How Will the COVID-19 Shoe Finally Drop?
After three years of raging and evolving, the SARS-CoV-2 virus has become somewhat less virulent, but its transmissibility has grown ever stronger. As the cost of control has mounted, governments around the world have successively adjusted their epidemic strategies, and China is no exception. We have lived three years of abnormal life—whether in countries and regions pursuing a coexistence strategy or those pursuing a zero-COVID strategy, life over the past three years has been vastly different from before the pandemic.How will the novel coronavirus ultimately affect us humans? How will this COVID shoe finally drop? I venture to offer some judgments of my own.First, beginning this winter, the disruption to people’s normal life from COVID-19 will draw to a close. All regions, including our own, will accept the reality that the virus cannot be eradicated and will gradually return to normal life.Over these three years, our government has taken epidemic prevention and control extremely seriously, consistently placing its citizens’ lives first; at present, both the infection rate and the case fatality rate among Chinese residents are among the lowest in the world. This is a truly remarkable achievement.But the novel coronavirus has become one of the permanent resident viruses of humankind and can no longer be completely eradicated from human society; moreover, the variants are no longer as virulent as the original strain. So sooner or later we, too, will return to normal life and stop mounting a strict, all-out defense.When will that day come? How will the shoe over our heads drop? The answer is: when we can no longer hold back the spread of the virus, we will be passively breached rather than deliberately giving up. That is, when we have done our utmost and still cannot stop the virus, when it has broken through every line of defense we set for it, then we will gradually accept it. But we will not abandon resistance on our own; the government will discharge its duty to safeguard the lives of the public, holding on until it truly can hold on no longer.The exact timing is hard to predict, but many signs suggest that this winter the virus will quite likely break through our defenses, forcing us to shift from a dynamic zero-COVID phase to a phase of gradual mitigation. Then, over the coming six to eighteen months, society as a whole will gradually adapt to a new normal—a state in which two choices coexist. Some people who are more self-disciplined and health-conscious will continue strict personal protection to avoid infection, while others will return to pre-pandemic life. How to manage prevention will become an individualized choice rather than a uniform national action. As the virus spreads ever more widely, some current prevention measures may lose much of their effect and will then be phased out.The spread of the virus will inevitably place enormous pressure on the healthcare system. When an infectious disease rages, patient numbers grow exponentially. Given China’s population size, the peak period could see millions to over ten million new patients per day; even if the proportion of severe cases is not high, medical resources will inevitably be overstretched.Training medical personnel takes a long time; no country can produce enough doctors and nurses in just three or four years to cope calmly with a major new infectious disease. That is why, over the past three years, no country or region in the world has been spared having its healthcare system stretched to near-paralysis by COVID-19.Therefore, when the epidemic is hard to stop and medical resources cannot be expanded in the short term, the most effective way to lower the case fatality rate is to flatten the infection curve, so that the growth of patients is not so rapid—striving to reduce the daily number of new cases and stretch out the infection period, so that the healthcare system does not collapse.Therefore a developing country like ours, where per-capita medical resources are still scarce, cannot simply let go all at once as some people hope; doing so would be deeply irresponsible and would lead to a higher fatality rate. Nor can we hold this strict defense forever. The shoe over our heads will come down slowly, so that the blow to society is not too great and the fatality rate is greatly reduced.Human life outweighs everything else; a government that does its utmost to protect its citizens’ lives is a government that truly serves the people. I believe that when we ultimately have to choose opening up, our government will move heaven and earth to flatten the curve, carry out all mitigation work well, and minimize casualties as far as possible.When the epidemic spreads, some people will respond rationally, but inevitably others will seek care in panic; so we will inevitably go through a fairly chaotic period before society as a whole gradually settles and stabilizes. Projecting from China’s population size, this process may take six to eighteen months.Once we have gradually accepted the virus, will its impact on us be over? The answer is no. The novel coronavirus will continue to mutate, and new variants will circulate each year; in future we will need, much as with flu vaccination, to keep receiving new vaccines to meet new variants.At the same time, some patients will develop long-COVID sequelae. These sequelae deserve attention but need not be feared too greatly. Many people also develop lingering effects after an ordinary cold; for those with fragile bodies, even a cold’s aftermath can be frightening, and in some cases even fatal. So the existence of post-COVID sequelae is a normal medical phenomenon, and treating them will be one of the research topics of medicine. Medicine has never lacked for health problems; post-COVID sequelae are merely one of the countless health problems of humankind.From a biological standpoint, the novel coronavirus will inevitably be written into the history of human evolution, and fragments of it will permanently take their place in our gene pool. Our gene pool already contains countless similar genes made of viral fragments; they are the biological evidence that our ancestors, surviving in the natural world, once fought other viruses. Other viruses failed to wipe us out; neither will the novel coronavirus. Our immune systems were even forged in the struggle against pathogens; the viruses that do not kill us ultimately make us stronger.What long-term effects will the novel coronavirus have on human health? More time is needed to observe. Perhaps in future we will discover it has further harms; perhaps it will promote the evolution of human intelligence; perhaps in some respects it will bring us other benefits. But like other pathogens that already coexist with us, it has become one of the microorganisms we cannot shake off and must face. Whether it is good or bad, we are fated to accept the fate of it making humans its host.It is wrong, out of weariness with prevention, to ignore the virus’s impact and deliberately play down the health problems it brings; it is equally wrong, in the name of prevention, to overhype its impact and exaggerate those problems. We need to treat it and study it with a rational, realistic attitude, and work to solve the various problems it creates.Finally, a word on my own attitude. Although I know that in all probability we will ultimately be unable to stop the virus’s spread, I personally will still protect myself as best I can to avoid infection. I hope to observe the virus for longer, to study countermeasures against the disease it causes and its sequelae, and to relax my own precautions only when it is safer. Others do not care whether they are infected; I respect their choice, but I personally will choose to keep avoiding infection.