COVID-19 third wave: The world is still dangerously unprepared

World enters an endless loop of disease outbreaks and remains dangerously unprepared for such crises even in third year of the COVID-19 pandemic

By Taran Deol, Kiran Pandey
Published: Thursday 06 January 2022

The COVID-19 pandemic has entered its third year, with no signs of ebbing. Till the last week of December, the novel coronavirus was raging in almost 200 countries and had killed more than 5.3 million people.

Such is the impact of the pandemic that the average life expectancy has plummeted in several countries. Researchers at the Universitat Pompeu Fabra’s Centre for Research in Health Economics in Barcelona, Spain, estimate in their study published in Scientific Reports in February 2021, that over 20.5 million years of life have been lost due to COVID-19 in 81 countries.

In India, life expectancy has reduced by nearly two years, as per an October 2021 study by the International Institute for Population Studies under the Union Ministry of Health and Family Welfare.

The fear and turmoil have deepened since the arrival of Omicron — by far the most mutated and transmissible of all the five variants of concern identified in the history of the COVID-19 pandemic.

“The severity of disease by the variant may be low but the sheer number of cases could once again overwhelm unprepared health systems,” warns Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), adding: “It might have already made its way through most countries. We have learned by now that we underestimate this virus at our peril.”

In hardly a month since South Africa first informed WHO about this new variant on November 24, 2021, some 91 countries have reported its presence. The subsequent uncertainty among countries and the public was similar to when COVID-19 first struck the world in late December 2019.

By the second half of December 2021, over 100 countries had once again imposed lockdowns and closures, and announced restrictions on festival-related gatherings. The scientific community was struggling to understand the new variant’s behaviour, baffled by its spread and manifestation in terms of symptoms.

Derailing all the progress made on containing the pandemic, the variant seemed to breach immunity acquired through vaccination or natural infection. Symptoms also did not appear for nearly a month after infection with Omicron, thus increasing the chances of transmission.

Are we prepared enough for the future? Unfortunately, this question before the world at the start of the pandemic has not changed either.

This pandemic has been termed as an event that occurs “once in a century” or “once in a lifetime”. But according to Metabiota, a US-based firm that deals with pandemic threats, a pandemic similar to the current one and of zoonotic nature has a 22-28 per cent chance of striking in the next decade. This is a cause for concern.

The 2021 Global Health Security (GHS) Index released by non-profits Nuclear Threat Initiative and the Johns Hopkins Center for Health Security shows countries across all income levels remain dangerously unprepared to meet future epidemic and pandemic threats.

The world’s overall performance on GHS Index slipped to 38.9 (out of 100) in 2021 from 40.2 in 2019. None of the 195 countries assessed reached the top tier of rankings, or even scored above 75.9.

Rather, 101 countries have slipped in performance since 2019. India, with a score of 42.8, has slipped by 0.8 points.

What’s worse, the pandemic over the past two years has also pulled down the world’s progress on various other health challenges. According to an assessment by the World Bank and WHO, the world for the first time in two decades is staring at a roadblock on the path towards universal health coverage.

The resultant health expenditure has pushed half-a-billion people into extreme poverty as they have had to spend more on health services.

Moreover, according to the UN Children’s Fund (UNICEF), nearly 20 million infants missed their first dose against measles in 2020, as the global vaccination rate fell to 84 per cent from 86 per cent in 2019.

Scientists say this is a mounting concern as measles can result in immune amnesia — a phenomenon wherein the viral respiratory illness can partially erase the immune system’s memory of other illnesses. It means children who recover from measles may become susceptible to other pathogens they may have had protection from earlier.

Several experts have highlighted concerns about a measles outbreak taking a threatening shape in a post-COVID-19 world. David N Durrheim, conjoint professor of public health medicine at the University of Newcastle, Australia, noted in his paper published in February 2021:

“The COVID-19 pandemic distracted attention from the worst global measles pandemic of this century. The decreased measles case reporting in 2020 is falsely reassuring and was occasioned by a combination of immunity after the large-scale 2018-2019 outbreaks.”

Rik De Swart, associate professor of neuroscience at Erasmus University Medical Center, Netherlands, tells Down to Earth that “Measles will linger around, and when it gets the opportunity it will find the pockets of people who are without immunity. We have a realistic danger now, that we may see an explosive measles outbreak in the near future.”

What does an unprecedented rise in measles cases and a significant drop in vaccination and surveillance alongside immune amnesia mean in COVID-19 times?

Explains a June 2021 study published by Spanish researchers in Journal of the Royal Society: “When measles vaccination policies are relaxed, the expected herd immunity for any secondary infectious disease X can be lost owing to the proliferation of individuals affected by immune amnesia. In particular, under its effects, the epidemic threshold is shifted so that severe outbreaks can take place even under extensive X vaccination.”

Swart says the risk may not be that high on an individual level, but it may potentially cause a risk of damaging the level of immunity to COVID-19 on a population level.

“Measles can impact COVID-19 caseload and death rate. We do have indications from several epidemiological studies that death rates, in some cases, increase during a long period after a big measles outbreak,” he says.

Even as we speculate on the future, dealing with the burden of the legacy diseases left behind by COVID-19 is not going to be easy.

The article was first published in DTE print edition January 1-15, 2022 

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