In the background

I have to admit I don’t give much thought to “regular flu.” I get my annual vaccination and live as I am called. “Regular” flu is just in the background of living in this modern world. Clearly the pandemic is not “in the background.” When asked when the pandemic would end, Jennifer Nuzzo, an epidemiologist at Johns Hopkins University, replied: “It doesn’t end. We just stop caring. Or we care a lot less. I think for most people, it just fades into the background of their lives.”

Vaccine research and development was just in the background of most people’s lives. So much in the background we don’t give it any thought. Now we can all fluently mention mRNA vaccine development. Within weeks of the covid DNA sequence being released, the already proven mRNA method produced vaccines that moved into testing. Researchers had been studying and working with mRNA vaccines for decades. Now “mRNA” is part of the lexicon of “regular” life.

I wonder about the covid-19 virus – is it heading to the background. The 1918 flu epidemic gave us the influenza A(H1N1) virus. The “A” stands for avian origination. The 1918 pandemic was thought to have taken the lives of 50 million people world-wide. The virus is still in circulation, genetically at least, present in people and pigs. It’s in the background, out of sight for the moment.

In 2004 a joint project among scientists from CDC, Mount Sinai School of Medicine, the Armed Forces Institute of Pathology, and Southeast Poultry Research Laboratory sought to reconstruct the A(HINI) virus to understand the nature of that viral pandemic of 100 years ago. One of, if not the largest of the unanswered questions  is why the Spanish flu proved so deadly to young adults, 18-35. The present-day science has hypotheses but no good answers. One suggestion is that the elderly enjoyed greater immunity because, as children, they had been exposed to a pandemic virus with a similar genetic makeup to the H1N1 Spanish flu. Conversely, there was a 1890 “Russian flu,” an H3 virus that might have created an immunological “blind spot” in younger people so that when 1918 rolled round they were particularly vulnerable to the 1918 virus. But these are just theories.

In any case genetic descendants of the 1918 H1N1 virus have been involved with other pandemic viruses, such as the 1968 Hong Kong flu and the hybrid H1N1 virus responsible for the 2009 swine flu pandemic. 100 years later and it is still in circulation.

Covid-19 is the disease caused by the SARS-CoV-2 virus, not related to H1N1 but it is in the same class as other SARS viruses. It is unlikely that the virus will go away, ever. Like most viruses, it will probably keep circulating, with cases rising sometimes and falling other times. But we have the tools — vaccines, along with an emerging group of treatments — to turn it into a manageable virus, similar to the seasonal flu. As for long-Covid, it is real but rare. It’s also not unique. The flu and other viruses also cause mysterious, lasting problems for a small share of people, studies show.

Maybe Dr. Nuzzo is onto something: the pandemic doesn’t end. Science has accomplished some amazing things in the last 18 months in vaccines, treatments, and not-yet-approved Covid-19 treatment in pill form (Merck Pharma). Aided by their advances, the virus seems more likely to fade into the background, and we just won’t notice as much.

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