So, eventually everyone will be vaccinated, or will survive COVID-19, or will be dead, and then things will be back to normal, right? That’s doubtful. It’s amazing to me that we got to 2020 without a serious pandemic like COVID. Given the local densities of the 8 billion people on this planet, this pandemic was long overdue. The crowding together of all the humans on this planet into very tight places has screamed for epidemic outbreaks. And there have been MANY epidemics before COVID. But now, there are about 35 megacities (>10 million people), and the numbers are growing rapidly as we continue to relocate to urbanized areas, and these giant cities are where every new pandemic will begin.
It’s worth noting that the viruses won’t originate in the cities though. That’s just where they will find the perfect opportunity for spread and they will spread rapidly once they arrive. And as the cites get larger and denser, they will spread faster than we can possibly control them. For COVID, China acted quickly by placing an entire large city under lock-down quarantine and they were able to contain the virus. But COVD is not very infectious and I suspect they were very lucky this time. China is the ideal location for new viruses given the human densities in rapidly growing megacities, but that still have very close ties to traditional food sources and food production practices.
The prospect of novel and highly contagious viruses is one of the main worries at the CDC and WHO and other international health agencies. Human history is rife with epidemics and pandemics dating back to at least 500 BCE. The prospect of a new unstoppable pathogen becomes almost inevitable given the conditions that now exist that favor highly virulent and infectious pathogens.
A few years back there was concern about bird flu in southeast Asia. The mortality rate was >60%, but all transmission was from ducks and chickens and no transmission had occurred from human to human. As long as the human link was missing, it was a watch and wait situation. Ebola was and is very serious, but fortunately containment is the best answer and it works. However, if ebola escapes to a big city, especially one with an international airport, that picture will change. And then there’s zika, dengue, and measles currently making the rounds.
However, we’re thinking about life after COVID-19 in the US. It’s about gone, right? Nope. Not going to happen. The Spanish Flu of 1918 was the H1N1 variant and it has returned with somewhat less ferocity in 1977 (Russian Flu, 1 million dead) and in 2009 (Swine Flu, 300,000 dead). While it appears to come back weaker each time, part of the lower death toll is the advancements of medical technology and the speed of response. The Cholera epidemic has returned 6 times in history and it’s an ever-present danger after natural disasters that affect drinking water. Bubonic Plague has never really gone away. After 40 years, the HIV pandemic is ongoing with no vaccine in sight.
So, what can we expect? Humans have a number of resident diseases and a number of recurring diseases that we have to be constantly on the lookout for. Measles, whooping cough, chicken pox, tuberculosis, polio, and diptheria to name just a few. Fortunately, these have been under control for 50-100 years due to vaccines and antibiotics. Nonetheless, “resident” means they are with us and we can’t get rid of them, and there are several reasons why.
First, there are carriers. Some people can be infected without showing symptoms and yet they can spread the disease. Second, we don’t always know where they hide. The cold virus hides in our nose and sinuses; it’s always there. The flu virus strains hide in pigs and chickens and other birds and emerges with new vigor every few years. COVID will do the same. In fact, during the lulls this past year, we have no idea what it was doing, but it was present and spreading.
Here is a prediction about COVID-19. First, we will see weaker strains in the sense that they might still be lethal, but the time to death will be slower and that will give hospitals more time to deal with it. As more and more people become immune to the current strains, it means the stronger ones will fail to be transmitted to new hosts and they will die with their current host. That will leave only the weaker strains that do not kill the host as quickly. This, by the way, is why quarantines are so important; they allow the hosts to recover or die before passing on the stronger strains. Herd immunity basically means there are few susceptible people moving around and they rarely encounter each other while also being infectious. Thus, the epidemic stops. But that doesn’t mean the virus is eliminated.
COVID and other viruses are always mutating and that results in new and different strains that vary in their infectiousness and their virulence. The second thing we will see is more highly infectious strains which are less lethal. If this happens, COVID will become a new “flu” in the sense that as new strains emerge, we will have waves of outbreaks, which we will begin to refer to as “COVID season” just as we do with “flu season”. And vaccinations will become a standard protection procedure for the most at-risk people.
We just had a spectacularly successful flu season thanks to COVID. By wearing masks and following other protocols to reduce transmission, we not only beat COVID, but the flu as well. Guess what? We should have been doing this with every flu season. Oh wait, that’s exactly what they do in hospitals to reduce flu exposure.