Ending the Pandemic
antiviral drugs, antibody tests, contact tracing, vaccines
'Finally, a virus got me.' Scientist who fought Ebola and HIV reflects on facing death from COVID-19
By Dirk Draulans May. 8, 2020 , 5:00 PM
Virologist Peter Piot, director of the London School of Hygiene & Tropical Medicine, fell ill with COVID-19 in mid-March. He spent a week in a hospital and has been recovering at his home in London since. Climbing a flight of stairs still leaves him breathless.
Piot, who grew up in Belgium, was one of the discoverers of the Ebola virus in 1976 and spent his career fighting infectious diseases. He headed the Joint United Nations Programme on HIV/AIDS between 1995 and 2008 and is currently a coronavirus adviser to European Commission President Ursula von der Leyen. But his personal confrontation with the new coronavirus was a life-changing experience, Piot says.
"Without a coronavirus vaccine, we will never be able to live normally again. The only real exit strategy from this crisis is a vaccine that can be rolled out worldwide. That means producing billions of doses of it, which, in itself, is a huge challenge in terms of manufacturing logistics. And despite the efforts, it is still not even certain that developing a COVID-19 vaccine is possible."
-- Peter Piot
www.statnews.com/2020/05/01/three-potential-futures-for-covid-19/
Three potential futures for Covid-19: recurring small outbreaks, a monster wave, or a persistent crisis
MAY 1, 2020
.... In one future, a monster wave hit in early 2020 (the current outbreak of millions of cases and a projected hundreds of thousands of deaths globally by August 1). It is followed by alternating mini-waves of much smaller outbreaks every few months with only a few (but never zero) cases in between.
In the second scenario, the current monster wave is followed later this year by one twice as fierce and even longer-lasting, as the outbreak rebounds after a summer when a significant drop in the number of cases and deaths led officials and individuals to let down their guard, relax physical distancing more than was safe, and fail to heed (or even detect) the early warning signs that a new outbreak was gathering force. After this doubly disastrous second wave, the sea is almost calm, marred only by an occasional wave of cases that number barely one-fifth of what the fall and spring of 2020 saw.
In the third possible future, the current wave creates a new normal, with Covid-19 outbreaks of nearly equal size and, in most cases, duration through the end of 2022. At that point, the best-case scenario is that an effective vaccine has arrived; if not, then the world experiences Covid-19 until at least half of the population has been infected, with or without becoming ill.
What all three scenarios agree on is this: There is virtually no chance Covid-19 will end when the world bids good riddance to a calamitous 2020.
www.cidrap.umn.edu/sites/default/files/public/downloads/cidrap-covid19-viewpoint-part1_0.pdf
COVID-19: The CIDRAP Viewpoint
Center for Infectious Disease Research and Policy (CIDRAP)
April 30th, 2020
Part 1: The Future of the COVID-19 Pandemic: Lessons Learned from Pandemic Influenza
Pressing Issues
- Because of a longer incubation period, more asymptomatic spread, and a higher R0, COVID-19 appears to spread more easily than flu.
- A higher R0 means more people will need to get infected and become immune before the pandemic can end.
- Based on the most recent flu pandemics, this outbreak will likely last 18 to 24 months.
- It likely won't be halted until 60% to 70% of the population is immune.
- Depending on control measures and other factors, cases may come in waves of different heights (with high waves signaling major impact) and in different intervals. We present 3 possibilities.
- States, territories, and tribal health authorities should plan for the worst-case scenario (Scenario 2), including no vaccine availability or herd immunity.
- Government agencies and healthcare delivery organizations should develop strategies to ensure adequate protection for healthcare workers when disease incidence surges.
- Government officials should develop concrete plans, including triggers for reinstituting mitigation measures, for dealing with disease peaks when they occur.
- Risk communication messaging from government officials should incorporate the concept that this pandemic will not be over soon and that people needto be prepared for possible periodic resurgences of disease over the next 2 years.
Scenario 1: The first wave of COVID-19 in spring 2020 is followed by a series of repetitive smaller waves that occur through the summer and then consistently over a 1- to 2-year period, gradually diminishing sometime in 2021. The occurrence of these waves may vary geographically and may depend on what mitigation measures are in place and how they are eased. Depending on the height of the wave peaks, this scenario could require periodic reinstitution and subsequent relaxation of mitigation measures over the next 1 to 2 years.
Scenario 2: The first wave of COVID-19 in spring 2020 is followed by a larger wave in the fall or winter of 2020 and one or more smaller subsequent waves in 2021. This pattern will require the reinstitution of mitigation measures in the fall in an attempt to drive down spread of infection and prevent healthcare systems from being overwhelmed. This pattern is similar to what was seen with the 1918-19 pandemic (CDC 2018). During that pandemic, a small wave began in March 1918 and subsided during the summer months. A much larger peak then occurred in the fall of 1918. A third peak occurred during the winter and spring of 1919; that wave subsided in the summer of 1919, signaling the end of the pandemic. The 1957-58 pandemic followed a similar pattern, with a smaller spring wave followed by a much larger fall wave (Saunders-Hastings 2016). Successive smaller waves continued to occur for several years (Miller 2009). The 2009-10 pandemic also followed a pattern of a spring wave followed by a larger fall wave (Saunders-Hastings 2016).
Scenario 3: The first wave of COVID-19 in spring 2020 is followed by a "slow burn" of ongoing transmission and case occurrence, but without a clear wave pattern. Again, this pattern may vary somewhat geographically and may be influenced by the degree of mitigation measures in place in various areas. While this third pattern was not seen with past influenza pandemics, it remains a possibility for COVID-19. This third scenario likely would not require the reinstitution of mitigation measures, although cases and deaths will continue to occur.
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