When will it ever end? When will it ever end?

Abstract

When will COVID‐19 ever end? Various countries employ different strategies to address this; time will tell what the best response was.

Peter Seeger’s anti‐war song with its poignant refrain, stretching out the second “ever” to convey hopeless fatigue with the continuing loss of life, applies to the pandemic too. “Where have all the old folks gone?” may replace the loss of young men in Seeger’s song. But they keep going, and it is not happening on distant continents; it is happening with them distanced in places they called home. At the time of writing in early March, there are a few answers to Seeger’s question from around the world. There are the isolationists who say that maintaining a tight cordon around a COVID‐free zone is the way to get out of the pandemic. There are the optimists with undiluted faith in the vaccines who say it will be all over when everyone will get a jab. And there are the fatalists who say it will eventually end when herd immunity stops the pandemic after many people have died or fallen ill.

Living in Australia where there are only sporadic cases of COVID, it is tempting to see the merits of the isolationist strategy. Only a small number of international travelers can enter the continent every week. Coming back from Europe in November, arrival at Brisbane airport was followed by police‐cordoned transfer to a pre‐allocated hotel—no choice, no balcony, no open windows—where we stayed (and paid) for a 14‐day confinement. On release, it was strange to find that life was close to normal: no masks and nearly no restrictions for public and private meetings. Sporting events and concerts do not have attendance restrictions. All that was different were easy‐to‐follow rules about social distancing in shops or on the streets, limited numbers of people on lifts, and a requirement to register when going to a restaurant or bar.

Since I settled back to COVID‐free life in Australia, the last incident in Queensland occurred a month ago when a cleaner at a quarantined hotel got infected. It was “treated” with an instant 3‐day “circuit‐breaker” lockdown for the whole community. Forensic contact tracing was easy, and large numbers of people lined up for testing. Seven days later, the outbreak was declared over. A police inquiry examined the case to see whether regulations needed to be changed. The same rapid and uncompromising lockdown protocols have been employed in Melbourne, Perth, or New Zealand whenever somebody in the community tested positive. There is also continuous monitoring of public wastewater for viral RNA to quickly identify any new outbreak. Small numbers of positive cases are treated with maximum restrictions until life can return to “normal”. The plan is to expand these state policies to achieve a COVID‐free in Australia along with New Zealand and eventually the Pacific Islands.

The strict isolationist policy has its downsides. Only Australian citizens or permanent residents are allowed to enter the country. Families have been separated for months. Sudden closing of borders makes the country play some musical chair game: When the whistle is blown, you stay where you are. Freedoms that have been considered as human rights have been side‐stepped. Government control is overt. Nonetheless, the dominant mood is that the good of the community trumps that the individual rights, which may come as a surprise in a liberal democratic society. People benefit from the quality of (local) life, and while there is an economic hiatus for tourism and international student business, the overall economy will come out without too much damage. Interestingly, the most draconian State leaders get the highest rating in the polls and elections. Clear, unwavering leadership is appreciated.

Given their geographical situation, Australia, New Zealand, and other islands have clear advantages in pursuing their successful isolationist policies. For most of the rest of the world though, the answer to “when will it ever end” points resolutely and confidently to vaccines. With amazing speed and fantastic efforts, scientists in university and industry laboratories all over the world developed these silver bullets, the Krypton that will put the virus in its place. Most countries have now placed all their chips on the vaccine square of the roulette table.

However, there are some aspects to consider before COVID will raise the white flag. It will take months to achieve herd immunity; a long time during which deaths, illness, and restrictions will continue. With different vaccines in production and use, it is likely that some will protect better against the virus than others. The duration of their protection is still unclear, and hence, the vaccine roll‐out could be interminable. More SARS‐CoV‐2 variants are on the rise challenging the long‐term efficacy of the vaccine(s). The logistics and production demands are significant and will become even more acute as the vaccines go to developing countries. Anti‐vaxxers already see this as an opportunity to spread their mixture of lies, exaggerations, and selective information, which may make it more difficult to inoculate sufficient numbers in some communities. And yet, for most countries, there is no real alternative to breaking the vicious cycle of persistent local infections that are slowed by restrictions only to explode again when Christmas or business or the public mood demands a break. The optimists are realists in this scenario.

The third cohort are the fatalists. The Spanish flu ended after two years, and 50 million deaths and COVID will also run out of susceptible targets in due course. But herd immunity is a crude concept when the herd is people: our families, friends, and neighbors. Fatalism could translate into doing nothing and let people die and that is not a great policy when facing disaster.

The alternative of doing nothing is to combine various strategies as Israel and the UK are doing: to adopt some of the isolationist approaches while vaccinating as many people as quickly as possible. The epidemiological data indeed show that restrictions on interactions do reduce the number of cases. Some countries, Ireland for example, have seen ten‐fold reductions in daily cases even before the first needle hit an arm following tightening of social interactions. This shows that the real impact of the vaccination will only be known when a sufficient percentage of the population has been immunized and the social restrictions are lifted. Australia with its significant travel restrictions is another successful example. In addition, contact tracing and testing are very helpful to contain outbreaks and create corona‐free zones that can be expanded in a controlled manner. Of course, there are local, political, and economic factors at play, but these should not block attempts to lower infection rates until sufficient numbers of vaccine doses become available.

So, the answer to the question “when will it ever end?” will require a combination of the isolationists and the optimists such that the fatalist solution does not prevail. It will be interesting to revisit this question in two years’ time to see what the correct answer turns out to be.

EMBO reports (2021) 22: e53119.