How long have public health and the US economy been widely endangered by Covid-19? We do not know. Without a vaccine, experts say, it will likely be years.
The future is dark for many reasons. Namely: so much depends on human actions, both individual and collective, that are easily difficult to predict and model in the long term.
But scientists are hoping to answer a basic question about the virus and how it interacts with the human body soon, to predict when the pandemic will end: how long will immunity to SARS-CoV-2, the virus that Covid-19 causes an infection?
If immunity lasts for a few years or more, Covid-19 may fade in a few years. If immunity decreases within a year, Covid-19 can make fierce comebacks annually until an effective vaccine is widely available. While there is hope that a vaccine will become available, it is not a given. The vaccine could also be less than perfectly effective. Manufacturers may struggle to produce enough.
Immunity is key to understanding the duration of this pandemic. This is what we know about it so far, and how scientists can unravel the mystery for good.
Without a vaccine, we need many immune people to stop an outbreak
Here is a simple math that explains how many people need immunity to a virus to stop an outbreak.
Outbreaks end when each new case of the virus results in less than one new infection on average. Immunity can help us do that.
If each case of the virus leads to two more cases on average, about half of the population must be immune to the virus for the outbreak to die naturally.
If one infection causes three others on average, two-thirds of the population must be immune to control the outbreak.
That’s the big simplified picture.
In practice it is messier. R0 – pronounced r-nothing, the basic reproductive number of the virus that describes the average number of new cases generated from a single infection – is not a fixed figure. It can change in different environments, in different populations, and when people display behaviors such as wearing a mask and washing hands.
Make things messy too: Not everyone is at the same risk of contracting the virus. The threshold to end the outbreak could, in theory, be reached a little earlier if the most vulnerable people – and the people most likely to be infected and spread it to others (because they work in a supermarket, for example) – get immune first.
Either way, researchers estimate that the current R0 of SARS-CoV-2 is between 2 and 3.
It follows that this virus continues to spread until between half and three quarters of the population is immune. That’s the threshold that epidemiologists talk about when they talk about “herd immunity.” When herd immunity is meticulously achieved, the number of new infections can decrease.
But there is another possible wrinkle here. Livestock immunity can only be reliably built up if immunity is sustainable. As immunity decreases, the percentage of the population that is immune decreases and the virus spreads further.
Assuming immunity is permanent, how long does it take for the outbreak to burn out on its own?
So at best – where immunity is permanent – how long would it take to reach herd immunity and end the pandemic?
Ideally, immunity will build up slowly over time in a population to avoid flooding hospital systems with cases and chaos and causing additional damage.
Recently, epidemiological researchers from Harvard, Christine Tedijanto, Marc Lipsitch, Stephen Kissler, Edward Goldstein and Yonatan Grad published a study in Science estimate how long it would take to gently reach herd immunity (which would still mean a lot of infection and death).
They modeled an approach where countries turn social distances on and off to avoid overwhelming single wave hospital systems. “And we see with such an approach that it may take until 2022 to build up the immunity of the population so that the virus no longer works by itself,” says Tedijanto, adding that this is just one hypothetical (and probably overly simplified) limitation is scenario. Who knows if people would adhere to a stop-and-go social distance policy?
But the result gives us an idea of how long it would take to end the pandemic if we adopted the goal of preserving healthcare capacity and occasionally easing restrictions. Their general conclusion, “It will be difficult to get back to normal until we have a vaccine,” she says.
Some have argued for an approach that builds herd immunity faster. Maybe we can make it before 2022? This would mean more infections and deaths overall (between 0.5 and 0.8 percent of all people infected with the virus). That’s because “there is an idea of overshoot, where if you just let go of an epidemic, without mercy, it has the momentum,” says Tedijanto. “Not only does it stop when it reaches the herd’s immunity, but you actually tend to exceed that number and become infected with a larger proportion of the population.”
Recently biologists Natalie Dean and biologist Carl Bergstrom calculated in the New York Times what damage a breach could cause. “If 100,000 people are contagious at the peak and they infect 0.9 people each, that’s still 90,000 new infections and more,” they write. “If the pandemic in the United States went unchecked, it could continue months after herd immunity was reached, infecting many more millions.” In this scenario, they write that by the time the pandemic ends, the number of infected individuals could well exceed the herd’s immunity threshold – perhaps as much as two-thirds.
“If it spreads, even cleverly, enough across the population to gain immunity to the herd, it will really result in a shocking death toll,” Dean told Vox. “Then the other solution will be blocked forever. Since those are the viable options, we definitely need to investigate other ones. ”
If immunity doesn’t last, we can live with Covid-19 outbreaks for years
The Science the finding of paper 2022 assumes that immunity lasts for years. If a person’s immunity decreases within a year, as is possible with other viruses in the coronavirus family, it can last longer than two years. If immunity is particularly weak – if it lasts less than a year – Covid-19 can stay with us for a long time.
“If immunity lasts for a year or less, we can expect annual winter outbreaks of Covid-19 until there is a vaccine,” says Kissler. “If the immunity lasts longer [around one to five years], then there may be sporadic winter outbreaks; maybe not every year, but possibly every few years. But the longer the immunity lasts, the more likely it will eventually disappear completely and the disease will be eliminated. ‘
For reasons that scientists don’t fully understand, for some infections, a person’s immunity never decreases. People who are immune to smallpox, for example are immune to life: Antibodies that protect against smallpox have been found as early as 88 years after vaccination.
Less reassuring here is that scientists have observed antibody levels for other coronaviruses (there are four strains that infect people as colds) can decrease over a period of years. But even if you lose the antibodies, that doesn’t mean you’re fully prone to the virus again. Yes, none of this is easy. More about this.
But the good news, for now, is that studies suggest almost everyone also develop antibodies to SARS-CoV-2 as T cells, another immune system cell that helps clear up an infection. More needs to be done to show which cells and concentrations confer the most long-lasting immunity.
We need further studies called ‘correlate of protection studies’. These are longitudinal studies that patients follow over time, “follow them to see if they develop reinfection and compare antibody levels and other immune markers between those who are reinfected and those who are not,” says Saad Omer, director from the Yale Institute for Global Health, says.
Unfortunately, these studies take time. We cannot know whether the immunity lasts for a year if less than a year has passed. It may also be that the immunity for different people has different durations depending on the severity of their infections.
“The worst case scenario I can imagine would be that mild or asymptomatic infections do not confer much immunity, and that the virus is much better transmitted in winter,” said Kissler. “This would be bad because in the summer the virus would have a lot of time to spread to most parts of the world and then explode into a major outbreak that affects almost everyone at once.”
We may have been living with Covid-19 for years. But that doesn’t mean we have to live in a closed space for years.
All this does not mean that we must remain in lockdown until 2022. There is a middle ground between lockdown and going all the way back to what it was like. A massive campaign of universal masking, testing, contact tracking, and isolating suspicious cases and their contacts can help reduce transmission and make our lives a little bit back to normal.
“I want to be optimistic and say that we can get to a place less extreme than what we are in right now,” said Tedijanto. There is no magic bullet, she says, to defeat Covid-19. But a combination of wearing universal face masks, better data on transmission hotspots (and how to avoid them), and improved testing and contact tracking are likely to pave the middle.
“It’s going to be a gradual process that requires a lot of patience,” she says. And we must be prepared to live with this virus for a long time.