Many an expert says there will be some semblance of normality by next summer. Our life has been turned around, independence curtailed, movement severely compromised, activities reduced, and many have seen their loved ones torn away from them by the virus SARS-COV-2. All this started about a year ago in Wuhan, China, and the virus responsible has infected 46 million people worldwide and killed 1.19 million.
Winter is going to be particularly dangerous for people living in temperate climates, as the reduced humidity would allow the virus more freedom. We, the victims, are likely to remain more indoors in confined spaces, encouraging transmission of the perpetrator, so minuscule, only visible with the aid of an electron microscope.
In winter, humidity falls as the cold air is less capable of holding moisture compared to warm air. Lower humidity, in absolute terms, is the most important determinant of respiratory viruses thriving in temperate climates. Reduced temperature, low micro-nutrient levels such as low vitamin D, reduced social distancing -- all augment the adverse effects of viruses like coronaviruses.
In the state of reduced humidity, cilia in our nasal passages would be less effective in clearing the virus, resulting in more and more of them gaining access to the lower respiratory tract, allowing the virus to damage respiratory cells, the repair of which will be adversely affected, allowing the damage to worsen when the surrounding humidity is low. Low humidity, in addition, interferes with the function of interferon that informs our body’s immune system of the imminent attack and initiates the immune response to fight and neutralize the virus.
With the lifting of the cold winter weather, and eventual setting in of the warmer weather, the environmental humidity would increase, with the possibility of avoiding increased crowding in households, and that would certainly improve our livelihood, and it is expected that by summer 2021 some semblance of returning to normal can be hoped for, as predicted by the most optimistic of scientists.
Professor Robin Shattock of the Imperial College believes that the vaccine would be approved and available around Christmas, and frontline workers in the NHS and the most vulnerable would have access to the vaccine in the first half of 2021. We may be fortunate enough to see our lives going back to the pre-Covid-19 era in the summer of next year. The advent of a single or several vaccines, their rolling out, and inoculation of frontline health workers and the vulnerable may enhance trust, and impart a sense of confidence in the future schema of the pandemic, leading to preparedness for a return to normal of the pre-pandemic times.
However, the initial vaccines are likely to reduce the severity of infection and even if it prevents infection, it is likely to produce short-term transient immunity with vulnerability to infection, necessitating further inoculation of the vaccine. The success of the corona vaccine does not mean life will go back to normal, but that people may contemplate to start setting out of the situation into an acceptable and dynamic new normal.
We know that Britain’s health regulator MHRA has already started an accelerated rolling review of the Oxford AstraZeneca vaccine. In the rolling reviews, regulators are able to directly see clinical data in real-time, and conduct dialogue and discussions with the vaccine manufacturer on the manufacturing processes and trials to accelerate the approval process.
It is specifically designed to accelerate the approval process of potential drugs or vaccines in a public health emergency like the ongoing Covid-19 pandemic. The Oxford vaccine, made from a combination of a common cold virus infecting chimpanzees but causing no harm in humans, has been endorsed with a few others, to run phase III of the vaccine trial simultaneous to phase II.
However, many other experts warn against the hope for a quick fix to returning to normal life. Rolling out a vaccine does not mean mass immunization against the virus within a matter of a month or so, and in fact, mass inoculation of the vaccine may take up to five years, depending on the speed of manufacturing, preparedness for transportation, distribution, preservation, and ultimately, inoculation of the vaccines that in turn would depend on public trust on the vaccine and their acceptability.
Then there is the question of effectiveness, duration of immunity conferred, and the doses to be injected to maintain continued or periodic immunity. According to Dr Anthony Fauci, a vaccine alone is not going to solve this pandemic, at least not at the present time. He emphasizes on the continued and committed use of public health measures -- social distancing, masks, hand-washing, now and even when the vaccines become available. He does not contemplate the start of the beginning of the return to normal before the third quarter of 2021. And that is just the start of the beginning.
Dr Raqibul Mohammad Anwar is Specialist Surgeon, Global Health Policy and Planning Expert, and Retired Colonel, Royal Army Medical Corps, UK Armed Forces.
