“The COVID-19 epidemic and SARS-CoV-2 have not disappeared, but they have changed. We must adapt to these changes. Pretending that the problem is gone and keeping up the illusion that ‘we will get by somehow’ are reprehensible” – scientists from the interdisciplinary COVID-19 Advisory Team to the President of the Polish Academy of Sciences write in their latest position statement. 

The COVID-19 pandemic has already surprised us many times. After the tragic fall seasons of 2020 and 2021, when COVID-19 claimed tens of thousands of lives in Poland each year, we were hit in early 2022 by a wave of infections with a new variant of SARS-CoV-2 called Omicron. The variant is highly contagious. What is more, neither vaccination nor previous infection guarantee protection. Consequently, the number of infections with this variant has been unprecedentedly high. Fortunately, the number of hospitalizations and deaths has not seen a similar rise. Reduced COVID-19 death rates resulted from two factors. First of all, Omicron is less likely to cause lower respiratory tract infections and general systemic symptoms of a severe nature. Second, almost everyone either has already had natural contact with the virus or has acquired certain immunity through vaccination. Research is being conducted into vaccine-induced, natural, and hybrid immunity (the latter being induced by both vaccination and previous infection). Initial reports indicate significant differences in the role of humoral and cellular responses, depending on the virus variant that a person originally had contact with and the amount of time that has passed from the contact.

The next wave of COVID-19 infections reached us in the summer, when the new Omicron subvariants named BA.4 and BA.5 proved contagious enough to transmit easily even when we spent more time outdoors. The situation has been exacerbated by a complete withdrawal from prevention measures in Poland.

As with the early spring wave, the very high number of mild cases has not posed a real threat to the functioning of the health-care system. However, the disease remains dangerous for the elderly, immunocompromised patients, and those with multiple comorbidities.

The statistically lower risk of a severe COVID-19 infection raises the question: what happens now? The overall tally of costs and benefits associated with possible epidemic control measures is now less clear. Does this mean we can forget about the pandemic? Or should we return to the kinds of measures taken in response to the observed rises in new cases? If so, then to what extent? In this position statement, we try to address these questions.

Reacting depending on the scenario

The biggest unknown now is how the epidemic will evolve in the fall. It is very difficult to give a definite answer right now, because this depends mainly on the variability of the virus. In the optimistic scenario, a variant of Omicron will be causing mild forms of the disease. If no restrictions are in place, the previously acquired immunological memory, also in individuals from risk groups, will remain enough to prevent hospitalizations and deaths. Consequently, we will experience a rise in the number of mild upper and lower respiratory tract infections, but the health care system will not be paralyzed, and there will be no disruptions in the functioning of the state. In the pessimistic scenario, a new dominant variant will emerge that will be highly virulent and will evade the immune response. This could be compounded by declining immunity, especially in high-risk individuals – in this case, the fall could once again bring numerous deaths and problems for the health care system.

Surveillance

We get information about the intensity of the epidemic from diagnostic tests. In the spring, as the pressure on health care eased off and the number of deaths dropped, the government decided to stop mass testing. Indeed, mass tests that do not result in isolation or quarantine are largely becoming pointless. On the other hand, the absence of disease surveillance forces us to adopt a reactive approach based on the number of deaths.

However, it is important to note that in terms of decisions related to the COVID-19 epidemic Poland was already “groping in the dark” as early as in the fall of 2020. The insufficient number of tests and the relatively high percentage of positive results throughout the pandemic clearly showed that many cases remained undiagnosed. By the same token, the assessment of the situation was unreliable. Faced with infrastructural and staffing shortages, we suggested two years ago that a system for testing relatively small yet representative population groups should be implemented, for example, based on a modified Sentinel system. Consequently, significantly reduced costs and burdens on the staff and infrastructure would allow us to react to ongoing events and decide about imposing potential countermeasures or a possible return to mass testing. Efforts to implement such a system should be definitely accelerated, especially if we take into account the fact that consecutive variants keep emerging at very short time intervals.

Drug availability

At the same time, in light of the absence of mass testing, we should enable rapid tests for individuals at high risk of developing a severe form of the disease. Why? We already have effective medicines that significantly reduce the risk of a severe disease. Molnupiravir was available in Poland for a short period of time. Paxlovid, a drug of a very high efficacy approved by the European Medicines Agency (EMA), has never been available in Poland. Both medicines should be made available as soon as possible, in the first place to seniors and people from high-risk groups as they may be insufficiently protected by vaccinations.

In the case of both drugs, the key to their effectiveness lies in the early start of treatment. This will only be possible if rapid individual tests are available, and people from risk groups are aware that they must report for tests as soon as they develop the first symptoms. The use of these medicines will then translate into real benefits.

Updating the vaccination program

The key line of defense, which should be treated as strategically important, involves offering booster vaccinations. Currently, the second booster dose is available to people over the age of 60 and those from risk groups, as recommended by the EMA and the European Center for Disease Prevention and Control (ECDC), and to medical professionals. However, a number of questions arise. Are the vaccines that are now available effective against the currently dominant Omicron subvariant? Should we wait until the fall for the promised shots targeting new variants? As a result of changes in the virus genome, the protection against infection and the development of COVID-19 offered by vaccines is indeed not high, but the protection against a severe disease, hospitalization, and death remains high.

People at a high risk of developing a serious illness in the current wave of infections should consider taking the vaccine immediately. The fall may bring vaccines that more effectively reduce the risk of infection or transmission, but what use will they to individuals who might lose their health or even lives by then? Also, let us bear in mind that we still do not have complete data on the efficacy of the new Omicron-specific vaccines in preventing infections and illnesses. What is more, we do not know which variant will be dominant in the fall. Will the new types of vaccines be available? If so, then when? What will be their effectiveness? These are all questions concerning the hypothetical future. Available scientific data show clearly that booster doses restore and improve the protective function of our immune system.

Scientific reports show clearly that the benefits of vaccines are far greater than the risks, also in children and in pregnant women.

Long COVID-19 and rehabilitation

Strategies implemented to combat the pandemic in Europe focus mainly on reducing the immediate risk of infection and on the transition to a stage when COVID-19 will be just one of many viral diseases contracted in the fall and winter seasons. However, we must remember that even a mild SARS-CoV-2 infection may have lasting effects on our bodies, and we must take into account the fact that the coming years we will be marked by a surge in illnesses related to the long-term effects of COVID-19. This includes not only respiratory deficits, but also cardiovascular diseases, neurological disorders (such as brain atrophy in people over 50), diabetes, and the long-term loss of smell or taste, which is seemingly trivial, but impacts significantly on the quality of life. Likewise, we should not omit to mention behavioral disorders indirectly caused by COVID-19, or more specifically by life in the conditions of the pandemic – anxiety, fear, aggression, suicide attempts, and addiction tendencies.

It is imperative that the system of rehabilitation should be urgently restored to reduce what is called health debt and the burden on the health care system in the coming years at least to some extent. Even if the effects of the disease prove to subside over time, we should not leave without care those who have been suffering the longest and the most. We should also bear in mind that many patients affected by long COVID-19 are people of working age, and their lower professional productivity and, in extreme cases, even withdrawal from the job market create real losses in the economy.

The COVID-19 epidemic and SARS-CoV-2 have not disappeared, but they have changed. We must adapt to these changes. Pretending that the problem is gone and keeping up the illusion that ‘we will get by somehow’ are reprehensible. A rational strategy should be based on the evaluation of likely scenarios. It should also take into account the needs of vulnerable individuals and use all the methods we know to reduce the number of infections (vaccinations, tests, drugs, face masks, social distancing, and disinfection). Only by adopting such approaches can we prevent another tragedy from occurring this fall for the health care system, the economy, and society. We have good protection tools at our disposal, so any deaths in the coming years will be needless, and possible lockdowns or restrictions placed on our freedoms will be largely avoidable.

 About the team 

The Interdisciplinary COVID-19 Advisory Team to the President of the Polish Academy of Sciences was set up on 30 June 2020. The team is chaired by Prof. Jerzy Duszyński, President of the PAS, with Prof. Krzysztof Pyrć (Jagiellonian University) as deputy chair and Dr. Anna Plater-Zyberk (Polish Academy of Sciences) as its secretary.  Other members of the team are: 

• Aneta Afelt (University of Warsaw)
• Prof. Małgorzata Kossowska (Jagiellonian University)
• Prof. Radosław Owczuk, MD (Medical University of Gdańsk)
• Dr. Anna Ochab-Marcinek (PAS Institute of Physical Chemistry)
• Dr. Wojciech Paczos (PAS Institute of Economics, Cardiff University)
• Dr. Magdalena Rosińska, MD (National Institute for Public Health – National Hygiene Institute, Warsaw)
• Prof. Andrzej Rychard (PAS Institute of Philosophy and Sociology)
• Dr. Tomasz Smiatacz, MD (Medical University of Gdańsk)