Covid after Covid

After having lived through two and a half years of the Covid19 pandemic, we find ourselves once again at the starting line, ready to start a new academic year, a new school year for our children, and a new year of social life, in the broader sense of the term. The pandemic hurt us badly, it made us feel the suffering of the disease with almost 6.5 million deaths (171,911 in Italy) and over 600 million confirmed cases in the world. It introduced us to the darkness of loneliness and isolation, the fear of uncertainty and the precariousness of planning. But we are strong, and we are starting over, some with more enthusiasm and some with lingering fear, but all well aware of the fragile balance in which we find ourselves.

According to WHO data, the number of cases in the last week of August fell by 16% compared to the previous week, and so did the number of deaths globally which fell by 13%, even though in Southeast Asia there was an increase. The numbers, however, must be taken with a grain of salt, given that in many countries testing policy has progressively changed and so has people's compliance in reporting positivity.



The Omicron variant, with its high transmissibility rates and reduced morbidity, especially among vaccinated and people that do not present other conditions, still remains the most prevalent one, with 99.6% of global cases sequenced over the last 30 days. Restrictions have gradually disappeared in most countries, with the reduction also in the number of days of isolation – which has gone down from 7 to 5 in Italy for asymptomatic cases, and from 21 to 14 days for cases that still test positive after two weeks – and the abolition of the obligation to wear a face mask, except on means of transportation and in hospitals and nursing homes.

We all want to start again, put the pandemic behind ourselves and forget about green passes and all the rest, but if we did that, that could be our worst mistake. Vaccination campaigns launched globally are far from being on track and the global imperative that WHO set out to vaccinate at least 70% of people in all countries of the world by June 2022 still remains wide of the mark. Inequalities in the distribution of vaccines persist and more than 30% of the world population has yet to receive their first dose of vaccine, not to mention the fact that in poor countries of the world only 21% of people have been vaccinated. Even in industrialized countries a significant percentage of the population continues to refuse vaccination. In Italy, over 6.8 million of people are not vaccinated and a very low percentage of over 60s that are eligible for the fourth dose of the vaccine are indeed vaccinated (5.2% in the 60-69 age bracket; 9.5% in the 70-79 and 29.4% in the 80+ age brackets).

Vaccination hesitancy has grown alarmingly over the last two decades, especially in advanced countries, perhaps fueled by poor communication policies and by a lack of investment in territorial medicine, leaving to social media and peer communication the task of handling the information. The pockets of susceptibles, combined with the low protection of current vaccines against infection, keep transmission high and, consequently, the emergence of new variants of SARS-CoV-2. It is essential to maintain surveillance and continue monitoring the circulation of the virus.

The situation remains complex. Two and a half years of the pandemic should have taught us that even when things seem to get better, we cannot in fact relax and let our guard down. The virus is still evolving, the perspective from which we observe it must continue to be the global, and our collective behavior remains the main form of deterrence in the pandemic. In addition, several other challenges need our attention, including the impact of the infection on medium- and long-term physical and psychological health, including children's, the effects of the pandemic on vaccination coverage for other infectious diseases (measles in particular but also influenza) and the development of strategies to increase individual adoption of prevention policies that are put in place by health policymakers. And if Covid weren't enough, since May there have been over 54,000 cases of monkeypox in 100 countries, 787 of which registered in Italy. Although the infection has very different characteristics from SARS-CoV-2, the lessons we learned during the pandemic should come in handy. In particular, well-organized surveillance on the evolution of the epidemiological situation, the definition of clearer and more effective communication strategies than those we have seen in the recent past, strategies that bring back trust in the whole health care system and, last but not least, attention to individual and group behavior, and their determinants. The uncertainty that characterizes the arrival of a 'new' infection in one's territory is an essential fact. It is up to us to systematize all the skills and capacities to find an effective way to contain it.