Extermination, elimination or coexistence with Covid-19?

“Elimination could represent a more realistic short-term goal for SARS-CoV-2,” says a study published Friday in the Journal of the American Medical Association JAMA.

In Israel, for example, the judiciary is within reach. New Zealand, Vietnam and Brunei may also be on the brink of it. On the other hand, the United Kingdom, the United States and China are currently more coexisting, which means that they are trying to deal with the virus. In India, other parts of Southeast Asia and much of South America, however, the virus is still raging at the moment like wildfire.

For scientists working with Aaron Kaufman of Emory University in Atlanta, the optimal scenario, global annihilation, is “a very ambitious goal even as a thought experiment.” It’s a reminder that smallpox has been eradicated, even though that was once considered unimaginable. Compared to smallpox, there is an increased risk with Covid-19: transmission of zoonoses by bats, farmed mink or as yet undetected reservoir animals. There was no such reservoir for smallpox.

Keep vaccinating

In order to prevent transmission of zoonoses, vaccination against SARS-CoV-2 and its variants must continue. In order to achieve global eradication – i.e. permanently reducing the spread of SARS-CoV-2 to zero – “adequate herd immunity must be achieved through vaccination and prior infection. This immunity must be “highly effective and long-lasting, preventing secondary transmission and re-infection, and protecting against all types of current and future virus variants.” These are very strict requirements.

According to the study authors, a viable alternative to extermination and eradication would be civilized symbiosis with SARS-CoV-2. In this scenario, vaccine-mediated protection would go so far as to prevent the most severe manifestations of COVID-19, break the chain of virus transmission, and fight the majority of emerging virus variants.

The global community decides

Prerequisites will be worldwide availability of vaccines, reduced reluctance to vaccinate and fewer variants. “In the long term, when global immunity becomes common due to exposure or vaccination, symptoms of illness can resemble those of the common cold caused by seasonal coronaviruses.”

The worst end-game scenario, a wildfire, could occur where there are gaps in the provision of vaccines against some variants and/or there is significant reluctance to vaccinate. Infections that are not controlled by people who are not immune will allow the virus to continue to evolve, making it more difficult to contain.

Ultimately, it will “depend on collective decisions and realities of the global community as well as the often ambiguous dynamics of SARS-CoV-2 as individual countries end up on the end-game spectrum.”