Abstract
Although this sudden decline in the disease was unexpected, the townspeople were in no hurry to celebrate. The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic. However, this new development was the subject of every conversation and , in the depths of people’s hearts , there was a great unadmitted hope. All else was secondary. The new victims of the plague counted for little beside this outstanding fact: the figures were going down. One of the signs that a return to a time of good health was secretly expected (though no one admitted the fact),was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganised after the plague. 1
As the second anniversary of the COVID pandemic looms into view, Camus’ metaphor of the plague as representative of the battle against repression and authoritarian rule seems at least as apposite as when it was first published in 1947. 2 If anything, COVID has taught us that despite the amazing advances in science that have marked the hundred years since the influenza pandemic of 1918/1919, we remain vulnerable to nature’s humblest organisms, that we seem to learn little from history and that we neglect basic public health systems at our peril.3,4
The much-heralded achievements of academic virology and of the pharmaceutical industry in delivering COVID vaccines from a standing start in under 12 months are currently being put in perspective with the emergence of new strains of the virus, the weakness of health systems and health governance internationally, and the inability to deliver vaccination to the most vulnerable.
The virus has forensically interrogated the quality of political and professional leadership and its commitment to openness, transparency and co-operation and in many cases has thrown away opportunities to get ahead of the pandemic by acting decisively in the recognition that economy and public health are interdependent rather than part of a zero-sum game.
In Camus’ description of the plague in the Algerian town of Oran, we can recognise some recent themes, not least in the United Kingdom, where a populist-minded administration has sought to proclaim that the end is in sight even as new infection rates return to levels not seen since the height of the second wave in the winter of 2020/2021, COVID deaths continue to hover around 1000 each month, tens of thousands turn out to have Long COVID with unknown long-term consequences, and health services threaten to buckle under the weight of new hospital admissions, suppressed and unmet demand, and demoralised and exhausted staff.
As the political pressures mount, the prospects of a clear end to the pandemic must be objectively unlikely and even if the world avoids a further, potentially even bigger wave, the tail will probably be very messy with many more than the current toll of five million yet to perish, especially in poorer communities around the world.
The tendency to think that pandemic phenomena conform to tidy structural configurations is a hazard to be avoided. This should be clear from the complexity of the tectonic plate overlays of the geo-demographic experiences of the coronavirus over the past two years. In the same way that pandemics start, they may end, chuntering around the world, coalescing and fragmenting, lingering and returning.
The influenza pandemic of 1918/1919 began in a small way in a remote county in Texas before building up and arriving in Europe with the American troops bound for the trenches of Flanders. COVID seems to have been incubating somewhere in China before exploding onto the world scene propagated widely by travel-borne seeding incidents such as the return of skiers from the slopes of Italy and Austria following the half-term school holidays in February 2020. The influenza pandemic receded in the summer of 1918 before returning with a vengeance the following year leading to between 50 and 100 million deaths worldwide; it actually continued into 1920 with significant numbers of further deaths, maybe met with the indifference that Camus describes.5,6
Implying that the pandemic was all but over in the United Kingdom with ‘Freedom Day’ in July 2021 gave the all-clear to abandon mask wearing and other basic non-pharmacological prevention measures, enabling the virus to spread to unprecedented levels among the younger unvaccinated groups in defiance of naive ideas of ‘herd immunity’ and representing a direct challenge to the virus to keep mutating.
In December 2021, it would be a foolhardy person who continues to advise that the game is over. Sadly, the incoherence of the handling of the pandemic makes it very hard to put Pandora back in the box and protect the vulnerable as we face the pandemic’s third year.