'Worst of pandemic should be behind us...': says US Covid expert to HT

The world has not seen the last of Covid-19 but the worst days of the pandemic are 'absolutely behind us', Dr Ashish K Jha, the United States government's Covid-19 response co-ordinator, said on Day 1 of the 20th edition of the Hindustan Times Leadership Summit.

Dr Jha pointed to high levels of immunity in the global population - due to both vaccination and prior infections - and said '... even if we see surges even if we see new variants. the worst of this pandemic should be behind us'.

"Covid is not fully over... in some ways it will be with us forever and we have to manage it. But if the question is, 'are the worst days of covid behind us', then my answer is 'absolutely'," he told R Sukumar, Hindustan Times' editor-in-chief.

Dealing with variants

Since Covid-19 erupted was identified there have also been various variants that have triggered waves of infections, including the deadly Delta variant that (some reports suggest) caused nearly a third of all Covid deaths in India.

As the world worries about Covid-19, particularly with newer and newer variants being identified regularly, Dr Jha was asked if this trend is a concern.

"Right now, I would say variants are a concern. We are seeing very rapid evolution... the speed at which SARS-CoV 2 is evolving is remarkable."

READ | New Omicron sub-variants: 5 ways mild Covid is affecting our health

"There are a variety of reasons. The primary is - we have so much immunity between vaccinations and prior infections that it is putting evolutionary pressure on the virus to find a way around that immunity," he explained.

"We are seeing immune-evasive versions. The good news is that we can do things... like update vaccines... that can get us ahead of the virus."

READ | UK says new Omicron variants could fuel fresh Covid infections

Dr Jha said that while the continuing evolution of the virus 'worries' him, "... it reassures me that we, as humanity, can respond to it and are not powerless."

Waves of infections

Following on from a discussion on variants, Dr Jha was also asked about infection surges, and said that 'over time the virus will settle into a seasonal pattern... a bit like influenza'.

"... there will come a time when it is more seasonal. It is already now… even if we are still seeing surges. That is because of rapid evolution... you get new immune-evasive variants and they cause mini-waves. But there is so much immunity in the population that it limits how big the wave can be," he said.

READ | Omicron's XBB variant cases rise; experts on symptoms, severity

Dr Jha also said he hoped the virus would become less lethal over time but warned it would be wrong to assume this is a given since 'viruses can surprise'.

Vaccines

The rapid development and distribution of Covid vaccines was a stunning achievement, Dr Jha said, noting that the Indian government, in particular, did an excellent job in this regard.

"... if you think about how India turned its situation around after the Delta wave, this ramp-up of vaccine production and a phenomenal vaccination campaign (helped). I will say it was one of the most impressive," he said.

Asked about how vaccines may also evolve - to counter the newer Covid variants - Dr Jha said the second generation of vaccines were already proving more effective because they were targeted towards the Omicron variant.

"The question out there in vaccine world now is - 'are we going to keep doing this... keep updating...' If that is where we land, then that's ok. That's what we do with the flu vaccine every year... not a big deal. But my hope is we can start building vaccines resilient to evolving viruses... these can really prevent infections. Right now vaccines can prevent serious illness and are decent at preventing infections. But that doesn't last as long as we want it to..."

"I think the current path is good but not good enough. We should be striving for more robust vaccines... but that is a year or two away," he said.

Misinformation and effective communication

The fight against Covid-19 - both over the past three years and going forward - has focused as much on the science as it has on the dissemination of available information. And given there was precious little in the early days, it meant governments had to deal with misinformation.

READ | Fighting the misinformation pandemic in the age of Covid-19

In this regard Dr Jha underlined the importance of scientists and political leadership communicating with the public, particularly since the major focus in the initial months was to change public behaviour; for example, encouraging social distancing and hand hygiene.

"Covid taught us the importance of investment in public health. It also taught us the importance of data, and the need for public health and political leaders to communicate openly and clearly with people."

"An information vacuum - where the public is not told about aspects of the virus - is fertile ground for misinformation. And this was a problem because scientists are (generally) cautious... this is good but we shouldn't leave a vacuum."

"If you don't know all the facts, tell the public what you do know. Say something. Say 'this is what we know... this is what we don't... this is what we're going to find out..." he said.

Long Covid

Perhaps one of the lesser known problems surrounding the Covid-19 is Long Covid or pot-Covid conditions, in which an infected person can suffer from symptoms for weeks afterwards, even after the virus itself has left his/her body.

"Post-viral syndromes are widely known... so this is common. That said, it does seem to be more of a problem with SARS Covid. We are learning but there are fundamental issues on which we need more information," he said.

READ | Long Covid real, can last from 90 to 150 days: Study

Dr Jha stressed, though, Long Covid is not one condition. "For some people it is immunological, for others it is something else. What we need to do is separate those as individual problems and work on targeted therapies," he clarified.

He also touched on the increased risk of heart attacks and strokes in Covid-infected people, something on which there are an increasing number of studies.

"We know Covid can cause vascular damage (damage to blood vessels). This is important because we know this can trigger heart attack or stroke. Clinically or physiologically it makes sense some people are at greater risk... the issue is we need more studies, bigger studies, to fully understand the problem."

On Covid and schools

One of the biggest concerns worldwide was the impact of Covid-19 on children and whether they could be allowed to go to school as normal. In the early days several countries, including India, shut down all educational institutions, and switched classes to an online mode.

The debate - should children attend in-person classes - split scientists and policy-makers. In India there was opposition, particularly since those below 18 were the last major age group to be vaccinated.

READ | Around 20,000 schools shut during 2nd year of Covid-19: Report

Dr Jha, though, is on the side of allowing children to continue going to school.

"I think all of us would agree education of children and making sure schools are open must be amongst our highest priorities. The good thing is that now - 2.5 years into managing the virus - we know how to keep schools safe, and we've done this in the United States, in Europe and in India," he said.

"Schools should be the last to close and first to reopen. In the context of where we are, I see nothing to suggest schools have to shut ever again," he added.

Zero Covid?

There were, broadly speaking, two major approaches to handling the virus. Most countries opted for an initial lockdown followed by phased re-opening of social and economic activities, including education, as we learned more about the virus and developed vaccines.

China, however, opted for a 'zero Covid' approach that has been questioned.

READ | China records highest infections in 6 months, sticks to zero-Covid plan

"... could have been a case for 'zero Covid' in the early days but, at this point, it doesn't make sense. When you don't vaccines, treatments, tests... being aggressive makes sense. But that is not where we are. We are at a point where vaccines are available... in that context 'zero Covid' doesn't make sense to me."

"At this point it is about managing the virus to make sure it doesn't kill a lot of people... it is going to be around forever and so I don't fully understand how sustainable 'zero Covid' is..."