Return to Normalcy

Ten plus months, and a million and more deaths. People around the world are now longing for closure of the new ‘normalcy’ imposed on them. The world waits in fortitude for the end of it, even if everyday life will never be quite the same as it was before we were introduced to COVID-19. So, more than six months after WHO has declared COVID-19 a pandemic, when, and how will the end of the pandemic be?

Searching out historical analogies to find a perspective on the current reality may be reassuring when facing the question of ‘when or how a pandemic will end.’ Medical historians have documented a lot about the 1918 pandemic and its culmination.

When enough people get immunity, the contagion will gradually die out because it's harder for the virus to find new susceptible hosts. i.e. One epidemiological end- point to a pandemic is when herd immunity is achieved.

Likewise, one end point of COVID-19 will probably happen when the percentage of society immune to COVID-19 is adequate to foil extensive and continuing transmission. Many countries hope that a vaccine will do the bulk of the work needed to achieve herd immunity. When this end point is reached, the public health emergency interventions deployed in 2020 will no longer be needed. And a fear of resurgence can be held in abeyance.

However, the COVID-19 pandemic won't really end until there's both a vaccine and a certain level of expo- sure in the global population. In the meantime, people can help the endeavour to contain the effect of the pandemic. A proactive approach to public health saved lives a century ago—this tactic is still acceptable.

The end of the 1918 pandemic wasn't just due to herd immunity. Social distancing was also key. Public health advice on curbing the spread of the virus was eerily similar to that of today: citizens were encouraged to stay healthy through campaigns promoting mask-wearing, frequent hand-washing, quarantining and isolating of patients, and the closure of schools, public spaces and non-essential businesses—all steps designed to cut off routes for the virus' spread.

A Markel and Navarro study of 2007 in the Journal of the American Medical Association in 2007 seems pertinent. It found that the U.S. cities that implemented more than one of these aforesaid control measures earlier during the 1918 pandemic and kept them in place for longer, had better, less deadly outcomes than cities that implemented fewer of these control measures and did not do so until later.

A pandemic has to end, following the pattern of all the other viral pandemics to date. One could be more realistic and accept the epidemiologist’s view that when the pandemic does subside, it’s going to be “a gradual and incremental process.”

With the endless optimism that’s the hallmark of the human race, we wait, debate and look forward to the ‘return of normalcy’.

Dr Azad Moopen, MD, FRCP

Founder Chairman & Managing Director, Aster DM Healthcare

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