sequencing at a very high level. Those things seem to have gone down quite a lot in the last few months. This is not a matter of urgency for the general public but from the public health point of view, we need to make sure these facilities are functional at a high level.

How do you see the China Covid surge?

If China had decided to open up six months ago, when it was their summer season and you are not dealing with multiple viruses, and had decided to first ensure all of its vulnerable population had gotten a booster dose with any vaccine but preferably not an inactivated one, it would have been better. Right now, most of the Chinese population has received only two doses of the inactivated vaccines, which seem to work slightly less well than other classes of vaccines. And this is a population that has not had a chance to develop hybrid immunity because they have been suppressing the circulation of the virus with very little exposure.

They have opened up in winter when there are other respiratory viruses and hospitals are anyway stressed. So, they are creating the perfect storm for cases to go up. The only mitigation is that this is Omicron. So it is not the same thing that would happen if it was Delta circulating. That would lead to much higher deaths.

Should India worry?

The virus can come to India. But is the virus from China going to encounter the same population in India as it does in China? No. Because 90 per cent of the Indian population has hybrid immunity, we have been vaccinated to a very high level, infected to a very high level. So if exactly the same virus circulating currently in China comes to India, it will not do the same things here as it can do in China. In China, they are predicting that anywhere between 50 and 70 per cent of the population will get infected. If the virus comes to India and infects 50 per cent Indians, we will see a lot of mild disease because most of us have already had an Omicron infection. Our worst case scenario is having cases and people getting infected, with a proportion having mild disease, and a very, very tiny proportion having severe disease.

Would we need annual boosters?

We might not. We might need boosters only every five years. Age is the most critical factor for how severe Covid becomes. A likely situation is that everyone above 60 years needs an annual booster whereas the rest do not because the risks of severe disease are lower for younger people.

Many haven’t taken boosters, is that fine?

At the moment, we have hybrid immunity: two doses of the vaccine in 90 per cent population and 90 per cent population already infected. That’s pretty good protection. How long will that protection last depends on whether you are looking at protection from infection which only lasts three months with any kind of a booster dose. But protection against severe disease and death — those seem to last much longer. The critical question is defining the right interval for the booster dose and we should be doing those studies. We cannot vaccinate a billion people every year. We need rationality of approach and can’t blindly follow the West.

With current immunity, how long can Indians be relaxed?

We can’t predict that without science. But with the variant circulating now and the sub-variants, there is absolutely no evidence that we will see severe disease. That does not mean tomorrow a new variant may not arise that can cause severe disease and infect vaccinated uninfected people. That possibility exists but today, that variant does not exist.

Will pandemics become routine?

Pandemics are already routine. We had H1N1 in 2009, MERS, Ebola. In 20 years, we have seen at least 10 infections that have happened on multiple continents and spread across. Why do we think it is going to become any different in the future?

If that’s the new normal, what’s the way forward?

Covid has shown us that we have the tools we need to detect, monitor and respond to infectious diseases. Going forward, it’s really for the governments to collaborate, share data, build platforms that allow for detection of pathogens and prevention of their spread.

Long Covid is impacting everyone’s lives.

We are getting our news from the West where they are getting high levels of long Covid. Lots of young people are dying of heart attacks, but how do you know these are Covid-related? You need data for the period before Covid so that you can say that after Covid, the numbers have gone up. Without that, you can’t predict accurately. Everyone is relating everything to Covid but to really clarify the confusion needs high-quality research.

What about fatigue, heart attacks?

Not everything is Covid-related. Some may be related to stress. People have been through a hugely difficult time and we are only just beginning to come out of it. The consequences of this on mental health, physical stress, two years of inactivity followed by high-stress situations, you are constantly uncertain about what you are encountering. People need to care for their mental and physical health.

What about wearing masks?

One thing we have learnt is that masks work very well to protect us against many respiratory infections. So, for those with respiratory symptoms, wearing masks and restricting movement is still important. Also, people who are older or vulnerable for other reasons must wear masks. But general population masking all the time is something that has not happened for many months. That is fine.

What has been your personal learning through Covid?

When you want to study an infectious disease, there are many kinds of studies you need. Some need to be quick studies that give you results in time for action. Some need to be long-term to understand the natural history of the infection. Both require strategic investments. We have not done well in developing a research strategy for Covid-19. It is not too late now.

What aspects should that research cover?

Aspects related to the future scenarios. What happens if there is a new surge, if the virus escapes immunity, if symptoms change? These are important questions for clinical practice. Once you answer these, you can think about — are we likely to need new vaccines tomorrow? Do we want bivalent vaccines? When should boosters be given? The West has decided on a four-month interval for a booster and timed it with winter. What is appropriate for us because we do not have the same kind of winter in the North and the South? The best way to address confusion is to generate the right data.

Do we know Sars-Cov2 origins any better?

Nothing can be ruled out. Given the history of emergence of viruses, it does appear likely that this was natural but we cannot rule out a lab leak.

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