Dr. Shyam P Lohani

The world has become a confusing place since the coronavirus was declared a pandemic by the World Health Organisation (WHO). The response to the pandemic has been different in different countries with mixed results in containing the spread of the disease. It has resulted in change in our normal traditions, disrupted our daily activities, and claimed hundreds of thousands of lives.
It has been proved that when people mix together, infections spread faster. Most often the virus disease spreads in households, and in workplaces, and on the journeys people make. There have been reports of the super spreader and that happens mostly in closed and confined places. Thus, in order to reduce human to human transmission and overall cases, the reduction of mixing among people becomes important.

Evidences
Having evaluated the way coronavirus has been behaving over the last seven months, it can be said that COVID-19 is going to stay for some time. The future course of the disease depends on many unknowns such as how immunity develops against it, when vaccine arrives for the masses, how seasonality affects its spread, how the government plans to tackle its spread, and how the individual behaves.
Still, the most important strategies to follow in dealing with COVID -19 have been to suppress transmission of the virus, through detecting, testing, isolating, and caring for those affected. Contact tracing must be comprehensive and rapid by tracing about 80 per cent of contacts within a few days to control an outbreak. Reducing contact between people probably also helps with other preventive strategies.
The strategy for containing infectious disease outbreaks is contact tracing and contacts to the infected are identified, then isolated to prevent further spread of the disease. In order to have significant control, it is imperative to trace a high percentage of contacts. Therefore, decreasing interaction between people results in fewer contacts and the required percentage of tracing can be achieved.
The preventive strategies require physical distancing, wearing masks, dissemination of public information based on facts and science, expanded testing, increased healthcare facility capacities, supporting healthcare workers, and ensuring adequate supplies. The most worrisome fact is that this highly infectious virus spreads rapidly. Preventive measures should be adopted to avoid a huge surge. These strategies will help people get healthcare in time and result in less mortality.
The recent pieces of evidence suggest that behaviour changes can prevent its spread if most people comply with preventive measures. As with other coronaviruses, if immunity lasts for less than a year, there could be an annual surge of COVID-19 cases for many years. This pandemic has provided opportunities for rapid advancements in healthcare and innovation in the coming days. Many human respiratory viruses such as influenza, and other human coronaviruses, and respiratory diseases follow seasonal oscillations that lead to winter outbreaks, so SARS-CoV-2 is likely to follow the same course.
Owing to the high reproductive number or attack rate, the virus causing COVID-19 appears to spread more easily than the flu does. Also, there have been reports that asymptomatic transmission may account for a greater proportion of the spread of this disease compared with the flu. It has been speculated that the SARS-CoV-2 outbreaks could occur in waves every winter. The risk to adults who have already had COVID-19 could be reduced, as with flu, but it would depend on how long immunity to this coronavirus lasts.
The virus must be eliminated completely or people develop lasting immunity through herd immunity or a vaccine so as to end the pandemic. But 55-80 per cent of a population must develop immunity in order for this to happen. Two factors that may play important role in determining the course of the pandemic in the coming years are when a vaccine is available for a large population and how long immunity lasts following vaccination or recovery from infection. The available vaccines are of different efficiencies, some provide lasting protection such as for measles or polio whereas for whooping cough and influenza lasts only for a short period of time. Similarly, some viral infections themselves prompt lasting immunity, others a more transient response.

What is next?
What happens when immunity lasts short-term as of other human coronavirus infection? This may result in people get re-infected and there could be annual outbreaks. Another optimistic possibility is that immunity to SARS-CoV-2 is long-lasting. In that case, even without a vaccine, it is possible that after an initial worldwide outbreak, the virus could turn itself into less infectious and disappear by the next year. However, if immunity is moderate, lasting about a few years, then it might seem as if the virus has disappeared, but it could surge back as late as after a couple of years.
The present trend has shown different patterns of viral infectivity. The countries with high proportions of older people have been much affected and children and younger people are fewer susceptibilities to the infection. Thus, the future course of the COVID-19 pandemic depends on many factors such as preventive strategies by the authorities, time of vaccine arrival, widespread distribution, and protection provided by the vaccines and immune response following viral infection. As the future is surrounded by uncertainties, the best approach to fighting off this pandemic would be to follow preventive strategies to protect the vulnerable populations. Finally, continuous impetus should be directed to upgrade the healthcare capacities in tackling serious COVID-19 cases.

(A Professor, Lohani is the founder and academic director of Nobel College. lohanis@gmail.com)