World needs to press Covid-19 reset button in 2022, say experts

As the door closes on the second year of Covid, experts say there is a good chance a modicum of normality will return in 2022.

On the horizon are a greater range of oral treatments,  booster vaccine shots, cheaper tests, fewer deaths and the management of Covid as an endemic disease that we live with.

New variants, however, could be waiting in the wings to turn everything upside down.

Shabir Madhi, dean of health sciences at Wits University and a professor of vaccinology, said the peak of the Omicron-fuelled fourth wave might have come and gone but “we might still see an increase in deaths”.

Even so, those deaths will “likely be one-tenth” of what the Delta wave brought on.

The world must “accept Covid is here to stay” and the goal remains “minimising severe disease and death”.

If we get that right, he said, “we are in a good space to get back to normalcy in the first quarter of 2022. But we will need to recalibrate how we continue surveillance and become less excited each time there is a new variant.”

According to a McKinsey report, what happens in 2022 depends on how societies respond. Researchers led by Sarun Charumilind said: “Three levers are likely to be especially important, starting with the extent to which countries can effectively scale and make available new oral therapeutics.”

These treatments are intended to reduce progression to severe disease.

Earlier this month, the Food and Drug Administration in the US approved treatment pills from Pfizer and Merck, and several others are being trialled or awaiting the regulators’ rubber stamp. 

McKinsey’s second lever is booster doses. “Evidence is accumulating that booster doses are especially important for protecting against the Omicron variant, and accelerating their rollout will help protect populations,” said Charumilind.

Third, “public fatigue and the lessons of the past two years” have made “finding the right combination of public health measures critical”.

In SA, the combination is proving tricky after the health department vacillated over protocols on contact tracing, testing and quarantine.

On Tuesday, five days after relaxing these protocols, officials did an about-turn and reinstated the more stringent approach.

For society, finding the public health sweet spot is not without tensions that affect daily life and harmony, said Hlonipha Mokoena, a historian at the Wits Institute for Social & Economic Research.

“We may be looking at a year ahead of innumerable legal and cultural confrontations that are going to test the foundations of even the most stable societies,” she said.

Because of these battles, “I think 2022 may end up being worse than both 2020 and 2021 combined”.

Mokoena said the virus “is obviously not resting and has no limits” — and that means anything could happen.

This has already been shown over the past two years as each variant changes the game.

Ronald Whelan, chief commercial officer at Discovery Health, said the medical aid’s data  showed that in the first wave there were 44 hospital admissions per 1,000 infections. This rose to 131 in the second Beta-fuelled wave and stood at 101 in the Delta wave.

In the fourth wave, dominated by Omicron, there have been only 38 admissions per 1,000 infections.

“It’s too early to comment on mortality rates, particularly given the lag time between infections and deaths on a population basis,” said Whelan. “We are cautiously optimistic, based on initial data and clinical insights, that mortality is lower for Omicron infection in SA.”

According to Lise Jamieson, a Wits University researcher who is part of the South African  Covid-19 Modelling Consortium, the unpredictability of variants makes forecasts for 2022 impossible.

“Because it is difficult to predict viral evolution, we are unable to predict the trajectory for 2022,” she said. 

It is also impossible to predict a 2022 that is uniform across countries because variables such as previous infection, vaccine access and rollout, and how governments and citizens respond, differ wildly.

Graeme Meintjes, a professor of infectious disease at the University of Cape Town, said: “One reason for the lower hospital admissions is that most South Africans now have some immunity to SARS-CoV-2 acquired through previous infection, vaccination or both.

“We know that immunity may not prevent infection, but it remains very effective at preventing severe disease.”

SILVER BULLET?

Scientists have identified antibodies that neutralise Omicron and other SARS-CoV-2 variants by targeting areas of the virus spike protein that remain unchanged during mutations.

This means it may be possible to design vaccines and antibody treatments that will be universally effective, said David Veesler from the University of Washington.

"This finding tells us that by focusing on antibodies that target these highly conserved sites on the spike protein, there is a way to overcome the virus’s continual evolution," he said.