Aiming for the end of the COVID-19 pandemic: the what, how, who, where, and when

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new virus, still full of surprises. As of September 2022, there have been over 605 million confirmed cases of coronavirus disease 2019 (COVID-19), including 6.5 million deaths reported to the World Health Organization (WHO).^[1] SARS-CoV-2 is a bad virus, which often produces new variants that scape natural immunity and sometimes vaccines [Figure 1].^[2]

Figure 1.

Worldwide temporal distribution of SARS-CoV-2 variants from February 2021 to February 2022. Source: Genomic epidemiology of novel coronavirus - Global subsampling.^[2] SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2. 20B, 21I (Alpha, V1), 21J (Delta), 21I (Delta) and 21K (Omicron) represent name of viral clade.

“2022 must be the year we end the pandemic.” This is not only wishful thinking but a verbatim quote from a conversation with journalists of Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, in Geneva on December 20, 2021.^[3]

Similarly, Bill Gates stated, “I think the acute phase of the pandemic will come to a close sometime in 2022. There's no question that the Omicron variant is concerning, but I’m still hopeful that, at some point next year, Covid-19 will become an endemic disease in most places.”^[4]

Mankind has survived devastating pandemics, such as the Plague of Justinian (541-542 AD), the bubonic plague that afflicted the Byzantine Empire and Mediterranean port cities, causing 25 million deaths, halving the population of Europe. Or the 1918 Influenza A/H1N1 pandemic, causing 17 to 100 million deaths. These whooping numbers were ridiculed by The Black Death (1346–1353 AD), another outbreak of Yersinia pestis that ravaged Europe, Africa, and Asia, with an estimated overall death toll between 75 and 200 million people.

Regrettably, the level of disinformation and un-coordination has been unprecedented at all levels of COVID-19,^[5] and lessons from recent history are yet to be learned, as elegantly stated elsewhere.^[6] Barely 2 years from the alert on December 31, 2019 in Wuhan, Hubei Province, China, due to a cluster of 27 hospitalized patients with pneumonia of unknown etiology,^[7] and after >294,000 peer-reviewed publications on all sorts of COVID-19-related topics,^[8] many questions remain unanswered. To start with, it is still questioned what was the origin of this new virus,^[9] although both bats and pangolin have been usual suspects.^[10] Additionally, as novelist Albert Camus^[11] described in La Peste, a novel on an outbreak of plague sweeping the French Algerian city of Oran, COVID-19 shows many examples of panic, hopelessness, despair, denialists, conspiration theories, fake news, irrationality, and pandemic tiredness.

All human pandemics have eventually come to an end. Therefore, the ongoing COVID-19 pandemic will end, somehow, sometimes, even though this is something difficult to admit when we face the great surge of cases due to the Omicron variant. The key issue is not when (probably there will be nothing as an end), but if we can set up the conditions to control COVID-19 the sooner the better with the minimum toll possible. Synergic and incremental efforts and investments from multiple stake-holders at the global, regional, national, and subnational levels will be required to achieve this goal. These efforts will no doubt arise opposition, and some might be difficult to implement. But inaction will produce a much greater burden in terms of suffering, lost lives, and economic costs.

By revisiting how previous pandemics were ended or controlled,^[12] and further implementing/reinforcing individual and community strategies of proven efficacy,^[13–15] we can summarize a set of interventions [Table 1] that could contribute to the end of the COVID-19 pandemic.^[16] If today we cannot predict when, we can reasonably say how: by applying in a smart, empathic, and consistent way the former list of interventions. Additionally, a key, new scientific landmark is still pending for the progressive elimination of SARS-CoV-2 across the globe. On the horizon are new, more effective vaccines, and potentially antivirals, that interrupt virus transmission,^[17–19] and produce neutralizing antibodies to provide sterilizing immunity against re-infection.^[20,21] They are eagerly awaited. Further, traditional Chinese Medicine has already been included in COVID-19 treatment guidelines^[22] and maybe incorporated in future updates of international guidelines.^[23]

Table 1.

List of interventions to stop/control COVID-19.

Type	Intervention
Non-pharmacological	Universal hygiene interventions (hand hygiene, face masks, social distance, ventilation) Screening and case-finding of asymptomatic carriers of SARS-CoV-2 and of pauci-symptomatic COVID-19
	Total and partial lockdowns
	Bats (and other animals) for planetary health
Pharmacological	Vaccines
	Antivirals
	Combined management strategies of clinical cases
	Testing traditional Chinese Medicine in non-Chinese populations
Fostering a more comprehensive health governance	Better coordination and cooperation of international and national health authorities/agencies
	Fast, complete, transparent data sharing of clinical and epidemiological data, with the capacity to perform and update real-time meta-analyses and identify risk and protective factors of COVID-19 and its sequelae
	Consistency in the legal and executive views on individual civil rights in the exceptional circumstances of pandemic risk
	Avoid electoral and political use of Public Health interventions
	Unified, clear, simple messages to the general population, to avoid misinformation
	Advancing on Universal Health Access to health care systems of good quality, particularly at the primary health care level.

COVID-19: Coronavirus disease 2019.

All of the above should be accompanied by significantly more financial support to national and international Public Health agencies that should work independently of any political drivers. Without health, there is no economy.

Last but not least, inequity is at the root of many health problems. The 12.5+ billion doses of vaccines administered to date, and the few new treatments, have been appallingly and utterly unevenly distributed in low and middle-income countries.^[1]

“If we are to end the pandemic in the coming year, we must end inequity,” Dr. Tedros also said.^[3] The final answer to COVID-19 will not be only medical, but research-based and focused on solid science and implementation research^[24] as well as on advancing universal coverage with health services of good quality, particularly at the primary care level.^[25] All with a truly global, planetary perspective.^[26] It is now time to sit down, prioritize, administer, and implement in practice such a road map.