At a time of both vaccination and the multiplication of variants around the world, this question, in the form of a joke, implies several levels of interpretation that call into question the sustainability of Covid-19 and our own. Is this coronavirus, which has made the whole planet hold its breath for over a year, set to stay in our lives and change the way we function for good?
Virus durability.
There are three ways to react to a virus or pathogen in terms of sustainability. So let’s start by detailing the various possible answers :
- Mitigation or “living with it”: this is the appropriate response to many pathogens, particularly influenza, which we are not trying to eradicate from the planet. Antoine Flahault, Director of the Institute of Global Health at the Geneva Biotech Campus:
“There is an influenza reservoir in birds and pigs. Pandemics recur regularly as a result of virus recombination in these reservoirs, and we don’t try to eradicate influenza despite the existence of vaccines, because we don’t know how to prevent the emergence of new pandemic viruses.”
In this case, we simply avoid overloading the healthcare system during epidemics.
2. Suppression or “low virus circulation”: this is the strategy adopted in the case of certain viruses such as HIV. We can’t eradicate them from the planet because we don’t have a vaccine, but we’re trying to achieve the lowest possible level of circulation, because the disease is formidable.
3. Eliminating the virus (or eradicating it from the entire planet): this is the so-called Covid zero strategy. It’s also the one used against smallpox, measles and polio.
The most sustainable strategy.
All Western countries – Europe and America as a whole, but also Russia and the Middle East – have opted for the ” live with ” strategy. Norway and Finland, like Japan and South Korea, have opted for the ” low traffic ” approach. Iceland, New Zealand, Australia, China, Vietnam and Taiwan have all opted to eliminate the virus from their territory. These countries had learned the lessons of SARS in 2003. Flahault :
” These countries were extremely well prepared for a SARS-type coronavirus attack from China and ready to respond to this type of threat… As early as January 10, 2020, when they saw the sequence of this new emerging disease, they understood that it was a virus close to that of SARS and decided to apply the recipes of SARS and not that of influenza so as not to let the virus in.”
For their part, Westerners considered this pandemic to be similar to a flu pandemic, forgetting the SARS episode and opting to “live with “. ” misdirection, wrong strategy? Flahault moderates :
” When countries were faced with the tsunami of the first wave, the only possible strategy was to struggle on as best they could. This was the case for China (Wuhan), Italy, South Korea and then the European countries. They had no other choice, given the urgency dictated by the epidemiological situation. When a wall falls on me, all I can do is protect myself.
In an emergency, reactive strategies such as containment are used to protect the healthcare system.
When it comes to taking stock, however, the figures are clear. If we analyze mortality – the best indicator of Covid’s performance in countries with comparable standards of living where data is collected in a homogeneous way – rates exceed 70 per 100,000 inhabitants in countries that have opted for “living with”, are between 1 and 20 per 100,000 in those that have opted for low circulation, and below 1 per 100,000 in those that have advocated elimination. Flahault:
“Health performance indicators differ radically between the three strategies. The same applies to economic indicators: in Taiwan, China and Vietnam, GDP growth is expected to be positive in 2020 (compared with 2019), while it will be negative in the “living with” countries.
Growth is less severely impacted in countries such as Japan and South Korea than in the European Union. Switzerland, despite its ” live with ” strategy, is an exception, but perhaps it benefits from an economic structure that is less vulnerable or more tertiary and conducive to teleworking (such as the banking sector) ?
Will the virus stay with mankind -and last- now that it’s well established ?
It’s hard to say. ” I don’t know if we’ll be able to eradicate Covid-19 from the planet, but we must do everything we can to try, ” admits Flahault.
The characteristic of RNA viruses is that they accumulate errors very easily as they replicate, mutations that persist as they adapt to their environment. These are zoonoses, viruses that have made a species jump after accumulating mutations and end up adapting to their new human host. The AIDS virus in Africa, for example, was eventually transmitted to humans, probably through primate contamination, and a number of mutations enabled it to adapt to humans and gradually spread to human populations. The initial sequence of SARS-CoV-2, meanwhile, probably corresponds to a bat coronavirus sequence passed on to humans via an as yet unknown intermediate animal host. It is now a virus with an extremely easy tropism for humans, adapted to the human population.
In addition, the reluctance of large segments of the population to be vaccinated does not make the project of eliminating it any easier. A valuable tool if we are to move towards eradication. It’s a tool that the whole world has worked hard to develop in record time. For example, reluctance to vaccinate has led to the return of diseases such as measles. Flahault :
” We’re having a hard time eradicating measles, which was eliminated from the entire American continent a few years ago, but is now being brought back by these vaccine-refractory groups. “
To eradicate Covid, it would probably be necessary to vaccinate more than 70% or even 80% of the world’s population, i.e. 5 to 6.6 billion people, and the WHO/GAVI Covax mission has promised only 2 billion for the poorest countries by 2021, with no plans for 2022 or beyond.
Lessons in sustainability from history.
The story tells us that we are about to be attacked by new viruses already present in nature, and that they are capable of decimating us. Measles has been with us for 20 to 30,000 years. So we need to learn to be more proactive, to detect them before they do any damage, and avoid misdirection in our choice of response strategies.
Infectious diseases – tuberculosis, measles, smallpox, whooping cough, pneumopathies – played a dominant role in history right up to the end of the 19th century, taking heirs to the throne and holding back entire armies, recalls Frédéric Tangy, Director of the Vaccine Innovation Laboratory at the Pasteur Institute, in his book Man shaped by viruses. The Prussian army was blocked by dysentery in the 18th
th
century, while Amerindian populations were decimated by measles and tuberculosis, and smallpox brought down the Aztecs and Incas. Frédéric Tangy, in the A whole world on RTS:
“Since the Pasteurian revolutions, and since the last century with the invention of all the new pediatric vaccines currently being given, most of the infectious diseases that used to frighten people have disappeared or manifested themselves very little, at least in our hemisphere. As a result, people are now more afraid of vaccination than of infection. Covid was an extremely violent backlash for our society.”
The solution : more sustainable lifestyles.
The spread of respiratory and mosquito-borne viruses may be linked to our activities and to the Anthropocene in general. Flahault:
” The spread of viruses is not only determined by social factors, but also by environmental factors. This would enable us to act upstream on epidemics. For example, the fact that wildlife is in closer contact with humans represents a new threat in terms of emerging diseases.”
In the case of Covid, fine particulate air pollution has proved to be a major determinant of epidemic outbreaks, whether linked to desert sands or fossil fuels released by human activity. The emergence of mosquito-borne infectious diseases is also partly linked to global warming and other global changes such as deforestation, urbanization and the population explosion. The release of germs linked to the thawing of permafrost is still poorly documented, but it is a hypothesis that needs to be monitored.
We need to learn from this crisis as quickly as possible, particularly with regard to the reasons behind the political choices that have determined the health, social and economic performance of our responses. ” Analyze how the ” champions ” did, and how we can better prepare ourselves following the example of these ” champions “, ” summarizes Flahault. The associated risk of this analysis being the ” Maginot Line syndrome “, ” prepare now for the arrival of a new coronavirus when the next pandemic may be due to a virus that will be neither a coronavirus nor perhaps even a respiratory virus. “
