Dr. Shyam P Lohani

More than one and a half years since the onset of COVID-19, every aspect of people’s life has still remained affected. Over 4.6 million people have died from this pandemic since January 2020. Many more are destined to die before we are equipped with better ways to manage or eradicate this disease, although eradication seems increasingly unlikely. This is a tragedy of almost incomprehensible proportions of recent times. Our society is vulnerable to surprises and adversities, but people suffer differently and some need a longer period of time to recover. People from low- and middle-income countries regularly experience a host of challenges that affect their vulnerability, such as high inequality, high poverty rates, and limited access to public safety networks.

Responses
The contagion has had unequal responses and impacts in countries around the world. Although science has uncovered much about SARS-CoV-2 and attained unprecedented progress on the development of COVID-19 vaccines, the world is still in great uncertainty as the pandemic continues to evolve. The largest vaccination drives are going on but this does not mean the crisis is approaching to an end. However, we are moving towards a new phase mainly due to a huge inoculation drive and natural infections that may have resulted in acquired and natural immunity.

The severity of disease caused by SARS-CoV-2 is bound to decrease with increasing immunity among the world population. Even in individuals who are not fully protected from infection by vaccination or previous infection, the outcome from infection has been perfected owing to the improvements in treatment. The infodemic has had real health consequences at the beginning of the pandemic. It was estimated that alcohol poisoning killed more than a thousand people from around the world who apparently believed an online rumour that drinking highly concentrated alcohol would prevent them from COVID-19. Therefore, the myths and rumours should be dealt cautiously by the concerned organisations.

With the ongoing inoculation drive of several highly effective SARS-CoV-2 vaccines in most countries throughout the world, there is an expectation that this pandemic will soon be over. However, unequal vaccine coverage due to disparities in global access to vaccines and jab hesitancy may lead to the prolongation of the pandemic. And vaccines may not always block virus transmission despite reducing the burden and severity of the disease. In addition, the increasing number of vaccine breakthrough cases has raised uncertainty about vaccine effectiveness for newer variants and their protection for the longer term.

At the beginning of this contagion, countries around the world imposed strict lockdowns and other restrictions, businesses were closed, toilet paper, hand sanitiser, and household cleaning supplies were depleted for months in stores. Zoom calls were building in popularity due to working from home. People were holding on celebrations and festivals and we watched the death tolls climb higher and higher each day with virtually no end in sight. The emergency use approval for vaccines against COVID-19 raised hope for the end of the pandemic albeit short-lived owing mainly to new variants.

The remarkably rapid and unprecedented development of safe and highly effective vaccines is a historic achievement. Nevertheless, fundamental questions remain still unanswered as to the mechanism(s) of protection against the disease, the extent of protection against symptomatic as well as asymptomatic infection, the duration of vaccine-induced immunity, and its protection. It is still unclear about the long-term effects of potential differences between the immunity induced by the vaccines compared with natural infection and between different COVID-19 vaccines.

Midway through the second year of COVID-19, the experience of managing few waves of the pandemic and the increasing numbers of people vaccinated against the SARS CoV-2 virus raises hope that the contagion will be controlled and allow a return to normal soon. Although we are understandably fatigued with restrictions, working from home or working under fear of exposure and infection, the social disruptions, and economic instability, a return to life, as usual, has taught us the importance of increased equity among communities and health for all. In a post-pandemic world, we need to think differently about infectious diseases.
It has been known to us that the foundation for the prevention of and response to infectious diseases begins with a robust public health infrastructure and system. The quality of the response to COVID-19 varied greatly across countries and regions because of inadequate funding, lack of planning, and limited support from the government.

Cooperation
As COVID-19 infections increased during the spring of 2020, the scarcity of personal protective equipment left frontline healthcare workers vulnerable to infection and increased dilemmas on how to balance patient care with personal risk as well as risk to their family members. There were no uniform guidelines to protect healthcare workers and varied by institutions, changed frequently, and deviated from long-established approaches for protection against airborne illnesses.

The pandemic has taught us the importance of greater coordination across public health systems and sharing best practices can avoid wasted effort. In the beginning, the necessary response was delayed due to a false sense of safety that the pandemic was under control or isolated to other locations. It has been seen with the new wave with Delta variant that the emergence of a new variant in one country is a great concern for all of us as we live in an interconnected world where the ease of international travel expedites the rapid global spread of infection.

The pandemic has revealed the weaknesses of our public health system and how important it is to increase funding and coordination among public health agencies across the world. It is equally imperative to increase support for international public health through the World Health Organisation (WHO) and other international agencies in order to tackle the future public health emergencies efficiently.

(Prof. Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)