On January 11, 2020, China announced the death of a man in Wuhan following what was then described as “mysterious” lung infection. The victim, whose identity is still unknown, had been treated for several days due to symptoms “worrying”, “unprecedented”, the Chinese press then reported.
Five years after the start of the Sars-CoV-2 pandemic, Covid is no longer at the center of a global storm, without being completely ancient history, because it still causes infections – sometimes persistent – and deaths. During this historic crisis, notable therapeutic advances were also developed. But prevention remains insufficient today in the face of the risk of a new global epidemic.
From pandemic to endemic disease
More than five years after its appearance in China, the virus causing Covid-19 has officially reached 777 million people. According to data recorded by the World Health Organization (WHO), it has caused more than 7 million deaths – many more in reality. But, over time and waves, the impact of respiratory infection on deaths and hospitalizations has greatly diminished, thanks to the immunity acquired by populations through vaccination as well as infections.
Covid still kills (more than 3,000 deaths from October to November 2024 in 27 countries, according to the WHO), but the overwhelming majority of deaths were recorded between 2020 and 2022. The pandemic has been over since spring 2023 and the lifting, by the WHO, of the maximum alert level.
Journal of a health system in crisis
The virus has, so far, no specific season but seems to be gradually becoming endemic, with regular resurgences, a bit like the flu, observe various experts. The omicron era has continued since fall 2021: one sub-variant replaces another, without being more severe. However, we should not entirely rule out the scenario of new variants that are more virulent or escape immunity, some scientists believe. In any case, Sars-CoV-2 will remain among humans.
More “the world wants to forget this pathogen that is still with us, people want to consign Covid to the past – and in many ways pretend it never happened – because it has been so traumatic,” observed Dr Maria Van Kerkhove, head of epidemic and pandemic preparedness at the WHO, in mid-December.
Successes in vaccines and treatments
Crucial against the pandemic, vaccination has been massive since the extraordinarily rapid development of serums. More than 13.6 billion doses have been administered worldwide, with very unequal access between poor and rich countries.
Vaccines adapted against omicron – in its JN.1 version – currently remain recommended, particularly for the most vulnerable, because they still protect against serious forms and the risk of long Covid. But vaccination coverage is insufficient, particularly among seniors and caregivers, warned the WHO.
The quest for vaccines that act longer and more powerfully against infection and transmission continues, as does the quest for new methods of administration (nasal, oral, cutaneous). In terms of treatments, the pharmacy has been reduced since Omicron: a few direct antivirals and a monoclonal antibody.
Certain innovations brought about or accelerated by the pandemic, particularly messenger RNA vaccines, remain a source of hope for other pathologies, such as cancer.
The persistence of long Covid
Fatigue, cough, shortness of breath, intermittent fever, loss of taste or smell, difficulty concentrating, depression… “Long Covid” manifests itself by one or more symptoms, generally within three months after infection, persisting at least two months and cannot be explained by any other diagnosis.
Around 6% of people infected with Covid experience this complex syndrome, the WHO estimated at the end of December, noting that this remains “a significant burden for health systems”. Women and people with previous health problems are more affected. And reinfections seem to increase the risks.
Scientists have made progress but have not fully elucidated its mechanisms, following several avenues: persistence of Sars-CoV-2 in the body, maintenance of an inflammatory state post-infection, formation of microclots, etc.
Insufficient prevention of future pandemics
Covid-19 is not the last pandemic, scientists are certain of that. The question is when the next one will come, and whether the world will be better prepared. Around 60% to 70% of emerging diseases are zoonoses, arising from pathogens transmitted from vertebrate animals to humans – they are multiplying due to deforestation, which increases contact with wildlife, a reservoir of unknown viruses.
Avian flu is currently under scrutiny, especially since a first human death Monday in the United States. This was an elderly patient who suffered from other pathologies and who had been infected via farmyard and wild birds.
For more than two years, WHO member countries negotiating an agreement to prevent pandemics have been slipping. The memory of the damage caused by Covid is fading, governments are changing, and a blockage persists between rich and poor countries.
The Covid era has also permanently increased mistrust of vaccines as well as misinformation. The re-elected President of the United States Donald Trump wants to appoint Robert F. Kennedy Jr., a vaccine skeptic, as Minister of Health.
