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When the pandemic began, the medical tool box was empty. There were no coronavirus vaccines, no treatments, not even tests to tell who was infected and who was not.
For the past two years, scientists and doctors have been building and expanding an arsenal. None of these tools are silver bullets. They can’t eliminate the coronavirus. But together, they can help turn the virus into a manageable risk, allowing people to hug relatives, go to the movies and travel without fear.
Deaths from covid-19 still have a long way to drop before the crisis of the pandemic recedes. But most experts believe that as immunity is broadened through vaccination and waves of infection, covid-19 will eventually blend into the other illnesses that are part of the daily background of respiratory disease.
That doesn’t mean the virus becomes harmless. Every year, respiratory diseases cause tens of thousands of hospitalizations and deaths. Precisely how much covid-19 contributes to that suffering remains to be seen.
What is certain is that the world needs to prepare the tools now to help control future waves and iterations of the virus and reduce their harm: vaccinations, antiviral pills, and other treatments and preventive measures.
“We’re looking forward, as I think everyone feels is appropriate, that ultimately … we’re going to have to ‘live’ with something that will not be eradicated and very likely would not be eliminated,” Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said at a coronavirus task force briefing.
One model for how to move forward comes from HIV. There isn’t a vaccine, but a slew of treatments and prevention strategies means infected people with access to health care can live nearly normal life spans with the right support and access to medicine. In the case of the coronavirus, scientists hope to build a medical tool kit stacked with vaccines, boosters, pills, monoclonal antibodies and other countermeasures that will provide layers of protection and defense, helping tame the pandemic.
“For HIV, we have a plethora of stuff, because we haven’t been able to have a vaccine,” said Larry Corey, a virologist at the Fred Hutchinson Cancer Research Center in Seattle. “Here, we may have a vaccine, but we still may need a plethora of stuff.”
At the beginning of the pandemic, experts were hopeful that vaccines could quickly help nations achieve herd immunity — a threshold when enough people are immune that chains of transmission fizzle out.
But it is now clear that the virus is here for the long term. Immunity fades over time, new variants can slip by a vaccine's shield of protection, and a sizable number of people refuse vaccination.
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Vaccines against the original strain of the coronavirus have shown remarkable versatility, protecting people against the variants that have emerged so far — particularly with a booster.
Even so, their limitations have come into focus. Immunity wanes over time. New variants can find vulnerabilities in the shield of protection, infecting people despite vaccination. Those problems are tractable with boosters or revised vaccine shots, but the realization that vaccination can’t vanquish the virus with a once-and-done public health campaign has been a major disappointment.
That has motivated scientists to stay hard at work, building vaccines that trigger even better immune protection for the long run. Vaccines delivered as nasal sprays might be better than current shots at preventing people from getting infected and spreading the virus. Existing vaccines protect best against hospitalization and death. Universal vaccines that protect against variants and even stop future coronaviruses from sparking pandemics are being developed.
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Tests that can be self-administered at home could be a powerful and simple way to detect active infections — allowing people to alert contacts of their diagnosis and seek treatments.
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Antiviral drugs, including one from Pfizer and another developed by Merck and Ridgeback Biotherapeutics, work best when initiated early — ideally within three to five days of the first symptoms. There’s experience with that approach for another a respiratory ailment: Tamiflu can shorten the duration of flu symptoms but is often given too late.
“If it takes you two to three days before you get tested, another one to two days before you get results — you are pretty close to that five-day time period,” said Rajesh Gandhi, an infectious-disease physician at Massachusetts General Hospital. “Testing and treatment have to go hand in glove.”
The first antiviral pills are now available: five-day regimens that can slash the risk that an infection puts a person in the hospital.
So far, those pills have been shown to help protect only people who are at high risk of infection because of age or other factors. But companies are testing whether they can shorten the duration of illness or decrease symptoms in people who are at lower risk. The pills could also be given to people known to have been exposed to the virus, if proved effective. That could help stop spread within households, inside nursing homes or at work.
Many clinicians think a single antiviral won’t be sufficient to thwart infections. Cocktail combinations and drugs that use different mechanisms could guard against the possibility that the virus develops resistance. Pfizer, one of the companies that launched an antiviral, is already working on a second-generation pill that could be effective against multiple coronaviruses — and even harder for the virus to escape. ...
The post-covid world will not look like the pre-covid world in at least one key way: We will be armed with medicines, treatments and testing.
The tool kit is not finished. Vaccines will need to be updated and boosters given to maintain immunity, particularly in those most at risk. Treatments may need to be combined and honed to combat new variants. People with compromised immune systems will need different treatment and prevention strategies — and protecting them will become a bigger priority as it has become clear that long-term infections can allow variants to arise.
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