Waves, Variants, Vaccines: What More to Expect From COVID-19

Salvador Macip, MD, PhD


December 15, 2021

The COVID-19 pandemic has entered a new phase, which for many is particularly confusing. After the improvements seen at the end of summer, a new wave is surfing the planet and a potentially dangerous variant has emerged in South Africa, which has the experts worried. Weren't vaccines supposed to solve everything? Why are we still feeling like we keep going back to square one?

Vaccines work, and they work beautifully. They have reduced mortality around 10-fold and brought hospital admissions to very low levels. However, they can't do what they were not designed to: eliminate transmission. A fully vaccinated adult has around 50% less chance of getting infected or transmitting the virus. Although these numbers are great, they are not zero. This means that if we throw all caution to the wind after being immunized, cases will rise again. Which is exactly what's happening.

This is the main reason behind what Europe is calling "the sixth wave," an uncontrollable rise in new cases that started after the summer, after the vaccination rates crossed the 70% threshold, particularly in Western Europe. Although the percentage of mortality is nothing close to what we saw in prevaccine waves, the trend is still worrying.

A high number of infections will inevitably lead to more severe cases, which could have been avoided if the wave had been nipped in the bud. But this requires remembering that the pandemic is still very much alive and we still have to continue doing what we know works: testing, handwashing, ventilation, masks. Many people seem to have forgotten that.

In the face of this new wave, there are different strategies to follow. The most logical one is to increase vaccination efforts, particularly in places like the US, where less than 60% of the population has received a full course. Reaching those that so far have refused to get a jab is not easy. Many are unlikely to change their minds, whatever we do. But others are still on the fence, and these should become the urgent target of all campaigns.

One way to promote vaccination is to limit the activities of those that are not fully immunized. This is the job of the COVID pass, aggressively implemented in some countries in Europe (even forbidding access to work or to leave your house if you don't have one), and more timidly in others (just to access recreational activities).

Meanwhile, other paths are being pursued in parallel. We are still not sure how effective boosters or child vaccinations will be, but they are likely to contribute somewhat to reducing the spread of the virus. That's why they are also at the top of the list of things to try before moving to the next level — going back to restrictions. Some countries can't afford the luxury of waiting for more people to get vaccinated and have already had to implement curfews and even lockdowns, which should always be the last resort, given the strong impact they have. We have to be aware that these strategies work, and we may still have to resort to them at some point while the pandemic is still active. One step forward, one step back. That's how it goes.

Apart from this, we have to start thinking once and for all about how to respond to the pandemic in a global way. As we discussed before, there is no point in vaccinating everyone in the richest countries if a full continent is still struggling to cross the 10% immunization rate. We know that this increases the chances of new, more aggressive versions of the virus appearing. The Omicron variant, spreading now across the globe, has just confirmed this. We still don't know how bad it's going to be (more infectious, certainly, but maybe not more deaths, and hopefully still sensitive to the antibodies we have); we'll have to wait and see. In any case, this will still happen in places where the virus can circulate freely, and we'd better reduce our chances of a truly aggressive variant coming up in the future by vaccinating those that need it the most first.

With cases in the States and Europe steeply rising again, even before we see whether Omicron is going to change the rulebook, the best we can do is to insist that, although we are much better than we were last year, this is far from over.

We have to remain vigilant. Get a jab if you haven't received one. Get another one if it's offered to you (or to your children). And don't forget that this is not enough and we still need the rest of tools we have to protect us, common sense being chief among them. While we do this, let's remind our leaders that we are all in it together and we have to help the countries that are still struggling if we want to improve everyone's chances of coming out of this alive. The pandemic is far from over, and no one will be safe from it until we all are.

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About Dr Salvador Macip
Salvador Macip, MD, PhD is a doctor, researcher and writer. He obtained his MD/PhD at the University of Barcelona (Spain) in 1998, then moved to do oncological research at the Mount Sinai Hospital (New York). Since 2008, he has led the Mechanisms of Ageing and Cancer Lab at the University of Leicester (UK). Macip has published over 30 books, including Where Science and Ethics Meet (2016) and Modern Epidemics (2021). Connect with him on Twitter: @DrMacip


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