Today it is exactly one year ago that a Dutch patient was first diagnosed with covid-19, the disease caused by the coronavirus SARS-CoV-2.
Concerned scientists all say that the disease will not go away, in other words: that the disease will become endemic. We have to learn to live with it, they argue, as with other viruses.
The NOS questioned a large group of scientists about the future with SARS-CoV-2 and covid-19.
“Corona has to leave the country,” said State Secretary Blokhuis of Health recently. Is that realistic?
No, say all the scientists surveyed. “This is not realistic given the number of undetectable infections and because new introductions from neighboring countries continue to occur,” says epidemiologist Quirine ten Bosch. “The virus will continue to circulate worldwide and therefore come back”, says microbiologist Marc Bonten.
Virologist Ann Vossen states that it is very likely that no “sterile immunity” is formed: an immune response in such a way that a pathogen does not enter the body. “Not after an infection as well as after vaccination, so the virus will continue to circulate from person to person.”
According to epidemiologist Christian Hoebe, there are “new abilities” ready every year: the 180,000 children born in the Netherlands every year.
If this virus becomes endemic, what will it look like?
This is a very likely scenario according to all the scientists surveyed. “The virus becoming endemic also means that everyone will come into contact with it and will be able to build partial defenses. As a result, the effects may diminish in severity and move towards a normal respiratory virus,” says microbiologist Paul Savelkoul.
“The extent to which we suffer will be different if a large part of the population is immune,” says epidemiologist Alma Tostmann. “Depending on how long the immunity lasts, we may flare up every year or every few years.”
People will always get covid-19, microbiologist Alex Friedrich thinks. “Especially people with a reduced resistance, as a secondary disease. A cancer patient who also gets covid-19 or a heart attack due to Sars-CoV-2. And sometimes an outbreak, especially in institutions with groups of very susceptible people.”
Do we have severe and mild ‘corona years’, just like with the flu?
According to the experts, SARS-CoV-2 will be similar in behavior to the flu virus. But there are caveats. “Such a comparison is not wrong, but it is still premature. What it will mean for the burden of disease or the IC, for example, can still be quite substantial. And you have to organize care accordingly,” says microbiologist Heiman Wertheim.
“Assuming that the virus, like other coronaviruses, is seasonal, we get a wave every year, as with influenza. In fact, that’s called epidemic, not endemic,” says epidemiologist Frits Rosendaal. If SARS-CoV-2 turns out not to be seasonal, it will keep circulating all the time: endemic.
“It could indeed develop similar to influenza, but the question is whether this will happen every year with infections. Maybe at first, but we don’t see the other coronaviruses every year,” says virologist Bert Niesters. “Because of the increasing immunity, we will have less problems with it every season. In bad years, the virus will lead to peaks, just like with flu,” says microbiologist Andreas Voss.
Field epidemiologist Amrish Baidjoe also considers this possible. “But it depends a lot on the level of virus circulation and the number of animal reservoirs.” Pediatrician and epidemiologist Patricia Bruijning warns of a major genetic change. “This could be associated with relatively more (serious) infections. It is therefore still important to develop vaccines to always have an answer.”
Do we have to be vaccinated every year and do the vaccines have to be adapted to new virus variants?
The experts are also relatively unanimous on this point. Virologist Menno de Jong thinks it is best to vaccinate the risk groups every year before the ‘season’, just as with the flu. “Unless it turns out that the impact of endemic circulation is not significantly different from the other seasonal coronaviruses, and vaccination may not be more cost-effective,” he added.
Much is unclear. The vaccines are so new that no one knows how long they protect against covid-19. “Nor do we know how many neutralizing antibodies are needed for protection and what role other immune mechanisms – non-neutralizing antibodies and T cells – play,” says vaccinologist Anke Huckriede.
According to immunologist Dimitri Diavopoulos, ‘booster vaccinations’, a kind of booster shot, may be needed in due course, as with other vaccines. “To be honest, it seems unlikely to me that this is necessary every year.”
Virologist Mariet Feltkamp considers annual adjustment of the vaccines unnecessary. There are too many differences with the flu for that. “There are several influenza virus strains in circulation that are naturally highly prone to mutate. The vaccines are adjusted annually to this. Corona is now one strain with the necessary variants. The current corona vaccines and some ad-hoc adjustments are a strong asset. against all circulating SARS-CoV-2 variants. “
Vaccinologist Cecile van Els thinks differently: “It is already clear that adaptation of vaccines to new dominant virus variants will be necessary, this is also being worked on.”
If the coronavirus remains, should vaccination be included National Immunization Program?
Yes, say the scientists. At least: for certain groups.
Epidemiologist Frits Rosendaal is thinking of a vaccination program such as influenza for the future, because of the combination of group immunity, vaccinations and the softening of the disease. “So: now vaccinate everyone over the age of 18 or even younger, because the epidemic has to go. Later only vaccinate for protection, so only the elderly and vulnerable.”
The vaccination against covid-19 for the elderly should be included in the National Immunization Program, says microbiologist Marc Bonten. Vaccinologist Cecile van Els agrees: “In the Netherlands, the flu shot and the pneumococcal shot are already offered to vulnerable groups. It is clear that a corona shot is also included.”
Does the endemic of SARS-CoV-2 also affect healthcare?
Opinions differ on this. “More intensive care and infectious disease beds are definitely needed, especially in all major Dutch hospitals,” says microbiologist Alex Friedrich. “In UMCs, infectious disease departments are needed with around thirty (isolation) beds, for existing infectious diseases and covid-19. These hospitals will receive covid-19 (suspected) patients from all over the region. For larger peaks, structural agreements with neighboring countries are important, to to treat patients there. “
“The IC capacity will continue to be expanded, but so will the capacity in the ordinary nursing units,” says microbiologist Paul Savelkoul. “Unless variants pop up that vaccines do not protect against, I expect that we will be able to respond adequately and in a timely manner to an endemic SARS-CoV-2 in the future and not have to stretch the IC capacity,” says epidemiologist Quirine ten Bosch.
But not all scientists agree. “If the disease burden of SARS-CoV-2 decreases, the virus becoming endemic will have no direct consequences for IC capacity,” says Ann Vossen. “However, it would be desirable to make preparations to be able to expand IC capacity faster than now in an emergency,” says vaccinologist Anke Huckriede.
“Investing in a national vaccination knowledge center and in own production capacity is, in my opinion, a better alternative. A kind of Delta works for vaccination,” says immunologist Dimitri Diavopoulos.
Microbiologist Andreas Voss wants to limit the number of patient contacts through more e-care. He also argues for flexible training of employees, so that they can be deployed in different departments. “To better tackle the next pandemic, we need to increase IC capacity, but also improve infection prevention in home care and in nursing and care homes,” says virologist Bert Niesters.
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