Chances are slim that new virus variants will emerge that are very deadly.
Belgium in Europe is experiencing a tenth peak in terms of coronavirus infections, but fortunately the consequences are no longer so dramatic. It is becoming something like a flu virus.

When will the corona pandemic stop requiring a global emergency? The scientific journal Nature recently wondered. Many people act as if the coronavirus is no more, but officially the World Health Organization (WHO) has still not decided that the crisis is over. There are still thousands of corona deaths per day worldwide and millions of people are still infected with the virus.

Yet there are signs that the pandemic is in transition. The high level of immunity that people in more and more places have developed against the virus means that it is less likely to spread and cause fewer casualties. It has been inspiring governments for some time to be less stringent with measures to contain the spread of the virus.

There is some concern about what will happen if the WHO – as expected sometime in April – will decide to lift the international state of emergency, which has been in place since the pandemic began in 2020. It could cause many governments to lose all focus on the virus and even more people to pretend it is no longer there. At worst, it could give rise to another upsurge of the virus. So caution remains in order.

Seven deaths per day
In our country, the virus is currently experiencing a new, albeit mild flare-up. Observers are talking about the “tenth wave of infection rolling over our country. On March 20, figures from the public health institute Sciensano gave 175 hospitalizations for corona treatment per day. 132 corona patients were in hospital intensive care units. Every day, seven people died from their infection. But the number of infections remains low compared to the spring of 2022. That could partly be due to the fact that many people are no longer testing for corona infection, but it also strongly suggests that the epidemic has lost momentum in our country.

The key question remains what the virus will cost us in long-term health care in its endemic phase.

Biostatistician Tom Wenseleers (KU Leuven)
‘I effectively think we have the worst behind us,’ says biostatistician Tom Wenseleers (KU Leuven), who became a world authority on analyzing infection rates during the pandemic. ‘With any luck, in the coming year we will see an impact of corona in terms of hospitalizations and mortality that is only slightly higher than for influenza. Due to the rapid succession of infection waves, until recently the corona virus caused mortality five times higher than that of influenza for our country. Globally, it would have been even ten times more. The difference is now rapidly narrowing.

Wenseleers explains how the virus became less of a problem. In 2021, the very dangerous delta variant proliferated, responsible for at least a third of the coronavirus’ estimated 20 million deaths worldwide already (for our country, the tally stands at 33,000 corona deaths). But delta was gradually replaced by the omikron variant. That one is more infectious, but less deadly.Since then, new “subvariants” of the omikron version have continually emerged, but they did not significantly alter the virus’ lesser aggressiveness. ‘The last year we saw a rapid succession of different subvariants, with six waves of infection in Western Europe alone,’ says Wenseleers. ‘Fortunately, these caused fewer and fewer hospitalizations, largely due to increased immunity in the population, thanks to previous infections and vaccinations. Because those waves were staggered over time, their effect on health care was not nearly as explosive as it was at the beginning of the crisis.’

According to Wenseleers, the virus is gradually reaching the “endemic phase” in our region. That means it will become something like the flu: it will pop up regularly and make people sick, but it will not be as bad as in the first years of the pandemic. ‘The key question remains what the virus will cost us in long-term health care in the endemic phase,’ says Wenseleers. ‘Presumably, new virus variants will continue to emerge. Combined with the fact that a body’s acquired resistance to the virus wears off over time, a new wave of infection is still likely to come regularly, with increased pressure on health care. But I consider it unlikely that variants would re-emerge that would be very pathogenic, although theoretically possible. The virus would have little to gain from it.’

Vaccine as nasal spray
Trying to avoid infections in the population at all costs is no longer an option for Wenseleers. The gain in terms of fewer infections would be canceled out by lower immunity in the population, which would imply higher vulnerability to any new virus variant. In China, they can speak to that. When Chinese authorities – finally – abandoned their zero contamination policy late last year, a heavy wave of omikron infections rolled over an immunologically virtually defenseless population. But people were mostly relieved to be freed from years of strict quarantine and other measures.

Wenseleers does warn against being too lax in terms of vaccinations. Younger generations in particular fit in en masse for the latest booster vaccine campaigns. ‘Offering a new vaccine dose once or twice a year to the most vulnerable population groups, such as the elderly and high-risk patients, would, in my opinion, continue to yield great benefits. A corona vaccination should be as natural as a flu vaccination.’

A review of new vaccine developments in Science concluded that corona outbreaks are still not seasonal in nature, like flu epidemics. They can appear year-round, rather than just in the winter months. But corona vaccination campaigns should be more mirrored to those of influenza. For example, there should be regular in-depth studies of the main circulating coronavirus variant and which vaccine would best combat it. This is what happens every year with flu vaccines. Scientists are even working on combined vaccines, which protect you against both a corona and flu virus with one shot. They are also working on vaccines that can be administered as a nasal spray.

Scientists are working on a vaccine that protects you against both a corona and flu virus with one shot.

A crucial question is how long you maintain resistance to the corona virus after infection or vaccination. An analysis in the medical journal The Lancet Infectious Diseases clocked in at “an average of eight months. That’s how long you are highly protected from becoming severely ill and risking hospitalization, but taking in a new load of virus and infecting other people remains possible.

Science published criticism from virologists of countries that still require you to present proof of vaccination before you can enter. To them, the coronavirus is now so widespread that checking who enters no longer makes much sense – unless a completely new variant were to emerge. Further, vaccination certificates too often give a false sense of security, causing people to jettison all other rules, such as keeping their distance. This can increase rather than decrease the risk of infection. Sticking with rigid measures for too long would also lead to a loss of confidence in them. At the beginning of the pandemic, they were crucial to controlling the outbreak as quickly as possible, but today they seem redundant.

However, it is important to remain individually vigilant. Kissing and shaking hands as greetings continue to increase the risk of infection. Quite a few Belgians are currently suffering from a fourth corona infection. The severity depends on how far their new virus differs from the previous infection and how efficiently their immune system reacts. But in general, the risk of serious health problems decreases after multiple infections and/or vaccinations. It is the main reason why the virus quietly trades off its dangerous nature for a flu-like endemic nature. We are not rid of it yet, but we are learning to live with it.

Thus, this virus will become the fifth coronavirus to become permanently established in humanity. The other four, relics of historical epidemics, we are virtually unaffected by.