COVID-19, 20, 21, 22: what next?

COVID-19 continues to ravage the world in waves and ways that are seemingly unstoppable. Even now, the unresolved debates about vaccination and herd immunity will ensure that the virus will affect us long into the future. And then there is the unspeakable discourse that centres around the possibility that the virus is a Darwinian cull – a kind of survival of the fittest. There are just too many of us and we consume too much to continue to inhabit this planet in our growing numbers. 

COVID-2022 needs to focus on effective and cheap early treatments.

Death is all around and even COVID-19, in its 2020 incarnation, is dead. The COVID-19 2020 model is obsolete as we realize that the pandemic is affecting more than just the elderly, and institutionalized and at-risk populations. Also, prevention of transmission, 2020-style, which is essentially based on wearing masks and physical distancing, is now past history. 

COVID-2020 politics arrived with the virus and is here to stay – at least for a few more days. All manner of people are infected and infective, including current leaders who promise to lead us out of this disaster, and our future leaders in schools and colleges. It hasn’t been a good year for global leadership. In the absence of a functioning WHO, we now have the experience of a panoply of differing approaches across the globe, all designed to prevent spread. Unfortunately, none appears to be effective in a sustainable way. 

As we near year end, COVID-2020 also has been the year of epidemiologists and infectious diseases experts. The former having some success in tracking the virus and disseminating information, the latter having some modest wins in managing the disease.  

What will COVID-2021 hold? It will be a year under the microscope. Micro experts such as geneticists, molecular biologists and mathematical modellers will take over where macro experts could never venture. The literature already is filled with complex diagrams and formulae, enumerating processes at a cellular level, developing anti-viral brews and predictive models of immunization outcomes. 

By COVID-2022, the first world populations who are relatively cashed-up and genetically and socially receptive, will be immunized against the virus, but not protected against the aftermath. Despite the best rhetoric and efforts, all eight billion inhabitants of the Earth will not be immunized by the end of 2022. 

More than vaccines are required. Improved treatment options need to be developed. Just as penicillin and the HIV anti-viral agents were game changers, both in the absence of vaccines, it is essential that we focus beyond vaccines to effective and cheap treatments. If the reinfection rates of COVID continue to increase, and HIV is any indication, treatment might have to be lifelong.

Global shortages of health professionals already exacerbated by the pandemic don’t help. There is certain to be a diminishing capacity to care for the increased morbidity that can be attributed to the long term effects of the virus and to the anti-viral treatments. More than ever, competent and caring clinicians are required. The current restrictive training programs need to become more flexible. With substantial and growing experience of remote learning, new-style training programs for health professionals can be developed that do not rely on the labour intensive experiential ones. Perhaps even a new category of COVID clinicians could evolve. Now that would be Darwinism at its best.   

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