New Delhi: It’s been more than 12 hours since the World Health Organisation (WHO) lifted the global emergency status – ‘Public Health Emergency of International Concern’ or ‘PHEIC’ – it gave to the COVID-19 outbreak more than three years ago. But it is still difficult to fully gauge the importance of this declaration or rather simply put: How will it play out in the common people’s mind?
When the history of the pandemic is written, Friday, May 5, 2023, will definitely be a milestone. A milestone is not necessarily one that is celebrated. January 30, 2020, was also a milestone. It was the day the WHO chief Tedros Adhanom Ghebreyesus declared COVID-19 a PHEIC. At the time, the world had no idea about what it was going to battle – certainly, nobody expected a once-in-a-century outbreak that would bring the entire human race to a grinding halt.
May 5, 2023 is also no cause for celebration. It may be an occasion to heave a sigh of relief, hoping that the worst may be behind us. Undeniably, it has come at the cost of an estimated 20 million people dying, with the WHO revising its earlier estimate of 15 million deaths. The statistic, though jarring in itself, does not take into account the millions of families the coronavirus has affected in myriad ways, and thus, the number of lives it shattered forever.
As far as the science and rationale of WHO’s Friday declaration are concerned, it simply means that the cases of infections and deaths have consistently come down over the past year. This is what the agency’s chief Ghebreyesus said at the press conference.
Thank you to the incredible people who I have the privilege to call my colleagues. For more than three years, the people of @WHO have laboured day and night, under intense pressure and intense scrutiny to help countries bring #COVID19 under control.
I’m immensely #ProudToBeWHO. pic.twitter.com/NhGRgBYEaM
— Tedros Adhanom Ghebreyesus (@DrTedros) May 6, 2023
I have been covering the COVID-19 outbreak ever since it began in 2020. Now, the challenge is to deconstruct the end of a global emergency. How does one communicate this, with all the complexities involved, in a world which largely perceives an outbreak in black and white? For most people, either the pandemic is over or not – just like vaccines either protect or don’t.
For more than two years, we have had access to COVID-19 vaccines. Ever since their emergence, the science was clear: vaccines are designed to protect against severe disease, hospitalisation and death; and not against virus transmission or acquiring infection. And, this has been communicated repeatedly. Yet, there is no dearth of people around us who would, at the drop of a hat, wonder, why they got an infection despite being fully jabbed!
So breaking down the complex idea that despite the WHO’s announcement, the pandemic is not yet over – the virus has not disappeared, and therefore, lowering the guard could still come at a cost – is still hard for me to do, in the fourth year since the outbreak began.
The COVID-19 messaging is ‘complex’, admitted WHO’s technical lead on the disease, Maria Van Kerkhove, at the press conference on May 5.
The simple answer is: In 2023, SARS-CoV-2, the virus responsible for causing the disease COVID-19, is definitely nowhere close to being as deadly as it was in 2020 or even 2021. It has largely, at least for now, settled into a pattern where it is evolving into forms or sub-variants of Omicron that may cause occasional ebbs and flows, lead to an uptick in cases but not increased disease severity for the general population or overwhelming the healthcare infrastructure.
But the fact remains, as Dr Michael Ryan, the WHO executive director who was part of the team to contain and treat the virus, put it on Friday:
“COVID has ended as an emergency from a global perspective, but COVID is still an emergency for a family who have a loved one who contracts COVID today and needs to go to hospital, that is still an emergency.”
After all, the virus is still killing 17,000 people globally every month. Several more fall ill, of which many are developing long-term sequelae – known as ‘Long Covid’ in common parlance (more on that later).
Theoretically, it is not difficult for common people to understand this nuance. But practically, COVID-19 has been “over” for people for quite some time now. Recently, India witnessed a minor wave – an uptick in cases and a small rise in the number of deaths also due to a new sub-variant of Omicron. Yet, in this time period, as opposed to a scenario when the nation is largely Covid-placid, there was hardly a renewed adherence to measures like masking and ventilation, even among vulnerable sections like the elderly. Therefore, at least for a significant part of the population, the May 5 announcement by the WHO will definitely become a licence to throw all precautions to the wind.
The WHO chief, while declaring an end to the global emergency, relied on the recommendations of the International Health Regulations (IHR) emergency committee. The IHR is an international treaty among nations, agreed upon to respond to a global crisis. The committee, which met recently, decided that the COVID-19 outbreak does not constitute an unusual event, now. On May 3, 2023, the WHO also issued a strategic plan for countries, guiding them on how to deal with the pandemic for the next two years. The US, incidentally, ended. its COVID-19 emergency in April.
The challenge of Long Covid
Looking forward, ‘Long Covid’ is going to be the single biggest fallout to deal with, apart from deaths. In one of his recent statements, WHO chief Ghebreyesus said one in 10 people who got an infection are estimated to suffer from Long Covid. India has yet not conducted any study to understand the prevalence. But if the WHO chief’s statement is anything to go by, a huge chunk of the Indian population might be suffering from one or other form of Long Covid – considering the country’s massive COVID-19 caseload.
Not all forms of Long Covid are necessarily severe, but some are. These include, but are not limited to, conditions such as sudden heart attacks due to clots or otherwise, neurological conditions, pulmonary diseases, kidney ailments, vision problems, autoimmune diseases like diabetes and others, and of course, long-term adverse mental health impacts. Sudden heart attacks, especially among the youth, is perhaps the most visible form of Long Covid. The other forms have largely gone invisible.
We have hardly seen any concrete policy from the Indian government as to how it is going to identify this invisible lot, let alone diagnose and deal with it, considering the skewed access to secondary and advanced healthcare in India for the common masses, especially for those living on the periphery.
The odds of having Long Covid are directly proportional to the number of times an individual has acquired infection, some experts say. A paper published in 2022 in Nature said:
“….assessment of the cumulative risks of repeat infection showed that the risk and burden of all-cause mortality and the prespecified health outcomes increased in a graded fashion according to the number of infections (that is, risks were lowest in people with one infection, increased in people with two infections and were highest in people with three or more infections).”
However, this inference was drawn from a study conducted on US veterans – a specific group of population – and hence its replicability in the general population is ‘up for debate’, Nature added.
For some, even one bout of infection gave them another long-term disease. Plus, there is no conclusive evidence yet if the initial disease severity of COVID-19 could determine the odds of acquiring Long Covid, or not. In other words, it is not cast in stone yet if a mild COVID infection will not necessarily lead to some form of Long Covid. The science is evolving, and therefore, the best bet is to avoid exposure to the virus by adopting precautions.
Ghebreyesus and other WHO experts, in the May 5 press conference, dwelled on ‘lessons learnt’. They said that everybody, including the WHO, has learnt lessons. For governments, there are several lessons. The first is to make the healthcare system prepared for a pandemic, so that people don’t die for want of hospital beds literally on roads. Politics and elections cannot be put above public health, as we saw in this outbreak. Government officials should also pull up their socks to gain the trust of the people. Some decisions, like former US president Donald Trump promoting the use of untested drugs like hydroxychloroquine or Indian Prime Minister Narendra Modi rolling out vaccine boosters before enough evidence emerged, had a very adverse impact on people’s trust. (Now, armed with evidence, scientists in India say that elderly people with comorbidities and immunocompromised persons should consider taking a third dose).
Some prickly issues may never see a resolution though, if present developments are any indication. One of them is more transparency with data like excess deaths, where countries like India – continue to resist the WHO estimates – unlike many other countries. The second issue is more transparency with science from governments. For example, WHO continues to call upon China to be more transparent about the origins of the virus, as all its efforts to have access to the vital information have not borne fruit. Chinese scientists also recently withdrew crucial databases from GISAID – a global repository of SARS-CoV-2 genome sequences.
And these unsettled issues, along with the vaccine inequity witnessed by low- and low-and-middle-income countries in the first three years of the pandemic, thanks to hoarding by their richer peers, will remain the hallmarks of this global health emergency.
Nonetheless, as Ghebreyesus pointed out in the press conference on May 5, significant “investments we have made and the capacities we have built must not go to waste”, especially in terms of genomic surveillance and vaccine science. The next big bet is the development and easy accessibility of drugs to deal with COVID cases that are not severe. The biggest bet, though, would be the development of a vaccine that is effective against all upcoming variants of Covid-19 – a daunting challenge that hasn’t been met for any of the viruses.