Just as cities were rejoicing that they had escaped the disaster – and even in some places arrogantly believing that they had repelled the virus – a third wave swept across the globe after the Ministry of Health and emergency committees revoked orders to close theaters, schools and churches and wear masks.
- The Great Flu: The Epic of the Deadliest Plague
On February 9, the number of confirmed COVID-19 cases worldwide exceeded 400 million.
In the history books about the COVID-19 pandemic, January 2022 could be an important turning point – in the face of a new, more contagious strain, countries have decided to abandon resistance and adopt a "lying flat" strategy.
The World Health Organization issued a statement: "Lift or ease the international travel ban".
In Europe, the UK was the first to abolish all vaccination measures, including mask mandates, work from home and vaccine passes, and even the Ministry of Education removed the requirement for secondary school students to attend classes and wear masks in public places in the guide; on February 1, Denmark announced that all COVID-19 restrictions would be lifted and completely flattened; on February 3, Sweden also began the same policy...
In the United States, as early as last Christmas, it had decided to shorten the quarantine to 5 days – even among developed countries in Europe and the United States, which is still the shortest.
In the winter of the third year with the new crown, the desire to return to normal life has never been stronger, and the sense of burnout has never been stronger. Many began to expect that the surge caused by Omi kerong would be the last big battle between humanity and the new crown, and this expectation, even in the rigorous scientific community, has spawned a wave of optimism.
More than 100 years ago, we had no vaccines, no drugs, and no knowledge of the virus as we do today, and the Spanish flu of 1918 ended three years after the outbreak. Now, with more and more data showing that the new strain that is sweeping the world, Olmiqueron, is more contagious than previous variants, but does not seem to cause serious diseases, what reason can we not be optimistic?
The appearance of Omikeron has fueled this optimism. Stronger transmission and milder symptoms, as Anthony Fauci, a top Infectious Disease Scientist in the United States, put it, this new strain seems to be a "live attenuated vaccine".
A great debate about the "end of the pandemic" has begun. The central question of this debate is: Can the COVID-19 pandemic end in 2022? Or, more precisely, can COVID-19 transform from a "pandemic" to an endemic this year?
The latter means that we will not need to take special public health measures, no longer need to record every case, and we will not have to test all those who have symptoms, that is, human beings will return to normal life.
However, for those countries that are actively preventing and controlling the epidemic, such as China and New Zealand, which have always adhered to the "zero clearance" strategy, the more countries "lie flat" according to the idea of "universal immunization", the greater the risk and pressure.
The end of the pandemic
Is it the wishful thinking of Western-centrists?
On January 19, The Lancet published a predictive article that became a "bombshell" in the debate and a global focal point. In this article, Chris Murray, director of the Institute for Health Metrics and Evaluation (IHME), who has long provided the White House with an epidemic prediction model and has been predicting the case fatality rate very accurately, makes the boldest prediction of the trend of the epidemic: the global pandemic is likely to end soon, marking the time point of March 2022.
According to Chris Murray's model cited in that article, during the peak period of infection around January 17, the number of daily COVID-19 infections in the world will reach more than 100 million, and by March this year, 50% of the world's population will have been infected with a variety of mutations of Omicron, thus creating a protective force and establishing an immune barrier for all mankind.
That is to say, whether it is through active immunization, that is, vaccination; or through passive immunity, that is, through natural infection to obtain immunity, the human immune barrier is about to be established, and herd immunity is about to be realized.
Who's Director for Europe, Hans Hans Kluge is equally optimistic, saying in an interview with Agence France-Presse on January 23 that Aumiqueron could infect 60% of Europeans in March, which would push the covid-19 pandemic to a new phase and potentially end it in Europe.
Not only foreign experts, Zhang Wenhong also has great confidence in ending the new crown pandemic at the end of this year, "In principle, in the coming year, whether it is the level of herd immunity, or the immune barrier established through vaccines, or the listing of new crown treatment drugs, it means that "this may be the last 'cold winter'".
However, although many experts expect that the more contagious but milder omilon will end the new crown pandemic, when it comes to the specific time point, whether it is March 2022 or the end of 2022, the academic community is far from reaching a consensus.
The main argument of opponents in European and American academic circles is that it is too early to predict that Omikejong will become a "endemic epidemic", because it is very likely that another variant will emerge.
Catherine Smallwood, WHO's senior European emergency officer, told a news conference that endemic epidemics require stable, predictable spread of the virus, "but we still face great uncertainty and the virus is rapidly evolving, creating new challenges." We certainly cannot say that this is a local epidemic. ”
The aforementioned Director of WHO Europe, Hans Krueger, while expecting a period of calm for TheOmicks, which is currently sweeping Europe, before the end of this year, acknowledges that the pandemic is still likely to make a comeback.
The reason for the WHO's decision to lift the international travel ban is not that the epidemic is coming to an end, but that given the speed and intensity of the spread of Theomilon, the travel ban has proved to have a limited effect on stopping the spread of the virus.
"Efforts to track the spread seem futile," the Murray model concluded. That is to say, the end of the so-called pandemic is not the subsidence of the epidemic, but the spread of the virus is too strong, and human beings have been unable to control it.
From this point of view, a number of virology and epidemiology experts interviewed by Eight Point Jianwen expressed their concerns, and this kind of "end of the pandemic" and "lying flat" arguments are more from the perspective of the European and American center.
"Their so-called end of the pandemic is actually a bit like a regional one, and these experts who have the right to speak subconsciously feel that the United States and Europe are over, then there will be no big problems elsewhere, and the global pandemic will end."
In Europe and the United States, the surge in cases has indeed passed, and the number of infected people is falling. At its peak around January 10, the average U.S. reported more than 800,000 cases a day, and two weeks later, it had dropped to 650,000.
But in Asia, which accounts for half of the world's population, the peak of cases has yet to come.
On January 15, when the epidemic in Europe and the United States began to retreat, the number of infections in Asian countries such as Japan, South Korea, Singapore, and other asian countries was experiencing record growth. By January 26, Japan's single-day confirmed cases had reached 80,000 and reached a record high for several consecutive days; South Korea's single-day confirmed cases had exceeded 10,000, and the country was taking strict social distancing measures; and in Singapore, the number of infected people had also reached record levels for several consecutive days.
In Southeast Asia, animal viruses that are highly homologous to the new crown virus have been found, and India has been the birthplace of delta viruses with high transmission and high severity rates. Considering that we still know little about the natural source of the new crown virus, Asia is destined to be a key continent to control the global epidemic, and the epidemic here is only just beginning.
Can the pandemic end this year?
Virology expert Chang Rongshan mentioned, "We may not be able to see until August, whether it is to end the global pandemic, August is the winter in the southern hemisphere, then we can see how the situation in the southern hemisphere is, whether there are new mutants." ”
How far away is influenza?
Lu Mengji, a German-Chinese virologist and professor at the Institute of Virology at the University of Essen School of Medicine, told Eight Point Kenwen: Perhaps, there was indeed a time node, at that time, if we can take measures, it is possible to eradicate the virus, and today, the time has passed, "we can't change."
For the entire human society, coexistence with the virus has become the only option at present.
So, when we talk about the "end of the global pandemic," we're not talking about whether the coronavirus will disappear completely, but when the new coronavirus will become an endemic like the flu. It also means that many people may experience a mild infection with the virus every few years, but it will not become seriously ill, and the government will hardly need to take any special measures.
Of course, a local epidemic does not necessarily represent a small threat. Tuberculosis, for example, remains an endemic disease in India and some countries, but causes more than a million deaths each year.
However, even optimistic forecasters have to admit that even if Omi kerong can quickly infect susceptible people and promote the rapid development of immunity in the human body to end the global pandemic, the current price is huge.
According to the CDC, more than 30 million people are infected with influenza in the United States each year, 12,000 to 61,000 flu-related deaths and 140,000 to 810,000 flu-related hospitalizations since 2010.
Compared to the flu, the data on infections, hospitalizations and deaths in Aumechjong are staggering. In the United States, the average number of infections per day in Aomi kerong fell from a peak of more than 800,000 around January 10 to 650,000; but the death toll continued to rise, averaging more than 2,300 a day around January 25; the number of hospitalizations was nearly stable, averaging about 155,000 per day.
With just a 10-day peak, Omikeron can reach the lethality of the flu for a full year. Moreover, influenza only breaks out every year during the flu season in autumn and winter, while COVID-19 is endemic throughout the year, and even in the summer, it will appear to be epidemic, which is very rare in respiratory infectious diseases.
"At the moment, our pursuit is to cut the peak, as long as it is not a huge impact on the medical system at one time." Lu Mengji, a professor at the Institute of Virology at the University of Essen In Germany, told Eight Point Kenwen.
The scale of the infection caused by Omicron is still not comparable to the impact on the medical system, but how toxic is it? It is the key to discussing whether "influenzaization" can be achieved.
On January 13, 2022, case Western Reserve University and the National Institutes of Health studied the severity of the first infection of the new crown virus in children under 5 years of age before and after the Omiljung epidemic, and the results of the study showed that 1.04% of the infected people in Omiquerong were hospitalized, which was 1/3 of The Delta's 3.14% hospitalization rate; of which 0.33% of the infected people in Omiqueron required mechanical ventilation, corresponding to 1.15% of Delta. The above research is currently published on the pre-print platform medRxiv.
The U.S. has yet to approve a COVID-19 vaccine for children under 5 years of age, which means that the result directly represents a change in the virulence of the Omilon and Delta mutants in unprotected populations.
On January 19, 2022, South African researchers published a large epidemiological study on Omiljung in The Lancet. The results showed that in South Africa, where the vaccination rate was only 26%, 2.4% of all Omilon infected people needed to be hospitalized and 23.4% of those hospitalized developed to severe disease; for the elderly aged 60 years and older, this data improved significantly, with 8.4% requiring hospitalization and 72.5% of hospitalized people progressing to severe illness. "It's still a high percentage." Chang Rongshan said.
Researchers at the World Health Organization's Focal Point for epidemiology and control of infectious diseases, in a review published in The Lancet, directly noted that the toxicity of Omikeron is "milder but not mild."
To be sure, the illness of the Omiljung infected was milder than that of the Delta infected. As for whether the new crown has evolved into a large flu virus? There is currently no comprehensive epidemiological data available to compare Omilon and influenza.
Lu Mengji believes that the fatality rate of the new crown is still higher than that of the flu, "the new crown fatality rate was estimated at 4% at the earliest, and according to the data two weeks ago, Germany confirmed 757 per 100,000 people, yesterday it was 122 deaths per 10 million people per week, and the confirmed mortality rate was roughly estimated at 0.16%. In Israel, the confirmed mortality rate estimated according to similar data is 0.11%, but it is almost the region with the best level of prevention and control and treatment, and the fatality rate of influenza is within 0.1%. ”
"The two main premises of influenza are, first, we have vaccines to prevent infection, and second, we have highly effective small molecule drugs. No one dares to say that the global pandemic will end until it reaches that level. An epidemiologist told Eight Points.
At present, achieving this goal through herd immunity seems to be just a dream. Following the advent of alpha variants, the WHO raised the threshold for herd immunity from 70 percent to 90 percent. In early 2021, the WHO acknowledged that the goal of herd immunity may not be achieved.
The future will definitely end
Yet we don't know how much it will cost
Tan Xiaodong, a professor at the School of Public Health of Wuhan University, told Eight Point Jianwen: "The fading of the global pandemic generally requires a slowdown, control, elimination, and finally to the stage of eradication, which is a major stage that must be passed, from measles to smallpox, we have responded to it in this way." ”
For today's new crown, eradication is almost impossible, influenza, coexistence with the virus, may be the only right direction in front of mankind at present. The only question in between is, how much do we need to pay in order to achieve this coexistence?
In the 1919 pandemic, it was estimated that more than half of the world's population was infected, and the death toll, according to today's historians and epidemiologists, was 50 million to 100 million, accounting for 2.5%-5% of the population at that time, 5-10 times the number of people who died in the First World War at the same time.
Another worrying analogy is that in the global pandemic a hundred years ago, there were three waves, and John M. Barry wrote in his book The Great Flu: "Just when cities are rejoicing in escaping the disaster – and even people in some places arrogantly believe that they repelled the virus, a third wave swept the world after the Ministry of Health and the emergency committee revoked the order to close theaters, schools and churches and wear masks." ”
As for the cause of the third wave, Barry wrote: "The virus mutates again, it becomes very different from before. People who fall ill in the second wave should be fairly immune to the recurrence of the disease, just as people who were knocked down by the first wave of the virus were more resistant than others when the second wave of flu hit. But this time the virus mutated too much, the degree of antigen drift was too large, and the spark of influenza was finally rekindled. ”
This description explains the biggest trouble we face in the face of epidemics, whether it is active immunity or passive immunity, the protection we get will weaken over time, and for the new crown, influenza, which mutates particularly quickly, this weakening will be particularly obvious, even fatal. Because, this means, the protection gained from Delta or Omikeron infections is likely to be inefficient against the new variant.
Over the past two years, the coronavirus has evolved multiple dangerous variants – Alpha, Delta, and Omikeron, among others. And at present, as far as the Aumechjong itself is concerned, the more contagious new subtype of Omiljung has emerged in many countries, and in Denmark, the infection cases of the new subtype have accounted for more than half of the total number of infections.
The new subtype of The Semikron, known as BA.2, has been classified by the UK Health Security Agency (UKHSA) as a "variant under surveillance". At present, more than 40 countries around the world have reported the discovery of this new subtype, and in the United Kingdom, India, Sweden, and Singapore, the strain has occupied a considerable proportion.
For this new subtype, in addition to indications that its transmission ability will be stronger and spread faster, we still know very little about its pathogenicity and escape ability.
If a new mutant strain emerges that can replace the mainstream strain of Aomi Kerong, Chang Rongshan said: "There are two things that can be determined, the first is that the transmission power will continue to increase, and the second is that the immune escape ability will continue to increase." But the virulence of the new mutant strain is difficult to predict. ”
The worst-case scenario, of course, is that the new variant strain is both highly contagious and highly pathogenic.
Evolutionarily, the ultimate goal of viruses is not to kill their hosts, but to spread their genes more widely. However, the future is clear, but the road is tortuous. In this uncertain world, no one knows whether the next new mutation will be more toxic or weaker, and no one knows how much the virus and its host, humans, will have to pay to reach a harmonious coexistence, or "flu", Happy End.
In an interview with Deutsche Radio, Christian Drosten, an authoritative German virologist, once said that if one of the two variants of Aumechron is combined with the Delta variant, it may produce a more dangerous virus. Omikeron mutates on the spinous protein, making it easier to evade the body's immune defense system.
That said, no one can guarantee that the coronavirus will evolve unswervingly in an increasingly benign direction. And even if the next variant is as mild or even mild as Omikejong, it could still wreak havoc on the health care system if it is strong enough to spread.
Given how often the coronavirus has upended expectations, even though two years have passed since the COVID-19 pandemic, no one dares to predict that today's Ombi Kejong will be the last blow in the evolution of this virus.
What are the conditions
Can China change its anti-epidemic strategy?
In January, in the Journal of the American Medical Association (JAMA), a finding by researchers at oregon Health and Science University was published: People who have a breakthrough infection after vaccination may gain "super immunity" to the virus.
One of the lead authors of the study once explained to the media: "Once you're vaccinated and then exposed to the virus, you may have fairly good protection against future variants." ”
The result of this study may be the starting point of the current European and American prevention and control strategies, so that most people are vaccinated and then infected, establishing this "super immunity" that is effective against all variants. Then, as the more contagious Omiljung expands this immune barrier further, COVID-19 will likely transform from a global pandemic to a local pandemic.
In the aforementioned "Lancet" prediction article, it was written that for those countries that are actively preventing and controlling the epidemic, such as China and New Zealand, which have always adhered to the "zero clearance" strategy, the more countries "lie flat" according to the idea of "universal immunization", which means the greater the risk and pressure.
The R0 of Omikejon is greater than 7 and is one of the most contagious diseases. Since December 13, 2021, after the first diagnosis of the Aumecreon variant in Tianjin, less than a month later, 13 provinces in China have found traces of local transmission of Themi kerong. As the pace of the outbreak in Europe and the United States begins to slow, Asian countries around China are expected to usher in an outbreak period. This means that China will also face greater import pressure in the near future.
And with the lifting of the global travel ban and the resumption of economic and trade activities, it is impossible to permanently keep Omicron out of the country, the cost of zeroing will become higher and higher, and the pressure of being a "zero country" will become more and more intense.
The tight contrast between the internal and external environment has caused a certain range of discussions in China – should we adjust our anti-epidemic measures and goals? The question worth exploring more than whether it should change its strategy is, under what conditions can China change its strategy?
On January 26, Zeng Guang, a member of the high-level expert group of the National Health Commission and former chief scientist of epidemiology at the China Center for Disease Control and Prevention, published an article through his personal Weibo account, and also pointed out that the timing is the core of China's next anti-epidemic road - "'dynamic zeroing' is not 'eternal zeroing'". However, he believes that at a time when "the epidemic situation abroad has reached a new peak, and the domestic epidemic has broken out in many places and the flames are continuous", China can only strengthen the existing protective measures, not weaken.
“...... Our internal skills are not enough, there is still a gap in the population immunization coefficient, that is, immunization coverage, the antibodies of people who have been vaccinated have been greatly reduced, the third injection of the reinforced injection has not been fully done, and the vaccination rate of some high-risk groups is still relatively low, especially the elderly. ”
Although preliminary data show that the severe illness and case fatality rate of Olmiqueron is lower than that of Delta, the large number of confirmed cases always means that there are constant lives lost due to the new crown, after all, in the tsunami of the Omilon epidemic in January this year, the number of new hospital admissions to the New Crown in the United States is 155,000, the number of new deaths is about 2200, and there is an emergency in the medical system in many places. In China, the original strain of new crown in early 2020 has been in Wuhan, a provincial capital city, causing a run on medical resources.
Compared with developed countries with abundant medical resources, the current status of medical resources determines the zeroing goal set by China since the beginning of the epidemic. All efforts devoted to this end over the past two years have been, to a considerable extent, aimed at minimizing this cost.
On the other hand, recognizing that there is an immunization gap between China's population immunity level and other countries with close economic and trade communication is the premise for the development of the epidemic in the future. In interviews with Eight Points, many experts also pointed out that China needs at least a more potent vaccine and a wider range of vaccinations to withstand the import impact of easing prevention and control.
In addition, in the past two years, the strict implementation of the zeroing strategy has also reshaped the psychological expectations of the Chinese for the destructive power of the new crown to a certain extent. In the whole of 2021, the cumulative number of COVID-19 deaths in China was 2. If the strategy is adjusted, the public psychology will inevitably go through a process of regulation.
In the past countless times, in the face of a surging plague such as the new crown that spreads through the respiratory tract, human beings can only choose to obtain immunity through natural infection and coexist with the virus. In the face of covid-19, perhaps for the first time, we have the hope of achieving coexistence with the virus without large-scale deaths, but only with vaccines and drugs.
An expert, speaking on condition of anonymity, said China's current epidemic prevention achievements rely heavily on non-pharmacological intervention (NPI) measures, including testing, tracing and isolation. The Northeast plague of 1910 was controlled entirely by these measures. However, in today's world-wide integration, to eliminate the impact of the epidemic on normal social life, both pharmaceutical and non-drug means are indispensable. More precisely, now, we are using physical barriers to win time for the development of second-generation vaccines and specific drugs.
In a sense, whether there will be a next wave of this epidemic or not, the next year will be the time when China's epidemic prevention strategy will truly accept the challenge. For China, it will be a year of great pressure.
Zhu Xueqi and Zhang Yuqi wrote
Li Shanshan | writer and editor.)
This article was first published on the WeChat public account "Eight Points Health" (ID: HealthInsight)
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