Across Europe, dozens of babies have died of whooping cough and measles has surged across the globe. Meanwhile a flesh-eating bacteria is spreading at record rates in Japan, cholera has staged a comeback, and tuberculosis is rising in southeast Asia. In Brazil and Argentina, overwhelmed hospitals are teeming with dengue patients.
SARS-CoV-2 might have subsided, but the pandemic has been followed by a seemingly never-ending stream of nasties. There are even reports that the incidence of heart attack and stroke has jumped in its wake.
And the hard data is clear. Since 2020, more than 40 countries have seen at least one disease outbreak peak at levels ten times higher than before Covid-19 emerged, according to a study by the analytics firm Airfinity and Bloomberg. It begs the question: has the pandemic somehow fundamentally changed us or the pathogens which surround us?
“We’re still feeling the post-shock impact,” Prof Emmanuel Andre, a microbiologist at KU Level in Belgium and advisor to the European Union on infectious disease outbreaks, told the Telegraph. “Coming back to the usual epidemiology takes time.”
The pandemic was a momentous two year event that had a profound impact on health ecosystems globally. The world had experienced nothing like it since the Spanish Flu of 1918. Behaviours changed across all walks of life. And for the first time in history, large scale- nationwide lockdowns reduced the exposure of hundreds of millions of people to a vast array of common bacterias and viruses.
But Covid’s grim legacy goes well beyond a possible immunity debt. The unprecedented event shifted geopolitics, disrupted global supply chains, drove economic crises and hit global vaccination rates – all of which have impacted one way or another on our health. The consequences have been wide ranging and unexpected. And while some current trends are likely to prove fleeting, others could be with us for decades to come.
The Covid pandemic “modified disease dynamics,” said Dr Andre. Several patterns of disease that we had come used to were “annihilated”. “It will take at least two or three years to find a new equilibrium. But some things have also changed for good,” he added.
A collapse in vaccination rates for common diseases like measles and whooping cough is one of the most obvious impacts of the pandemic – and one which explains the resurgence of these and other illnesses across the world. While governments focused on Covid-19 jabs, routine immunisation programs for other diseases all but stopped in many places and were set back in others.
In many countries, including the UK, schools, GP surgeries and clinics were shut down during lockdowns, making it difficult for people to access basic healthcare and leaving them vulnerable when restrictions were eventually lifted. bIn England, NHS waiting lists surged from 4.2m just ahead of the pandemic to 7.6m today. Similar trends have been seen in health systems across the globe.
Unicef described the drop in vaccination coverage as the worst in a generation. Roughly 25 million children across the world missed out on jabs for things like polio, measles, and hepatitis, and 14 million still haven’t caught up.
“Declining childhood immunisation rates in several countries are certainly contributing to the resurgence in vaccine-preventable diseases,” said Dr. Katie Anders, a director at the World Mosquito Programme.
Since the pandemic, deaths from measles have jumped globally by 44 percent, with huge outbreaks reported in America, Australia, Africa, Central Asia, and Europe. Whooping cough, known clinically as pertussis, is also surging, with eight infant deaths reported in the UK this year and dozens more in Europe.
For other diseases like influenza and RSV, a respiratory virus that can be lethal in infants, the post-pandemic comeback has been linked to lockdowns. Isolation measures kept people apart – and their germs. As we returned to normal life, many were reintroduced to common viruses that they hadn’t been exposed to in two years and case numbers boomed.
Influenza – almost wiped out during the pandemic – has jumped by about 40 per cent in the United States in the two seasons since the pandemic, while case numbers for RSV have surged more than 20-fold in Eastern European countries like Lithuania and Czechia.
The same phenomenon may explain the resurgence of strep A – which made headlines in the UK 18 months ago when at least 30 children died and hundreds more were admitted to hospitals as the bacteria spread through the country’s schools.
In Japan, step A has recently been linked to a record spike in a flesh-eating bacterial disease. Some experts attribute these and other outbreaks to “immunity debt”. “Pandemic-related measures including masking and social distancing have led to many individuals, especially children, missing out on opportunities to build natural immunity,” said Prof Charin Modchang, a disease modeller at Mahidol University in Bangkok.
“As a result, a large pool of susceptible people accumulated during the pandemic. Now that control measures have been lifted, we are witnessing a surge in these respiratory viruses.” Still, immunity debt is a controversial concept – and Prof Modchang said many have misunderstood or overhyped the phenomenon. “I prefer the term “immunity gap,” as it more accurately suggests a temporary delay in immune system education rather than a debt that needs to be repaid,” said Prof Modchang. Prof Eng Eong Ooi, a researcher at Duke-NUS Medical School’s Emerging Infectious Diseases programme in Singapore points out that surveillance systems have also been bolstered since the pandemic, meaning that at least some of the rise may be due to better reporting. “Increased awareness of infectious diseases post-Covid-19 have led to more testing… making the rates of these diseases appear more common now,” he said.
Airfinity also flagged this as a limitation of its’ analysis, which compiled data from over 60 health organisations looking at 13 different infectious pathogens. They compared the worst outbreaks in the years preceding 2020, with the largest epidemics in the years since, and found that at least one disease surged to rates at least 10 times higher than the pandemic baseline in 44 countries and territories. “The trend is concerning,” said Kristan Piroeva, an analyst at Airfinity involved in the research. “[But] we should bear in mind that some of these high fold increases are due to better testing. We don’t have testing rates pre and post pandemic, so for some countries these large-fold increases in the peak of outbreaks may be to do with testing rates.”
Others suspect Covid may have weakened a segment of the population, making them more vulnerable to other diseases. “We need to consider the fact that coronavirus has infected large swathes of the global population, and there may be a link between Covid and increased susceptibility to other pathogens,” said Dr Ravindra Gupta, a microbiologist at the Cambridge Institute. Some studies have suggested that Covid-19 may affect immune memory and responses to subsequent infections, potentially increasing susceptibility to other diseases. Experts suggest that Covid increases the risk of cardiovascular disease and stroke in some patients for up to one year after infection, even in mild cases, for example. One study from Washington University found that those who had coronavirus had a 72 per cent increased risk of heart failure compared to those who hadn’t contracted the virus.
Covid’s impact on economies worldwide has also caused pestilence to spread, with as many as 150 million more people plunged into extreme poverty in its wake. Although all countries were affected by the pandemic, the World Bank has found that the extreme poverty rate in the most deprived nations was more than eight times the global average as a result of reduced economic activity. In the world’s 75 poorest countries – largely located in Africa – one in four people have to survive on less than $2.15 a day, the global benchmark for extreme poverty.
Poverty weakens people and communities, making it much easier for disease to get a grip and thrive. Malnutrition, poor sanitation and limited access to healthcare all make disease outbreaks much more likely and difficult to control. Increased poverty combined with antimicrobial resistance is blamed for the recent surge in tuberculosis, for example. In 2022, 7.5 million people were newly diagnosed, the highest figure since the World Health Organization began global monitoring in the 1990s.
Cholera – which thrives where hygiene systems have collapsed – has also staged a comeback since 2021. Syria, which had no cases in 2019, is now battling an outbreak of almost 10,000 infections. The country, which was already struggling prior to the pandemic after years of conflict, saw huge economic challenges during Covid – when 90 per cent of its population were plunged below the poverty line. Meanwhile Afghanistan has seen nearly 9,000 infections this year – 8,529 times the number reported before the pandemic. The bacterial disease can kill in just a few hours if left untreated.
Conflict itself can significantly contribute to the spread of disease – a violence has surged in many regions of the world in Covid’s wake. Ukraine has battled outbreaks of HIV, tuberculosis, and polio since its war with Russia erupted in 2022. And since October 7, hundreds of thousands of children in Gaza have come down with respiratory infections, scabies, lice, and diarrhoea. In Myanmar, diseases including malaria and HIV are rising as health systems collapse.
These are not isolated cases. Since 2020, hundreds of conflicts have erupted across the globe, many triggered by falling living standards and political instability. In 2023 alone, the International Institute for Strategic Studies documented 183 conflicts – the highest number in three decades.
Vector-borne diseases (those carried by insects like mosquitoes, ticks, and fleas) have also spiked since the pandemic – though not always because of it. More than seven million people in the Americas have been infected with dengue fever so far this year, in the region’s worst outbreak to date. Meanwhile last year in Mozambique, a powerful cyclone drove a surge in malaria cases by destroying pest control efforts and creating vast lakes of standing water for mosquitoes to thrive in.
While the pandemic hobbled containment efforts in some regions, rising temperatures have allowed mosquitoes, ticks and other disease carrying animals to spread. Dengue fever, carried by the tiger mosquito, has been detected in several European countries, including France, Spain, and Italy – which saw a 66-fold increase in cases since 2019. Earlier this month it was reported that Parisian health officials are racing to kill off the threat ahead of the Olympics which open in July.
Covid-19 has clearly been disruptive, disrupting patterns of disease and making many of us sicker in all sorts of ways. But what is perhaps most worrying, is that some experts think it may be a harbinger of things to come. Far from being a “once in a 100 year” event, some suspect that the pace and intensity of global development mean we could be entering a “pandemic age”. According to Prof Andre and many other experts, increased travel, the spread of mega cities and humanity’s gradual intrusion into more and more report areas means the chances of zoonotic “spillover” events like Covid are becoming more and more likely. “Humanity has always tried to impact the spread of diseases from the very early days of human history… but we just can’t control everything,” he said.
Any opinions, views and beliefs represented in this article are personal and belong solely to the author/s and do not necessarily reflect the opinion, views and beliefs of the organisation and employees of New Image™ International
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