'When will it end?': How a changing virus is reshaping scientists’ views on COVID-19

By Julie Steenhuysen and Kate Kelland
CHICAGO (Reuters) - Chris Murray, a University of Washington disease expert whose predictions of COVID-19 infections and deaths are being closely monitored around the world, is changing assumptions about the course of the pandemic.
Murray had until recently hoped that the discovery of several effective vaccines could help countries achieve herd immunity or nearly eliminate transmission through a combination of vaccination and previous infection. Last month, data from a vaccine study in South Africa showed not only that a rapidly spreading variant of the coronavirus could dampen the effects of the vaccine, but it could bypass natural immunity in previously infected people.
"I couldn't sleep," Murray, director of the Seattle-based Institute for Health Metrics and Assessment, told Reuters after seeing the data. "When will it end?" he asked himself, referring to the pandemic. He is currently updating his model to take into account the ability of variants to escape natural immunity and expects to come up with new projections as early as this week.
A new consensus is emerging among scientists, according to Reuters interviews with 18 specialists who are closely monitoring the pandemic or are working to contain its effects. Many described how the breakthrough of two vaccines around 95% effective against COVID-19 late last year initially raised hopes that the virus could be largely contained, similar to what happened with measles.
However, data over the past few weeks on new variants from South Africa and Brazil have undermined this optimism. They now believe that SARS-CoV-2 will not only stay with us as an endemic virus that continues to spread across communities, but is likely to cause a significant burden of disease and death in the years to come.
As a result, people could expect to continue taking steps like routinely wearing masks and avoiding crowded areas during the COVID-19 surges, especially for those at high risk.
Even after vaccination, "I would still want to wear a mask if there was a variant," said Dr. Anthony Fauci, Chief Medical Officer of US President Joe Biden, in an interview. "All you need is a little strip of a variant (which will trigger another spike) and there is your prediction" of when life will be back to normal.
Some scientists, including Murray, acknowledge that the outlook could improve. The new vaccines, which have been developed at record speed, appear to prevent hospitalization and death even when new variants are the cause of infection. Many vaccine developers are working on booster and new vaccinations that could keep a high level of effectiveness against the variants. And scientists say there is still a lot to learn about the immune system's ability to fight the virus.
COVID-19 infection rates have been falling in many countries since the beginning of 2021, with the number of serious illnesses and hospital stays among the first groups of people who were vaccinated.
Murray said if the South African variant or similar mutants continue to spread rapidly, the number of COVID-19 cases leading to hospitalizations or death this coming winter could be four times higher than the flu. The rough estimate is a 65% effective vaccine given to half of a country's population. In the worst case scenario, that could add up to 200,000 US winter-related COVID-19 deaths, based on federal government estimates of annual flu deaths.
His institute's current forecast, which runs through June 1, assumes there will be an additional 62,000 deaths in the United States and 690,000 deaths worldwide from COVID-19 by then. The model contains assumptions about the vaccination rates and the transferability of the South African and Brazilian variants.
The change in thinking among scientists has influenced more cautious statements by the government about when the pandemic will end. The UK said last week it was expecting a slow emergence from one of the strictest lockdowns in the world despite having one of the fastest vaccination campaigns.
The US government's predictions of a return to a more normal lifestyle have been rolled back repeatedly, most recently from late summer through Christmas and then through March 2022. Israel issues "Green Passport" immunity documents to those who have or have recovered from COVID-19 vaccinated so that they can go back to hotels or theaters. The documents are only valid for six months as it is not clear how long the immunity will last.
"What does it mean to be out of the emergency phase of this pandemic?" Said Stefan Baral, an epidemiologist at the Johns Hopkins School of Public Health. While some experts have asked if countries could completely eradicate a case of COVID-19 through vaccines and strict lockdowns, Baral sees the goals as more humble but nonetheless meaningful. "In my opinion, hospitals are not full, the intensive care units are not full, and people don't tragically pass by," he said.
The new coronavirus has been a moving target from the start.
At the start of the pandemic, leading scientists warned that the virus could become endemic and "may never go away," including Dr. Michael Ryan, director of the World Health Organization's emergency program.
There was still a lot to learn, however, including whether it would be possible to develop a vaccine against the virus and how quickly it would mutate. Would it be more like measles, which can be kept almost entirely in check in communities with high vaccination rates, or flu, which infects millions worldwide each year?
For much of 2020, many scientists were surprised and reassured that the coronavirus hadn't changed significantly enough to become more communicable or deadly.
A major breakthrough came in November. Pfizer Inc and its German partner BioNTech SE and Moderna Inc said their vaccines were about 95% effective in preventing COVID-19 in clinical trials, an effectiveness rate much higher than any flu shot.
At least some of the scientists polled by Reuters said they didn't expect the vaccines to wipe out the virus even after seeing these results. But many told Reuters that the data raised hopes within the scientific community that it would be possible to virtually eliminate COVID-19 if only the world could be vaccinated fast enough.
"We were all pretty optimistic about these first vaccines before Christmas," said Azra Ghani, Chair of Infectious Disease Epidemiology at Imperial College London. "We did not necessarily expect that such highly effective vaccines would be possible in this first generation."
The optimism was short-lived. In late December, the UK warned of a new, more transmissible variant that was quickly becoming the dominant form of the coronavirus in the country. Around the same time, researchers learned about the effects of the faster-spreading variants in South Africa and Brazil.
Phil Dormitzer, a senior vaccine scientist at Pfizer, told Reuters in November that the US drugmaker's vaccine success signaled that the virus was "vulnerable to vaccination" in what he called a "breakthrough for humanity." In early January, he recognized the variants that heralded "a new chapter" in which companies must constantly look for mutations that could dampen the effects of vaccines.
At the end of January, the impact on vaccines became even more apparent. Novavax clinical trial data showed the vaccine was 89% effective in a UK study, but only 50% effective in preventing COVID-19 in South Africa. A week later, data followed showing that the AstraZeneca PLC vaccine offered limited protection against mild illnesses against the South African variant.
The recent change in the heart has been significant, several scientists told Reuters. Shane Crotty, a virologist at the La Jolla Institute of Immunology in San Diego, described it as "scientific whiplash": In December, he believed it was plausible to achieve what is known as "functional eradication" of the coronavirus, similar to measles.
"Getting as many people as possible vaccinated is still the same answer and the same way as it was on December 1st or January 1st," said Crotty, "but the expected result is not the same."
(Reporting by Julie Steenhuysen in Chicago and Kate Kelland in London; additional reporting by Michael Erman in New York; editing by Michele Gershberg and Cassell Bryan-Low)
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