Chandrakant Lahariya | Covid virus hasn't gone, but risk now is very low

On November 8, 2022, India reported zero Covid-19 deaths for the first time since March 30, 2020. The daily Covid-19 positive cases, at 625 cases, were at the lowest since April 9, 2020. The decline has been sustained for a few weeks.  Understandably, the Covid-19 pandemic is not on the front pages of newspapers, the face masks have been shelved by most people and hardly anyone is talking about hand-washing and physical distancing. Life seems to have returned to the “pre-Covid-19” period. However, a key question remains — whether Covid-19 is still a cause of worry or not? The short answer is “no”. Let’s deep dive.

Though SARS-CoV-2 — the virus which caused Covid-19 — is still around and circulating in most settings (and is unlikely to disappear even in the future, either); but its ability to cause disease has been blunted, due to either past infection or Covid-19 vaccination and — in most cases — both natural infection and vaccination, the fresh infections are not resulting in the symptomatic disease. That’s why Covid-19 is being considered endemic in India. There is a very important distinction in hospitalisation whether they are admitted “due to Covid-19” or “due to other health conditions but with the Covid test positive”. The number of active cases as well as people admitted to hospitals due to the Covid are also lowest since the early months of the pandemic.

Yet, even though Covid-19 has become endemic in India, the pandemic at the global level is not over. In those countries, where natural infection has been low and/or the coverage with vaccines is sub-optimal, it is too early to conclude the disease is endemic. Clearly, all countries have not transitioned to the endemic stage, and that’s why the Covid-19 pandemic is still ongoing in the world.

This raises another question: can we in India forget Covid-19 completely? The short answer, again, is “no”. A disease which becomes endemic does not rule out a fresh spike. The mutations in SARS-CoV-2 are a normal process. There have been hundreds of mutations in SARS-CoV-2 since it was first detected. While low transmission and endemicity would mean a slow rate of mutation, those would continue.  If in time a few mutations happen in SARS-CoV-2, that gives the virus the potential to escape immunity and ability to transmit faster, a fresh wave is possible; but the probability is low. Then, every mutation in SARS-CoV-2 doesn’t become an immediate concern. Of all mutations, only a few have been considered variants of concern. The last variant of concern of SARS-CoV-2 has been Omicron — first detected nearly a year ago. Omicron continues to be the only currently circulating variant of concern. In between, many subtypes and variants have emerged, but none had characteristics very different from Omicron. With most of the population developing some form of immunity — natural or vaccine-induced — even new mutations are unlikely to make a major impact.

So should people drop all precautionary measures, such as face masks, etc.? All children (whether vaccinated or not) and every adult who has got at least two shots can start living a normal life. A small group of those with “high risk” of severe Covid-19 disease, with comorbidities, with weaker immunity and who are under treatment for any illness need to be careful, especially if there is a reported spike in cases in any setting. Children don’t need to wear masks, at least not to protect from Covid-19. For adults, wearing a mask is an entirely personal choice, keeping in mind that the risk is very low, but not zero.

The uptake of Covid-19 precaution shots in India is low and people are not very keen to get a third shot. Then, there are a few who received precaution shots in early 2022, for many of them it is more than months since the third dose. Should they get another (fourth) Covid shot?  The short answer is: not needed. It’s a fact that the level of antibodies declines as the time since vaccination elapses. However, in India, with most people having received two vaccine shots and arguably more than one natural infection in the last two-and-a-half years, everyone has been boosted, immunologically speaking. Therefore, the role of Covid-19 precaution shots is very limited. Children younger than 12 years don’t need Covid-19 vaccines. Those children in the 12-17 age bracket who got two shots don’t need a third shot.

What lies ahead for Covid-19? In the time ahead, SARS-CoV-2 infections and a few Covid-19 cases will always be reported from almost all settings. “Zero-Covid” isn’t a workable strategy, as the world is watches with utter disappointment the harsh measures being implemented in China with absolutely no logic and no success. Clearly, it’s time to develop evidence-informed approaches by the government and realistic expectations and personal protection approaches by citizens. While it is difficult to predict the course of SARS- CoV-2 transmissions, regular mutations in the virus are a given; however, the possibility of them being able to cause fresh waves remains low.

What is the future of Covid-19 vaccination and booster doses?  It is likely that a subsection of the population — mostly high risk — may need regular booster shots. However, more scientific evidence is needed to determine the interval for such booster doses. It could be annual, every two years or when a new variant emerges. It is also possible that SARS- CoV-2 strains are combined with future flu vaccines. It is possible that the second generation Covid-19 vaccines will provide long lasting immunity and thus booster doses will be less frequent. Future Covid-19 vaccines may also be combination of multiple variants and may also be universal SARS-CoV-2 vaccines, influenced by AI, with the ability to take care of circulating variants but also those variants which may emerge in time ahead. Clearly, a recommendation for a fourth Covid-19 shot is not on the horizon immediately.

It is a given that there will be a day — most likely an otherwise uneventful one, in the year 2023 — when the Covid-19 pandemic will be officially declared over. However, we as individuals, society and nations, need to learn from the last two and half years — to do everything to prevent the emergence of new pathogens and to be better prepared to respond to any outbreak or epidemic, which would continue to be reported.