In the days before Covid, I’d often get frustrated by the response that doctors would give when I turned up at their clinics with some infection or other: “It’s just a virus,” they’d say.
As someone who’s long been fascinated by the detective work that goes into tracing the origins and history of infections,(1) the answer always seemed too perfunctory. Which virus was it? Where and when did this strain emerge? How many other people were getting infected with this same variant this year?
Those questions aren’t of much relevance to most general practitioners, because the majority of viruses simply burn themselves out as part of the teeming backdrop of endemic infections that roll around the globe each year. At some point, with rising immunity from vaccinations, infections and booster shots, Covid-19 will join that club.
Early last year, the world urgently needed to raise its sense of alarm around the SARS-CoV-2 virus, and see it as the imminent threat it was rather than a more routine infection on a par with influenza. Right now, though, the vaccinated parts of the planet need to mentally send themselves in the opposite direction. It's time to remind ourselves that, for those who’ve been inoculated, Covid-19 is no longer a horseman of the apocalypse but instead is gradually becoming “just a virus.”
That’s broadly the place that some of the countries that have advanced furthest in their vaccination programs are reaching. In Singapore, where 81% are fully immunized, the Ministry of Health has started prioritizing data on hospitalizations rather than infections, since the vast majority of cases are now relatively benign. Israel is riding out a surge in new cases without returning to lockdowns for the vaccinated, since the vast majority of infections no longer result in serious illness.
The calls from some quarters to stop publishing daily case totals may be premature for a disease that’s still killing thousands of people a day. At some point, though, when Covid has passed from its current pandemic status to the endemic situation where it fades into the background, we’re likely to be as vague on daily or even annual case numbers as we are in the case of influenza.
It’s hard to believe that an infection that’s killed more than 4.5 million people could be thought of in such a routine way, but viruses through history have flipped between endemic and pandemic status with remarkable frequency.
The “Russian Flu” pandemic which circled the world in the late 1970s appears to have been an unremarkable seasonal flu strain from the 1940s and 1950s, possibly released to the world anew via a laboratory accident. People over the age of 25, who’d been exposed to the variant in their childhood, were largely immune. Yellow fever, which shaped the history of the Americas for four centuries through its devastating effects on expeditionary military forces who lacked immunity, has now largely vanished from urban areas of the western hemisphere, while remaining a devastating infection in sub-Saharan Africa.
A July study in the journal Microbial Biotechnology even presented an argument that a coronavirus strain called HCoV-OC43 might have been responsible for an 1889 outbreak also known as the Russian Flu, arguably the first true modern global pandemic. That particular strain now crops up as one of the main causes of the common cold, a classic example of an endemic infection that doctors safely dismiss.
We’re not at that stage yet. Fully vaccinated, I feel relatively sanguine about the likelihood that at some point in the years ahead I, too, will be exposed to Covid-19. Still, fully inoculated friends who recently moved from Sydney to New York and caught the virus within weeks of arrival have suffered a vicious infection that spread to their unvaccinated preteen son. That’s reason to keep treating this disease with respect, at least until everyone has had the chance to be vaccinated and we have a clearer sense of how long protection against severe infection persists.
This terrible scourge will always be with us, but in a milder, less troubling form. After the trauma of the past two years, it’s hard to believe that we’ll ever look upon that prospect with a sense of equanimity — but that’s what must ultimately happen. The moment we’ve beaten Covid won’t be when we eradicate it from the human population, but when we’ve reached a level of vaccinated and natural immunity where we no longer have reason to fear it. That moment will come — and when it does, even this dreadful infection will be just another virus.
1. For those with similar interests, "The Origins of AIDS" by Jacques Pepin, "Epidemics and Society" by Frank M. Snowden, and "Mosquito Empires" by John Robert McNeill are well worth reading.