Even with successful vaccination programs, we cannot expect to completely eradicate Covid-19 from the world.

It will continue to circulate for many years to come.

Right now, Covid-19 is spread almost all over the globe. Over time, in most countries, it will change from an epidemic disease – when the number of cases suddenly increases – to an endemic disease – when cases continue to appear over a long period of time, with periodic peaks and troughs.

Many diseases are endemic, ranging from relatively minor ones like the common cold viruses to serious killers like malaria.

A disease can become endemic in a small region, like Lassa fever in parts of West Africa, or worldwide, like chickenpox.

An infectious disease becomes endemic when it is not spreading so fast that it gets out of control, but at the same time it is not completely eliminated. This may be because:

• we develop only limited immunity;
• the disease spreads in ways that we cannot completely prevent – for example, through insect bites, when we breathe or talk, or;
• the disease is spread in wildlife populations where it cannot be eradicated.

In fact, the only human infectious disease that we have been able to completely eradicate is smallpox. It was a long and complex process and required a global effort, aided by the facts that smallpox infects only humans (not animals), it has a short incubation period, and we had a highly effective smallpox vaccine.

For most other diseases, complete elimination is not possible – we reduce their spread through measures such as vaccination.

Outlook for post-pandemic Covid-19

This is something that is starting to happen with Covid-19 in countries that have had access to vaccines, such as the UK, Germany and the US.

People are increasingly building up immunity through a combination of vaccinations, booster doses and the natural immunity that people develop after infection. However, where there was no vaccine, the level of protection against the virus is lower.

The longer the virus continues to spread among largely unvaccinated populations, the more likely it is to evolve and create new variants, such as Omicron or Delta. These could spread faster or cause more serious illness in humans and even reduce the effectiveness of our current vaccines.

If we can increase global immunity, it will make it harder for the coronavirus to spread.

We could then get to a point where countries regularly have only a small number of Covid-19 cases – which might seem like mission accomplished. But we still have work to do to protect ourselves.

An example of large outbreaks that started again after the disease was brought under control is measles in 2018. Vaccination rates dropped in several countries, causing collective immunity to fall below the threshold that kept the disease under control, and the number of cases worldwide rose to around 10 million.

So, what can we do to fight Covid-19 in the future?

This pandemic is not yet under control, and there is still much we do not know about Covid-19, including how long a person’s current immunity can last and the impact of existing and future variants.

But we already know what a long-term plan to deal with Covid-19 should include:

• Monitoring the virus. Knowledge is power, and the global genomic surveillance program, combined with other epidemiological and clinical data, will tell us when and where the virus is spreading and how it is evolving. Let’s not be caught off guard again.
• Invest in vaccines and treatments. If new variants emerge, such as Omicron or Delta, that behave more dangerously, we must be prepared to find ways to prevent their spread, treat people who become infected, and reduce the overall impact on health systems and societies.
• Ensure everyone in the world has access to vaccines, treatment and tests. If we have learned anything over the past two years, it is that infection anywhere is a threat everywhere. The more people who have Covid-19, the more chances the virus has to grow and spread. This means that controlling the virus in any country will benefit people in all other countries.
• Sharing and coordinating resources. Many countries do not have the means to implement effective vaccination programs. For reasons of solidarity and self-interest, richer countries need to invest in the ACT-Accelerator, a global collaboration to ensure access to tests, treatment and vaccines for everyone, everywhere. Wealthy countries that have provided many excess doses of vaccine can also donate them through COVAX, ensuring that vaccines get to where they are needed most.
• Global solidarity. Acting in national self-interest will only perpetuate this crisis, trapping us in a cycle of waves, new options, lost lives, and continued economic and social disruption. Clear and rational political decision-making, communication and global cooperation are crucial if we are to end the pandemic.

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The second and more likely scenario is a transition to an epidemic seasonal disease such as influenza. Effective treatments that prevent the progression of COVID-19 disease (e.g., monoclonal antibodies, which reduce hospitalization and mortality by 70-85%) can reduce the burden of SARS-CoV-2 infection to levels equivalent to or even lower than influenza. However, we must remember that the annual mortality burden of influenza in non-pandemic years is estimated to be between 250,000 and 500,000 deaths, with up to 650,000 deaths from all causes worldwide, accounting for about 2% of all annual respiratory deaths (two-thirds among people 65 years and older). This is an extremely important health burden, and it amounts to a relatively “optimistic” view of the future of the COVID-19 pandemic.

The third scenario is a transition to an endemic disease, similar to other human coronavirus infections that have a much lower disease burden than influenza or SARS-CoV-2. However, there is limited data on the global burden of disease caused by common human coronaviruses, and as noted above, it is impossible to predict with certainty whether further adaptation of SARS-CoV-2 to humans will increase or decrease its intrinsic virulence.

To better anticipate which scenario is likely to emerge and to better prepare the world to respond appropriately, we suggest several key questions that need to be answered and critical tools that need to be developed. These include gaps in our knowledge in terms of epidemiology, immunology and virology, as well as missing surveillance, preventive and therapeutic tools.

This pandemic has shown both the importance of initiatives in individual countries and the interdependence of the world, as well as the need for global cooperation to control the pandemic. It was the investments of a limited number of countries that led to biomedical discoveries that offered tools to stop the spread of the pandemic. However, the absence of international structures to implement these tools has drawn attention to the disparities between advantaged and disadvantaged groups, both within and between countries. This highlights the current mismatch between health care delivery systems and access to new biomedical interventions. Global health leaders will need to be vigilant about the trajectory of SARS-CoV-2 in the near future, evaluating the strategies and approaches used during the pandemic to develop more effective structures and processes to ensure a more efficient and equitable response for the future.

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The Coronaviridae family is characterized by relatively high replication fidelity compared to other RNA viruses, which is determined by the processivity of their polymerases, as required by their extremely large genome 12 . Based on this, it has been argued that the evolution of SARS-CoV-2 will be limited, which in turn will ensure the durability of vaccines and therapeutics and support optimism that population immunity can end the pandemic. However, while on average SARS-CoV-2 evolves (perhaps 3-4 times) slower than influenza viruses 13, the virus is accumulating mutations faster than might be expected given its relative replication accuracy with approximately two mutations recorded per month 14 and much higher rates of change have been observed in some variants that are of concern. Coronaviruses also have a high rate of viral RNA recombination 15 ; thus, people infected with two SARS-CoV-2 variants may acquire multiple mutations from both variants simultaneously. We also cannot rule out possible recombination events in the future between SARS-CoV-2 and other human coronaviruses. In addition, prolonged infections of immunosuppressed individuals who cannot effectively clear the infection may create the opportunity for the accumulation of multiple mutations. Furthermore, vaccination may not be effective for immunocompromised individuals 16 .

Why do we observe the emergence of variants despite the relatively fastidious mechanism of coronavirus replication? The rate of evolution of a viral pathogen depends not only on the frequency of background mutation, but also on the time of virus generation, the duration of infection, the number of variants that develop during infection of an individual, structural and functional constraints in specific regions of viral proteins, as well as the degree and strength of natural selection acting on the virus. In addition, the greater the number of people infected with a virus, the greater the pool and diversity of mutant viruses that are produced. Although transmission events between two hosts regularly create bottlenecks that clear most low frequency mutant viruses, a large number of transmission events can facilitate the transmission of a more fit virus with the global spread of B.1.1.7 (alpha) and the current spread of B.1.617 (Delta) in India being important examples 17 , 18 , 19 , 20 .

Functional domains in viral proteins that can accept mutations without losing their overall structure and function are potentially selectable mutation sites. The region of the SARS-CoV-2 junction protein that interacts with the human ACE2 receptor shows particular structural and functional plasticity 21 , 22 . With new selection pressures created by vaccines or immunity to natural infection or the use of antiviral agents, the possibility of viruses adapting to overcome immune and/or antiviral pressures is likely to be a constant reality. There is a risk of virus diversification in the current uncontrolled or incompletely controlled pandemic in many regions of the world. In this regard, the level of knowledge about the impact of mutations outside the viral adhesion protein is in its infancy, which limits the ability to predict the evolutionary paths the virus will take in the future.

The rapid transition to the endemic phase may reduce the number of circulating variants of the virus, limiting the extensive exploration of the fitness landscape that occurs during the pandemic phase. Thus, the nature of the future equilibrium between SARS-CoV-2 and humans depends on both the speed and inclusiveness of the pandemic response in different geographic regions and cultures, as this directly affects the rate of emergence of problematic variants.

Understanding the transition to the endemic phase with potential seasonal peaks will benefit from new tools that can predict which virus variants are likely to emerge and spread. Spreading variants can be predicted to some extent by epidemiological and biological data, including ACE2 binding measured in the context of deep scan mutagenesis of the viral adhesion protein 23 . Immune escape begins to facilitate the spread of virus variants during a pandemic when high levels of vaccine- and infection-induced immunity have not yet been achieved worldwide 24 . Complete containment of the pandemic would minimize the likelihood of SARS-CoV-2 adapting to the host by reducing the length of transmission chains 25 . This seems unlikely unless very high vaccination rates can be achieved worldwide.

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1. Strengthening Public Health Infrastructure

The Need for Robust Health Systems

The pandemic has underscored the importance of a strong and well-resourced public health infrastructure. South Africa’s healthcare system faced significant challenges during the pandemic, including shortages of medical supplies, insufficient ICU capacity, and overwhelmed healthcare workers. One crucial lesson is the need to invest in and strengthen health systems to ensure they can effectively respond to emergencies.

Building Resilience in Health Facilities

Improving the resilience of health facilities, including the expansion of ICU beds and enhancing emergency response capabilities, has become a priority. The pandemic highlighted gaps in the healthcare system that need to be addressed to ensure better preparedness for future health crises.

2. Enhancing Data Collection and Sharing

Importance of Real-Time Data

The COVID-19 crisis demonstrated the critical role of real-time data in managing a pandemic. South Africa’s experience highlighted the need for accurate and timely data collection and sharing to inform public health decisions and interventions.

Leveraging Technology for Data Management

The use of technology for data collection, tracking, and analysis has proven invaluable. Tools like digital health records and data analytics platforms are essential for monitoring the spread of diseases, managing resources, and coordinating responses. Enhancing these capabilities will be crucial for managing future health emergencies effectively.

3. Addressing Socioeconomic Inequalities

Exposing Existing Disparities

The pandemic revealed and exacerbated existing socioeconomic inequalities in South Africa. Vulnerable populations, including those in low-income communities and informal sectors, faced severe economic and health impacts. The crisis highlighted the need for targeted interventions to address these disparities and support the most affected groups.

Strengthening Social Safety Nets

One important lesson is the necessity of robust social safety nets to protect individuals during crises. Providing financial support, access to healthcare, and social services to those in need can mitigate the impact of future pandemics on vulnerable populations.

4. Importance of Public Communication and Trust

Effective Communication Strategies

Clear and consistent communication has been essential during the pandemic. The need for transparent information about health measures, risks, and vaccination efforts became apparent. Effective public communication helps build trust and ensures that individuals adhere to public health guidelines.

Building Trust with Communities

Engaging with communities and addressing misinformation are critical for effective health communication. Building trust between public health authorities and the public can enhance compliance with health measures and improve overall response efforts.

5. Promoting Scientific Research and Innovation

Investment in Research

The pandemic highlighted the importance of investing in scientific research and innovation. South Africa’s contributions to vaccine research and development, as well as genomic surveillance, have been crucial in managing the pandemic. Supporting research and innovation is essential for advancing medical science and preparing for future health challenges.

Encouraging Collaboration

Collaboration between researchers, institutions, and international organizations has been vital in addressing the pandemic. Strengthening partnerships and encouraging collaborative research can enhance the effectiveness of responses and accelerate the development of solutions.

6. Improving Crisis Management and Planning

Need for Comprehensive Crisis Plans

The COVID-19 crisis demonstrated the need for comprehensive and flexible crisis management plans. South Africa has learned the importance of developing and regularly updating crisis response plans to address various scenarios, including health emergencies, economic disruptions, and social impacts.

Building Multi-Sectoral Coordination

Effective crisis management requires coordination across multiple sectors, including health, finance, and social services. Ensuring that different sectors work together seamlessly can improve the overall response and resilience to crises.

7. Fostering Community Resilience

Empowering Communities

The pandemic highlighted the role of communities in managing crises. Empowering local communities and organizations to play an active role in response efforts can enhance resilience and ensure that interventions are tailored to local needs.

Supporting Mental Health

The impact of the pandemic on mental health has been significant. Supporting mental health services and promoting community well-being are essential components of building resilience and ensuring a holistic response to health crises.

The COVID-19 crisis has provided South Africa with valuable lessons that will shape its approach to future health emergencies. Strengthening public health infrastructure, enhancing data collection, addressing socioeconomic inequalities, and promoting scientific research are key areas of focus. By implementing these lessons, South Africa can build a more resilient and equitable society, better prepared to face future challenges.

As the nation continues to recover from the pandemic, these lessons will guide efforts to improve public health responses, support vulnerable populations, and foster community resilience. The experience gained from the COVID-19 crisis will contribute to a more effective and coordinated approach to managing future health emergencies.

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The same half was prone to panic economic behavior. The panic manifested itself in a variety of ways, including attacks on the toilet paper sections of stores and selling stocks on the stock exchanges. Obviously, it exacerbated the budding crisis.

As a result, many countries stepped up the fight against fake news. And then there is a new danger: the victims of the fight may become scientific data that does not suit the authorities. It is believed that it was because of the fight against doctors who disseminated data about the outbreak in the city of Wuhan that the Chinese authorities failed to realize in time that the virus is transmitted from person to person, and missed the start of the epidemic.

But the major trust issues may still be ahead: it all depends on how quickly authorities and scientists can tackle the epidemic.

Will online business defeat the traditional industry?

It would seem that all the online services that have boomed in recent years are set to profit at a time when their traditional competitors are forced to close or cut back on sales due to quarantines and “lockdowns” around the world. This is the best moment to show their advantages to a wide range of consumers. But it’s not all straightforward: new services – from online sales and delivery to online learning, telemedicine and government services – are being baptized in the face of multiplied demand. Not everyone will be able to cope with this; many online companies have already virtually collapsed under the shaft of orders. It is impossible to predict what the industry will look like when offline competitors return. Perhaps a renaissance awaits the “traditional” business.

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Right now, staff in hospitals and other healthcare facilities are under significant stress, and in this environment, innovative technology is helping them fight the virus and its effects.

A joint step into the future of technological innovation

One of the most interesting initiatives was the proposal of the PEPP-PT (Pan-European Privacy-Preserving Proximity Tracing) organization. The organization brings together scientists and researchers from eight countries under its umbrella; they are developing smartphone technology to track people who have come into contact with COVID-19 infected individuals.

Many other countries, including Austria, Germany, Norway and the UK, are developing social mobile tracking apps to help bring the situation with the virus under control. One German startup company has also developed a chatbot called “Corona-Bot” that asks users a series of questions based on which it infer symptoms and possible COVID-19 infection.

Also in Germany, more and more doctors are using telemedicine services and organizing remote video consultations with patients, which allows them to perform their duties without violating the rules of social distance. In terms of hospital capacity, centralized control panels are helping to organize the workflow – they ensure that beds and wards are used efficiently, taking into account the current workload and situation.

Researchers and scientists around the world are conducting their own tests and studies to understand the mechanisms of the virus and develop a vaccine, but the European Commission has also announced the launch of a data portal where tools and datasets can be accessed. This resource will be very useful to those who are working tirelessly to defeat the dangerous virus.

Each of these innovations reduces the burden on the healthcare industry in one way or another, but it is also worth considering the effectiveness of the technology used in hospitals and other healthcare facilities.

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South Africa’s Vaccine Development Infrastructure

1. Established Research InstitutionsSouth Africa boasts several prominent research institutions that are central to vaccine development efforts. Institutions such as the South African Medical Research Council (SAMRC), the University of Cape Town (UCT), and the National Institute for Communicable Diseases (NICD) are at the forefront of research in infectious diseases and vaccine development. These institutions have established expertise in immunology, virology, and epidemiology, providing a strong foundation for developing new vaccines.
2. Biotechnology and Pharmaceutical SectorThe biotechnology and pharmaceutical sector in South Africa is growing, with several companies and research organizations focused on developing vaccines and therapeutic interventions. The country has facilities for vaccine production and clinical trials, which are crucial for advancing vaccine research from the laboratory to real-world applications.

Key Initiatives and Collaborations

1. The African Vaccine Manufacturing Initiative (AVMI)South Africa is actively involved in the African Vaccine Manufacturing Initiative, which aims to boost vaccine production capabilities across the continent. The initiative seeks to enhance Africa’s self-sufficiency in vaccine production, reducing reliance on external suppliers and improving the continent’s ability to respond to future pandemics. South Africa’s involvement includes supporting infrastructure development, technology transfer, and capacity building.
2. Partnerships with Global OrganizationsSouth Africa has formed strategic partnerships with global organizations to advance vaccine development. Collaborations with entities such as the World Health Organization (WHO), GAVI (the Vaccine Alliance), and the Coalition for Epidemic Preparedness Innovations (CEPI) have facilitated access to resources, expertise, and funding. These partnerships enable South African researchers to contribute to global vaccine research and participate in international vaccine development initiatives.
3. Local Vaccine Research and Development ProjectsSouth African researchers are engaged in several local vaccine development projects. For instance, the country is involved in researching vaccines for various infectious diseases, including HIV, tuberculosis (TB), and malaria. These efforts contribute to a broader understanding of vaccine development and help build the necessary expertise for future pandemic preparedness.

Advancing Vaccine Research

1. Clinical Trials and TestingSouth Africa plays a critical role in conducting clinical trials for new vaccines. The country’s diverse population and experience in managing large-scale health studies make it an important site for testing vaccines in different demographic groups. Clinical trials conducted in South Africa provide valuable data on vaccine safety and efficacy, contributing to the development of vaccines that are effective for a global audience.
2. Genomic Surveillance and Data SharingSouth Africa is also involved in genomic surveillance, which involves monitoring and analyzing the genetic makeup of pathogens. This data is crucial for identifying new variants of viruses and understanding their impact on vaccine efficacy. South African researchers contribute to global databases and platforms, such as GISAID, which facilitate the sharing of genomic data and support vaccine development efforts.

Preparing for Future Pandemics

1. Investment in Research and DevelopmentTo effectively respond to future pandemics, South Africa is investing in research and development (R&D) infrastructure. This includes funding for scientific research, support for innovation in vaccine technology, and enhancement of laboratory facilities. By strengthening R&D capabilities, South Africa aims to be better equipped to develop and deploy vaccines quickly in response to emerging infectious diseases.
2. Building Local and Regional CapacitySouth Africa’s efforts to build local and regional capacity are essential for pandemic preparedness. This includes training healthcare professionals, developing local manufacturing capabilities, and establishing robust public health systems. By enhancing capacity at both local and regional levels, South Africa can contribute to a more effective and coordinated response to future health crises.
3. Fostering International CollaborationCollaboration with international partners is vital for addressing global health challenges. South Africa’s engagement in global vaccine research and development initiatives highlights its commitment to international cooperation. By working with other countries and organizations, South Africa helps ensure that vaccines are developed, tested, and distributed efficiently and equitably.

South Africa is making significant contributions to the development of vaccines for future pandemics through its research institutions, partnerships, and local initiatives. By leveraging its scientific expertise, participating in global collaborations, and investing in R&D, South Africa is playing a crucial role in enhancing global health preparedness. As the world continues to face new health challenges, South Africa’s efforts will be vital in developing effective vaccines and ensuring a swift response to future pandemics.

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Rehabilitation after coronavirus is important because physical and intellectual impairments may not be as noticeable in the first time after a coronavirus infection. This is especially true for people who are exposed to regular psycho-emotional stress, such as drivers, who may have slower reactions when driving.

It is important to realize that rehabilitation after coronavirus infection is not only physical, such as massage, swimming or breathing exercises, but also psychological. Psychological counseling and psychological rehabilitation helps you cope with the emotional difficulties that resulted from prolonged self-isolation or complications from COVID-19.

Does everyone who has survived coronavirus need rehabilitation?

A course of rehabilitation treatment after a coronavirus infection is needed for almost all survivors. Doctors distinguish four groups of patients who need rehabilitation:

• The first group includes patients who have been in the intensive care unit for a long time;
• The second group includes patients whose physical and mental condition deteriorates rapidly or gradually during the course of their illness, such as developing disorders of consciousness, heart failure or disorientation;
• the third group are patients who have chronic diseases, such as diabetes mellitus, immunodeficiency or hypertension;
• the fourth group is people who, due to social isolation, have a risk of reduced physical or social activity, are at risk of substance abuse, or are likely to have disordered eating habits.

Theoretically, almost any patient with coronavirus can be placed in one of the four groups for rehabilitation. Doctors recommend the following: people who have had moderate to severe COVID-19 need physical rehabilitation, while everyone needs psychological rehabilitation. If you fall into one of the four groups, then you should undergo coronavirus rehabilitation.

When to start rehabilitation after COVID-19

Regardless of the severity of the disease, rehabilitation after a coronavirus infection should begin as early as possible. What kind of recovery methods doctors use depends on the condition of the patient. For example, in patients who are on oxygen support, breathing exercises are performed.

Also in the early stages of the recovery course after COVID-19, methods are used to prevent muscle weakening and bedsores. When the patient gets better, they are prescribed light physical therapy, as a result of which the patients’ saturation index increased – the blood is better saturated with oxygen.

Rehabilitation should be individual – the program of recovery after coronavirus is prescribed by the doctor, depending on the initial state of the patient. Recovery can be carried out at home, in hospital and sanatoriums, if they are designed for this purpose.

In addition to improving objective physical indicators, in early rehabilitation after COVID-19, patients often note an improvement in their emotional state and mood. Stabilization of the psycho-emotional sphere is an important element of treatment, as it often influences the course of the disease and its outcome.

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