Wherever Did the Pandemic Go?

Covid has attenuated. But is that from its own evolution, or from our immune reactions to it?

Looking at recent gatherings such as the political conventions and the Olympics, it is evident that the pandemic is over. A graph from the CDC says that mortality from Covid-19 is now similar to influenza- not great, but not catastrophic either, running at roughly a thousand deaths a week, and this with negligible public precautions.

Overall mortality of Covid-19 in the US.

A fundamental scientific and policy question about this is why: did the virus evolve to a less virulent state, or have we evolved (or engineered) enough immunity to fend off the worst? Even after the intense focus on this virus and all the research that has been done, this is a difficult question to answer. There has been a parade of variants, one supposedly more virulent and dangerous than the last, except that we are less affected and increasingly able to ignore them. The scientific community is evidently divided on this causal question, with no good ways to test these basic hypotheses.

I am personally very much in the viral evolution camp, believing that this virus has on its own evolved to be less virulent, even as it gained in transmissibility and ability to evade our immune systems. Surveillance of the virus shows quite high levels this summer, even while its effects are minor, overall. The logic is that this kind of virus does not gain from people shutting themselves up at home and being miserable, let alone dying. Much better for us to be surreptitiously infected and infectious, and able to go about our business, at work and play. We recall that Covid was markedly more lethal at the very outset of the pandemic, before the first set of variants developed. Other cold-type viruses seem to have followed a similar path, and the many zoonotic infections we have picked up (including this one) come from other organisms which carry these pathogens without much difficulty, doubtless after a long evolutionary standoff.

But the graph above makes a different argument, since the vaccines came online around the spring of 2021, reached about fifty percent of the population in late 2021, which is followed by the dramatic drop in covid mortality in spring of 2022. Some researchers point to the lack of attenuation of other pathogens, like HIV, tuberculosis, and smallpox, to say that the evolutionary argument does not hold water. After a pathogen has replicated and spread, (in the case of Covid, in the first week of infection, roughly), it doesn't care what happens to the host- literally whether it lives or dies. They would say that it was the immunization campaign that saved us, and continued infection leading to herd immunity that has created a population increasingly resistant to Covid mortality.

Testing these hypotheses would require Covid-naive populations, which would be ideally split into two study sets, one with vaccination followed by infection, and the other infected directly. This kind of thing may happen as a natural experiment somewhere, and perhaps the closest we can come is the release of Covid restrictions in China. In late 2022/early 2023, China switched abruptly from a zero-tolerance policy of social contact and infection, to a zero-tolerance policy towards bad publicity and accurate mortality reporting, while relaxing anti-Covid restrictions. The result was a surge in death rates, to levels estimated to be higher than those elsewhere, including in the US. This argues that during the restrictive period, the virus had not significantly attenuated via its natural evolution, though then the subsequent mass infection and inoculation did eventually lead in China, as it has elsewhere, to the lower mortality rates seen around the world. 

So, despite the rapidity of viral evolution, one has to conclude that over the short term, the immune hypothesis appears superior to the viral evolution hypothesis, as an explanation of general attenuation of Covid mortality. (Robert Kennedy may disagree, of course!) The evolution of virulence is closely related to the whole lifecycle of a pathogen, especially the way it spreads, making comparisons with other pathogens hazardous. Respiratory pathogens have the opportunity to spread without damaging the host too much, and that seems, in principle, like an advantageous evolutionary path. So I would still hypothesize that over the long term, Covid will settle into a less virulent form that triggers less immune activation (the most lethal aspect of Covid infection), in favor of high transmission and co-existence with our immune systems. Other viruses seem to have followed a similar path. How it interacts with further naive populations would be dispositive, though there may not be any left at this point.

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