The Prof Writes: Covid-19 - The one that got away from us

The SARS-CoV-2 pandemic has been a global psychological scar on all of us as a species. Coronaviruses are a family of RNA-based viruses, a simple structure which when viewed in more detail with electron microscopes looks like a sphere coated with spikes of protein. It resembles a crown, hence the Latin name 'Corona'. 

These protein spikes are the very inducers of a reaction and the instigators for the virus to initially bind and then infect healthy cells. There have been seven coronaviruses found in humans, four of which are fairly common and cause a much milder clinical presentation along with respiratory symptoms (HCoV- NL63, HCoV-229E, HCoV-OC43 and HKU1). 

The other more severe pathogenic ones of MERS, SARS and Covid-19 are known to cause moderate to severe respiratory symptoms, including breathing difficulties, which can lead to death unless contained early. Genetic susceptibility to an adverse effect does play a part, but for vulnerable patients such as the elderly or immunocompromised, Covid-19 is potentially fatal. 

Covid-19 was duly named as it was discovered in 2019 and like SARS and MERS is thought to have crossed from animal to human, in this case from bat to human. This was based on extensive genomic testing and is in keeping with previous crossings from animal to human, known as zoonotic transmissions. 

Although the exact origins have been speculated, the first clinical cases of this global public health and medical emergency were first reported in Wuhan, China. Clusters of patients were observed to quickly develop severe atypical pneumonia which required ventilatory support. Most patients in these early stages eventually succumbed to the disease. 

All of these early cases in Wuhan seemed to be linked to a live animal market. Unconfirmed reports suggested that these may not have been the only cases and that there may have been more cases which were quickly dismissed by the official government sources.

According to the WHO, there have been 9.6 million cases of Covid in China with a total death toll of 30,166. Photo: Reuters

Whatever the case may be, a Pandora's box was opened and almost three years and 640 million global cases later, the official death toll of 6.6 million continues to rise. Newer variants have come and continued to evolve, therefore testing our immunity and ingenuity. 

One thing is clear - were it not for the global concerted efforts in developing the Covid-19 vaccines, the situation would have been far worse. The commencement of the global vaccination programme is estimated to have averted 19.8 million deaths, representing a 63% reduction in total worldwide deaths.

That said, we did see the uglier side of human behaviour, whereby the equity of vaccine access and the hoarding of vaccine supplies highlighted the true power of those countries which had a monopoly on scientific investment and research. In the end, for all the gusto for human endeavours, capitalism was the real currency here. 

The United Kingdom's Oxford- AstraZeneca vaccine was built upon a tried and tested method from studies on other primates, while the United States-based Pfizer -BioNTech and Moderna vaccines utilised a new and previously not fully clinically tested but promising methodology of mRNA vaccines.

Other vaccines from Russia, the Sputnik, V and Chinese Sinopharm, soon became the source of national pride amongst their respective countries and so began the biotechnology vaccine showmanship of 'my vaccine is better than your vaccine.'

Meanwhile, it was left to large-scale global clinical trials to finally validate the hypotheticals into safety profiles and outcomes for mass public vaccination strategies. All of these processes were done at hyper-speed, while typical vaccines would normally take at least 10 years to get to clinical trial; this was done in 12-18 months. 

Yet, for many developing nations, demand outstripped the supply for such vaccines and one could not avoid feeling somewhat helpless as many lives were lost to the ticking time bomb of political jostling. Never was this more brutally seen than in the many African countries that were promised much but due to poor logistics, supply issues and misapprehension amongst the public, the uptake of vaccines was very low. 

In the end, it felt as though everyone was out for themselves and although supplies finally did get through, it was certainly not reflective of the massive investments that countries like the UK or US had put into mass vaccinations for the more vulnerable groups such as the elderly. 

Again, money was being thrown around, probably in a very inefficient and haphazard manner during a state of global chaos. It is fair to say even our politicians had little experience dealing with such a dire global calamity. Yet, we collectively continued to stumble through. We have accepted that we have to live with the ongoing Covid variants much like the annual influenza flu. 

We need to continue to conduct ourselves with greater personal responsibility for our health, whilst in the background we should continue to develop and have vaccines specific to the emerging variants up our sleeve.

That is the theory at least, but in practice, the ongoing mass vaccination effort by the WHO and the Covax programme has thus far delivered 1.8 billion vaccines to 146 countries worldwide. It is a start, but we have a long way to go as our global population is now approximately 8 billion people.

In the interim, economies have had to open up, the complete lockdowns could not continue for fear of destroying our fragile global institutions. The majority of countries have gone for a new normal where we and especially the more vulnerable groups have little choice but to get on with our lives and shield ourselves as best as we can whilst staying vaccinated. Not ideal, but nothing ever is.

This is a contrast to the more stringent zero Covid case strategy employed by the Chinese government. In China, lockdowns remain the staple method for public health management. The aim is to also avoid cases to stop the rise of new variants such as the omega variant. Therefore there have been relatively lower infection and lower death rates compared to the total population of 1.4 billion, at least according to the official data. 

To date, according to the WHO, there have been 9.6 million cases of Covid in China with a total death toll of 30,166. Yet, active daily cases continue to rise at 38,000 cases per day. This grumbling problem has the potential to erupt given the growing frustration among the people in lockdown. 

This is coupled with worrying economic outlooks of a general slowdown in the Chinese economy. Cities such as Shanghai for example are in a constant start-stop mentality given the city-wide lockdowns in the mega city. 

How long this public health strategy can continue with the winds of a global recession coming across remains to be seen. China is the major supply chain hub for our shared global economy. The main issue appears to be the lower-than-expected vaccination uptake in vulnerable elderly populations.

In the above 80 age group, for example, only 20% have decided to take the Covid vaccine, given that access is not an apparent issue. Compare this to other nations such as the UK where over 80% of 80-year-olds have had the booster Covid vaccine, meaning a total of four vaccine shots. Having a more aggressive public health plan for vulnerable age groups may be the only way to provide long-term Covid security at a population level.

Another issue with the short-term methodology of using lockdowns means that the natural herd immunity cannot build up within the wider population and so the ability to cope with newer variants of the virus becomes trickier. One can see the logic of the current programme though as, without such lockdowns, the potential for ICUs to be overwhelmed with cases could be a real issue. With such a large population, the numbers could become exponential very quickly.

However, no matter how compliant the Chinese people have been, the long-term mental health and social impact of mass lockdowns are clearly having a negative effect. This does not bode well for our current trajectory towards a global recession with some severe inflationary crosswinds to contend with as well.

A solution for China to open up to a post-Covid economy with a sustainable public health strategy is no longer just a Chinese issue, it is fast becoming a global issue as well.

Happy holidays!

Professor Rameen Shakur MD PhD(Cantab) FRSA FIBMS FRSPH FRSB is a Professor of Genomics and Cardiovascular Medicine and Director of the Precision Health and Translational Medicine Centre, University of Brighton, UK

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.