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What Is Coronavirus Disease 2019 (COVID-19)?

A coronavirus is a kind of common virus that causes an infection in your nose, sinuses, or upper throat.They’re called coronaviruses because under a microscope, they look like a crown.

Most coronaviruses aren’t dangerous. But in early 2020, after a December 2019 outbreak in China, the World Health Organization identified a new type of coronavirus. Officials named this new virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This is the virus that causes COVID-19.

What Is COVID-19?

Coronavirus disease 2019, or COVID-19, is a disease that can cause what doctors call a respiratory tract infection. It can affect your upper respiratory tract (sinuses, nose, and throat) or lower respiratory tract (windpipe and lungs).

The COVID-19 outbreak quickly spread around the world. It spreads the same way other coronaviruses do, mainly through person-to-person contact. Infections range from mild to serious.

COVID-19 is one of seven types of coronavirus, including the ones that cause severe diseases like Middle East respiratory syndrome (MERS) and sudden acute respiratory syndrome (SARS). The other coronaviruses cause most of the colds that affect us during the year but aren’t a serious threat for otherwise healthy people.

Is There More Than One Strain of SARS-CoV-2?

It’s normal for a virus to change, or mutate, as it infects people. A Chinese study of 103 COVID-19 cases suggests the virus that causes it has done just that. They found two strains, which they named L and S. The S type is older, but the L type was more common in early stages of the outbreak. They think one may cause more cases of the disease than the other, but they’re still working on what it all means.

What Are the Symptoms of COVID-19?

Early symptoms include:

  • Fever
  • Dry Cough
  • Fatigue

The virus can lead to pneumonia, respiratory failure, septic shock, and death. If you notice these severe symptoms in yourself or a loved one, get medical attention right away:

  • Trouble breathing or shortness of breath
  • Ongoing chest pain or pressure
  • New confusion
  • Can’t wake up
  • Bluish lips or face

If you’re exposed and infected, symptoms can show up in as few as 2 days or as many as 14. It varies from person to person

The most common symptoms and the percentage of people who have them include:

  • Fever: 88%
  • Dry cough: 68%
  • Fatigue: 38%
  • Coughing up sputum, or thick phlegm, from the lungs: 33%
  • Shortness of breath: 19%
  • Bone or joint pain: 15%
  • Sore throat: 14%
  • Headache: 14%
  • Chills: 11%
  • Nausea or vomiting: 5%
  • Stuffy nose: 5%
  • Diarrhea: 4%
  • Coughing up blood: 1%
  • Swollen eyes: 1%

How Do You Know if It’s COVID-19, a Cold, or the Flu?

When you have symptoms, they can be similar to a bad cold or the flu. Your doctor will suspect COVID-19 if:

  • You have a fever and breathing problems and you’ve traveled to places where the virus has spread.
  • You’ve been exposed to people who have it within the last 14 days.

What Caused the New Coronavirus?

Doctors aren’t sure. Coronaviruses can affect different species of animals, in addition to people. MERS and SARS were both linked to animals. Studies show COVID-10 has ties to snakes, bats, and pangolins. Many people who got the disease early on were linked to a large live seafood and animal market in China — you might hear it called a “wet market.” The first cases may have come from animals sold in the market, then spread from person to person.

How Does the New Coronavirus Spread?

SARS-CoV-2, the virus, mainly spreads from person to person.

Most of the time, it spreads when a sick person coughs or sneezes. They can spray droplets as far as 6 feet away. If you breathe them in or swallow them, the virus can get into your body. Some people who have the virus don’t have symptoms, but they can still spread the virus.

You can also get the virus from touching a surface or object the virus is on, then touching your mouth, nose, or possibly your eyes. Most viruses can live for several hours on a surface that they land on. A study shows that the COVID-19 coronavirus can last for several hours on various types of surfaces:

  • Copper: 4 hours
  • Cardboard up to 24 hours
  • Plastic or stainless steel: 2 to 3 days

That’s why it’s important to disinfect surfaces to get rid of the virus.

What Is Community Spread?

Doctors and health officials use this term when they don’t know the source of the infection. With COVID-19, it usually refers to someone who gets the virus even though they haven’t been out of the country or haven’t been exposed to someone who’s traveled abroad or who has COVID-19.

In February 2020, the CDC confirmed a COVID-19 infection in California in a person who had not traveled to an affected area or been exposed to someone with the disease. This marked the first instance of community spread in the U.S. It’s likely that person was exposed to someone who was infected but didn’t know it.

How Fast Is It Spreading?

The number of people infected by SARS-CoV-2 changes every day. See our news story for the latest updates on this developing story.

How Do You Prevent the Spread?

If you’re in an area where it’s spreading, take these steps:

  • Wash your hands often with soap and water, or clean them with an alcohol-based sanitizer. This kills viruses on your hands.
  • Practice social distancing. Because you can have and spread the virus without knowing it, you should stay home as much as possible. If you do have to go out, stay at least 6 feet away from others.
  • Don’t touch your face. Coronaviruses can live on surfaces you touch for several hours. If they get on your hands and you touch your eyes, nose, or mouth, they can get into your body.
  • Clean and disinfect. You can clean first with soap and water, but disinfect surfaces you touch often, like tables, doorknobs, light switches, toilets, faucets, and sinks. Use a mix of household bleach and water (1/3 cup bleach per gallon of water, or 4 teaspoons bleach per quart of water) or a household cleaner that’s approved to treat SARS-CoV-2. You can check the Environmental Protection Agency (EPA) website to see if yours made the list. Wear gloves when you clean, and throw them away when you’re done.

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How to Wash Your Hands

Scrub away! There’s a correct way to wash your hands and get rid of germs.ABOUT

There’s no need to wear a face mask unless your doctor tells you to. You will need one if you’ve been exposed to SARS-CoV-2 or have COVID-19, or if you’re a health care worker or caring for someone who has it.

Some herbal therapies and teas have been said to prevent infection, but there’s no proof any of these work.

How Do You Plan for a COVID-19 Outbreak?

In addition to practicing the prevention tips listed above, you can:

  • Meet as a household or larger family to talk about who needs what.
  • If you have people at a higher risk, ask their doctor what to do.
  • Talk to your neighbors about emergency planning. Join your neighborhood chat group or website to stay in touch.
  • Find community aid organizations that can help with health care, food delivery, and other supplies.
  • Make an emergency contact list. Include family, friends, neighbors, carpool drivers, doctors, teachers, employers, and the local health department.
  • Choose a room (or rooms) where you can keep someone who’s sick or who’s been exposed separate from the rest of you.
  • Talk to your child’s school about keeping up with assignments.
  • Set yourself up to work from home if your office is closed.
  • Reach out friends or family if you live alone. Make plans for them to check on you by phone or email.

Is There a Vaccine?

Not yet, but clinical trials are under way in the U.S. and in China to test vaccines for SARS-CoV-2/COVID-19.

One vaccine called mRNA-1273 (which was developed by using messenger RNA) would tell your cells to pump out a protein that will kick-start your immune system to fight the virus. It’s worked well in animals and is ready to test in humans.

Testing for COVID-19

Call your doctor or local health department if you think you’ve been exposed and have symptoms like:

  • Fever of 100 F or higher
  • Cough
  • Trouble breathing

In most states, decisions about who gets tested are made at the state or local level.

The test looks for evidence of the virus in your upper respiratory tract. The person giving the test puts a swab up your nose to get a sample from the back of your nose and throat. That sample goes to a lab that looks for viral material. If it’s there, the test is positive. A negative test could mean there is no virus or there wasn’t enough to measure. That can happen early in an infection. It usually takes 24 hours to get results, but the tests must be collected, stored, shipped to a lab, and processed.

There’s no home test kit for COVID-19. The FDA is cracking down on these bogus products.

What Is the Treatment for COVID-19?

There’s no specific treatment for COVID-19. People who get a mild case need care to ease their symptoms, like rest, fluids, and fever control. You can take over-the-counter medicine for a sore throat, body aches, and fever. But don’t give aspirin to children or teens younger than 19. You might have heard that you shouldn’t take ibuprofen to treat COVID-19 symptoms — the World Health Organization made that statement in March 2020. But they reversed it soon after and said there’s no proof that taking it causes any harm.

Antibiotics won’t help because they treat bacteria, not viruses. If you hear about people with COVID-19 getting antibiotics, it’s for an infection that came along with the disease.

Those with severe symptoms need to be cared for in the hospital.

Numerous clinical trials are under way to explore treatments used for other conditions that could fight COVID-19 and to develop new ones. Several studies are focused on an antiviral medication called remdesivir, which was first created to fight Ebola. A study in China showed that hydroxychloroquine and chloroquine, which are used to treat malaria and autoimmune conditions like rheumatoid arthritis and lupus, helped people with COVID-19 pneumonia.

What’s the Outlook for People With COVID-19?

Every case is different. You may have mild, flu-like symptoms for a few days after exposure, then get better. But some cases can be severe or fatal.

Doctors aren’t sure yet if you can get reinfected after you’ve had it. With other coronaviruses that only cause colds, you have a period that you’re immune, but that goes away over time.

Who Gets It?

Anyone can get it, and most infections are usually mild, especially in children and young adults. But if you aren’t in an area where COVID-19 is spreading, haven’t traveled from an area where it’s spreading, and haven’t been in contact with someone who has it, your risk of infection is low.

Older people and those with weakened immune systems or medical conditions like chronic bronchitis, emphysema, high blood pressure, heart disease, lung disease, cancer, or diabetes are most likely to get a serious illness.

What to Do if You Think You Have COVID-19

If you live in or have traveled to an area where COVID-19 is spreading:

  • If you don’t feel well, stay home. Even if you have mild symptoms like a headache and runny nose, stay in until you’re better. This lets doctors focus on people who are more seriously ill and protects health care workers and people you might meet along the way. You might hear this called self-quarantine.
  • Call the doctor if you have a fever, cough, and trouble breathing. You need to get medical help as soon as possible. Calling ahead (rather than showing up) will let the doctor direct you to the proper place, which may not be your doctor’s office. If you don’t have a regular doctor, call your local board of health. They can tell you where to go for testing and treatment.
  • Follow your doctor’s advice and keep up with the news on COVID-19. Between your doctor and health care authorities, you’ll get the care you need and information on how to prevent the virus from spreading.

Are Coronaviruses New?

Coronaviruses were first identified in the 1960s, but we don’t know where they come from.

Almost everyone gets a coronavirus infection at least once in their life, most likely as a young child. In the United States, regular coronaviruses are more common in the fall and winter, but anyone can come down with a coronavirus infection at any time.

The symptoms of most coronaviruses are similar to any other upper respiratory infection, including a runny nose, coughing, sore throat, and sometimes a fever. In most cases, you won’t know whether you have a coronavirus or a different cold-causing virus, such as a rhinovirus. You treat this kind of coronavirus infection the same way you treat a cold.

Have There Been Other Serious Outbreaks?

Yes, coronaviruses have led to two serious outbreaks:

  • Middle East respiratory syndrome (MERS): About 858 people have died from MERS, which first appeared in Saudi Arabia and then in other countries in the Middle East, Africa, Asia, and Europe. In April 2014, the first American was hospitalized for MERS in Indiana, and another case was reported in Florida. Both had just returned from Saudi Arabia. In May 2015, there was an outbreak of MERS in South Korea, which was the largest outbreak outside of the Arabian Peninsula.
  • Severe acute respiratory syndrome ( SARS ): In 2003, 774 people died from an outbreak. As of 2015, there were no further reports of cases of SARS.

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Diet and Lifestyle

SUPPORTING EXAM STRESS and Kids going back to School.

stress

Tests and exams can be a challenging part of school life for children and young people and their parents or carers. But there are ways to ease the stress.

Watch for signs of stress

Children and young people who are stressed may:

  • worry a lot
  • feel tense
  • have headaches and stomach pains
  • not sleep well
  • be irritable
  • lose interest in food or eat more than normal
  • not enjoy activities they previously enjoyed
  • be negative and have a low mood
  • feel hopeless about the future

Having someone to talk to about their work can help. Support from a parent, tutor or study buddy can help young people share their worries and keep things in perspective.

Encourage your child to talk to a member of school staff who they feel is supportive. If you think your child is not coping, it may also be helpful for you to talk to their teachers.

Try to involve your child as much as possible.

Make sure your child eats well 

A balanced diet is vital for your child’s health, and can help them feel well during exam periods.

Some parents find high-fat, high-sugar and high-caffeine foods and drinks, such as energy drinks, cola, sweets, chocolate, burgers and chips, make their children hyperactive, irritable and moody.

Where possible, involve your child in shopping for food and encourage them to choose some healthy snacks.

Read more about healthy eating for teens.

Help your child get enough sleep 

Good sleep improves thinking and concentration. Most teenagers need 8 to 10 hours’ sleep a night. Learn more about how much sleep children need.

Allow half an hour or so for your child to wind down between studying, watching TV or using a computer and going to bed, to help them get a good night’s sleep.

Cramming all night before an exam is usually a bad idea. Sleep will benefit your child far more than a few hours of panicky last-minute study.

Be flexible during exams

Be flexible around exam time. When your child is revising all day, do not worry about household jobs left undone or untidy bedrooms.

Staying calm yourself can help. Remember, exams do not last forever.

The Family Lives website has more about coping with exam stress.

Help them study

Make sure your child has somewhere comfortable to study. Ask them how you can support them with their revision.

Help them come up with practical ideas that will help them revise, such as drawing up a revision schedule or getting hold of past papers for practice.

To motivate your child, encourage them to think about their goals in life and see how their revision and exams are related to them.

Talk about exam nerves

Remind your child that it’s normal to feel anxious. Nervousness is a natural reaction to exams. The key is to put these nerves to positive use.

If anxiety is getting in the way rather than helping, encourage your child to practise the activities they’ll be doing on the day of the exam. This will help it feel less scary.

For example, this may involve doing practice papers under exam conditions or seeing the exam hall beforehand. School staff should be able to help with this.

Help your child face their fears and see these activities through, rather than avoiding them.  

Encourage them to think about what they know and the time they’ve already put into studying to help them feel more confident.

Encourage exercise during exams

Exercise can help boost energy levels, clear the mind and relieve stress. It does not matter what it is – walking, cycling, swimming, football and dancing are all effective.

Activities that involve other people can be particularly helpful.

Support group Childline says many children who contact them feel that most pressure at exam time comes from their family.

Listen to your child, give them support and avoid criticism.

Before they go in for a test or exam, be reassuring and positive. Let them know that failing is not the end of the world. If things do not go well they may be able to take the exam again.

After each exam, encourage your child to talk it through with you. Discuss the parts that went well rather than focusing on the questions they found difficult. Then move on and focus on the next test, rather than dwelling on things that cannot be changed.

Make time for treats

With your child, think about rewards for doing revision and getting through each exam.

Rewards do not need to be big or expensive. They can include simple things like making their favourite meal or watching TV.

When the exams are over, help your child celebrate by organising an end-of-exams treat.

When to get help

Some young people feel much better when exams are over, but that’s not the case for all young people.

Get help if your child’s anxiety or low mood is severe, persists and interferes with their everyday life. Seeing a GP is a good place to start.

Some basic rules coming up to exam time

A quiet place to study – A suitable environment to study is important to help concentration levels.

A balanced diet – Good nutrition is essential at any time of year, but especially during exam time. Batch cook some healthy meals and stock up on nutritious snacks. Having some of the student’s favourite dinner to hand is important too.

Omega 3 is essential to fuel the hard-working brain at this time. Keep brain and vision in tip top shape by making sure to top up your good fats daily. Consider taking Cleanmarine® Krill Oil High Strength. It contains 590mg of concentrated, high strength Omega 3 Krill Oil. This concentrated formula of EPA, DHA, Astaxanthin and Choline provides the essential fatty acids required for the normal function of the heart, brain and vision. DHA contributes to the maintenance of normal brain function and vision, the beneficial effect is obtained with a daily intake of 250mg. Also eating 2 – 3 portions of oily fish a week will provides more essential fats for your body. Examples include salmon, mackerel and herring. Easy to cook in steam parcels in the oven with garlic, lemon and oil.

A good night’s sleep – Studying all night may seem like a good idea but if your child doesn’t get enough sleep, they are more likely to forget the information or under perform. When your mind is buzzing with exam questions, quotes and scientific theories, having something to help you switch off, relax and support deep sleep is a must. Try melissa-dreams which contains all-natural ingredients including the herbs lemon balm (Melissa officinalis) and Chamomile in combination with selected B-vitamins, Magnesium and the amino acid L-theanine. Magnesium contributes to a reduction of tiredness and fatigue while vitamins B6 and B12 contribute to the normal function of the nervous system. With no drowsiness or side effects the next day, Melissa Dream helps you to wake up rested and full of energy.

Exercise – Even a 20-minute walk will help your child to relax and destress their mind, this will also help oxygenate the entire body.

Stress is the biggest obstacle to overcome. It’s so important to get enough B vitamins in foods like broccoli. Kale, spinach. Getting your 5-a-day is bound to be the least of your worries as exam time approaches; ironically this is when your nutritional and energy needs are at their highest. Make sure you keep your nutrient and energy levels up with One Nutrition® Organic Power Greens. This is a unique combination of nature’s finest green foods including kale, broccoli, spirulina, wheat grass and barley grass juice powders in a handy capsule or powder to add to your morning smoothie.

Take time out to do something you love such as walking your dog, reading a magazine, chat online to your best friend. Journaling is also therapeutic, to put your thoughts and feelings onto paper. Try family time such as playing a board game to distract your mind from the books for a while.

Don’t forget to celebrate – when the exams are over, go out and celebrate together, hopefully everything will be back to normal by then.

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Research

Can vitamin D really prevent Covid-19? Here’s what the evidence says.


Vitamin D supplement sales have soared amid the pandemic as people try to curb their risk of contracting the novel coronavirus—but some experts are urging caution, noting that not enough research has been done to establish a definitive relationship between taking the supplement and fending off Covid-19.

What the research says about vitamin D and Covid-19

According to Sabyasachi Sen, a professor of endocrinology and medicine at George Washington University (GW), deficiencies of vitamin D are “not rare” and are especially common in older adults, obese people, and people with darker skin—some of the same populations most affected by Covid-19.

While vitamin D is known for protecting bone health, it also helps with the immune system, Sen said. It’s believed that vitamin D improves the function of certain cells, including T cells, which fight off pathogens and can assist in modulating inflammatory responses.

In addition, Sen continued, research has found vitamin D deficiencies have been associated with an increased risk of infection. “Now, what is unknown is whether it’s a cause and effect rather than an association,” he said.

According to the Washington Post, researchers studying the relationship between vitamin D and Covid-19 outcomes are interested in precisely that question: whether there’s a cause and effect relationship, or merely an association.

For example, one study, published in JAMA Network Open, looked at the health records of 489 people in Chicago and found patients with a vitamin D deficiency in the year prior to testing for Covid-19 were 77% more likely to test positive for the disease than those with normal vitamin D levels. Taking a converse approach, another study looked at a small group of Covid-19 patients in Italy who had been hospitalized with acute respiratory failure and found that 81% of them had a vitamin D deficiency.

Meanwhile, an experimental study in France at a nursing home with 66 people found that taking vitamin D supplements was “associated with less severe Covid-19 and a better survival rate.” Similarly, a study in South Korea of 200 people found that a deficiency of vitamin D could “decrease the immune defenses against Covid-19 and cause progression to severe disease.” And a small study in Spain involving 76 hospitalized Covid-19 patients found that those treated with calcifediol—an activated version of vitamin D, distinct from the over-the-counter supplement—seemed to curb the severity of the disease.

On the flipside, however, a recent paper considered by the National Institute for Health and Care Excellence in the United Kingdom looked at vitamin D levels from up to 14 years ago and didn’t find any correlation between vitamin D levels and Covid-19 mortality. And while the lead author of that study has in other papers called for further research on the link between vitamin D and Covid-19 outcomes, the researchers concluded, “For now, recommendations for vitamin D supplementation to lessen Covid-19 risks appear premature and, although they may cause little harm, they could provide false reassurance leading to changes in behaviour that increase risk of infections.”

Similarly, a double-blind randomized controlled trial of 240 patients in Brazil, which has yet to be peer-reviewed, found that one large dose of vitamin D didn’t reduce hospital stay length or mortality rates among patients with a severe case of Covid-19 compared with those in a placebo group.

Correlation—not necessarily causation

“We do know that people who have lower blood levels of vitamin D tend to have a higher risk of being infected with Covid-19 and having severe Covid-19 illness,” JoAnn Manson, chief of the Division of Preventive Medicine at Brigham and Women’s Hospital, said. “But as we say in epidemiology, ‘Correlation doesn’t prove causation.’ We don’t know for sure that the low vitamin D level is causing an increased risk of Covid-19.”

According to Natasha Chida, an infectious disease expert and assistant professor of medicine at Johns Hopkins University, people who have a vitamin D deficiency typically have other health factors that could affect how likely they are to develop a severe case of Covid-19—and people who do develop diseases such as Covid-19 often experience a drop in vitamin D levels.

“Unless you take into account all those factors and separate all those out and look at just vitamin D … it’s really hard to make any inferences about what vitamin D is doing here,” she said.

Chida added that there’s “some biologic plausibility” that vitamin D could help Covid-19 patients. “It’s just that despite years of research into the use of vitamin D in respiratory tract infections, there still hasn’t really been a clear, slam-dunk answer that there’s a benefit.”

Research into the relationship is ongoing, however. According to the Washington Times, about 70 clinical trials assessing vitamin D and Covid-19 have been filed in the U.S. National Library of Medicine database.

Should you take vitamin D supplements?

As of now, experts say people who know they have vitamin D deficiencies should continue their treatment, and those thinking about taking supplements should talk to their health care provider first, given there’s no firm evidence that vitamin D supplements curb people’s risk of infection or serious Covid-19 illness.

“People should be wary of taking mega doses of vitamins or unproven interventions specifically for Covid-19, because we don’t have good quality data yet to suggest that this is of any help,” Hana Akselrod, an infectious disease specialist at GW, said.

Instead of supplements, people can add more vitamin D to their lives by being outdoors for 15 or 20 minutes a day, Akselrod added. And some foods, such fatty fish or fortified dairy products, could also improve vitamin D levels, Manson said.

“There are all of the positive confluences around nutrition and outdoor exercise that aren’t just limited to the number of how many units of vitamin D you get every day,” Akselrod said. “And on top of that, people absolutely need to continue all the other safety precautions, like masking and safe distancing and avoiding gatherings, because we’re in the most dangerous phase of the pandemic yet”.

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Research

COVID-19 will likely be with us forever. Here’s how we’ll live with it.

As COVID-19 continues to run its course, the likeliest long-term outcome is that the virus SARS-CoV-2 becomes endemic in large swaths of the world, constantly circulating among the human population but causing fewer cases of severe disease. Eventually—years or even decades in the future—COVID-19 could transition into a mild childhood illness, like the four endemic human coronaviruses that contribute to the common cold.

“My guess is, enough people will get it and enough people will get the vaccine to reduce person-to-person transmission,” says Paul Duplex, director of the University of Pittsburgh’s Center for Vaccine Research. “There will be pockets of people who won’t take [the vaccines], there will be localized outbreaks, but it will become one of the ‘regular’ coronaviruses.”

But this transition won’t happen overnight. Experts say that SARS-CoV-2’s exact post-pandemic trajectory will depend on three major factors: how long humans retain immunity to the virus, how quickly the virus evolves, and how widely older populations become immune during the pandemic itself.

Depending on how these three factors shake out, the world could be facing several years of a halting post-pandemic transition—one marked by continued viral evolution, localized outbreaks, and possibly multiple rounds of updated vaccinations.

“People have got to realize, this is not going to go away,” says Roy Anderson, an infectious disease epidemiologist at Imperial College London. “We’re going to be able to manage it because of modern medicine and vaccines, but it’s not something that will just vanish out of the window.”

The long road to another common cold

One of the essential factors governing the future of COVID-19 is our immunity to the illness. Immunity to any pathogen, including SARS-CoV-2, isn’t binary like a light switch. Instead, it’s more like a dimmer switch: The human immune system can confer varying degrees of partial protection from a pathogen, which can stave off severe illness without necessarily preventing infection or transmission.

In general, the partial protection effect is one of the reasons why the four known endemic human coronaviruses—the ones that cause a common cold—have such mild symptoms. A 2013 study in BMC Infectious Diseases shows that on average, humans are first exposed to all four of these coronaviruses between the ages of three and five-part of the first wave of infections that young children experience.

These initial infections lay the foundation for the body’s future immune response. As new variants of the endemic coronaviruses naturally evolve, the immune system has a head start in fighting them off—not enough to eradicate the virus instantly, but enough to ensure that symptoms don’t progress much beyond the sniffles.

“The virus is also its own enemy. Every time it infects you, it tops up your immunity,” says Marc Veldhoen, an immunologist at the Portugal’s University of Lisbon.

Past studies make clear that partial immunity can keep people from getting seriously ill, even as coronaviruses successfully enter their systems. Long-term, the same is likely to be true for the new coronavirus. Emory University postdoctoral fellow Jennie Lavine modeled SARS-CoV-2’s post-pandemic trajectory based on the 2013 study’s data, and her results—published in Science on January 12—suggest that if SARS-CoV-2 behaves like other coronaviruses, it will likely morph into mild nuisance years to decades from now.

This transition from pandemic to minor ailment, however, depends on how the immune response to SARS-CoV-2 holds up over time. Researchers are actively examining the body’s “immunological memory” of the virus. A study published in Science on January 6 tracked the immune response of 188 COVID-19 patients for five to eight months post-infection, and while individuals are varied, about 95 percent of patients had measurable levels of immunity.

“Immunity is waning, but certainly not gone, and I think this is key,” says Lavine, who wasn’t involved with the study.

In fact, it’s even possible that one of the cold-causing coronaviruses sparked a serious outbreak in the 1800s before fading into the litany of mild, commonplace human pathogens. Based on the spread of its family tree, researchers estimated in 2005 that the endemic coronavirus OC43 entered humans sometime in the late 19th century, likely the early 1890s. The timing has led some researchers to speculate that the original version of OC43 may have caused the “Russian flu” pandemic of 1890, which was noted for its unusually high rate of neurological symptoms—a noted effect of COVID-19.

“There’s no hard proof, but there are a lot of indications that this wasn’t an influenza pandemic but a corona-pandemic,” Veldhoen says.

The crucible of evolution

Though the carnage of past coronaviruses has faded over time, the road to a relatively painless coexistence between humans and SARS-CoV-2 will likely be bumpy. In the medium-term future, the impact of the virus will depend largely on its evolution.

SARS-CoV-2 is spreading uncontrollably around the world, and with every new replication, there’s a chance for mutations that could help the virus more effectively infect human hosts.

The human immune system, while protecting many of us from a serious illness, is also acting as an evolutionary crucible, putting pressure on the virus that selects for mutations that make it bind more effectively to human cells. The coming months and years will reveal how well our immune systems can keep up with these changes.

New SARS-CoV-2 variants also make widespread vaccination and other transmission-blocking measures, such as face masks and distancing, more crucial than ever. The less the virus spreads, the fewer opportunities it has to evolve.

We’re going to be able to manage it because of modern medicine and vaccines, but it’s not something that will just vanish out of the window.

ROY ANDERSONIMPERIAL COLLEGE LONDON

Current vaccines should still work well enough against emerging variants, such as the B.1.1.7 lineage first found in the United Kingdom, to prevent many cases of serious illness. Vaccines and natural infections create diverse swarms of antibodies that glom onto many different parts of SARS-CoV-2’s spike protein, which means that a single mutation can’t make the virus invisible to the human immune system.

Mutations may produce future variants of SARS-CoV-2 that partially resist current vaccines, however. In a preprint posted on November 19 and updated on January 19, Duplex and his colleagues show that mutations that delete parts of the SARS-CoV-2 genome’s spike protein region prevent certain human antibodies from binding.

“What I’ve learned from our own work is how deviously beautiful evolution is,” Duplex says.

Other labs have found that mutations in 501Y.V2, the variant first found in South Africa, are especially effective at helping the virus elude antibodies. Out of 44 recovered COVID-19 patients in South Africa, blood extracts from 21 of the patients didn’t effectively neutralize the 501Y.V2 variant, according to another preprint published on January 19. Those 21 people had mild to moderate cases of COVID-19, however, so their antibody levels were lower, to begin with, perhaps explaining why their blood did not neutralize the 501Y.V2 variant.

So far, currently authorized vaccines—which spur the production of high levels of antibodies—seem to be effective against the most concerning variants. In a third preprint published on January 19, researchers showed that antibodies from 20 people who had received the Pfizer-BioNTech or Moderna vaccines didn’t bind quite as well to viruses with the new mutations as they did to earlier variants—but they still bound, suggesting the vaccines will still protect against severe illness.

The new variants bring other threats as well. Some, such as B.1.1.7, appear to be more transmissible than earlier forms of SARS-CoV-2, and if left to spread uncontrollably, these variants could make many more people severely ill, which risks overwhelming healthcare systems around the world and even higher death tolls. Veldhoen adds that new variants also may pose a greater risk of reinfection to recovered COVID-19 patients.

Researchers are closely monitoring the new variants. If vaccines need to be updated in the future, Anderson says that it could be done quickly—in roughly six weeks for currently authorized mRNA vaccines, such as those made by Pfizer-BioNTech and Moderna. That timetable, though, doesn’t account for the regulatory approvals that updated vaccines would need to go through.

Anderson adds that depending on how the evolution of the virus progresses, lineages of SARS-CoV-2 may arise that are distinct enough that vaccines will need to be tailored to specific regions akin to vaccines for pneumococcus. To successfully guard against SARS-CoV-2 going forward, we will need a global monitoring network similar to the worldwide reference laboratories used to collect, sequence, and study variants of influenza.

“We’re going to have to live with it, we’re going to have to have constant vaccination, and we’re constantly going to have to have a very sophisticated molecular surveillance program to keep track of how the virus is evolving,” Anderson says.

The promise and challenge of widespread vaccination

Experts agree that transitioning beyond a pandemic depends on the prevalence of immunity, especially among older and more vulnerable populations. Younger people, especially children, will build up immunity to SARS-CoV-2 over a lifetime of exposure to the virus. Today’s adults have had no such luxury, leaving their immune systems naive and exposed.

The exact threshold for achieving population-wide immunity that slows down the virus’s spread will depend on how contagious future variants become. But so far, research of early variants of SARS-CoV-2 suggests at least 60 to 70 percent of the human population will need to become immune to end the pandemic phase.

This immunity can be achieved in one of two ways: large-scale vaccination, or recovery from natural infections. But achieving widespread immunity through uncontrolled spread comes at a terrible cost: hundreds of thousands more deaths and hospitalizations around the world. “If we don’t want to push forward vaccines and champion vaccines, we have to decide collectively how many old people we want to die—and I don’t want to be the one making that decision,” Duplex says.

Jeffrey Shaman, an infectious diseases expert at Columbia University, points out that the global push for vaccines also exposes existing inequities in global health. In a widely shared map from December, The Economist Intelligence Unit estimated that rich countries such as the U.S. will have widely accessible vaccines by early 2022, which may not happen for poorer countries in Africa and Asia until as late as 2023.

Efforts to vaccinate the developing world hinge, in part, on vaccines that can be stored with standard refrigeration, such as the vaccines under development by Oxford/AstraZeneca and Johnson & Johnson. (See the latest on COVID-19 vaccine development around the world.)

As of the week of January 18, according to a World Health Organization estimate, some 40 million COVID-19 vaccine doses have been administered around the world, mostly in high-income countries. In Africa, only two countries, Seychelles and Guinea, have started providing vaccines. And in Guinea, a low-income country, only 25 people have received doses.

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