Smallpox is the only human virus that the World Health Organization officially considers eradicated. Wiping out an infectious illness is incredibly difficult. It’s far more common for a pathogen to become endemic which means it becomes part of life in a particular place. Endemic viruses circulate consistently. They cause illness and death, but they don’t stop society from functioning. Many infectious disease experts around the world believe this is what will happen to Covid19.

How do we shift Covid19 from a pandemic virus to an endemic one?

Influenza is a good example of an endemic human virus that causes illness and death, yet we live with it. In tropical areas, influenza occurs throughout the year. In the Northern Hemisphere, the influenza season typically lasts from autumn until spring. The World Health Organisation estimate that there are 3-5 million cases of severe influenza globally each year, resulting in approximately 290,000 to 650,000 respiratory deaths. Currently, Covid19 is still considered to be a pandemic, meaning that it is occurring on a scale that crosses international boundaries, usually affecting people on a worldwide scale. So, the question is how do we shift Covid19 from a pandemic virus to an endemic one?

The good news is that we’ve already started that journey. We have several vaccines and people are being vaccinated. 44.8% of the world’s population has received at least one dose of the Covid-19 vaccine. However, this figure is misleading because it is mainly the richer countries that have high vaccination rates compared to poor countries.

Country	% of population receiving 1 dose (Oct 2021)
China	76%
United Kingdom	72%
Germany	68%
Australia	66%
USA	64%
Bangladesh	20%
Ethiopia	2.4%
Sierra Leone	2.4%

Source: Our World in Data

Only 2.3% of people in low-income countries have received at least one dose of the vaccine. So, we still have a long way to go.

Some restrictions are here to stay

It will take time for Covid-19 to transition into an endemic virus and as a result we may have to accept some restrictions on how we lead our lives. Think about some of the restrictions we have been living with and you can predict those that are likely to remain either voluntarily or imposed upon us.

Face masks will probably still be worn particularly in crowded places or public transport.
Social distancing will still be practised by some people.
Hand shaking will become less frequent.
Hand washing will become more frequent along with the use of hand gels.
Travelling will still be more complicated especially for someone returning from a country with a low vaccination rate. Passenger locator forms, masks, and vaccination certificates will become the norm.
Vaccination proof either electronic or paper is likely to be required to enter large sporting occasions and nightclubs.
Indoor venues such as shops, schools, universities, offices, and hospitals are going to be better ventilated and possibly cooler in winter.

The introduction of the “green pass”

Most European countries have eased Covid restrictions but have maintained social distancing rules, wearing face masks indoors and the increased use of hand sanitisers. Some countries such as Austria, France, Germany, and Italy are enforcing a “green pass” system for entry to public and indoor venues. Denmark has lifted all Covid restrictions. In England most Covid restrictions have been lifted but individuals are encouraged to assess the risk and wear face masks and socially distance if the feel the to do so. A Similar picture exists around the world where countries are easing restrictions at different rates. In the USA the federal government is at loggerheads with state governments resulting in varying levels of restrictions across the country. The exceptions are Australia and New Zealand who are still imposing strict lockdowns. It seems the world is unable to agree on what living with Covid 19 looks like. I suspect the coming winter in the northern hemisphere and the impact on healthcare systems of Covid 19 and influenza will frame the answer.

Global supply chain, shipping constraints and reduced labour markets

The trickle-down effect is both far reaching and all encompassing. In many cases supply chains have been simultaneously squeezed on both ends - supply and demand. We’re all aware of the toilet paper supply at the supermarket when a lockdown announcement is made. This is the tip of the iceberg with a wide range of products like timber and building materials, minerals, food produce, furniture, aluminium, appliances all the way through to replacement parts squeezed throughout the pandemic.

While we’ve all been at home with an insatiable appetite for lockdown comforts - the unscheduled closures of manufacturing and distribution centres, bottlenecks at borders and sick workers have caused massive choke points in supply lines.

What about nurses administering vaccines? There’s a huge shortage of nurses throughout the healthcare industry affecting routine surgical procedures, elective surgery and general practice. This is just a fraction of the flow on effect of covid, for which we’ll be experiencing the repercussions for years to come.

While learning to live with delays, stock shortages, availability of products and resources - Innovgas continues to ensure we’re doing everything possible to maintain our global supply throughout this challenging time.

Hospitalisations and elective surgery

As far as healthcare is concerned, hospitalisations due to Covid19 have risen slowly but the vaccination programmes are keeping the numbers relatively low. Covid19 is still affecting elective surgery and the backlogs reported across the world are still high. Visitor access to patients is improving and the number of beds in wards is increasing which is increasing capacity. The main worry is infected patients and staff coming into hospital and infecting hospitalised patients. I wrote about the impact Covid 19 is having on elective surgery in July this year and hospitals are still doing everything they can to prevent hospitalised patients becoming infected with covid 19. Why is that? Simply, a patient infected in hospital with Covid 19 is 25 times more likely to die while in hospital compared to someone not infected(1)

The steps that hospitals are taking are not optional because we must reduce the huge backlog of surgery around the world and at the same time prevent those surgical patients becoming infected with Covid19. A safe, functioning healthcare system that is treating lots of patients will be a good indication that a country is living successfully with Covid19, and the virus has been tamed.

There is of course a financial cost to all of this, but the money has to be found because patients with Covid19 infection undergoing surgery have much higher risk of severe postoperative respiratory complications and death. Equipment is a key factor in play to help mitigate the risk of transmission of Covid19.

So, isn’t it time to stop using medical tape on your patient’s eyes in the operating theatre and ICU, removing a potential Covid-19 transmission route and switch to sterile, single use EyePro™, the only sterile eyelid occlusion dressing available. The additional costs for EyePro™ are negligible.

References

1. Mortality after surgery with SARS-CoV-2 infection in England: a population-wide epidemiological study. T. Abbot, A. Fowler, et al. bja.2021.05.018

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Learning to Live with an Elephant in the Room