Dr. Tom Frieden: Why I’m cautiously optimistic about Covid-19
Dr.  Tom Frieden: Why I’m cautiously optimistic about Covid-19

Dr. Tom Frieden: Why I’m cautiously optimistic about Covid-19

Despite growing pandemic fatigue and harsh weeks ahead as the Omicron tsunami subsides, we are better defended against Covid than ever before. Vaccines and past infections have steadily strengthened our collective immune system. We have now built a wall of immunity – even though we have lost far, far too many people on the road to reaching it.

By 2020, non-compliance with public health recommendations greatly increased the death toll in the United States and elsewhere. In 2021, failure to reach people with vaccination – mainly due to biased opposition and entrenched opposition in the United States and lack of access in many countries – had fatal consequences.

We have already lost nearly 900,000 people to Covid in the United States alone and are approaching the grim milestone of one million American deaths. Most things could have been prevented. But now we may have taken over Covid because our defenses are multi-layered and strong, starting with immunity.

Based on antibody seroprevalence among people who donated blood, an estimated 94% of Americans had at least some protection against Covid back in November – before the rise of the Omicron variant hit – through either vaccination or previous infection. Immunity to severe infection stops, especially for people who get booster shots. In December, the number of Covid-associated hospitalizations was 16 times higher in unvaccinated adults than among adults who were up to date on vaccination.
Globally, 10 billion doses of life-saving vaccines have been administered in just over a year. However, it is an amazing achievement vaccine inequality continues to cost lives and create the conditions for dangerous variants such as Omicron to occur. Africa remains particularly vulnerable, e.g. less than 1 in 10 people across the continent are fully vaccinated.

We have new drugs that are extremely effective in preventing severe Covid. Laboratory studies suggest that they will work just as well against the Omicron variant as the Delta. In general, medical treatments do not come close to the life-saving effect of the vaccines, but they do help. These pills can be a lifesaver for people at high risk for severe Covid, though we still need to overcome supply challenges, pair tests with early treatment, and ensure equal access for all who need them.

Most people understand that masks work and that better masks (such as N95s) work better, and there are now more of them. Masks can stop the airborne spread of the variant Covid throws at us. We can learn from East Asia by masking whether we are sick or vulnerable, to resist not just Covid, but flu and other respiratory diseases.

Although there have been bumps along the way, testing is more accessible, including quick antigen tests that can be performed at home. When Covid spreads in our community, we can test before we gather indoors with vulnerable people or in large groups, or test if we feel sick; if they are infected, we can isolate them at home until they are no longer infected.

Genomic monitoring is another tool that we have sharpened. South Africa set a good example by warning the world about Omicron. Many countries have increased their capacity to perform robust genetic sequencing. We can be at the forefront of the virus by continuing to be on the lookout.

Genomic monitoring brought to our attention a new version of Omicron, called BA.2, which is becoming more common in more countries. This Omicron subvariant has caused concern, but results from the UK suggest that BA.2 does not escape immunity more than the version we have been dealing with.

All of the above are reasons for cautious optimism, but there are wild signs. Protection against Omicron infection may not be strong or long lasting; less severe infections often result in less lasting immunity. And while vaccine protection has held up well against serious illness, we may need additional doses to stay up to date.

Long Covid is another enduring challenge. We do not know how often an Omicron infection leads to long-term Covid, or how best to treat people who have the disease, although we learn more every day and wait anxiously survey results from the National Institutes of Health. A new study suggests that vaccinated people who become infected are much less likely to develop long Covid, another reason to keep your vaccinations up to date.
BA.2, the newly discovered version of Omicron, is not a cause for alarm, scientists say

The biggest wild card: SARS-CoV-2’s ability to mutate. It is highly unlikely that Omicron will be the last variant. What does it mean that a deadly, highly transmissible, immune-escaping variant will not emerge? Honestly, it could.

But even though a worse variant emerges, we are better prepared than ever: more immunity, more vaccines, more treatments, better masks and more of them, better tests, better understanding of Covid, more sequencing. Covid does not have to keep dominating our lives, and with our improved defense, we can soon surely resume many activities.

Another reason for optimism? We have a unique opportunity to put public health systems in place to find, stop and prevent health threats whenever and wherever they appear, anywhere in the world. Together with our partners, Resolve to Save Lives is in favor 7-1-7 as a global target for early disease detection and response. Each outbreak should be detected within seven days, with public health authorities notified and investigation commenced within one day, and all significant control measures should be established within the next seven days.
The world has a unique opportunity to make the world safer from health threats. The Global Fund, which last week celebrated its 20th anniversary, has made impressive progress against AIDS, tuberculosis and malaria, and it should play a key role to prevent the next pandemic.

Every country and every organization has made mistakes and there are still challenges, but we have come a long way in the last two years. The most important lesson we can learn from Covid is that we are all in this together – that a disease outbreak everywhere is a threat everywhere.

Far, far too many lives have been lost to Covid, and it is not over yet. But we can learn the lesson from the last two years and work together to create a safer world where the connections between us instead of increasing the fear of infection strengthen our health, our economy and our common community.

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