Reaching Covid magic number to get back to normal is a Hollywood thing, says historian

History shows that there are no objective criteria to define the end of the Covid-19 pandemic and, as with other epidemics in the past, it will be up to societies to determine when to return to normal, as the coronavirus will continue to circulate, mutating and reinfecting people.

The opinion is of researchers Peter Doshi, 41, senior editor of the scientific journal BMJ (British Medical Journal) and associate professor at the University of Maryland (USA), and David Robertson, 34, historian of science and doctoral candidate at Princeton University (USA). . They have recently published articles in the BMJ and the American newspaper The Washington Post on the topic.

According to them, more than a century after the Spanish flu, there is still no agreement on which was the last wave of that pandemic. “This idea of ​​hitting some magic number and then declaring the pandemic over and getting back to normal is more Hollywood stuff than history,” says Robertson in an interview he and Doshi gave to sheet by email.

For the researchers, the wide variety of responses that countries have given to the pandemic, some still with strict measures, such as closing schools, and others already open since the second half of 2020, shows that these decisions were not made based on objective criteria. , in epidemiological metrics, but in different assessments of the impacts of the virus.

They claim that while many things about Covid are still uncertain, there is a certainty that Sars-CoV-2 will not go away. But that does not mean that the virus will continue to cause the suffering it has caused in the last two years, because immunity levels are higher, either from previous exposures to the coronavirus or from vaccination.

“The main lesson of history is that societies move forward, accepting the continued circulation of the new virus. We can and must continue to develop ways to protect the most vulnerable​​ from Covid-19, but this will not involve its eradication”, say.

Is there an objective criterion for declaring the end of the Covid-19 pandemic?

David Robertson – History shows that there are no objective criteria for the end of a respiratory pandemic like Covid-19 because the pandemic is first and foremost a social event, not a biological one. We can see this in the wide variety of government responses to the virus.

Even in the US, states have varied greatly. [as respostas]with some continuing to enact strict measures, such as school closures and vaccine passports, and others, for the most part, “open” since the second half of 2020.

There was no epidemiological metric to determine these different responses. They reflected different assessments of the impact of the virus on society, as well as the impact of public health measures such as prolonged school closures.

You say that, historically, the resumption of normal life guides the end of a pandemic. This is already a reality in several countries. Do you think it’s time for major restrictions to be dropped?

DR – Things seem to be going in that direction. But it is remarkably uneven. For example, I live in a European country that recently suspended all measures [de proteção] to the coronavirus. More and more European countries have announced the need to get back to normal and start living with the virus.

However, my university in the United States recently ordered [doses de] reinforcement for students and staff and continues to require masks, weekly tests and still holds many meetings virtually.

It’s hard to see how they’ll get to the “end”, because they seem to be waiting for the virus to be eliminated, and it’s not going to happen. At some point they will have to accept that we have to live with Covid, things will return to normal, and the pandemic will end for them too. But at the moment it is unclear when that will happen.

Peter Doshi – If there is a desire for a return to normalcy, then yes [as principais restrições devem ser abandonadas].

Not everyone agrees with your statement that there are no metrics to identify the end of the pandemic. They cite, for example, hospitalization rates or the proportion of positive tests. Are these metrics not valid? Because?

DR – Trying to establish an epidemiological metric that can tell us when the pandemic is over suggests that the end of a social event, like a pandemic, should be determined purely by a single group of experts. But even these experts don’t agree on what that metric should be!

Some still believe that the pandemic must not end until we eliminate the virus. We’ve also seen this issue historically, with different pandemics getting different “end” dates.

Even more than a century after the Spanish flu [iniciada em 1918], there is considerable disagreement over which “wave” was the last of the pandemic. In our article, we wanted to point out that this idea of ​​hitting some magic number and then declaring an end to the pandemic and getting back to normal is more Hollywood stuff than history.

It never happened like that. At least, not with an endemic respiratory virus. As these things become endemic, affecting us all, it’s up to us to determine when we want to get back to normal. Reducing this to a number is not possible.

PD – I agree with David. I will just add that if we were to use some of these metrics proposed in the question, the pandemic would have “ended” several times in the last two years.

You say that in the last century the end of respiratory pandemics was never clear. But given the fact that everything is new at Covid, it is reasonable to compare the current situation with what has happened in the past. distant?

DR – In general terms, the current pandemic is not radically different from previous flu pandemics. Covid-19 is far less deadly than the Spanish flu and deadlier than the 1957, 1968 and 2009 pandemics. That said, Covid-19 is also less deadly for young people, while flu pandemics are always particularly mortals among the young.

The big historical difference is that this time, with Covid, we thought we could make the virus go away or come under our control. As wave after wave and variant after variant have made clear, we cannot eliminate this respiratory virus.

That doesn’t mean we shouldn’t do anything. But many pandemic governments behaved as if they could eliminate the virus through lockdowns, school closures, border closures, working from home, etc. It was entirely predictable that Sars-CoV-2 would become another one of our endemic seasonal pathogens. Historically, this is what happens after pandemics like this one.

So do we need to stop with the idea that if we do everything right, the coronavirus will disappear?

PD – Yes, we need to stop with the idea of ​​eradicating the virus. This has not happened in previous epidemics of respiratory viruses like influenza and coronavirus, and we have seen that it will not happen for Covid-19.

Don’t these statements end up serving as ammunition for the denialists and contributing to people lowering their guard even more in relation to preventive measures?

PD – I want to comment on what you call “ammunition for the denialists”. I think journalism needs to move away from this notion that the world is as simple as truth versus misinformation and denial. There’s a lot more gray. There are nuances. There are such things as well-informed minority opinions.

In the article, you also question the availability of data in this pandemic as something negative. What exactly do you mean by that?

DR – During Covid, the main argument has been that having more data is always better. But is this really true? Data on Covid hospitalizations and deaths is obviously important to manage the health crisis. But other data, like the daily cases displayed on Covid-19 dashboards, can create more problems than it solves.

Why, for example, do we count and report asymptomatic infections in the same way as critically hospitalized ones? Are these things really the same? Is a Covid case in a nursing home comparable to a Covid case in an elementary school? Failure to distinguish these points in the data has worsened the pandemic, fueling public panic and promoting illusions of control.

Do you really consider it reasonable to suggest that the best way to deal with this would be to eliminate the information? That wouldn’t give more space to the news false?

DR – We certainly wouldn’t ask for the deletion of information. It’s not that data is totally irrelevant to making decisions about the pandemic, but rather that data, by itself, cannot tell us when the pandemic is over.

Data visualized in dashboards became similar to Oracle of Delphi [local de profecias na Grécia antiga], as if the “end” simply announced itself to us when the infection curve went down and stayed low. Given that history makes it very clear that the curve will never stay low, we think it’s important to call attention to this unprecedented adoration of data.

In Brazil, about 600 people still die every day from the coronavirus. More than 650,000 have already died. How to get back to a normal life with these numbers?

DR – One of the key points that we highlighted in the article is that pandemics never end in the same way and at the same time everywhere. How the pandemic ends in Brazil will depend on how Brazilian society will continue to respond to the virus in the coming months and years.