Is the end of the pandemic in sight?

Assuming that SARS-CoV-2 is close to becoming endemic: Why will testing remain crucial for the time being?
Assessing where we stand with COVID-19.

Andrea Lutz
Published on March 31, 2022

On average, COVID-19 has killed 99 people in Europe every hour since the pandemic began. Worldwide, 375 million people were infected in the first two years – and 5.6 million of them died with or from the virus.[1] Many people were forced into poverty, and children’s mental health has suffered.[2] Now, however, the tide seems to be turning at last. 

<p>Death rates are falling, and vaccination rates are rising.[3] Hans Henri Kluge, MD, WHO Regional Director for Europe, is optimistic: “I am hopeful we can end the emergency phase in 2022.” He believes “that a new wave could no longer require the return to pandemic-era, population-wide lockdowns or similar measures.” Among other things, he puts this down to “high vaccination uptake”.[4]</p><p>Worldwide, ten different vaccines have now been approved. And while studies so far show that none of them provide protective immunity, the Robert Koch Institute says that “evidence of potent neutralizing antibodies suggests that they provide protection from serious disease and offer increased chances of survival.” It also notes that “these antibodies provide at least partial protection from re-infection with the SARS-CoV-2 variants currently circulating”.[5]</p>
<p>There’s no definitive answer to this question because people don’t all react in the same way to a vaccine and not everyone who gets infected experiences the same course of the disease. The level of antibodies that are associated with virus neutralization vary from person to person – as does the length of time that the antibodies remain active in the blood. While it’s reasonable to assume that more neutralizing antibodies mean better protection against infection, it is also true that antibody levels in the blood begin to decline in both vaccinated and recovered individuals within a few months [6] but, at the same time, there are other immune system responses that contribute to subsequent protection.</p>
<p><a href="Details%20on%20quantitative%20tests?" target="_blank">Quantitative antibody tests</a> assess and report the amount of antibodies present. Qualitative tests provide a yes/no answer as to whether the blood sample contains antibodies. But results can be negative after the levels wane in a person who has produced antibodies in the past. Hence, a negative result can occur in someone who was previously infected and whose antibody levels have declined to below the level of detection.</p>
Learn more about SARS-CoV-2 IgG Assays
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Clinical accuracy is typically measured by the test’s sensitivity and specificity. Sensitivity means the probability that the test reliably detects antibodies when they are present in the blood. Specificity means the probability that the test correctly identifies cases where none of the tested antibodies are currently present in the blood.
<p>The closer a test’s sensitivity and specificity come to 100%, the more reliable it is for such a factor. The Centers for Disease Control and Prevention (CDC, part of the U.S. Department of Health &amp; Human Services) recommends using antibody tests with a high sensitivity and specificity.</p>
<p>People will continue to become infected with SARS-CoV-2,[7] meaning that tests will remain crucial for the time being. However, the number of people who have been infected by the virus has been rising rapidly and this, according to various health experts worldwide, could lead to a situation of the kind we now have with the influenza (flu) virus: An annual season will create ideal conditions for the virus, allowing it to spread widely. For most people, the illness will be mild because their immune system will provide good protection against serious illness. In this scenario, we will be able to live relatively freely with the virus. It will have become <a href="endemic" target="_blank">endemic</a>. However, the light at the end of the tunnel (in other words, the hope that we are transitioning to the endemic stage), is currently only visible in certain parts of the world. WHO Director-General Tedros Adhanom Ghebreyesus doubts that the pandemic will be over on a global scale any time soon. He also warns that new variants could develop and says that the conditions for this to happen “are ideal”.[8] He has the numbers to back this up: 86 WHO member states failed to hit the year 2021 target of vaccinating at least 40% of their populations; 34 member states were unable to vaccinate even 10% of their populations; and 85% of all Africans have yet to receive their first dose.[9] Given that variants are more likely to develop in areas with high levels of infection, this situation could radically change things in Europe, too.</p>
An endemic virus is one that regularly causes a similar number of cases in a particular region or population – either continually (such as the HIV virus) or periodically (such as the flu virus).
<p>When coronaviruses multiply, around 30,000 <a href="RNA" target="_blank">RNA&nbsp;</a>nucleotides are copied thousands of times over. In the process, errors (mutations) can occur that then carry on in future copies as a virus infects new cells or new hosts. Most of these mutations are insignificant. From time to time, however, mutations result in new characteristics, as epidemiologist Maria van Kerkhove, PhD, explains: “… the more this virus circulates, the more opportunities it has to change. Omicron will not be the last variant […] and the possibility of future emergence of variants of concern is very real”.[10] These mutations and variants are not uncommon for RNA viruses.</p><p>Compared with the original SARS-CoV-2 virus first identified in Wuhan, China, the Omicron variants have around 30 mutations in the <a href="" target="_blank">spike protein</a> and these have made the virus more transmissible. This is why Omicron is spreading much faster than, for instance, the Delta variant.[11] That said, a study by UC Berkeley found that Omicron infections were only half as likely as Delta to require hospitalization, 74 percent less likely to require ICU admission, and 91 percent less likely to result in death.[12] Another piece of good news is that, while the flu sequence was found to amass 25 mutations per 10,000 nucleotides each year, coronaviruses accumulated roughly six. This means the coronaviruses changed much more slowly than the flu virus.[13] That gives us valuable time.</p>
Ribonucleic acid carries key information and performs important functions in a cell. RNA is the genetic material used by coronaviruses instead of DNA.
<p>This is the message from the World Health Organization, which estimates that around 5.6 billion people need to be doubly vaccinated for the pandemic to come to an end. The COVAX vaccine initiative was founded to help reach this figure as soon as possible. As part of the largest vaccine rollout in history, as of January 2022 <a href="COVAX" target="_blank">COVAX</a>&nbsp;had delivered over 1 billion COVID-19 doses to 144 countries.[15] The focus is specifically on the world’s poorer countries. For its part, Europe must continue working to keep the spread of Omicron as low as possible with appropriate testing strategies.</p>
The COVID-19 Global Vaccine Access (COVAX) initiative aims to guarantee fair and equitable access to COVID-19 vaccines globally.
<p>The CLINITEST® Rapid COVID-19 Antigen Test*, the Atellica® IM/ADVIA Centaur® SARS-CoV-2 Antigen (CoV2Ag) Assay*, and the FTD SARS-CoV-2 PCR Assay* have now all been evaluated for their ability to detect Omicron (as well as our SARS-CoV-2 antibody assays* for detection of antibodies produced after an Omicron infection). An <a href="in%20silico%20analysis" target="_blank">in silico analysis</a> showed that Omicron has over 98 percent similarity with other SARS-CoV-2 variants[16] – but how are these similarities and differences actually detected? It starts with genome sequencing analysis, which is a detailed examination of the genetic material to establish the precise sequence of RNA nucleotides within the specific virus variant’s genome.[17]</p>
An in silico analysis is one performed on computer or via computer simulation.
<p>This involves decoding around 30,000 base pairs and comparing them with wild-type SARS-CoV-2 to identify mutations. The sequences are then stored in an international database so that scientists can quickly identify more concerning variants and examine them in more detail, and countries can work to stop them spreading. The molecular-biological details about the variants can be accessed through the Robert Koch Institute.[18] The website <a href="" target="_blank">Cov-Lineages</a> publishes comprehensive maps showing the virus’s international spread. Based on the analyses completed, the tests from Siemens Healthineers are well designed to detect Omicron.</p>

By Andrea Lutz
Andrea Lutz is a journalist and business trainer specialized on medical topics, technology, and healthcare IT. She lives in Nuremberg, Germany.