A diagram of SARS-CoV-2 replication and method of action understood in early 2020.

In November 2019 the corona virus, now known as SARS-CoV-2, first began infecting people in Wuhan, China. The earliest identifiable person with what is now known as Covid-19 first displayed symptoms on December 1. Then people started to die. Then it spread. The World Health Organisation declared a pandemic on 11 March 2020. To many of us it was perfectly obvious long, long before that we had passed the containable outbreak stage.

Two years after the virus’s first appearance, the official global death toll is about 5.1 million. I think that’s a serious underestimate; the Economist agrees, suggesting that the global total is closer to 17 million.

17 million is both a policy failure and a human triumph. It’s a failure because people are, well, people: not perfect. Looked at kindly, we don’t want to believe what is inconvenient or frightening. Looked at cynically, a lot of people used the pandemic as an opportunity to increase their following and/or strengthen their brand. It’s a triumph because people are, well, magnificent: we formed mutual aid networks, we worked heroically, we moved at feverish speed to bring together teams to research, test, produce, and administer vaccines, antivirals, and treatment best practises. Right now, if you are a healthy person living in any of the richest countries, you are very, very unlikely to die of Covid. This is because there are a series of medical filters available to you—or, in the case of antiviral pills, very soon to be available to you—that reduce the odds, stage by stage. The biggest and best filter is a mRNA vaccine, such as Moderna: two full doses followed by a half-dose booster.1 Then there are N95 or KN95 masks. Then there’s social distancing. Then there are HEPA filters. If you still somehow get the virus, and—even more unluckily—develop symptoms, then there are antiviral pills such as Merck’s polymerase inhibitor, Molnupiravir, which—if administered within the first five days of symptoms—reduces the risk of hospitalisation by 50%, and, even better, Pfizer’s protease inhibitor, Paxlovid, which, also if administered in the first five days, cuts the risk of hospitalisation by an almost unbelievably impressive 89%. If you don’t get the vaccine, or don’t get an antiviral early, then there’s still remdesivir, another polymerase inhibitor, by IV. If that doesn’t start helping and you begin to develop those first stages of inflammation that are really the most dangerous aspect of Covid, then there’s dexamethasone, a cheap but very effective corticosteroid. If that, plus the remdesivir, doesn’t help then you add in baricitinib, a janus kinase inhibitor, which blocks the activity of some of those enzymes that lead to inflammation. It is a series of almost miraculous science-based treatments filtering out and reducing harm.

For some, of course, the miracles are less effective. If your immune system is compromised—if you have to be on immune-suppressing medications for some kinds of cancer, for MS, organ transplants, or other conditions—then vaccines won’t trigger the production of antibodies and you can’t develop immunity. Luckily you can take the antivirals, and if you take them early enough your odds of staying out of hospital are very good.

Then there are those people who choose not to take vaccines.2 I won’t waste words on those selfish fools here.

Then, of course there are all those billions living in less rich countries who have very little access to any of the technologies I’ve mentioned here.

So where will we be two years from now? I don’t know. I think it’s likely Covid will be endemic in most countries; I think the virus’s deadliness will wax and wane; I think there will be waves of mutations—some more deadly that the Delta variant, some more contagious, and some—like Delta when compared to the original strain—that are both. But the antivirals will become cheaper to manufacture and eventually (I hope) available to all everywhere. Eventually, too, mutations will be routinely tracked and vaccines routinely tweaked to counter them. On the whole, I think Covid will become flu: occasionally terrible, mostly not. It’s the next new virus that worries me—but there will be another (and another, and another).

But the Covid-like-flu evolution is very much a people-are-magnificent scenario which, as we’ve seen, we can’t always afford to rely on. It is also predicated on the no-new-disasters-soon scenario—whether geopolitical, climatological, financial, or one of those wild, from-left-field unk-unks such as asteroids, aliens, and inter-dimensional portals. Hey, after the last six years you look me in the eye and tell me none of that can happen…

1 I have, as they say, Some Thoughts on the booster shot but will save it for another post.

2 There are a few people, particularly from traditionally marginalised groups, who have every right to be wary of government-sponsored medical treatment; I think they’re dangerously wrong, but I hope we can all do a better job of listening and helping assuage their wariness