The Pandemic Endgame

By Dr Nestor Sosa

During a game of chess, when there are few pieces left on the board, priorities and strategies change tremendously. This key stage is appropriately known as the endgame, and is usually played differently from the other stages, such as the opening and middlegame. Likewise, this pandemic, at a given moment, is going to enter a final stage. And during this final stage, as in chess, it will be necessary to change strategies and adapt them to the particularities and changes that the new clinical and epidemiological conditions demand.

At this time, we have several effective tools to reduce the severity of the disease caused by SARSCoV-2. We have multiple vaccines that are safe and have been shown to significantly decrease the percentage of hospitalizations and admissions to intensive care. We have several effective oral treatments and injectable drugs have also been developed that substantially reduce the progression of the infection or the mortality associated with it.

An increasing percentage of the population has immunity against the virus, acquired through vaccination or having had a previous infection. And although we have learned that this immunity does not confer 100% protection against reinfection or infection in vaccinated individuals, it is clear that the risk of severe infection decreases substantially if you have immunity.

Acquired knowledge
On the other hand, after more than two years of the pandemic, we have accumulated an enormous amount of knowledge about the transmission, epidemiology, genetics, and behavior of the virus and its various variants. We have several types of diagnostic tests available and we know the effectiveness of non-pharmacological measures, such as masks and respirators, the importance of good ventilation and low transmission in open spaces.

The important thing now is to determine when the strategy can be changed. When can it be assumed that the greatest danger has passed? How to know that a new outbreak of the virus will not bring the health system to its knees and will not cause pain and loss like the first pandemic waves?

To begin with, it is necessary to have an adequate supply of vaccines for people of all ages, including very young children. The company Pfizer has already requested emergency authorization from the Food and Drug Administration to administer its vaccine to children between 6 months and 5 years of age.

Of course it is not enough to have the vaccines available in the freezers. It is necessary to have a high percentage of people vaccinated, say above 80% or 90%, with at least the three required doses. Including, of course, those who have had the infection. The solidarity and cooperation of everyone is needed, especially those who have not yet been vaccinated or those who have not wanted or been able to complete their boosters.

Although more than 10 billion vaccines against Covid-19 have already been administered worldwide, there are countries, especially in Africa, that have less than 10% of their population properly vaccinated.

On the other hand, there must be an adequate supply of effective medications and a structure to administer them quickly and to those who really need it. No corruption, no trickery. These medications have shown efficacy only if they are administered within the first 5 to 7 days of symptom onset. For this reason, it is necessary to have the capacity to carry out rapid diagnostic tests, including home tests that allow people to access treatments expeditiously.

Case surveillance should focus on severe Covid-19 hospitalizations, intensive care unit admissions, and deaths. The statistics should include rates of these indicators in previously infected and vaccinated with 1, 2, and 3 doses. This will make it possible to adjust strategies in the event of detecting an unexpected increase in the most serious cases and to assess the need for reinforcements or modification of the vaccines to make them closer to the circulating variants.

At the global level, it is necessary to continue with genomic surveillance, that is, the detection of variants and the rapid evaluation of their capacity for immune evasion and their pathogenicity.

The isolation of patients can be shortened with the rational and timely use of antigenic tests that fairly well predict who is contagious and who is not. Those who have recently recovered can wear an N95 mask or respirator for several days to protect those around them once their symptoms have improved and especially if their tests are negative. People exposed to a positive case who have both their vaccine doses and a booster, or two vaccines and a previous infection, may be able to skip quarantines if they remain asymptomatic.

Many experts believe that SARSCoV-2 is not going away. This is more or less evident after more than two years. The key is to make sure it doesn’t kill or seriously ill so many people. Convert it with vaccination and medications into yet another respiratory infection, one that does not affect the functioning of society.

 We all have tiredness or pandemic fatigue. But humanity has faced much greater challenges. Wars that have lasted for decades, pandemics with much higher mortality and great famines. We have to go ahead and, like at the end of a game of chess, adjust our strategies and win. We have no other.

The author is a specialist in infectious diseases